Cognitive- Behavioural

Behavioural therapy is based on the fact that people can learn behaviours through classical conditioning, which was first recorded by Ivan Pavlov at the end of the nineteenth century, and operant conditioning (Skinner, 1953. ) Therapists believed what the behavioural therapists were helping their clients to do, such as encouraging self- assertion and self-understanding to help develop new approaches to dealing with life, incorporate a wide range of cognitive processes including decision-making and problem-solving. Beck (1976) founded cognitive-behavioural therapy after becoming disillusioned by psychoanalytic methods. (McLeod J. 008)Cognitive- Behavioural Approaches To Counselling Essay

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Person-centred counselling is a non-scientific therapy developed by Carl Rogers in the 1940s and 1950s. It is a humanistic approach where it is believed that the client needs to feel valued and understood for them to be able to develop a self-awareness so they are able to deal with any difficult situation they feel they are in, giving them the power to change their own lives. Person-centred therapy is non-direct approach where the therapist and client develop an equal friendship to develop trust between the two, creating a safe therapeutic environment which enables the client to figure out what makes them the way they are.

When the client begins to trust their feelings and become emotionally confident they can begin to find the answers to their own problems within themselves. For this to happen a core conditions model is in place. Without these conditions this type of therapy would not be effective (Rogers, C. 1957. ) Therapist-Client Psychological Contact- A relationship which two people have impact on each other and the therapist needs to be engaged by the client. Client incongruence, or Vulnerability- The client needs to be in a state of incongruence, feel that their real self is not how they would ideally like be.Cognitive- Behavioural Approaches To Counselling Essay

The client is also vulnerable to anxiousness which means they will be motivated stay in the relationship. (McLeod, J. 2008) Therapist Congruence or Genuineness- The therapist needs to be congruent within the therapeutic relationship- needs to be genuine in dealing with the client and use their own experience to enable the relationship. Unconditional Positive Regard- The therapist needs to have unconditional positive regard for the client. Acceptance, empathy and genuineness without judgement, is needed for the client to feel a higher sense of self-regard so they can realise that their self-worth was distorted by others.

The therapist needs to accept the client for who they are now, not what they could become. Empathetic understanding- accurate empathy on behalf of the therapist can help the client believe that the therapist has unconditional love for them. Client Perception- If the therapist communicates to the client their unconditional regard and empathetic understanding to at least a minimal degree this is effective. In contrast cognitive-behavioural therapy is a direct approach where clients are taught how to think and behave in ways in which enables them to obtain their goals.Cognitive- Behavioural Approaches To Counselling Essay

They are not told what it is they want, but instead how to achieve the goals they may have this develops a student (client) and teacher (therapist) relationship. In order for this to be successful, intervention techniques are used to ensure that the goals agreed with the client is met. (Haaga and Davison1986, Meichenbaum 1986) These include; Systematic desensitization- a relaxation technique is taught to help the client to overcome anxiety to enable them to extinguish their phobias. Once this has been learnt the client must use this to enable them to overcome these by using a fear hierarchy.

Homework assignments- practicing techniques learnt in therapy between sessions. Experimenting with different self- statements in everyday situations. Thought stopping- instead of letting anxious thought take over the client learns to use something to interrupt these thoughts such as flicking a rubber band on their wrist. Challenging irrational beliefs- the therapist tries to identify the clients’ irrational beliefs that are causing issues in their life and challenges it so that the client develops a less extreme way they view the problem.Cognitive- Behavioural Approaches To Counselling Essay

Reframing the issues – getting the client to perceive a certain emotion as something different. An example of this is perceiving fear as excitement. In vivo exposure- going into highly fearful situations with the therapist whilst they are talking through cognitive-behavioural techniques to help you deal with the situation. Scaling feelings- placing present feeling of anxiety and rating them on a scale off 0-100 is an example of this. Rehearsing different self-statements in role-play in therapy sessions. Assertiveness or social skills training.

