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Chapter 9

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  1. Chapter 9 Cognitive andCognitive-Behavioral Therapy

  2. Cognitive and Cognitive-Behavior Therapy • Cognitions – thoughts, beliefs, and internal images that people have about events in their lives. • Cognitive counseling theories focus on mental processes and their influences on mental health. • A common premise is that how people think largely determines how they feel and behave.

  3. Aaron Beck • A Philadelphia psychiatrist who was originally trained as a psychoanalyst. • His approach to mental disorders emphasizes the importance of cognitive thinking, especially dysfunctional thoughts. • Found that cognitive therapy is effective as a short-term treatment for depression and general anxiety.

  4. Donald Meichenbaum • Considered to be one of the founders of Cognitive-Behavior Therapy (CBT). • Born and raised in New York City where he frequently observed people on the street talking to themselves. • Noted for his work with individuals with anger control and aggressive behavior and training adults with post-traumatic stress disorder.

  5. View of Human Nature/Personality • Usually employed with individuals who suffer from: • dysfunctional automatic thoughts - involving content specific to an event. • schemata - general rules about themselves or the world associated with an event. • These individuals often engage is self-statements that affect their behavior.

  6. Cognitive Distortions • “All or Nothing” Thinking • Selective Abstraction • Overgeneralization • Magnification • Minimization • Personalization • Labeling (Mislabeling) • Catastrophizing • Mind-reading • Negative Predictions

  7. Roles of the Counselor • Operate as a collaborator. • Share responsibility with clients to bring about change. • Function as experts on cognitions, behaviors, and emotions. • Allow clients to examine their beliefs functionally. • Diagnoses are used only as a way of working with clients to overcome a disorder.

  8. Goals • Primary goal is to teach clients ways to monitor their negative or automatic thoughts. • Recognize the relationship between thoughts and emotions or behavior. • Compile evidence for and against the distorted automatic thoughts.

  9. Process and Techniques • Specific and goal-directed. • Emphasizes modification of thoughts in order to bring about therapeutic changes. • Thought organization • Cold cognition – descriptive and non-evaluative • Warm cognition – preferences and non-preferences • Hot cognition – heavily-laden emotional-demand statements

  10. 4 Step Procedure of Implementing Cognitive Strategies(Burns, 1989; Schuyler, 1991) • Use standardized guidelines for understanding in a concrete manner the events in people’s lives. • Set up a way of recording or reflecting people’s thoughts about those events in order to understand their cognitions in a clear, precise way. • Counselors and clients work to find a means to identify and challenge distorted thoughts. • Implement new ways of thinking that are realistic and productive.

  11. Prevalent Cognitive Techniques • Specifying automatic thoughts. • Homework. • Cognitive interventions. • Challenging absolutes. • Reattribution. • Labeling of distortions. • Challenging “All or Nothing” thinking. • Cognitive Rehearsals. • Scriptotherapy.

  12. Cognitive-Behavioral Techniques • CBT’s as a group emphasize: • The present • The environment • Learning • Common Interventions of CBT • Self-instruction training • Stress-inoculation training • Thought-stopping • Cognitive restructuring

  13. Multicultural and Gender Sensitive Issues • Cognitive counseling and CBT approaches are applicable to multicultural populations. • Cognitive approaches may also be appropriate for both men and women in dealing with gender-specific concerns. • Drawback: Some women may become too dependent on their counselors to structure sessions and help them examine their beliefs.

  14. Strengths and Contributions • Focused on teaching how to identify and monitor thoughts and behaviors and how to change or modify them. • Proactive in nature. • Demystify the process and techniques that are associated with choice and change. • Generally empowering. • Applicable to a wide range of disorders.

  15. Limitations and Criticisms • For maximum benefit, clients need to have average or above-average intelligence. • Clients can not be psychotic or disabled by present problems. • Clients must be willing and able to complete systematic homework assignments. • Clients must possess a repertoire of behavioral skills and responses or be able to learn them rapidly. • Do not explore past influences including the unconscious or underlying conflicts.

  16. The Case of Linda: Cognitive and Cognitive-Behavioral Therapy • How would you conceptualize this case using cognitive and cognitive-behavior therapy? • What would be your treatment plan for this client using a cognitive or cognitive-behavioral approach?