MIKI 5113

COUNSELLING AND PSYCHOTHERAPY THEORIES IN CONTEXT AND

PRACTICE

(Cognitive Theory And Therapy)

NURULHADI BIN MOHAMAD M1420286M05

HASLINA BINTI JUNID M1420240M05

WAN MUAMMAR SYAZNI BIN WAN CHEE M1510767M05

CRITICAL CORNER

The following comments about cognitive therapy represent both real and exaggerated

criticisms. They’re offered to stimulate your thoughts about cognitive therapy. Please

read the comments and then write your thoughts and reactions to the criticisms.

1. Some critics, especially humanistic and existential therapists, contend that

cognitive therapy is too intellectual. They emphasize that most clients actually

need to more deeply feel, experience, and understand their emotions, rather than

using cognitive tactics to talk themselves out of important emotional states. What

are your thoughts on this criticism? Do clients need to be intellectual or more

emotional?

Response:

The answer is yes and no. There are the situations when a counselor need a client to be

intellectual and emotional, depends to the client’s ability to talk of something. A normal

person (client) may be can express his or her feeling intelligently, but how about people

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with learning disability? We cannot insist them to express their feeling by using a

complete sentence.

According to Mac Millon dictionary, intellectual is relating to ability to think in an

intelligent way and to understand things, especially difficult or complicated ideas and

subjects. Intellectual is often used to describe intensive reasoning and deep thinking,

particularly in relation to subjects that tend to spark deep discussion, such as literature or

philosophy. An intellectual is also a noun for a cerebral or brainy person who engages in

deep thinking, like Plato, Albert Einstein, or someone who can speak at length about the

relationship between French existentialism and ice hockey.

Emotions – how to understand, identify and release your emotions – different people

define emotions in different ways. Some make a distinction between emotions and

feelings saying that a feeling is the response part of the emotion and that emotion

includes the situation or experience, the interpretation, the perception, and the response or

feeling related to the experience of a particular situation. For the purpose this article, I

use the terms interchangeably.

The only person who can change what you feel is you. A new relationship, a new house,

a new car, a new job, these things ca memontarily distract you from your feelings, but no

other person, no material possession, no activity can remove, release, or change how you

feel.

Positive emotions – it is crucial that you identify your positive emotions during these

exercise. You are probably very loving, caring, compassionate, trusting, forgiving,

generous, many times in each day. Be certain to include the wonderful and good things

about yourself as you identify your emotional self. This provides a realistic picture. If

you record only negative emotions, your picture of yourself will quite distorted and

lacking in reality. Each one of us is born with all emotions and each emotion needs to be

seen in its full and loving energy.

On my point of view, I would like to suggest that people with learning disabilities

are often unable to express their feelings in words, and use behavior to communicate with

others. The emotional experience the person with a learning disability has is often most

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obvious in its behavioral correlate. It is, therefore critical to take behavior as well as

mood into account these clients. Sudden changes in behavior (or mood) and/or a clients’

inability to engage in activities he or she could previously accomplish are important signs

that the client may be depressed.

People with learning disabilities have complex communication needs. Clients

may have difficulty forming sentences, have a reduced understanding of key and abstract

concepts, his or her speech may be unclear, or the client may need increased time to

process and retrieve information. Furthermore, a person with learning disabilities is

likely to have reduced vocabulary (Bumip, 2002), and he or she will probably be more

susceptible to suggestibility and may tend to change his or her answer to questions when

provided with negative feedback (Clare & Gujonsoon, 1993; Everington & Fuller, 1999).

This is all further complicated by the fact that linguistic and cognitive abilities vary

considerably from person to person within this population.

2. The foundation of all cognitive therapies is the same: As an expert, the therapist

first demonstrates to the client that the latter is thinking in a way that is either

irrational or maladaptive, and then the therapist teaches the client new and better

ways to think. When you consider this fact, isn’t it true that all cognitive

therapies are a bit presumptuous? Then, when you consider this presumptuous

assumption even further, doesn’t it make you want to become a more sensitive

cognitive therapist-perhaps a constructivist who honors clients’ experiences and

helps them rewrite their personal narratives in a more positive and strength-based

manner? It’s no wonder that Mahoney and Meichenbaum have moved on.