Although a therapeutic relationship is important in both practices, cognitive -behavioural therapists believe this is not sufficient enough alone to help clients work through their problems, and while many therapists have different styles the main cognitive behavioural therapy programme have an outlined structure in place. (Kuehnel and Liberman 1986; Freeman and Simon 1989,) which is the main focus. Cognitive-Behavioural Therapy is more client action orientated to produce a change in the way they think which then will lead to a change in the way the client will behave.Cognitive- Behavioural Approaches To Counselling Essay

However in Person-centred therapy a therapeutic process is put in place as a series of stages. These stages help promote a therapeutic change in the client or a “process of greater openness to experience” (McLeod, J. 2008. ) (Rogers, C. 1951) considered the management of therapeutic growth as including the awareness of the clients of any experiences they have been denied. They stop seeing the world in a generalised view and begin to see it differently. This enables them to rely on their personal experience to create their own set of values.

These personal developments lead to a “reorganization of self” (Rogers, C. 1951) and is vital to develop new behaviours. In conclusion although both approaches to counselling realise that a counselling relationship is important, person-centred therapists believe that the counselling experience and effectiveness of the therapy is determined solely on that of the relationship. Cognitive-behavioural therapists find, through past experiments other techniques, such as systematic desensitization and behavioural self-control, are equally important to the success of the therapy.Cognitive- Behavioural Approaches To Counselling Essay

This essay will assess the use of cognitive counselling approach to help the client through the process of change and cope with depression.

Joan is 28 years old woman, suffering from depression; the Gp referred her to the counsellor who will help her to overcome it. Due to the nature of the problem, Cognitive behavioural therapy can be used to treat Joan’s depression condition. This therapy is an effective approach that is used for helping people to change their behaviour, thoughts and feelings.

NICE 2009 illustrated that depression is a common mental health problem and it affects nearly 1 in 6 in the United Kingdom. The main signs of depression are losing interest in the normal activities as well as isolating from other people. A person suffering from depression might experience sadness feeling, crying, irritable or feeling exhausted, feeling low, blaming and feeling unworthy to live, changes in appetite and having sleepless night and the person might experience poor memory and concentration. For these reasons, the person can become critical and holding negative thoughts about himself or herself. These feelings can lead to suicide or harm.Cognitive- Behavioural Approaches To Counselling Essay

Cognitive therapy is simply a kind of psychotherapy that was created by Aaron T. Beck and Albert Ellis. This therapy is believed to alter unrealistic views and the way of thinking psychologists’ use cognitive therapy approach to view psychological problems for instance, depression develops from different areas of life experience. Beck discovered that cognitive therapy was an efficient intervention for treating depression. Cognitive therapy assists clients to feel better, to be aware of their feelings and to battle with their negative thoughts and perceptions (Beck, 1995; Beck, 2005).

Behavioural therapy was originated from classical learning theories which come from the work of Ivan Pavlov -respondent conditioning, John B. Watson and B. F. Skinner—operant conditioning. Behavioural therapy helps the person to tackle the problems by behaving positively. For instance the person who has fear of a dog, the therapist usually helps the person by spending more time on the situation in order to make the person feels comfortable in this particular situation (Masters. et. al, 1987).Cognitive- Behavioural Approaches To Counselling Essay

Therefore cognitive behavioural therapy adds both the two techniques and normally it is performed in a structured environment with the main objective of overcoming the specific problem. A person requires doing tasks within sessions, for example using a diary to record events and finally the person learns to become his or her own therapist (Freman.et.al).

In Joan’s case as a depressive person, the diary can be used to monitor the mood and activities as this would be useful and helpful for both the counsellor and Joan to obtain more objective view of the problem and assess possible causes and changes of symptoms during the day or week (Foreman et.al. 2009).

Cognitive behavioural therapy is cheap and also a short term treatment with long lasting outcomes. It is a proficient treatment for many psychiatric conditions. The National Institute for Health and Clinical Excellence (NICE) suggested that  Cognitive behavioural therapy has a reputation in treating diverse problems such as relationship problems, emotional problems, stress, schizophrenia, fear, phobia and eating disorders, anxiety, depression. Several controlled trials have shown its positive outcome (www.nice.org.uk/CG91publicinfo).Cognitive- Behavioural Approaches To Counselling Essay

According to the therapeutic research, the duration of cognitive therapy is offered for 10-20 sessions. But The National Institute of mental health study on depression indicated that  16-20 sessions of cognitive behavioural therapy are not enough for most patients to overcome depression .

