Counseling In Psychology

Advance Counseling

During the mid-1950s, Aaron T.Beck developed this approach to treat mental disorder as a result of his research on depression. His observations of depressed clients revealed that they had a negative bias in their interpretation of certain life events, which contributed to their cognitive distortion. It is psychological education model of therapy.

Beck’s approach is based on the theoretical rational that the way people feel and behave is determined by how they perceive and structure their experience.

The basic theory of Cognitive therapy holds that to understand the nature of an emotional episode or disturbance it is essential to focus on the cognitive content of an individual’s reaction to the upsetting event or stream of thoughts.

                                                                                            (DeRubies & Beck, 1988)

It is active, directive, time-limited, present-centered, and structured approaches.

                                                                            (Beck, Rush, Shaw, & Emery, 1979)

Theoretical Assumption of Cognitive Therapy:

1) People’s internal communication is accessible to introspection.

2) Client’s beliefs have highly personal meanings.

3) These meanings can be discovered by the client, rather than being taught or interpreted by the therapist. 

The goal is to change the way clients think by using their automatic thoughts to reach the core schemata and begin to introduce the idea of schema restructuring.

Biography of Beck:

Aaron Temkin Beck (b.1921) was born in Providence, Rhode Island. His childhood and early schooling was interrupted by a life threatening illness.

Beck used his personal problems as a basis for understanding others and developing his theory.

A graduate of Brown University and Yale School of Medicine, Beck was initially attracted to neurology but switched to psychiatry during his residency. He attempted to validate Freud’s theory of depression, but his research resulted in his parting company with Freud. and then has successfully applied cognitive therapy to depression, generalize anxiety, panic disorder alcoholism, eating disorder, marital and relationship problems.

He has developed a assessment scales for depression, suicide risk, anxiety, self concept, and personality. 

He is the first founder of the Beck Institute, which is a research and training center.

Theory of Personality

Theory of personality for cognitive therapy emphasizes the role of cognitive processes on the development of mental disorders such as depression and anxiety.

nCognitive therapy contends that the etiology of many mental disorders can be directly traced to cognitive dysfunctions such as misinterpreting environmental cues, for example, “My friends did not shown up, so he must not like me.”

Beck’s Theory of Depression:

The most important theory that regarded thought processes as causative factors in depression is that of Aron Beck. According to him, in childhood and adolescence depressed individuals acquired a negative schema.

View of human nature

Beck contents that people are a product of the interaction of innate biological, developmental, and environmental factors.

He also suggests that people have the capacity for self-determination by emphasizing the role of cognition in mental health.

 Key Concepts

Beck and Weishaar describes the following key concepts associated with cognitive therapy.

a) The role of cognition in Mental Health:

 Emotions and behaviors are determined primarily by how a person perceives, interprets, and assigns meanings to events.           

b) Cognitive Vulnerability:

 Personality structures have vulnerabilities that predispose them to psychological distress. Schemata, which are fundamental beliefs and assumptions that develop early in life and are reinforced by learning situations throughout life characterize these vulnerabilities. They create beliefs, values, and attitudes about oneself, others, and the world. A schema can be functional or dysfunctional. Example of statements indicating dysfunctional schemas of a borderline personality is;

     “There is something fundamentally wrong with me ” and “People should support me and my feelings.”

A dysfunctional schema can contribute to cognitive distortions, systematic bias in information processing, and other problems associated with emotional distress.

Cognitive Distortions:

A cognitive distortions is a systematic distortion in reasoning that results in psychological distress. Cognitive distortions identified by beck and Weishaar include in following;

1) Arbitrary Inferences:

    A conclusion drawn in the absence of sufficient evidence or of any evidence at all.

2) Selective abstraction:

    A conclusion drawn on the basis of negative details of situation while ignoring others.

3) Overgeneralization:

     It is a process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings.

4) Magnification and Minimization:

Depressed people often underestimate the significance of positive experience or exaggerate that of negative events

5) Personalization:

     Depressed people often incorrectly view themselves as the cause of negative events.

6) Labeling and Mislabeling:

It involves portraying one’s identity on the basis of imperfections and mistakes made in the past and allowing them to define one’s true identity. Thus if any student is not able to do work hard, might say to him, “I’m totally worthless and should turn my capabilities in right way.”

7) Polarization:

 It involves thinking and interpreting in all-or –nothing terms, or categorizing experiences in either or extremes. With this dichotomous thinking, events are labeled in black or white terms (total succeed or flop).

Therapeutic Process

The therapy is a collaborative process of empirical investigation, reality testing, and problem solving between therapist and client.

Cognitive therapy is a short term treatment that was develops primarily for the treatment of depression and anxiety. It is now being used for personality disorders, eating disorders, and some of the other types of problem that have been more unmanageable to psychotherapy in the past

Therapeutic Goals

Cognitive therapy aims to help the client to become aware of thought distortions which are causing psychological distress, and of behavioral patterns which are reinforcing it, and to correct them.