Response:

What is cognitive therapy? It is relatively short-term focused psychotherapy for a wide

range of a psychological problems including depression, anxiety, anger, marital conflict,

loneliness, panic, fears, eating disorders, substance abuse, alcohol abuse and dependence

and personality problems. The focus of therapy is on how you are thinking, behaving and

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communicating today rather than on your early childhood experience. Cognitive Therapy

also helps people to look at their “rules for living” called schemas. Schemas are

cognitive structures or templates that organize how we think, feel, act, relate and

understand and are typically referred to as our personality style. Schemas are outside of

conscious awareness and determine how we interpret the world and respond to situations.

Whilst cognitive structures can be adaptive, allowing us to process information rapidly,

the same rapid processing can result in entrenched maladaptive structures. This is

because they are strong beliefs and assumptions about how we should live our lives,

which we develop whilst we are growing up. The therapist assists the patient in

identifying specific distortions (using cognitive assessment) and biases in thinking and

provides guidance on how to change this thinking.

Cognitive therapy helps the patient learn effective self-help skills that are used in

homework assignments that help you change the way you think, feel and behave now.

Cognitive-behavioral therapy is action-oriented, practical, rational and helps the patient

gain independence and effectiveness in dealing with real-life issues.

Many people wonder what to expect when they begin therapy, such as:

Initial Assessment

Reading Material

Periodic Assessments

Plan of Treatment

Self-Help

Agenda-setting

Aren’t my emotions important?

Isn’t Medication Important?

Why Cognitive Therapy?

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Numerous outcome studies show that cognitive therapy is as or more effective than

medication in the treatment of depression, anxiety, obsessions and other fears and does

not have the negative-side-effects of medications.

Cognitive therapy incorporates a variety of features that differ from traditional

psychotherapy and shorten the process of change. Five of these elements are briefly

described below:

Formulation of client’s problems guides the treatment plan

The cognitive therapist actively directs clients to the discovery of central

thinking problems.

Cognitive therapist and clients actively work together to resolve negative

feelings, behaviors and functioning.

Cognitive therapy focuses on the resolution of current, specific problems,

providing a clear structure and focus to treatment.

The therapist makes joint decisions with the client and regularly asks for

feedback to maintain a high degree of collaboration and empathy.

The scientific research on the benefits of so-called expressive writing is surprisingly vast.

Studies have shown that writing about oneself and personal experiences can improve

mood disorders, help reduce symptoms among cancer patients, improve a person’s health

after a heart attack, reduce doctor visits and even boost memory.

Researchers believed that by writing and then rewrite their personal narratives in a more

positive and strength-based manner can lead to behavioral changes and improve

happiness. Narrative therapy is a form of psychotherapy that seeks to help people

identify their values, so they can effectively confront whatever problems they face. The

narrative therapist focuses upon assisting people to create stories about themselves, about

their identities, that are helpful to them. This work of “re-authoring identity” claims to

help people identify their own values and identify the skills and knowledge they have to

live these values. Through the process of identifying the skills and knowledge they have

to live these values. Through the process of identifying the history of values in people’s

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lives, the therapist is able to co-author a new story about the person. The story people tell

about themselves and that is told about them is important in this approach which asserts

that the story of person’s identity determines what they think is possible for themselves.

The narrative process allows people to identify what values are important to them and

how they might use their own skills and knowledge to live these values. Narrative

therapy can be used for individuals, couples, or families. In a couple or family setting,

the technique of externalizing a problems sets the stage for creating positive interactions

and transforming negative communication or responses into more accepting,

nonjudgmental, and meaningful exchanges. Seeing a problem objectively helps couples

and families to reconnect with the heart of their relationship and address the ways in

which the problem has challenged that core strength.

I would like to conclude that I have to become more sensitive cognitive therapist

as to direct clients to write and then rewrite on their own way in order to express their

feeling.

