Notes on CH 9-10 therapies PDF

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IT IS JUST SOME GOOD NOTES....

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Key points about Behavior Therapy… Pages 286-288 advantages  Behavior therapy challenges us to reconsider our global approach to counseling. Some may assume they know what a client means by the statement, “I feel unloved; life has no meaning.” A humanist might nod in acceptance to such a statement.  The behaviorist may respond with: “Who specifically do you feel is not loving you?” “What is going on in your life to make you think it has no meaning?” “What are some specific things you might be doing that contribute to the state you are in?” “What would you most like to change?”  Ledley, Marx, and Heimberg (2010) state that therapists can help clients learn about the contingencies that maintain their problematic thoughts and behaviors and then teach them ways to make the changes they want. These things can be included in any therapist’s repertoire, regardless of theoretical orientation. o Techniques such as… o role playing o relaxation procedures o behavioral rehearsal o coaching o guided practice o modeling o feedback o learning by successive approximations o mindfulness skills o homework assignments An advantage behavior therapists have is the wide variety of specific behavioral techniques at their disposal. Because behavior therapy stresses doing, as opposed to merely talking about problems and gathering insights, practitioners use many behavioral strategies to assist clients in formulating a plan of action for changing behavior. The basic therapeutic conditions stressed by person-centered therapists are… These things need to be integrated in a behavioral framework. o o o o o o o

active listening accurate empathy positive regard genuineness respect acceptance immediacy

Of all the therapies presented in this book, this approach and its techniques have been subjected to the most empirical research. Behavioral practitioners are put to the test of identifying specific interventions that have been demonstrated to be effective.  A major contribution of behavior therapy is its emphasis on research into and assessment of treatment outcomes. It is up to practitioners to demonstrate that therapy is working. If progress is not being made, therapists look carefully at the original analysis and treatment plan. (refer and compare to the ABC plan)  Most studies show that behavior therapy methods are more effective than no treatment.  A strength of the behavioral approaches is the emphasis on ethical accountability. Behavior therapy is ethically neutral in that it does not dictate whose behavior or what behavior should be changed.  At least in cases of voluntary counseling, the behavioral practitioner only specifies how to change those behaviors the client targets for change.  Clients have a good deal of control and freedom in deciding what the goals of therapy will be. A collaborative therapist–client relationship is an essential aspect of behavior therapy. Because clients are active in selecting goals and procedures in the therapy process and are applying what they are learning in therapy to daily life, the chance that they will become the target of unethical behavior is decreased (Speigler, 2016). Key points about Behavior Therapy… Dis-advantages  Behavior therapy has been criticized for a variety of reasons. Let’s examine four common criticisms and misconceptions people often have about behavior therapy, together with my reactions.  Some critics argue that feelings must change before behavior can change.  Behavioral practitioners hold that empirical evidence has not shown that feelings must be changed first, and behavioral clinicians do in actual practice deal with feelings as an overall part of the treatment process.  A general criticism of both the behavioral and the cognitive approaches is that clients are not encouraged to experience their emotions.  In concentrating on how clients are behaving or thinking, some behavior therapists tend to play down the working through of emotional issues.  (observation from the author) Generally, I favor initially focusing on what clients are feeling and then working with the behavioral and cognitive dimensions. When clients’ feelings are engaged, this seems to me to be a good point of departure. I can still tie a discussion of what clients are feeling with how this is affecting their behavior, and I can later inquire about their cognitions.  If this assertion is indeed true, behavior therapists would probably respond that insight is not a necessary requisite for behavior change.  Follette and Callaghan (2011) state that contemporary behavior therapists tend to be leery of the role of insight in favor of alterable, controllable, causal variables.