The therapist will make every effort to understand experiences from the client’s point of view, and the client and therapist will work collaboratively with an empirical spirit, like scientists, exploring the client’s thought, assumptions and inferences.

The therapist helps the client learn to test these by checking them against reality and against other assumptions.

Therapy is focused on current problems regardless of diagnosis, although the past may be brought into therapy under certain circumstances, such as when the client expresses a strong desire to talk about a past situation; when work on current problems results in little or no cognitive, behavioral,  and emotional change; or when the therapist considers it essential to understand how and when certain dysfunctional beliefs originated and how these ideas have a current impact on the client’s specific schema.

The therapy goals include providing symptom relief, assisting clients in resolving their most pressing problems, and teaching clients relapse prevention strategies.

Role of Counselor

The counselor should be Warmth, Accurate, Empathic, and Genuineness during the counseling process.

Therapist encouraged the client that he takes an active role in the counseling process in setting goals, recounting cognitive and behavioral reactions to problems situations, and doing homework assignments.

The counselor functions as a guide in the counseling process by helping the client understand the role of cognitive in emotions and behaviors.

The counselor also acts as a catalyst by promoting corrective experiences that result in necessary cognitive restructuring and skill acquisition. In this process counselors avoid the role of passive expert.

Counselors do not tell the client that a particular belief is irrational or wrong. Instead they explore with the client the meaning, function, usefulness, and consequences associated with the belief. The client then decides whether to retain, modify, or reject a belief.

Cognitive therapist provides the direct way to change dysfunctional emotions and behaviors and to modify in accurate and dysfunctional thinking.

The cognitive therapist teaches clients how to identify these distorted and dysfunctional cognitions through a process of evaluation and realistic thinking. Through a collaborative effort clients learn to discriminate between their own thoughts and events that occur in reality. They learn the influence that cognition has on their feelings & behaviors and even on environmental events.

Client’s experience in therapy

Clients are thought to recognize, observe & monitor their own thoughts and assumptions, especially their negative automatic thoughts. Throughout this process of learning, exploring and testing, the client acquires coping strategies as well as improves skills of awareness, introspection and evaluation.

This enables them to manage the process on their own in the future, reducing their reliance on the therapist and reducing the likelihood of experiencing a relapse. Active participation from the client is critical for success as the client needs to recognize the changing in thought that is required in order for changes in behavior to be realized.

Relationship between counselor and client

Therapy session focus on the client’s experiences in the present with a specific role of learner and doer between counselor and client. Counselor should engage in a process of collaboration with the client with the ultimate goal of eliminating systematic biases in thinking.

In addition, clients are expected to actively work outside the therapy session usually with homework assignments to continue the learning and development.

Therapists are open and often self-disclose their own beliefs and views with the client to provide modeling of healthy choices. Cognitive therapists are continuously active and completely interactive with clients they also strive to engage clients active participation and collaboration throughout all phases of therapy.

Cognitive therapists aim to teach clients how to be their own therapist, a therapist will educate clients about the nature and course of their problem, about the process of cognitive therapy, and how thoughts influence their emotions and behaviors. Homework and bibliotherapy are often used as a part of cognitive therapy.

Techniques

Decatastrophizing

nCatastrophizing is a negative overgeneralization. It is "making a mountain out of a mole hill!" For example:

nOne person at work does not like you, and tells you, so you know it's not mistaken judgment. You then assume no one at work likes you, or you assume that you must be a terrible person if he/she does not like you.

nYou make a small mistake on a project, and assume that you will be fired when the boss finds out.

nYou try your hand at a new hobby, and it does not turn out well. You conclude, "I'm  no good at anything."

nWe all make mistakes. If you overgeneralize one, or even a few mistakes, to the conclusion that you are bad, incompetent, or useless, you might become depressed. Cognitive therapist help you identify and change negative overgeneralizations.

Reattribution

   Reattribution techniques test automatic thoughts and assumptions by considering alternative causes of events. Reattribution techniques encourage reality testing and appropriate assignment of responsibility by requiring examination of all the factors that impinge on a situation (Beck & Weishaar, 1979)

Redefining

   Redefining is a way to mobilize a client who believes a problem to be beyond personal control.

    Burns in 1985 recommends that lonely people who think,

“Nobody pays any attention to me,”

redefine the problem as,

 “I need to reach out to other people and be caring.”

  (Beck & Weishaar, 1979)

Decentering

    This technique is primarily used with the anxious people who wrongly believe they are the focus of everyone’s attention. So through this clients make observations to obtain a more realistic understanding of other people’s reactions. It can alleviate anxiety by helping clients realize that they are not the center of attention.

     Beck has done extensive work on depression. In the 1970s, many psychologists began writing about cognitive aspects of depression, identifying different cognitive components that affected depression, and developing cognitive interventions to treat depression. So, further are some cognitive factors in depression.