3. apabila terapi mahu menggunakan terapi, kebanyakan mereka samada terapis

kognitif atau tingkah-laku, pergi kepada terapis psikodinamik atau terapis

berorientasikan eksperiensial (experientially oriented). Mengapa begini? Suatu

kemungkinannya ialah melibatkan pendekatan kognitif dan tingkah-laku yang

rigid itu akan menjadikan keadaan sangat terdesak dan menyusahkan /

menjemukan. Berapa ramai klien yang boleh tahan / boleh menyesuaikan secara

tepat akan pelbagai prosedur dalam kognitif? Tidakkah anda fikir adalah benar,

iaitu terapis berorientasi-pemahaman dan tanggapan itu lebih memberangsangkan

(more exciting) daripada pendekatan kognitif dan tingkah-laku? Bahkan lebih-

lebih lagi, tidak benarkah iaitu berlawanan dengan terapi kognitif, dan terapi

berorientasikan-pemahaman / tanggapan adalah lebih menghasilkan motivasi

untuk pembelajaran baharu?

Response:

Samada terapis kognitif atau terapis tingkah-laku, pergi kepada terapis psikodinamik atau

terapis berdasarkan eksperiensial, supaya berlaku atau terjadi pelarasan yang stabil antara

teknikal terapi yang hendak dilalui oleh klien. Dan dengan ini klien tidak jemu terhadap

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perjalanan sesi terapi tersebut. Memang benarlah terapi psikodinamik atau yang

orientasikan eksperiensial akan memberi rangsangan yang lebih kepada klien untuk

terus / ada bersama dalam sesi terapi dengan tenang dan penuh harapan. Ianya juga

meningkatkan motivasi kepada klien dalam merealisasikan dirinya dan organisme dalam

kehidupan sebenar. Semua perubahan yang dialami dalam diri (self) klien, dan juga sifat-

ciri luaran seperti dalam tingkah-laku klien, sedikit demi sedikit dirasainya melalui proses

terappi yang dijalankan. Semakin banyak pembelajaran bahawa berlaku dan diterima, dan

di fahami oleh klien, semakin besarlah harapan berlakunya pengurangan simptom negetif

yang dimiliki klien sekian lama. Aliran pengurangan simptom negetif diri dan peribadi

klien akan kelihatan lebih ketara bersama terapis berorientasikan eksperiensial yang

bijaksana. Dari luar, kita akan dapat melihat aliran pengurangan simptom psikopatologi

dan psikologi ini pula, sebagai satu langkah / tahap kedua motivasi, bukan sahaja kepada

klien, tetapi juga kepada terapinya.

Memanglah terapi yang berorientasikan eksperiensial (pengalaman), mudah

diurus-selia semasa sesi terapi, kerana pengalaman-pengalaman negatif ini telah sedia

dihamburkan oleh klien. Terapis memang sedia menerima klien dengan seadanya, sedia

mendengar eksperien dalam kehidupan kliennya, akan dapat membuat asesmen yang

sesuai kepada kllien dengan mudah sekali. Hubungan (relationship) antara terapis dengan

klien pula akan berlaku dengan baik. Inilah keperluan asas yang secara terus dan tidak

terus memberi / menyediakan peluang yang besar untuk / perubahan menyeluruh (total)

dalam diri klien itu.

4. Despite the fact that cognitive therapists pride themselves on their empirical

foundation, relatively little data are available on the application of cognitive

therapy with various cultural groups. Given the complete absence of empirical

data on cognitive methods with diverse clients, in order to stay consistent with

their orientation, cognitive therapists should either label their treatment

approaches as “experimental” with non-White clients or refrain from using their

treatment methods with non-White clients. What are your thoughts on this issue?

Because of their criticism of humanistic-existential therapists, aren’t cognitive

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therapists being hypocritical when they apply their techniques on non-White

clients?

Response:

There’s little doubt about the efficacy of cognitive therapy. Both philosophically and

empirically it has demonstrated itself to be a logical and effective form of treatment.

Cognitive theory and therapy also provide us with an excellent general metaphor

representing the many paradoxes of counseling and psychotherapy theory.

