Cognitive Behavior & Reality Therapy

Albert Ellis's Rational Emotive Behavior Therapy (REBT)

 This was the first of the cognitive behavior therapies.  The basic assumption is that people contribute to their own psychological problems, as well as to specific symptoms, by the rigid and extreme beliefs they hold about events and situations. Cognitions, emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship.  It is based on the premise that we learn irrational beliefs from significant others during childhood and then re-create these irrational beliefs throughout our lifetime. 

REBT Encourages people to accept themselves even though they will make mistakes

A-B-C Framework

This framework is central in theory and practice.  Essentially it is a tool used for understanding the client's feelings, thought, events, and behavior.  

• A = the activating event
• B = belief
• C = Emotional and behavioral consequence
• D = Disputing intervention
• E = Effect
• F = New Feeling

The therapist/client relationship in this therapy is more of a teacher/student role.  The therapist is there not to form a warm relationship with the client, but to teach them how to understand and rationalize their emotions effectively.  The idea is to create an understanding that the activating event (A) does not cause the emotional and behavioral consequence (C), it is however the belief of the person (B) that causes the negative feelings.  At that point disputing intervention (D) comes into play.  Then a client must detect irrational beliefs, debate the dysfunctional or irrational beliefs by learning to logically question them then argue within themself and act against them.  This occurs over several therapy sessions.  Finally, clients learn to identify irrational beliefs from rational beliefs.  Clients learning to monitor, adapt, and substitute rational beliefs.  This then brings us to an effective philosophy (E), which is a new and effective beliefs system.  This system is acheived over time, with many therapy sessions of disputing intervention and self-growth and ultimately leads to the goal of new feelings (F).  Feelings of healthy disappointment and apology may override nervousness and anxiousness.

Aaron T. Beck's Cognitive Therapy (CT)

To produce lasting change in dysfunctional emotions and behaviors is to modify inaccurate and dysfunctional thinking.

Cognitive Therapy is an insight-focused therapy that was developed independently from, but during the same time as REBT.   Cognitive therapy perceives psychological problems as stemming from commonplace processes such as faulty thinking, making incorrect inferences on the basis of inadequate or incorrect information, and failing to distinguish between fantasy and reality.  Cognitive therapy is highly collaborative and involves designing specific learning experiences to help clients monitor their automatic thoughts, examine the validity, understand the relationship among cognition feelings, and behavior, and develop more accurate and realistic cognitions as well as change underlying beliefs and assumptions.  Beck believes people with emotional difficulties tend to commit characteristic "logical errors" that distort objective reality.  These are called cognitive distortions.

• Arbitrary Indifferences - making conclusions without supporting and relevant evidence
• Selective Abstraction - forming conclusions based on an isolated detail of an event
• Overgeneralization - holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings
• Magnification and minimzation - perceiving a case or situation in a greater or lesser light than it truly deserves
• Personalization - tendency for individuals to relate external events to themselves, even when there is no basis for making this connection
• Labeling and mislabeling - portraying one's identity on the basis of imperfections and mistakes made in the past and allowing them to define one's true identity.
• Dichotomous thinking - categorizing experiences in either-or extremes, it's either black or white, there's no gray area

Cognitive Therapy initially gained recognition as an approach to treating depression, but research has been devoted to the study and treatment of many other psychiatric disorders.   The relationship between client and therapist in cognitive therapy emphasizes the quality of the relationship.  Empathy and sympathy plays a great role in Beck's cognitive therapy.  The therapists are actively and continually interactive with clients to help them frame their conclusions in the form of testable hypotheses.  These specific and measurable goals and to move directly into the areas that are causing the most difficulty for the client.  Educational readings of the cognitive behavior therapy process may be assigned to clients to enhance their educational focus, self-help books may also be utilized, as well as homeowork may often be given to the clients for the next session.

Reality Therapy

William Glasser contends that clients should not be labeled with a diagnosis except when it is necessary for insurance purposes.  From his perspective diagnoses are descriptions of the behaviors people choose in their attempt to deal with the pain and frustration that is endemic to their unsatisfying present relationship. Glasser defined the premise of reality therapy in his books.

What is it?

This therapy is based on choice theory and assumes that we need quality relationships to be happy.  Psychological problems are the result of our resisting the control by others or of our attempt to control others.  Choice theory is an explanation of human nature and how to best achieve satisfying interpersonal relationships.  This therapy is geared towards teaching people ways of using choice theory in everyday living to increase effective behaviors.  It has been applied to individual counseling with a wide range of clients, group counseling, working with youthful law offenders, and couples and family therapy.  In some instances it is well suited to brief therapy and crisis intervention.