 It is possible for therapy to proceed without a client knowing how change is taking place. Although change may be taking place, clients often cannot explain precisely why. Furthermore, insights may result after clients make a change in behavior.  Behavioral shifts often lead to a change in understanding or to insight, which may lead to emotional changes as well.  The psychoanalytic assumption is that early traumatic events are at the root of present dysfunction.  Behavior therapists may acknowledge that deviant responses have historical origins, but they contend that history is less important in the maintenance of current problems than environmental events such as antecedents and consequences. However, behavior therapists emphasize changing current environmental circumstances to change behavior.  Related to this criticism is the notion that unless historical causes of present behavior are therapeutically explored new symptoms will soon take the place of those that were “cured.”  Related to this criticism is the notion that unless historical causes of present behavior are therapeutically explored new symptoms will soon take the place of those that were “cured.”  Furthermore, they assert that there is no empirical evidence that symptom substitution occurs after behavior therapy has successfully eliminated unwanted behavior because they have changed the conditions that give rise to those behaviors (Spiegler, 2016).  All therapists have a power relationship with the client and thus therapy involves social influence; the ethical issue relates to the therapist’s degree of awareness of this influence and how it is addressed in therapy.  Behavior therapy recognizes the importance of making the social influence process explicit, and it emphasizes client-oriented behavioral goals. Therapy progress is continually assessed and treatment is modified to ensure that the client’s goals are being met.  Behavior therapists address ethical issues by stating that therapy is basically a psychoeducational process.  At the outset of behavior therapy, clients learn about the nature of counseling, the procedures that may be employed, and the benefits and risks. Clients are given information about the specific therapy procedures appropriate for their particular problems. To some extent, they also participate in the choice of techniques that will be used in dealing with their problems. With this information clients become informed, genuine partners in the therapeutic venture.

Key points about Cognitive Therapy… Pages 304-312 Intro and origins 

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In group therapy, members are taught how to apply REBT principles to one another. Ellis recommends that some clients experience group therapy as well as individual therapy. Group members (1) learn how their beliefs influence what they feel and what they do, (2) explore ways to change self-defeating thoughts in various concrete situations, and (3) learn to minimize symptoms through a pro-found change in their philosophy. Ellis and Ellis (2011, 2014) contend that group REBT is frequently the treatment of choice because it affords many opportunities to practice assertiveness skills, to take risks by practicing different behaviors, to challenge self-defeating thinking, to learn from the experiences of others, and to interact therapeutically and socially with each other in after-group sessions. All of the cognitive, emotive, and behavioral techniques described earlier are applicable to group counseling as are the techniques covered in Chapter 9 on behavior therapy. Aaron T. Beck developed cognitive therapy (CT) about the same time that Ellis was developing REBT. They were not aware of each others’ work and created their approaches independently. Ellis developed REBT based on philosophical tenets, whereas Beck’s CT was based on empirical research (Padesky & Beck, 2003). Like REBT, CT emphasizes education and prevention but uses specific methods tailored to particular issues. The specificity of CT allows therapists to link assessment, conceptualization, and treatment strategies. Evidence-supported CT approaches were developed for many disorders including depression, panic disorder, social anxiety, phobias, posttraumatic stress disorder, schizophrenia and other psychotic disorders, hypochondriasis, body dysmorphic disorder, eating disorders, insomnia, anger issues, stress, chronic pain and fatigue, and distress due to general medical problems such as cancer (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012; White & Freeman, 2000). Evidence-supported CT approaches were developed for many disorders including depression, panic disorder, social anxiety, phobias, posttraumatic stress disorder, schizophrenia and other psychotic disorders, hypochondriasis, body dysmorphic disorder, eating disorders, insomnia, anger issues, stress, chronic pain and fatigue, and distress due to general medical problems such as cancer (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012; White & Freeman, 2000). This led Beck to believe that a therapy that helped depressed clients become aware of and change their negative thinking could be helpful. Unlike Ellis, Beck did not assert that negative thoughts were the sole cause of depression. it could also be precipitated by genetic, neurobiological, or environmental changes. One of Beck’s early contributions was to recognize that regardless of the cause of depression, once people became depressed, their thinking reflected what Beck referred to as the negative cognitive triad: negative views of the self (self-criticism),the world (pessimism), and the future (hopelessness). Beck believed this negative cognitive triad