As a theory and technique the cognitive approach is both new and old. It is empirical and

philosophical. Its roots come from the behavioral, psychoanalytic, and constructivist

philosophical traditions. In addition, the study of cognitive approaches raises crucial

questions about the nature of the relationship between therapist and client. Should the

therapist be a judgmental expert or an empirically oriented collaborator? How much faith

should we place in the client’s mentalistic processes? Do we rely on objective scientific

facts or subjective client experiences?

In a relatively short time period, cognitive approaches have performed exceptionally

well under the experimental microscope, with precisely defined symptoms and carefully

measured outcomes. Within this set of definitions, cognitive therapy can claim significant

scientific support. So have we arrived? Do cognitive-behavioral techniques provide the

ultimate answer to human suffering? Is cognitive therapy the way forward for human

growth and actualization? Wherever there is certainty, there is always room for doubt,

and Mahoney provides us with some. He states:

I do not believe that the simple cueing, recitation, or reinforcement of positive self-

statements or the rationalistic “reconstruction” of explicit beliefs are optimal or sufficient

approaches for facilitating significant and enduring personal development. (Mahoney,

1985, p. 14)

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Even further, in his magnum opus, Human Change Processes (Mahoney, 1991), he

quotes Hayek (1979), suggesting there may even be a superstitious quality to scientific

validation:

An age of superstitions is a time when people imagine that they know more than they do.

In this sense the twentieth century was certainly an outstanding age of superstition, and

the cause of this is an overestimation of what science has achieved—not in the field of

comparatively simple phenomena, where it has, of course, been extraordinarily

successful, but in the field of complex phenomena, where the application of the

techniques which prove so helpful with essentially simple phenomena has proved to be

very misleading. (Hayek, 1979, p. 176)

Hayek’s comments suggest that it might be possible to ask larger, more complex

questions than “does this technique make this symptom go away?” Cognitive and

cognitive- behavioral approaches are very effective and, in many ways, very satisfying.

Failing to at least think about using cognitive and behavioral techniques in certain

situations and with certain diagnoses might almost be considered malpractice, due to their

proven efficacy. But the question always remains: Shall we continue our search for even

more optimal approaches for facilitating enduring personal development?

Review Questions

1. What are the main differences between Ellis’s REBT and Beck’s cognitive

therapy?

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Albert Ellis views the therapist as a teacher and does not think that a

warm personal relationship with a client is essential. In contrast, Beck

stresses the quality of the therapeutic relationship.

REBT is often highly directive, persuasive and confrontive. Beck

places more emphasis on the client discovering misconceptions for

themselves.

REBT uses different methods depending on the personality of the

client, in Beck’s cognitive therapy, the method is based upon the

particular disorder.

2. What are the five bedrock assumptions of Ellis’s REBT?

The five bedrock assumptions of Ellis’s REBT are as follows:

i. People dogmatically adhere to irrational ideas and personal

philosophies.

ii. These irrational ideas cause people great distress and misery.

iii. These ideas can be boiled down to a few basic categories.

iv. Therapist can find these irrational categories rather easily in their

clients’ reasoning.

v. Therapists can successfully teach clients how to give up their

misery-causing irrational beliefs.

3. Meichenbaum’s approach is based on verbal meditational processes. In

practical terms, what does he mean by verbal meditational processes?

Verbal meditational is private speech that facilitates learning and problem

solving. Speech produced via verbal mediation cab be either subvocal or

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uttered aloud; in either case, the speech is intended for the speaker, not an

outside listener. Further, although verbal mediation can be accessible to

conscious awareness, it is often automatic and implicit. Verbal mediation

strategies increase with the development of fluent language. Although a

verbal process, verbal mediation also improves performance on visuospatial

and motor tasks. This process was identified early in the study of learning and

memory.

4. List and describe four of Beck’s cognitive distortions.

i. Filtering

We take the negative details and magnify them while filtering out all positive

aspects of a situation. For instance, a person may pick out a single, unpleasant

detail and dwell on it exclusively so that their vision of reality becomes

darkened or distorted.

ii. Polarized Thinking (or :Black and White” Thinking).

In polarized thinking, things are either “black or white”. We have to be

perfect or we’re a failure – there is no middle ground. You place people or

situations in “either/or” categories, with no shades of gray or allowing for the

complexity of most people and situations. If your performance falls short of

perfect, you see yourself as a total failure.

iii. Overgeneralization.

