C82COU
INTRODUCTION TO
COUNSELLING
Lecture 4:
Cognitive-Behavioral Approach
to Counseling
Module Convenor: Dr. Laura De Pretto
[Link]@[Link]
Lecture 3 recap
Three basic assumptions of the psychoanalytic and
psychodynamic approaches to counseling:
[Link] client difficulties have their ultimate origins in childhood
experiences;
[Link] client might not be consciously aware of the true motives or
impulses behind his or her actions;
[Link] usefulness of the interpretation of the transference relationship.
Attachment theory:
1.4 types of attachment: secure, avoidant-insecure, ambivalentinsecure, disorganized-insecure (Bowlby & Ainsworth, 1978);
[Link] relationship styles in adult life: autonomous, depressive,
phobic, eating/obsessive disorders;
[Link] attachment style can be changed through a counseling relationship
where the expectations for an insecure attachment are not met.
Learning objectives
1. An understanding of origins and developments of the
cognitive-behavioural approach to counselling.
2. An exploration of the main areas of focus of the
cognitive-behavioural approach to counselling.
1. Origins and developments of the
cognitive-behavioural approach to
counselling
- Behavioral methods
- Cognitive methods
- The combination of the t
- The third wave
Behavioural Methods
Ultimate origin of cognitive-behavioural
approach in behavioural psychology of J.B.
Watson.
A behavioural method that has been used in
therapy is the so called behaviour modification,
based on the operant conditioning of Skinner:
- in any situation people have a repertoire of
possible responses and the desired response is
reinforced or rewarded.
- used in psychiatric hospitals (highly controlled
environments; risk of corruption and abuse).
Behavioural
Methods
How can behavioural methods be applied in
counselling?
- In a cooperative relationship, the principles of behaviour
modification can be explained to the client, who would be
encouraged to apply them.
- Functional Analysis (Cullen, 1988): analysis of a problembehaviour in terms of stimulus, behaviour and consequences.
- Systematic desensitization (Wolpe, 1958): fear or anxiety
are acquired following the principles of classical conditioning.
By re- exposing the person to the fearful event and
associating it to a relaxing stimulus, the fear or anxiety
would disappear.
Cognitive Methods
Albert Ellis and Aaron Beck as
seminal figures in the emergence of
cognitive therapies:
- began their careers as psychoanalyst but then
became
dissatisfied with psychoanalytic
methods, and became
more aware of the
importance of the ways in which their
clients
thought about themselves.
Cognitive Methods
Albert Ellis: REBT
Ellis (1950s) developed the Rational-Emotive
Therapy (RET), that later became Rational-Emotive
Behavioural Therapy (REBT), based on the idea
that, if we help someone to change his/her irrational
beliefs, it will be possible to change also his/her
dysfunctional emotions and behaviors.
Ellis explains this ideas using the ABCDE model:
there is not a direct relation between A (activating
event) and C (consequences emotional and
behavioral reactions), but these are due to B
(rational or irrational beliefs of the subject regarding
the event).
D represents the therapist "disputing" the irrational
belief and the E stands for the more "effective" way
of thinking.
Cognitive Methods
According to Ellis, irrational beliefs are beliefs based on
shoulds and musts.
Irrational beliefs are caused by a number of distorted
cognitive processes, for example:
- overgeneralization (I must be loved at all times);
- dichotomous thinking (if people dont love me they
must hate me);
- arbitrary inference (I failed that exam today so I must
be totally stupid);
- personalization (my husband is in a bad mood
because I didnt call him this morning).
Ellis identified a set of irrational beliefs, that provide the
counsellor with a starting point for exploring the
cognitive content of the client.
ACTIVITY: Can you find rational alternatives to irrational
beliefs?
Cognitive Methods
Aaron Beck: Cognitive Therapy (CT)
Beck (1970s) though that the key to a successful
therapy was the acknowledgment by clients of their
automatic thoughts (cf. irrational beliefs in
Ellis).
