Research Methodologies and Philosophy in Cognitive Behavioral Psychotherapy - Essay Example

Research Methodologies and Philosophy in Cognitive Behavioral Psychotherapy Cognitive Behavior Therapy (CBT) is one of the major orientations of psychotherapy and represents a unique category of psychological intervention because it derives from cognitive and behavioral psychological models of human behavior that include for instance, theories of normal and abnormal development, and theories of emotion and psychopathology. The term cognition is used in several different loosely related ways. In psychology it is used to refer to the mental processes of an individual, with particular relation to a view that argues that the mind has internal mental states (such as beliefs, desires and intentions) and can be understood in terms of information processing, especially when a lot of abstraction or concretization is involved, or processes such as involving knowledge, expertise or learning for example are at work. It is also used in a wider sense to mean the act of knowing or knowledge, and may be interpreted in a social or cultural sense to describe the emergent development of knowledge and concepts within a group that culminate in both thought and action. Behavior therapy, the earliest of the cognitive and behavioral psychotherapies, is based on the clinical application of extensively researched theories of behavior, such as learning theory (in which the role of classical and operant conditioning are seen as primary). Early behavioral approaches did not directly investigate the role of cognition and cognitive processes in the development or maintenance of emotional disorders. Cognitive therapy is based on the clinical application of the more recent, but now also extensive research into the prominent role of cognitions in the development of emotional disorders. "The term 'Cognitive-Behavioral Therapy' (CBT) is variously used to refer to behavior therapy, cognitive therapy, and to therapy based on the pragmatic combination of principles of behavioral and cognitive theories" (Brown, 2000). New CBT interventions are keeping pace with developments in the academic discipline of psychology in areas such as attention, perception, reasoning, decision making etc. "Cognitive and/or behavioral psychotherapists work with individuals, families and groups. The approaches can be used to help anyone irrespective of ability, culture, race, gender or sexual preference" (Mythos & Logos). Cognitive and/or behavioral psychotherapies can be used on their own or in conjunction with medication, depending on the severity or nature of each client's problem. Kinds of Research in CBT Put in simple words, CBT involves two different kinds of researches: Qualitative and Quantitative. Quantitative methods are useful for describing social phenomena, especially on a larger scale, whereas qualitative methods allow social scientists to provide richer explanations (and descriptions) of social phenomena, frequently on a smaller scale. There is some debate over whether "quantitative" and "qualitative" methods can be complementary: some researchers argue that combining the two approaches is beneficial and helps build a more complete picture of the social world, while other researchers believe that the epistemologies that underpin each of the approaches are so divergent that they cannot be reconciled within a research project. While quantitative methods are based on a natural science, positivist model of testing theory, qualitative methods are based on interpretivism and are more focused around generating theories and accounts. Positivists treat the social world as something that is 'out there', external to the social scientist and waiting to be researched. Interpretivists, on the other hand believe that the social world is constructed by social agency and therefore any intervention by a researcher will affect social reality. Herein lies the supposed conflict between quantitative and qualitative approaches - quantitative approaches traditionally seek to minimize intervention in order to produce valid and reliable statistics, whereas qualitative approaches traditionally treat intervention as something that is necessary (often arguing that participation can lead to a better understanding of a social situation). However, it is increasingly recognized that the significance of these differences should not be exaggerated and that quantitative and qualitative approaches can be complementary. They can be combined in a number of ways, for example: Qualitative methods can be used in order to develop quantitative research tools. For example, focus groups could be used to explore an issue with a small number of people and the data gathered using this method could then be used to develop a quantitative survey questionnaire that could be administered to a far greater number of people allowing results to be generalized. Qualitative methods can be used to explore and facilitate the interpretation of relationships between variables. For example researchers may hypothesise that there would be a positive relationship between positive attitudes of sales staff and the turnover of a store. However, quantitative structured observation could reveal that this was not the case, and in order to understand why the relationship between the variables was negative the researchers may undertake qualitative case studies of four stores including participant observation. This might confirm that the relationship was negative, but that it was not the positive attitude of sales staff that led to low sales, but rather than high sales led to busy staff who were less likely to be positive at work! Epistemological Assumptions of the Research "Epistemology from the Greek words episteme (knowledge) and logos (word/speech) is the branch of philosophy that deals with the nature, origin and scope of knowledge" (Baron, 1980). Historically, it has been one of the most investigated and most debated of all philosophical subjects. Much of this debate has focused on analyzing the nature and variety of knowledge and how it relates to similar notions such as truth and belief. Much of this discussion concerns the justification of knowledge claims. Not surprisingly, the way that knowledge claims are justified both leads to and depends on the general approach to philosophy one adopts. Thus, philosophers have developed a range of epistemological theories to accompany their general philosophical positions. More recent studies have re-written centuries-old assumptions, and the field of epistemology continues to be vibrant and dynamic. Explanations in social theories can be idiographic or nomothetic. An idiographic approach to an explanation is one where the scientists seek to exhaust the idiosyncratic causes of a particular condition or event, i.e. by trying to provide all possible explanations of a particular case. Nomothetic explanations tend to be more general with scientists trying to identify a few causal factors that impact a wide class of conditions or events. For example, when dealing with the problem of how people chose a job, idiographic explanation would be to list all possible reasons why a given person (or group) choses a given job, while nomothetic explanation would try to find factors that determine why job applicants in general chose a given job. "One central topic in social epistemology is "testimony," construed broadly i.e. the habit we have of learning from other people" (Wittig, 2002). One central question in social epistemology is: assuming that we are very often justified in believing something based on the testimony of other people, where does this justification come from, and in particular, does