3 The Common Ground Collaborative relationship Psychological distress originates in faulty cognitive processesChanging cognitions will change feelings and behaviorsShort-term educational modelhomeworkclient responsibility in and out of sessionvariety of technique
4 Ellis’s REBTThoughts, emotions and behaviors have a reciprocal cause and effect relationshipWe do not need to be loved or accepted.People are not disturbed by things, but the view they take of themAdlerian:social interestgoals and purposesteaching and persuasionEmotions follow beliefs, so therapy focuses mainly on changing beliefs
5 Human Nature and Source of Distress Humans are capable of rational lives, but also susceptible to faulty thinkingWe are self-talking, self-evaluating, and self-sustainingWe mistake our preferences for essential needs
6 Sources of Faulty Thinking Significant othersOur own thought processes -- superstitions and dogmasAssumption that we need acceptanceAssumption that there’s someone or something to blameOur preferences turn into shoulds and musts.
7 A-B-C Theory of Personality A is activating eventB is beliefC is emotional and behavioral consequenceD is disputing (either by therapist or client) -- by detecting, debating, discriminatingE is effect of intervention, that is, an effective belief system or philosophF is new feeling
8 Therapeutic Goals of REBT Minimizing emotional disturbancesAcquiring more realistic philosophyAcquiring unconditional self acceptance (USA)Developing unconditional other acceptance (UOA)
9 Therapist’s FunctionEncourages and persuades client to change “musts” into preferencesDemonstrate how client is keeping emotional disturbance activeHelping client modify thinkingChallenge client to develop rational philosophy
10 The Client’s Experience in Therapy LearnerDoerExpected to work outside sessionHomework is carefully co-designed
11 Therapeutic Relationship Relationship is minimizedTherapist models UOA, encouraging clients to do likewiseTherapist discloses in order to model healthy imperfectionTransference is challenged as unnecessary, part of irrational beliefs
12 Interventions of REBT Cognitive Disputing irrational beliefs Doing cognitive homework, making lists of problems, detecting absolutist beliefs and disputing them.Client is expected to take risks to overcome negative expectations.Changing one’s languageUsing humor, laughing at oneself
13 Interventions of REBT, continued Emotive TechniquesRational emotive imagery-- imagining worst case scenarios and feeling appropriate reactionsRole playing -- noting specific beliefs and feelings that arise as evidence of irrational philosophyShame attacking exercises, going counter to usual efforts to win acceptanceUse of force and vigor, role playing with therapist
14 Interventions of REBT, continued Behavioral Techniquesstandard behavior therapy techniques, such as operant conditioning, systematic desensitization, etc.Research Effortstechnical eclecticism makes research difficult.
15 Aaron Beck’s CTSimilar to REBT in that focus is on changing faulty thoughts and beliefsBut CT is based on three tenets.Client’s internal dialogue can be accessed through introspectionBeliefs have highly personal meanings, so therapist can’t presume to know what’s best.These meanings have to be discovered by the client.By accessing cognitive content of upsetting experience, therapist can work with restructuring underlying “core schema.”
16 Aaron Beck’s CT, continued Cognitive distortionsarbitrary inferences -- conclusions that are without supporting evidenceselective abstraction -- forming conclusions on the basis of one detailovergeneralizationmagnification and minimizationpersonalizationmislabelingpolarized thinking, all-or-nothing, either-or
17 Differences Between REBT and CT REBT is highly confrontive and focuses on teaching role of therapist. Beck uses an inquiring method.Disputes Ellis’s method of confronting irrational beliefs, believing that people think they are being rational.Beck prefers collaborative empiricism, arriving at the facts together, so that confrontation can be based on discovery, rather than on therapist’s impressions.Beck prefers to see problems as a misapplication of underlying rules that may be okay. Beliefs are not so much irrational as interfering.
18 Therapeutic Relationship in CT Much more emphasis on quality of relationshipTherapist functions as catalyst and guideClient expected to take an active roleTherapist’s teaching role minimized in favor of supporting client’s role in self discoveryClient becomes her own therapist
19 Applications of CT Applying CT Helping clients become aware of automatic thoughts (cognitive distoritions)Helping clients make alternative interpretations
20 Applications of CT, continued Treatment of depression: It’s basis:1) negative self concept2) interpreting experiences negatively3) projection of negativity into futureTreatment of depression: InterventiosnGetting client to do somethingPointing out “tyranny of shoulds”Breaking tasks into manageable units to offset tendency of depressed persons to exaggerate the obstacles
21 Meichenbaum’s Cognitive Behavior Modification Self instructional training helps clients become aware of self talkself observationstarting new internal dialoguelearning new “coping” skills practiced in real life situations
22 Meichenbaum’s CBM continued Stress managementstress innoculationconceptual -- becoming aware of nature of stress and how they are responding to it, as well as creating itskills acquisition and rehearsal -- strategizing new responsesapplication -- transfer and maintenance of changes
23 Contributions of REBT, CT, CBM RBTConfrontation is importantAction orientationBecoming your own therapistCTExtremely effective for depressionfocuses on client’s inner world -- existentialist
24 Contributions of REBT, CT, CBM, continued MeichenbaumLike CT, based on educational model; dymystifies therapyEncourages a working allianceEmpowers the individual
25 Limitations of Cognitive Behavioral Approach Ellis’s REBTDenies pastEncourages misuse of powerBeck’s CM and Meichenbaum’s CBMsimplistic and superficialemotions are overlookedteaching isn’t only way learning takes place