maintained depression, even when negative thoughts were not the original cause of an episode of depression (A. Beck 1967; A. Beck, Rush, Shaw, & Emery, 1979). A generic cognitive model Faulty information processing is a prime cause of exaggerations in adaptive emotional and behavioral reactions. Our thinking is directly connected to our emotional reactions, behaviors, and motivations. When we think about things in erroneous or distorted ways, we experience exaggerated or distorted emotional and behavioral reactions as well. Beck identifies several common cognitive distortions: Psychological distress can be thought of as an exaggeration of normal adaptive human functioning. Definitions Arbitrary inferences are conclusions drawn without supporting evidence. This includes “catastrophizing,” or thinking of the absolute worst scenario and outcomes for most situations. You might begin your first job as a counselor with the conviction that you will not be liked or valued. You are convinced that you fooled your professors and somehow just managed to get your degree, but now people will certainly see through you! Selective abstraction consists of forming conclusions based on an isolated detail of an event while ignoring other information. The significance of the total context is missed. As a counselor, you might measure your worth by your errors and weaknesses rather than by your successes. Overgeneralization is a process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings. If you have difficulty working with one adolescent, for example, you might conclude that you will not be effective counseling any adolescents. You might also conclude that you will not be effective working with any clients! Magnification and minimization consist of perceiving a case or situation in a greater or lesser light than it truly deserves. You might make this cognitive error by assuming that even minor mistakes in counseling a client could easily create a crisis for the individual and might result in psychological damage. Personalization is a tendency for individuals to relate external events to themselves, even when there is no basis for making this connection. If a client does not return for a second counseling session, you might be absolutely convinced that this absence is due to your terrible perfor-mance during the initial session. You might tell yourself, “This situ-ation proves that I really let that client down, and now she may never seek help again.” Labeling and mislabeling involve portraying one’s identity on the basis of imperfections and mistakes made in the past and allowing them to define one’s true identity. If you are not able to live up to all of a client’s expectations, you might say to yourself, “I’m totally worthless and should turn my professional license in right away.” Dichotomous thinking involves categorizing experiences in either-or extremes. With such polarized thinking, you might view yourself as either being the perfectly competent counselor

(you always succeed with all clients) or as a total flop if you are not fully competent (there is no room for any mistakes). More Key Points Our beliefs play a major role in determining what type of psychological distress we will experience. Each emotional and behavioral disorder is accompanied by beliefs specific to that problem. Example Part 1 1. Consider two students who apply to college and are not accepted to their first choice of school. One of the students becomes depressed, the other becomes anxious. Depression is accompanied by negative thoughts about oneself (“I’ve failed,” “Nothing will work out for me,” “I’ll never get into medical school”). Anxious thoughts reflect overestimations of threat or danger (“Everyone will think less of me when they find out I wasn’t admitted to that college”) and underestimations of one’s coping (“I won’t know what to say to people about it”) and underestimation of resources (“These other colleges won’t prepare me well enough for medical school”). Central to cognitive therapy is the empirically supported observation that “changes in beliefs lead to changes in behaviors and emotions” (A. Beck & Haigh, 2014, p.14). Example Part 2 2. If the students in the previous example can change the way they think about not being accepted to their first choice school, their depression and anxiety are likely to be lessened. The first student will undoubtedly feel less depressed once a more balanced view of the rejection letter is adopted (“More good students apply than can be admitted. My rejection does not mean I failed. I’m sure many students from my second choice school go on to attend medical school.”). Similarly, the anxious student would benefit from new beliefs as well (“I can tell others that I am disappointed that I did not get into my first choice college. Some people might think less of me, but those who really care about me will understand that not everyone gets their first choice and they will be supportive.”). If beliefs are not modified, clinical conditions are likely to reoccur. Even without counseling or a change in beliefs, people often recover from feelings of depression or anxiety and return to their usual healthy functioning. However, these feelings may return in times of future stress or disappointment if their basic beliefs have not changed. In cognitive therapy, clients learn how to identify their dysfunctional thinking. Once clients identify cognitive distortions, they are taught to examine and weigh the evidence for and against them. This process of critically examining thoughts involves empirically testing them by looking for evidence, actively engaging in a Socratic dialogue with the therapist, carrying out homework assignments, doing behavioral experiments, gathering data on assumptions made, and forming alternative interpretations (Dattilio, 2000a; Freeman & Dattilio, 1994; Tompkins, 2004, 2006). From the start of treatment, clients learn to employ specific problem-solving and coping