A study in British Medical Journal in 2002, reported that people with severe depression received treatment from their general practitioners which included behavioural and educational self help materials.

In November 2007,the government decided to spend £170 million as a strategy to better psychotherapy service program and to make it more viable especially for patients with depression and anxiety. Most of them cannot afford to pay private therapists and also they have to be on the waiting lists (http://www.rcpsych.ac.uk/default.aspx).

Counsellor needs to work within the British Association Code of Practice which are values, principles and personal moral qualities (http://www.bacp.co.uk/ethical_framework/. Actually these are similar to Rogerian three core conditions, empathy, non-judgement, warmth and genuiness (Sanders, 2002).Cognitive- Behavioural Approaches To Counselling Essay

Cognitive behavioural therapy needs counsellors who have experience and knowledge on how to perform interview with the patients. As (Sanders, 2002) pointed out depressive people need help, support and encouragement. Cognitive behavioural therapy usually encourages a patient to talk freely about whatever comes in his/ her mind because sometimes the patient can turn up without being prepared or planned on what to talk about (Foreman, et. Al., 2009)

The counsellor should totally address the confidentiality issues with the client to make him or her feel secure in advance before the session starts (Sanders, 2002)Cognitive- Behavioural Approaches To Counselling Essay

During the session, for example looking at Joan as a depressive person she will be required to learn and practice specific strategies in every session and she will have an assignment to do such as recording events in the diary and bringing the result to the next session. The aim of this is to improve her present condition. Although this needs a lot efforts for a person who is feeling depressed. Therefore, the counsellor plays a big part and becomes very important in engaging Joan in the therapy. This can be achieved when Joan realises that the counsellor understands her situation and empathise with her feelings and able to proffer solutions to her problem (Hough,2006)

Rogerian interviewing techniques are very helpful in creating good environment in therapeutic. The interviewing techniques involve paraphrasing, reflection of feelings, and summarising (Hough, 2006)Cognitive- Behavioural Approaches To Counselling Essay

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Paraphrasing include repeating what the patient spoke, the counsellor supposes to use his or her own words. This indicates that the counsellors has understood accurately and reassure the client that the counsellor has been concentrating and obtaining the key message. In this point if the counsellors misinterpret the client’s key points, then the client can rectify the counsellor’s fault (Sutton & Williams).

Reflection of feelings entails the statements; the counsellor usually expands the client’s factual feeling and elaborates in his or her own words. This way again indicates that the counsellor has been listening accurately and identifies client’s emotional state. Actually, in this section, the counsellor will be informing the client that they are emphasising together. Furthermore at this stage, the counsellor also shows his emotional reaction towards the story (Sutton & Williams).Cognitive- Behavioural Approaches To Counselling Essay

Summarising is carried out throughout the session; it includes gathering and breaking down the final few moments of the discussion. As a result, this would help the client to see and understand the situation more effectively (Sutton & Williams, 2002)

Above all, the counsellor has to ensure that during this time in dealing with a depressive client, there should be some boundaries. Joan can feel helpless and aimless with the situation; this does not mean that the counsellor should step back. The counsellor must make sure that he is not too carried away with the client’s emotions as he needs to be strong before the client and find possible way of uplifting the client (Sutton & Williams, 2002).

In counselling session, active listening skills are regarded as the main vessel in communicating with the client. To break the communication barrier, the counsellor needs to consider listening effectively to his client’s verbal means of communication as well as understanding the non-verbal means of communication. Suppose, in Joan’s depressive condition, the counsellor must be able to identify and work on the clues such as negative statements that need contradiction and short phrases (Egan, 1998).Cognitive- Behavioural Approaches To Counselling Essay

However asking questions sometimes can be problematic in counselling as it reflects on external rather than internal reference. The method of asking questions enables the counsellor to get facts for their own use instead of having a desire to understand client’s subjective experience of things (Sanders, 2006).