Peoples difficulties are not caused by events, but by
the way they interpret events. When helped to pay
attention to their internal dialogue, people can make
choices on the appropriateness of their automatic
thoughts, and, if necessary, introduce new thoughts
and ideas.
Similarly to Ellis, Beck thought that automatic
thoughts are subject to cognitive distortion, which
can be addressed in therapy.
The combination of
behavioural and cognitive
methods
+
Researchers and
practitioners, both in
behavioural therapy and
cognitive therapy, soon
realized that the two
approaches have vast
commonalities:
-Vast problem solving or symptom
reduction approach;
-Highly active therapist style;
The two approaches were combined, and that was the beginning of a
-Emphasis
oncounselling,
the here and
now.
hugely productive stage in the
history of
with
many
new techniques being developed.
Behind the core ideas of CBT lies the committment to the application
of scientific methods (measurement, assessment and
sperimentation) high levels of research productivity more
evidence on CBT efficacy than for other approaches.
The third wave
From the 1990s willingness to expand the
boundaries of CBT. Theorists and practitioners started
to look beyond psychology, to the realm of philosophy,
to find new hints for practical interventions within CBT:
Dialectical Behaviour Therapy (DBT)
(especially effective
with borderline personality disorder) acceptance of the client emotional
distress; emphasis on learning life new skills for self regulation and self
control; multiple helpers; telephone support, long time treatment.
Acceptance and Commitment Therapy (ACT)
Accept
Choose Take Action. Extending the repertoire of possible answers, to
develop enhanced cognitive flexibility.
Mindfulness Based Cognitive Therapy (MBCT)
Integration of meditation to Becks cognitive therapy.
Constructivist Therapy
Clients use of language, metaphors
and narrative to construct their own worlds.
2. Main areas of focus of the cognitivebehavioural approach to counselling
- Therapeutic
relationship
- Assessment
- Case formulation
- Intervention
- Monitoring
- Relapse prevention
Therapeutic relationship
The therapeutic relationship is
important, but not a vehicle of
change in itself.
Concept of collaboration between
counsellor and client.
Assessment
Assessment will elicit information in four key domains:
-
cognition
emotions
behaviour
physical domain
Techniques for eliciting information include:
- interview
- questionnaires and rating scales
- self-observation and self-monitoring
Functions of assessment are:
- setting the scene for treatment planning
- beginning of understanding, from part of the client, of how he/she
may be actively engaged in
constructing the problem-behaviour
- client and counsellor start working collaboratively, beginning to
develop trust
and
understanding.
Case formulation
The circumstances of the clients life
and problems are explained in terms of
CBT theory and concepts.
The client is involved in the formulation,
learns about CBT concepts, and receive
a written copy of the formulation.
Formulation includes:
- explanation of the current problem;
- the underlying personality predispositions;
- factors that can facilitate or be of obstacle
to the
therapeutic progress.
Intervention strategies (1)
Some of the techniques that are
frequently used include:
Socratic dialogue to create connections
between
thoughts and behavioural consequences;
to create alternatives.
- How much do you believe in what you have just
said?
- What evidence is there to support this believe?
- What is the worst thing that could happen?
Intervention strategies (2)
Mindfulness to learn to accept and be
aware of ones
own experiences.
Typically taught in session, and trained at home
through the use of CDs.
Lets listen to a mindfulness exercise
Intervention strategies (3)
Behaviour experiments They
imply enacting sequences of
behaviours.
- sometimes in the counselling room
- sometimes in the outside world.
Social skills training.
Homework.
Self-help learning materials
Monitoring
Through general scales or specific
instruments for specific tendencies.
Relapse prevention
The client learns to identify situations
that are likely to evoke a lapse, and might
be given written instructions or a
telephone number to call.
References
McLeod, J. (2009). An introduction to counselling
(4th ed). UK: Open University Press. [Chapter 5].
Corey, G. (2009). Theory and practice of
counselling and psychotherapy (8th ed). USA:
Brooks and Cole Cengage Learning. [Chapter 10].