Self-evaluation

      Self-evaluation is a process that is ongoing. We evaluate how we are managing life tasks, and we evaluate whether we are doing what we should, saying what we should, or acting the way we should. In depression, self-evaluation is generally negative and critical. When a mistake occurs, we think, "I messed up. I'm no good at anything. It's my fault things went wrong." When someone is depressed, he/she tends to take responsibility for everything that goes wrong, and tends to give others credit for things that turn out fine. Psychologists assume that self-evaluation, in depressed individuals, is too critical, and feeds low self-esteem and a sense of failure (Franklin, 1999).

Identification of Skill Deficits

     In depression, the person assumes that he/she cannot learn how to do what is necessary to achieve a better outcome. The depressed person believes that he/she cannot learn how to act differently. Accurate identification of social skill deficits complicates depression, because it provides a reality base for the other irrational and exaggerated negative perceptions of the depressed person. The result is a long list of the "things I cannot do," or "tasks I'm no good at," or "mistakes I've made." Psychologists help depressed persons identify their social skill deficits, and also help them develop a plan to improve those skills (Franklin, 1999).

Evaluation of Life Experiences

     If anything goes wrong, the depressed person evaluates the entire experience as a failure, or as a negative life experience. For example, after a vacation at the beach, the depressed person will remember the one day it rained, rather than the six days of sunshine. Psychologists help you to develop realistic expectations about life, and help you determine what you need versus what you want (Franklin, 1999).

Self-talk

     Self-talk is a way of describing all the things we say to ourselves all day long as we confront obstacles, make decisions, and resolve problems e.g. "Okay, how do I handle this?' or "This looks like it is difficult, I better ask for help." or "I know how to fix this!" Self-talk is not bad, or wrong, or a sign of psychological problems. It is normal. But, negative self-talk prevents us from solving problems, and can contribute to a variety of psychological problems, including depression. Psychologists help depressed individuals identify negative self-talk, and also teach them how to challenge these negative statements (Franklin, 1999).

Pessimistic Thinking

      Hopelessness is a central feature of depression, along with helplessness. If you view your world as bad, filled with problems, and don't think you can do anything about the problems, you will feel helpless. If you don't believe your life will improve, if you think the future is bleak, then you will begin to feel hopeless. Pessimism encourages these negative assessments of your life.  Optimism prevents you from reaching those conclusions. In fact, psychologists have researched ways to learn how to be more optimistic, as a way of fighting depression (Franklin, 1999).

Behavioral techniques

  cognitive therapy uses behavioral techniques to modify automatic thoughts and assumptions. It employs behavioral experiments designed to challenge specific maladaptive beliefs and promote new learning.

It includes:

•Skill training

•Progressive relaxation

•Activity scheduling

•Behavioral rehearsal

•Exposure therapy

Psychological disorders

    The Cognitive therapist described that there is a bias in information processing in most of psychological disorders. The kind of bias found in typical disorders is described in following table:

This table is given by Beck and Weishaar

Disorder	Systematic bias in processing information
Depression	Negative view of self, experience and future
Hypomania	Inflated view of self and future
Anxiety disorder	Physical or Psychological danger
Panic disorder	Catastrophic interpretation of bodily/mental experiences
Phobia	Danger in Specific avoidable situations
Anorexia Nervosa	Fear of being fat
Compulsions	Rituals to ward off threat

Comparison with Psychodynamic therapy

·         To some extent, most or all of the psychodynamic and psychoanalytic theories of depression can be described as having cognitive components.

·         For example, Freud, in Mourning and Melancholia, published in 1917, suggests that melancholia (depression) can occur in response to an imaginary or perceived loss, and that self-critical aspects of the ego are responsible in part for depression. The main difference between these psychodynamic therapies and cognitive therapies lies in the motivational assumptions made by the therapists, and the techniques used to effect change. 

·         Psychodynamic theories presume that the maladaptive cognitions arise from specific internal needs (such as the need for affection, acceptance, sexual gratification, etc.), or from unresolved developmental conflicts from childhood. The cognitive therapists presume that the maladaptive cognitions may arise from faulty social learning, or from a lack of experiences that would allow adaptive learning (such as the development of coping skills) to occur, or from dysfunctional family experiences, or from traumatic events, etc.

·         In other words, psychologists using a cognitive therapy approach recognize that psychological problems such as depression can develop from a variety of life experiences, depending on the individual. 

Criticism

• Cognitive psychologist focus on the process of knowing rather than merely responding to stimuli.

• Their emphasis is on the mind not on the behavior.

• Cognitive psychologist are interested in how the mind structures or organizes the experiences. Gestalt psychologist and Piaget argued in favor of innate tendency to organize conscious experiences into meaningful wholes and patterns.

• Cognitive therapy don’t give as much importance to unconscious.