On the other hand, difficulties in therapeutic alliance might happen as some of the clients can find it difficult to express themselves and to explore their interpersonal problems particularly to those problems that are connected to personal belief, others and relationships. For example (i must never let anyone to see my true ‘self). Thus, In this situation the clients might not be willing to discuss their problems openly. This can cause the therapist’s behaviour to be misinterpreted because the therapist might activate his or her own negative belief and dysfunctional assumptions. As a result of this, dismiss the development of warm, equal collaborative alliance (Safran & Segal, 1990).Cognitive- Behavioural Approaches To Counselling Essay

The behavioural approach helps to treat undesirable behaviour and sometimes, the problems can be deep rooted from inside. For example, in counselling session, a depressive client might re-act positively well to behavioural approach. The problem can still persist until the source of depression is recognised then lasting cure of the depression is unlikely (Hough, 2006).

Furthermore, to solve this problem, it appears that a depressive client will need to be committed and starts to show high level of stress in the beginning of the session while the behavioural is occurring. Thus, counsellor who works as a strict behavioural perspective might overlook client’s view. Because of the basic principle of approach which lies on people’s reaction in an automatic way to stimuli. This view does not take into account the influence of thinking or cognition in determining behavioural (Hough, 2006).Cognitive- Behavioural Approaches To Counselling Essay

In comparison, cognitive behavioural approach to psychodynamic approach, these two approaches have dissimilar features; firstly cognitive behavioural therapy gives client a reason for the approach and techniques used. A cognitive behavioural therapy is an educative, as well as inspires clients to actively involve in the therapeutic process. Unlike psychodynamic therapy, Cognitive behavioural therapy normally pays attention on a person’s functions at present time by searching the connection between feelings, belief, thoughts, attitudes, goals and behaviour. Rather than trying to evaluate unconscious psychic facts and events. Cognitive behavioural therapy assumes that person’s emotional reaction is caused by his thoughts and belief about a particular event or situation (Hough, 2006).

In Joan’s depressive condition, using psychodynamic approach, the counsellor will look at various factors that are influencing or causing depression. For instance, early childhood experiences and how these are related to an early attachment with her parents. Moreover, the counsellor will also link to Joan’s present relationships and the things she is doing without being aware of them as to protect herself from depressive thoughts and feelings as a result of experiencing a traumatic event (Gabbard & Western, 2003).Cognitive- Behavioural Approaches To Counselling Essay

Counselling at work place module,  links with life span development module and sociology of health module. In life span development, Erick Erickson theory of eight stages of psychosocial development which stress the important of helpful and supportive environment in human life to meet psychological needs. Freud, psychodynamic theory looks at the important of relationship with other people and also considering their early childhood experience or present experience. Psychodynamic theory gives us an idea to think about other people’s feelings especially in a difficult time as it is normal for a human being to feel anxious (Bee & Boyd, 2006).Cognitive- Behavioural Approaches To Counselling Essay

Counselling in the work place module,  links to sociology of health and healthcare, in terms of social behaviour and how to deal with people in professional manner. Biological model and social model of health and illness are explored and we looked at the mental health problem which can be treated not only with medicine but also with talking therapies such as psychodynamic therapy and cognitive therapy (Taylor & Field, 2007).

Cognitive behavioural therapy can be adequate for people who suffer from major depression. This is especially true for people who experience severe resources problems such as living in dangerous environment, food and shelter. Hence, it is obviously that these people’ depression is not in their head or neurotransmitter. Because of the hardship life they are experiencing, to dedicate time and make an effort to deal with depression can be inconvenience for them (Williams, 2006).Cognitive- Behavioural Approaches To Counselling Essay

There are several evidences which have shown cognitive behavioural treatment approach in various studies. Although it should be remembered that cognitive behavioural therapy has shown a lot of achievement in treating different health problems with various studies have supporting its desirable outcomes.

Cognitive behavioural therapy has its weaknesses and strengths since it requires treating the clients’ main problems. For example, a client who suffers from depression, anxiety and phobia needs a therapist who identifies both the rewards and criticisms available for the cognitive behavioural therapy. So, the client should be wise and careful to choose experienced and knowledgeable therapist who can bring about some changes in the client’s psychological problems.Cognitive- Behavioural Approaches To Counselling Essay

In the past, when behavioural therapy was newly established, it was a non-humanistic approach to treatment. Behavioural therapy was unable to produce warmth and emotions to the client. But it is crucial to be aware that these behavioural plans have emerged from far away until now. In the past, behavioural therapy process included repetitious training sessions involving pairing a stimulus with a reinforcer. Since the cognitive treatment strategies added with cognitive behavioural strategies, cognitive behavioural therapy has considered and reflected on the person.

