Cognitive-Behavioral Therapy: Theory, Techniques, and Applications, 3rd Edition _ _____________________
A) Help Steve understand the social, cultural, and developmental needs and realities that contributed to these thoughts. B) Focus solely on the irrationality of “no good,” having Steve restructure his thoughts. C) Attend to Steve’s metacognitions of “exceptions” and functionality of thoughts. D) Focus solely on the irrationality of the thought that he was “on his own without an instruction manual.” E) Both a and c. KEY FEATURES OF COGNITIVE THERAPY Cognitive therapy’s course of treatment is individualized for each client. Treatment plans are based on a case conceptualiza- tion that uses the cognitive model to understand the client’s presentation. However, regardless of the interventions chosen for the individualized treatment plan, cognitive therapy has key features that are consistently employed with all clients. The following presents a summary of these features and is drawn, in part, from J. Beck’s (2020) principles of cognitive therapy. Cognitive therapy is conducted with a hypothesis-testing approach. Formulating the relationship between a client’s thoughts, behaviors, and emotions is ever evolving. For exam- ple, as new information arises, the therapist continues refining their conceptualization, shares the conceptualization with the client (at appropriate points within the course of therapy), and inquires about the client’s perspective on the matter. This highlights a key component of cognitive therapy: It is collaborative. The therapist does not conceptualize the case and select intervention techniques alone. The client is invited and expected to participate in most aspects of the therapy, including conceptualization and treatment planning. This means the client is expected to take an active role in their therapy and recovery. This collaboration between therapist and client is facilitated through the therapeutic relationship. The therapist and client are considered equals, each bringing a unique expertise to the relationship. The therapist is an expert in understanding and treating psychological problems, and the client is an expert in their experience of psychological problems (Ledley et al., 2020). The client is not viewed as a “sick” person to be “cured” by the therapist. Instead, the client’s problems are understandable and result from learned beliefs and patterns, as described previously. The therapist can assist the client in learning alternative ways to understand problems, alter maladaptive thought patterns, and manage, tolerate, or accept emotional experiences. The therapeutic relationship serves as a foundation from which the therapist and client work together to understand the client’s problems, set goals for therapy, and navigate the more distressing aspects of change. Cognitive therapy emphasizes goals in the effort to address client problems (J. S. Beck, 2020). The therapist and client work as a team to identify, clarify, and prioritize the issues the client is facing. They select a problem to address through
and ignoring emotions. The premise of cognitive therapy is one that most people grasp relatively quickly, but this does not mean that conceptualization or application of cognitive therapy is just as easy. Cognitive therapy is not conducted in a vacuum where only the client’s thoughts are discussed and addressed. Attending to emotions and behaviors are core practices within cognitive therapy. The cognitive therapist must also consider biological, medical, developmental, social, cultural, and environmental factors in their conceptualization and treatment of the client. Also, the impact of cultural and societal values and beliefs on the client’s appraisals, perceptions, cognitions, and behaviors must be considered when conceptualizing and developing culturally sensitive treatment plans. Another misconception is that cognitive therapy is relatively rigid when, in fact, it is quite adaptable; cognitive therapy can vary in level of intensity. Cognitive therapy can address superficial and easily accessible factors such as automatic thoughts and go much deeper (e.g., addressing maladaptive schemas). Cognitive therapy may also include attending to metacognitions (a person’s thoughts, beliefs, and attitudes about their own thinking patterns). The depth of cognitive therapy depends on the conceptualization of the treatment issues and the client’s goals for therapy. Also, cognitive therapy does not rid people of their beliefs through logic or debate. Nor does cognitive therapy seek to change all negative thoughts. Not all negative thoughts are unrealistic, biased, or dysfunctional; some are valid and appropriate, even when they result in stressful, emotional experiences. As described in the material, cognitive therapy occurs through guided discovery, Socratic questioning, and collaborative empiricism; the client and therapist are a team. The therapeutic relationship or alliance is also essential and will be discussed in greater detail. Finally, some argue that cognitive therapy models to the client that emotions are “bad” and should be minimized. Cognitive therapy seeks to assist clients in attending to their emotions, understanding how unrealistic or biased appraisals can create undue emotional distress, and learning/accepting realistic expectations about their emotional experiences. Cognitive therapy attempts to assist clients by applying specific strate- gies and techniques so they are not paralyzed into inaction by such distortions. Self-Assessment Question 1 Steve is a 32-year-old man raised by his mother, the youngest of 3 children. His father left the family when he was 3 years-old and his mother worked two jobs. He was left feeling sad and helpless, like he was “on his own without an instruction manual.” He acknowledges a core belief that he’s “no good,” as well as an understanding that the core belief protects him from “standing up and being accountable.” When working with Steve, you may want to:
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