skills. Through a process of guided discovery, clients acquire insight about the connection between their thinking and the ways they act and feel. Cognitive therapy is focused on present problems, regardless of a client’s diagnosis. The past may be brought into therapy when the therapist considers it essential to understand how and when certain core dysfunctional beliefs originated and how these ideas have a current impact on the client’s difficulties (Dattilio, 2002a). The goals of this brief therapy include providing symptom relief, assisting clients in resolving their most pressing problems, changing beliefs and behaviors that maintain problems, and teaching clients skills that serve as relapse prevention strategies. Similarities and differences Cognitive therapy (CT) has a number of similarities to both rational emotive behavior therapy and behavior therapy. All of these therapies are

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o Active o Directive o time-limited o present-centered o problem-oriented o collaborative o structured o empirical. They include homework assignments and require clients to explicitly identify problems and the situations in which they occur (A. Beck & Weishaar, 2014). Similar to REBT unlike behavior therapy, CT is based on the theoretical rationale that the way people feel and behave is influenced by how they perceive and place meaning on their experience. Three theoretical assumptions of CT are (1) that people’s thought processes are accessible to introspection, (2) that people’s beliefs have highly personal meanings, and (3) that people can discover these meanings themselves rather than being taught or having them interpreted by the therapist (Weishaar, 1993). From the beginning Beck developed specific treatment protocols for each problem whereas Ellis might teach similar philosophical principles to people with anxiety, depression, or anger. Despite these differences, therapists who practice behavior therapy, REBT, and CT learn from each other, and considerable overlap exists in methods used by all three schools of therapy in contemporary clinical practice. The highest standard of practice today is to offer the best “evidence-based practice” Many therapists refer to themselves as offering cognitive behavioral therapy regardless of whether their original training was primarily in behavior therapy, REBT, or CT.

More differences from later in the chapter on page 308  REBT is often highly directive, persuasive, and confrontational, and the teach-ing role of the therapist is emphasized. The therapist models rational thinking and helps clients to identify and dispute irrational beliefs.  collaborative empiricism CT places more emphasis on helping clients identify misconceptions for themselves rather than being taught. Through this reflective questioning process, the cognitive therapist collaborates with clients in testing the validity of their cognitions (a process called collaborative empiricism). There are also differences in how Ellis and Beck view faulty thinking. 1) Through a process of rational disputation, Ellis works to persuade clients that certain of their beliefs are irrational and nonfunctional. 2) Beck views his clients’ distorted beliefs as being the result of cognitive errors rather than being driven solely by irrational beliefs. Beck asks his clients to conduct behavioral experiments to test the accuracy of their beliefs (Hollon & DiGiuseppe, 2011). 3) Cognitive therapists view dysfunctional beliefs as being problematic when they are a distortion of the whole picture, or when they are too absolute, broad, and extreme (A. Beck & Weishaar, 2014). 4) For Beck, people live by rules (underlying assumptions); they get into trouble when they label, interpret, and evaluate by a set of rules that are unrealistic or when they use the rules inappropriately or excessively. If clients decide they are living by r...