it necessarily come from observations we have made regarding other people's reliability "Interpretevism is a school of thought that believes that law is not a set of given data, conventions or physical facts, but what practitioners aim to construct or obtain in their practice" (Wikipedia). This marks a first difference between interpretivism and positivism. There is no separation between law and morality, although there are differences. This is the opposite of the main claim of positivism. Norms are not immanent in nature nor do legal values and principles exist independently and outside of the boundaries of practice itself. This is the opposite of the main claim of natural law theory. Positivists believe in the unity of scientific method - logic of inquiry is the same across all sciences (social and natural) the goal of inquiry is to explain and predict. Most positivists would also say that the ultimate goal is to develop the law of general understanding, by discovering necessary and sufficient conditions for any phenomenon (creating a perfect model of it). If the law is known, we can manipulate the conditions to produce the predicted result. scientific knowledge is testable. Research should be mostly deductive, i.e. deductive logic is used to develop statements that can be tested (theory leads to hypothesis which in turn leads to discovery and/or study of evidence). Research should be observable with human senses (arguments are not enough, belief is out of question). Positivists should prove their research using logic of confirmation or logic of falsification. Implications of the Research Epistemology Mischel states that "The cognitive and behavioral psychotherapies target problems in the here and now with much less therapeutic time devoted to experiences in early life" (1986). The therapeutic relationship is seen as an essential ingredient but unlike other psychotherapies is not viewed as the main vehicle of change. Instead the focus is in collaborative working on jointly agreed problems. The effectiveness of CBT is supported by evidence from randomized controlled trials (RCTs), uncontrolled trials, case series and case studies. It is both highly structured (although always based on a formulation of the relationship between the client's presenting problems and underlying cognitive and/or behavioral processes) and flexible due to the constant evaluation of the outcome of the interventions. The non-radical approach to social epistemology is essentially the study of the contribution of various social mechanisms to the growth of knowledge. It takes the traditional conception of knowledge as the justified, true beliefs of individuals as a point of departure, augmenting it with the social factors that impinge on these beliefs. Radical social epistemologists believe that taking account of the effects of social factors on the production of knowledge will have much more serious consequences for epistemology. "Cognitive therapists do not usually interpret or seek for unconscious motivations but bring cognitions and beliefs into the current focus of attention (consciousness) and through guided discovery encourage clients to gently re-evaluate their thinking" (Schultz, 2002). It is a form of therapy that addresses problems in a direct and targeted way. It focuses on a shared model of understanding, using a psycho-educational approach, open sharing of the formulation and teaching of self-evaluation and management skills. Its potency as a model is shown by its increasing use and accumulating recommendation by a range of evidence-based guidelines. Evaluation of the Research Concepts The process of research, therapy and the skills required by CBT psychotherapists involve: (a) Assessment - knowledge and understanding of a range of CBT assessments. (b) Formulation - to derive formulations of presenting problems or situations which integrate information from assessments within a coherent CBT framework drawing upon theory and evidence based practice. (c) Intervention - On the basis of the formulation the therapist will be able to implement therapy or intervention techniques appropriate to the presenting problem and to the psychological and social circumstances of the client. (d) Evaluation - to select and implement appropriate methods to evaluate the effectiveness, acceptability and broader impact of the interventions (both individual and organizational), and use this information to inform and shape practice. This method would allow a way of being with clients based on an equal partnership, each party bringing something to the relationship. The therapist brings skills and knowledge of psychological processes, theories of emotion and techniques that have helped others and could help the current client. The client is an expert in their own experience, and brings their own resources. The therapist should not have pre-conceived ideas about where the therapy is going. The overall aim is for the individual to attribute improvement in their problems to their own efforts, in collaboration with the psychotherapist. Therapy is not experienced as something that has been "done to" the client. Here, the concept of formulation deliberates upon a unique map or hypothesis of presenting problems or situations which integrate information from assessments within a coherent CBT framework drawing upon theory and evidence based practice. Socratic dialogue/ guided discovery - is a style of questioning to both gently probe for people's meanings and to stimulate alternative ideas. It involves exploring and reflecting on styles of reasoning and thinking and possibilities to think differently. CBT is not about trying to prove a client wrong and the therapist right, or getting into unhelpful debates - rather by skillfully collaborating, clients come to see for themselves (discover) that there are alternatives Homework - the client tries things out in between therapy sessions, putting what has been learned into practice. This is referred to as homework and sometimes includes behavioral experiments. "Researchers must have an effective understanding of the range of cognitive, cognitive-behavioral and/or behavioral models of Human Behavior and/or the Person" (Personality Research). They must have an effective understanding of the theoretical and research-based models of individual development across the lifespan, and within the cultural and social contexts prevailing. Further, they must have a good knowledge of the philosophical and theoretical bases of CBT, their practical application to various client groups and their current empirical status. CBT psychotherapists are able to identify and critically evaluate relevant research. The CBT psychotherapist should be able to justify the interventions being used with clients on the basis of research evidence. The process of therapy itself is based on a scientist-practitioner model. A hypothesis (formulation) is formed which leads to an intervention the results of which are then evaluated for their effectiveness. Conclusions are drawn and the hypothesis may change due to the outcome of the intervention and evaluation process. This in turn may lead to the intervention being changed. References Baron, R. et al (1980). Psychology. Japan: Holt-Saunders. Brown, R. (2000). Therapeutic Counseling. New York: Brooks/Cole. Mischel, W. (1986). Introduction to Personality. New York: HRW, 4th edition. "Mythos and Logos". Cognitive Behavior Therapy. 10 Dec 2005. . "Personality Research". Personality Theories. 26 Nov 2005. . Schultz, D. (2002). Psychology & Work Today. India: Pearson Education. "Wikipedia". Social Research. 10 Dec 2005. . Wittig, A. (2002). Introduction to Psychology. Ohio: McGraw Hill. Read More