Cognitive and Cognitive-Behavioural Therapies - Essay Example

WORK ESSAY Cognitive Behavioural Therapy According to Dr. Greg Mulhauser, Cognitive therapy (or cognitive behavioural therapy) helps the client to uncover and alter distortions of thought or perceptions which may be causing or prolonging psychological distress. Cognitive therapy suggests that psychological distress is caused by distorted thoughts about stimuli giving rise to distressed emotions. The theory is particularly well developed (and empirically supported) in the case of depression, where clients frequently experience unduly negative thoughts which arise automatically even in response to stimuli which might otherwise be experienced as positive. For instance, a depressed client hearing "please stop talking in class" might think "everything I do is wrong; there is no point in even trying". The same client might hear "you've received top marks on your essay" and think "that was a fluke; I won't ever get a mark like that again", or he might hear "you've really improved over the last term" and think "I was really abysmal at the start of term". Any of these thoughts could lead to feelings of hopelessness or reduced self esteem, maintaining or worsening the individual's depression. Usually cognitive therapeutic work is informed by an awareness of the role of the client's behaviour as well (thus the term 'cognitive behavioural therapy', or CBT). The task of cognitive therapy or CBT is partly to understand how the three components of emotions, behaviours and thoughts interrelate, and how they may be influenced by external stimuli -- including events which may have occurred early in the client's life. (http://counsellingresource.com/types/cognitive-therapy) Therefore, in order for me (as a behavioural therapist) to help the child, I should, first of all, know what experience/s or specific event has caused the child to develop this reaction to mealtimes and eating. It would take a lot of effort on the therapist's side, but it is still the client's prerogative to share his/her reason. In some cases, the client is not comfortable talking about their phobia, so it will also be helpful to have someone (especially an immediate relative) with them during the initial interview or interrogation. It is important to know whether the client is comfortable with the whole process of the therapy, since he/she will play a major part in order for the therapy to be successful. Besides, it is the client's behaviour that really matters; all we can do as therapists is to help them overcome the anxiety, depression, indifference, etc. or sometimes, help them to distinguish whether their beliefs are in tune with reality. In addition, still according from Dr. Mulhauser, clients who are comfortable with introspection, who readily adopt the scientific method for exploring their own psychology, and who place credence in the basic theoretical approach of cognitive therapy, may find this approach a good match. Clients who are less comfortable with any of these, or whose distress is of a more general interpersonal nature -- such that it cannot easily be framed in terms of interplay between thoughts, emotions and behaviours within a given environment -- may be less well served by cognitive therapy. Cognitive and cognitive-behavioural therapies have often proved especially helpful to clients suffering from depression, anxiety, panic and obsessive-compulsive disorder. CBT works by addressing the way the client thinks and behaves in response to similar situations and by developing more flexible ways to think and respond, including reducing the avoidance of activities. If, as a result, the client escapes the negative thought patterns and dysfunctional behaviors, the feelings of depression may, over time, be relieved. The client may then become more active, succeed and respond more adaptively more often, and further reduce or cope with his negative feelings. It is also important to establish the "we-will-work-on-this" relationship between the therapist and the child. Assuring the client that this therapy is not a one-way thing and that it will involve his whole participation, it increases the client's trust and willingness to fight the phobia or at least alter his beliefs. After this is established, the therapist can now ask for the child's assumptions about eating and test whether it is realistic or not. Therapy may consist of testing the assumptions which one makes and identifying how certain of one's usually-unquestioned thoughts are distorted, unrealistic and unhelpful. Once those thoughts have been challenged, one's feelings about the subject matter of those thoughts are easier subject to change. (http://amazines.com/Cognitive_therapy_related.html) In this situation, let us put the child's eating phobia in a more specific context. For example, (we will name the young child as Ben) I found out that he avoids eating since he was five (let us assume that Ben is an 8-year-old kid when this therapy began). During the initial interrogation, his mother came with him to provide the necessary information that Ben refuses to tell. I found out that a specific event, in which Ben ate something (during a mealtime) in the past that had him hospitalized for a very long time and made him suffer a lot after he was released, triggered this fear of eating. He developed a "everything-I-will- eat-during-mealtimes-are-not-good" mentality. Phobias that are neglected at first will eventually develop and worsen, and in Ben's case, he now avoids eating in general because he believes that whether it is mealtime or not, it will have the same effect on him. Now we see the pattern: the event serves as our stimuli, which gave Ben the thought that "any food that he will eat will not give a positive reaction to his body", and now results to having this emotion of fear to food, mealtimes, and eating itself as a reaction. Then, I could show Ben my conceptualisation and share with him my plan on how to get on with the whole therapy process. In Michael J. Scott's Developing Cognitive-Behavioral Counselling, it was stated that drawing and sharing your conceptualisation of the client's difficulties gives the client a map of how he or she arrived at the present position, and also opens up the possibility that alternative routes could have been taken if the client had known then what he or she knows now. It also highlights the arbitrariness of the client's initial interpretations. This could be one way to persuade Ben to face his fears-clich as it may sound-because it is the only way for him to overcome it. One way of facing it is making a list of the things, events, people, time, or even places that triggers the emotion. Then we will rank them according to the difficulty of achieving or facing them alone. I made a list here as an example: EATING DURING MEALTIMES: Watch people eating in public areas. Watch while your family eats, but do not join them in the dining table. Join the group during mealtime, but do not eat. Join the group during mealtime and eat. Buy food alone during mealtime but do not eat it. Buy food alone during mealtime and eat it. In this example, Ben's list progressed from watching from afar to buying and eating alone. It is important for Ben to realize that the belief as well as the reaction needed to be changed, but not to do it abruptly. It should be gradual, and should always be according to what the client can take at the moment. Time is essential in CBT, especially if the client have had this phobia for a long time. Here are some general guidelines in making a plan: - Build up slowly: start with easy tasks and build up to harder tasks. The first step should make you slightly anxious but not frighten you so much you can hardly tackle it. -Only move on to a harder task when you feel comfortable with the task you are working on. -Practise tasks regularly, once a day is better than twice a week. -Plan things you enjoy so that you have something to look forward to each time you move on a step. -Expect setbacks and do not give up because of them. Everyone's confidence varies. If something is too hard, find ways of breaking it down into smaller steps or go more slowly. -Discuss your problems with your doctor and/or your counsellor or a friend you trust. (http://www.mentalneurologicalprimarycare.org/downloads/primary_care/04-3_overcoming_particular_fears.pdf) After making a list, I could also persuade Ben to keep track of his progress. It will motivate him to keep on working hard and to continue the therapy until such time that he loses his fear of eating. Children are stimulated when they are given something to do and are very agitated to finish the task given to them. This list serving as Ben's goal could help him focus on finishing the therapy. References: Beck, Aaron T. Cognitive Therapy. 12 February 2009. Mental Disorders in Primary Care, a WHO Education Package. 1998. Date Retrieved: February 11, 2009 Mulhauser, Greg. An Introduction to Cognitive Therapy & Cognitive Behavioural Approaches. 12 February 2009. Scott, Michael J., Stephen G. Stradling, and Windy Dryden. (1995) Developing Cognitive Behavioural Counselling, 13-16. Read More