In this cognitive distortion, we come to a general conclusion based on single

incident or a single piece of evidence. If something bad happens only once,

we expect it to happen over and over again. A person may see a single,

unpleasant event as part of a never-ending pattern of defeat.

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iv. Jumping to Conclusions.

Without individuals saying so, we know what they are feeling and why they

act the way they do. In particular, we are able to determine how people are

feeling toward us. For example, a person may conclude that someone is

reacting negatively toward them but doesn’t actually bother to find out if they

are correct. Another example is a person may anticipate that things will turn

out badly, and will feel convinced that their prediction is already an

established fact.

5. Provide examples of what sorts of self-talk Meichenbaum might teach anxious

or angry clients when using stress inoculation training approaches.

Stress inoculation training procedures have been used in the treatment of a wide

variety of clinical problems (Meichenbaum, 1985, 1996; Novaco, 1979). These

procedures involve three separate but interrelated treatment phases.

1. Conceptualization. This phase includes the development of a collaborative

relationship, the use of Socratic questioning to educate clients about the nature

and impact of stress, and conceptualization of stressful situations as

“problems-tobe- solved” (Meichenbaum, 1996, p. 4). When stress is viewed as

a challenge, the therapist can begin assisting the client in formulating personal

or individualized methods for preparing for, confronting, and reflecting on

stressful experiences.

2. Skills acquisition and rehearsal. During this phase specific coping skills are

taughtand practiced in the office setting and eventually in vivo. The particular

skills taught are related to the individual problems. Examples include

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relaxation training, self-instructional training, emotional self-regulation, and

communication skills training.

3. Application and follow-through. In this phase, clients apply their newly

acquired coping skills to increasingly challenging stressors. Personal

experiments are used to help inoculate clients from the effects of later stressful

situations. Relapse prevention strategies, attribution procedures (in which

clients are taught to take credit for their accomplishments), and booster

sessions are built into this final phase of the stress inoculation training model.

6. List and describe the REBT ABCs (including D, E, and F).

1. A = The behavior’s antecedents (everything that happens just before the

maladaptive behavior is observed)

2. B = The behavior (the client’s problem specifically defined in concrete

behavioral terms; e.g., rather than being called an “anger problem,” it’s

referred to as “yelling or swearing six times a day and punching others

twice daily”)

3. C = The behavior’s consequences (everything that happens just after the

maladaptive behavior occurs)

4. D = the irrational belief. He might choose to directly dispute Jem’s belief

by asking, “Is it true that your wife must always be home right on time to

prove her love for you?” or “Isn’t it true that sometimes your wife can be

late and that it’s really not all that awful—it doesn’t mean she doesn’t love

you, but instead it’s just an inconvenient behavior that sometimes happens

to the best of couples?” As we will discuss later, REBT is a flexible form

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of therapy that allows therapists to use a wide range of techniques, all in

the service of disputing, annihilating, or destroying the client’s misery-

causing irrational beliefs.

5. E = on Jem. Hopefully, this effect will be the development of a set of

alternative, more effective beliefs.

6. F = Finally, if the therapy is successful, Jem will experience a new feeling.

7. Describe what Beck means by a self-schema.

This technique is a variation of response prevention discussed by Beck

and colleagues (Beck et al., 1979; Shaw & Beck, 1977). It was employed

in Jackson’s case because much more work was needed to help him

change his self-schema. Specifically, Jackson was instructed to clearly

verbalize his “should” rule, to predict what would happen if the should

was not followed, to carry out an experiment to test the prediction, and to

revise his should rule according to the outcome of the experiment (Beck et

al., 1979, p. 255).

As in the example in Beck’s work, Jackson was given a series of activities

designed to test his should statement: “Every task I do must (should) be

performed flawlessly or there is just more proof that I’m defective.” He

predicted that he might receive a reprimand from his boss if he ignored

this should and turned in poor-quality work. Consequently, he was asked

to perform several work tasks as quickly as he could, but still keeping his

overall work quality within the 75–84 “marginally acceptable” range.