There are a number of different approaches used by professional counsellors. Perhaps the three main approaches are psychodynamic, humanistic and behavioural. Each of these has a different theory and ideas underpinning it, and the therapists and counsellors using each will approach problems and issues in different ways.Cognitive- Behavioural Approaches To Counselling Essay

These three main approaches each support a number of individual therapies. Some therapies may also use ideas from more than one approach. Some professional counsellors use only one approach, but others are more flexible and might use techniques from more than one method.

Critical Evaluation of CBT Counselling Session
The most frequently utilised evidence based psychotherapy intervention is Cognitive Behavioural Therapy (CBT; Beck, 1995). CBT is a goal-orientated intervention strategy, derived from learning theory with principles of cognitive theory (Arch & Craske, 2009). The efficacy of CBT, for a wide range of psychological concerns, is demonstrated extensively in the literature. CBT’s empirical validation has made it a well-accepted choice for psychotherapists seeking evidence-based approaches (Dobson & Dobson, 2009; Granvold, 2011). Therefore, this essay will evaluate a CBT counselling session with a client who presents with a fear of flying. The essay will critically evaluate the advanced micro-skills of challenging, reflection of meaning, and influencing, and how these skills influence the process of therapy. The essay will further utilise Hill’s (2004) Helping Skills Model to evaluate these advanced micro-skills within the stages of exploration, insight, and action, which is based on cognitive behavioural techniques.Cognitive- Behavioural Approaches To Counselling Essay

Cognitive Behavioral Therapy (CBT) is a general classification of psycho therapy, based
on social learning theory, which emphasizes how our thinking interacts with how we
feel and what we do. It’s based on the view that when a person experiences depression,
anxiety, or anger that these stressors can be exacerbated (or maintained) by exaggerated
or biased ways of thinking and that these patterns can be modified by reducing
erroneous and maladaptive beliefs. A counselor using CBT helps a client to recognize
their style of thinking and to modify it through the use of evidence and logic.
Principles and Elements of CBT
There are several different types and/or applications of CBT. They focus on cognitive
restructuring, modifying behavior, and/or developing alternative coping skills. Most
share some common principles and elements, such as:
Brief and Time Limited yields positive results for a client in a relatively short period of
time. The average number of sessions clients receive is approximately 16. CBT is brief
because it is instructional and makes use of homework assignments.
Present Centered What is happening with the client in the “here and now?”
Thought Focused Helps client recognize and understand personal thoughts that can
lead to irrational fears and worries. Cognitive distortions, such as those listed on page
3, are explored by the client and counselor collaboratively.
Practice and Homework Develops new skills by teaching different ways to understand
situations and their responses. The counselor acts as a teacher and coach. Home work
(including reading assignments) encourages the client to practice the techniques learned.
Sound Therapeutic Relationship Establishes a trusting relationship and builds rational
self counseling skills in the client that helps the client learn to think differently. The
counselor’s role is to listen, teach, and encourage, while the client’s role is to express
concerns, learn, and implement that learning.
The advantages of using CBT include:
• Structure that reduces the possibility that sessions will become “chat sessions”, and
more therapeutic work may be accomplished,
• An emphasis on getting better by learning how to recognize and correct problematic
assumptions, the root cause of many problems, and
• Clearly defined goals and methods that can be evaluated using scientific methods.
Components of CBT
There are 2 critical components of CBT Functional Analysis and Skills Training.
Functional Analysis plays a critical role in helping the client and counselor assess
high risk situations that are likely to lead to substance use and providing insights into
what may trigger or stimulate the client’s substance use (e.g., interpersonal difficulties,
opportunities to take risks or feel euphoria not otherwise available in the patient’s life Cognitive- Behavioural Approaches To Counselling Essay

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