Jackson successfully completed this test of his should rule and discovered

that instead of receiving a reprimand from his boss, he received a pat on

the back for a job well done.

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8. Apakah tiga langkah-langkah latihan Inikulasi tekanan (stress inoculation

training)?

Tiga langkah-langkah Latihan Inokulasi Tekanan ialah:

1. Konseptualisasi / pengkonsepsian (Conceptualization). Fasa ini

termasuklah:

perkembangan hubungan usaha-sama (collaborative relationship),

penggunaan kaedah-menyoal Socratis untuk mengajar klien tentang

keadaan dan kesan tekanan, dan konseptualisasi situasi tekanan-penuh

(maksima) sebagai masalah-yang-mesti diselesaikan (Meichenbaum,

1966, p.4). bila tekanan dipandang sebagai satu cabaran, terapis bolehlah

mula membantu klien memformulakan suatu cara sebagai cadangan untuk

melawan dan mengambil tindakan keatas eksperien tekanan-penuh

tersebut.

2. Kemahiran Perolehan dan Latihan (skill acquisition and rehearsal).

Semasa fasa ini, kemahiran berupaya tertentu adalah difikirkan dan

dipraktiskan didalam pejabat / ofis dan akhirnya didalam vivo (vivo).

Kemahiran tertentu yang difikirkan adalah berkaitan dengan masalah

individu itu. Contohnya termasuklah Latihan Kerehatan, latihan

instruksional-kendiri (self-instructional training), regulasi-kendiri (self-

instructional training), regulasi-kendiri tentang emosi, dan Latihan

Kemahiran Komunikasi.

3. Aplikasi dan mengikuti-melaluinya (Aplicational follow-through).

Dalam fasa ini, klien mengaplikasi mengguna-pakai kemahiran yang telah

diputuskan tadi untuk meningkatkan cabaran terhadap apa-apa tekanan.

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Eksperimen personal digunakan untuk membantu klien daripada kesan

‘stresful’yang terakhir. Mengulangi strategi penghalang dan prosedur yang

member kesan, dan sesi yang menggalakkan hendaklah dibuat / direkakan

dalam fasa akhir ini.

9. Apakah informasi yang akan anda masukkan kedalam Rekod Pemikiran (Thought

Record)?

Informasi yang akan dimasukkan kedalam senarai Rekod Pemikiran ialah:

1) Haribulan dan masa respon emosional itu berlaku.

2) Situasi dimana respon emosional itu wujud.

3) Tingkah-laku yang ada pada klien ketika itu.

4) Emosi yang bagaimana terhasil / wujudnya.

5) Bagaimana pemikiran klien semasa wujudnya emosi.

6) Respon yang berkaitan yang timbul ketika itu.

10. Apakah kognitif bercerita (cognitive story-telling), dan apakah tijuan

menggunakannya kepada klien muda?

Jawapan:

Kognitif bercerita adalah satu teknik yang direka-bentuk, iaitu terapi per-kognitif

untuk mengilustrasikan prinsip Terapi Kognitif untuk menyentuh minat semasa

menggunakan prinsip kognitif ini dalam kehidupan. Klien muda kebanyakannya

adalah jemu dengan terapi ini, juga disebabkan oleh tekanan, kurangnya motivasi,

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halangan dari perbezaan dan keadaan otoriti. Oleh yang demikian, untuk

memulakan teknik ini, terapi hendaklah memberitahu klien-klien muda ini, yang

kita ada satu cerita yang sangat menarik, dan menghendaki mereka mendengarnya

dengan baik, dan memberi pendapat masing-masing, apakah moral cerita ini.

Lebih baik lagi, sebagai menyuntik minat yang lebih hebat lagi daripada klien

muda ini, kita menyediakan hadiah yang sesuai kepada klien yang terbaik dengan

persepsi moral dalam cerita tadi. Sebagai teknik tambahan, hadiah utama diberi

kepada yang terbaik dan yang lain mendapat hadiah juga (sagu hati)-i.e; rupa-

bentuk hadiah yang biasa digemari oleh kanak-kanak.

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