Key Concepts

• The basic focus is on what clients are doing and how to get them to evaluate whether their present actions are working for them
• People are mainly motivated to satisfy their needs, especially the need for significant relationships
• The approach rejects the medical model, the notion of transference, the unconscious, and dwelling on one's past

Goals of Therapy

To help people become more effective in meeting all of their psychological needs.  To enable clients to get connected with the people they have chosen to put into their quality worlds and teach clients choice theory.

Therapists Role

The key of a successful client/therapist relationship is to build a good relationship with the client.  They must also

• Engage clients in an evaluation of all their relationships with respect to what they want and how effective they are in getting this
• Find out what clients want
• Ask what they are choosing to do
• Invite them to evaluate present behavior
• Help them make plans for change
• Get the client to make a commitment

The therapist is a client's advocate, as long as the client is willing to attempt to behave responsibly

Therapy Techniques

Realistic therapy is an active, directive,  and didactic therapy.  Skillful questioning is a central technique used for the duration of the therapy process.  Various techniques may be used to get clients to evaluate what they are presently doing to see if they are willing to change.  If clients decide that their present behavior is not effective, they develop a specific plan for change and make a commitment to follow through.

Gestalt & Behavior Therapy

Frederick S. "Fritz" Perls, MD, PhD

Gestalt Therapy

 "Awareness, Choice, and Responsibility"

Frederick "Fritz" Perls was the main originator and developer of Gestalt therapy.  Gestalt therapy is an existential, phenomenological, and process-based approach created on the premise that individuals must be understood in the context of their ongoing relationship with the environment.

Key Concepts

View of Human Nature

• Clients are manipulative and avoid responsibility
• Clients and Therapists are viewed as interdependent
• People have the ability to self regulate
• People change when they become aware of who they are

 Four Basic Principles 

• Holism - Nature is seen as a unified and coherent whole, and the whole is different from the sum of its parts.
• Field Theory - One must become and understand it's part of the ever changing environment.
• Figure-Formation Process - How one views the organization of their environment
• Organismic Self-Regulation - Taking action or responsibility to achieve equilibrium when a want or need arises.

The Now

• The present moment is the most significant in Gestalt Therapy.  Past and Future focus is an avoidance
• Phenomenological inquiry is coming into contact with the present moment, asking what and how rather than why.
• When the past arises, it must be brought into present tense

Unfinished Business

• When figures emerge from the background but are not completed and resolved, individuals are left with this
• Can create grief, guilt, unexpressed feelings, resentment, etc.
• Is brought forward and may interfere with the present
• Must be faced and dealt with to prevent persistence

Contact and Resistance to Contact

• Contact is necessary for change and growth to occur 
• Good contact requires clear awareness, full energy, and the ability to express oneself without losing ones individuality
• There are 5 main kinds of contact boundary disturbances
• Introjection - to uncritically accept others' beliefs and standards without assimilating them to make them congruent with who we are
• Projection - to disown certain aspects of ourselves by assigning them to the environment, the opposite of introjection
• Retroflection - turning back onto ourselves what we would like to do to someone else or doing to ourselves what we would like someone else to do to or for us
• Deflection - the process of distraction or veering off, so that it is difficult to maintain a sustained sense of contact
• Confluence - blurring the differentiation between the self and the environment.

Energy and Blocks to Energy

• Special attention given to where energy is located, how it is used, and how it can be blocked
• Blocked energy is another form of defensive behavior
• This energy must be addressed and recognized 
• Energy must be transformed into effective productive behavior

 

 Goals of Therapy

The basic goal of therapy is an existential encounter out of which clients tend to move in certain directions.  Moving towards increased awareness of themselves, assuming ownership of their experiences, develop self-satisfaction without violating others, awareness of all senses, accepting responsibility for what they do, and learn to be able to ask for help and get help from others as well as having the ability to give to others.

Therapist's Role 

Engaging with clients to assist them in developing their own awareness and experiencing how and who they are in the present moment.  They also create a safe space for clients to explore themselves and try out new behaviors as well as encouraging their clients to bring their thoughts experiences and feelings to the present, and to the surface.  Therapist's must also pay close attention to body language patterns as well as language patterns to ensure that the client is focusing on the present.  Therapist's treat the clients as equal and does little talking, mostly listening, and reminding and encouraging to focus on the present.

Techniques and Processes

• Experiments are developed from interaction between therapist and client.  They are aimed at helping the client to learn by experience, and the client is typically surprised by what they have learned.  The experiments are typically spontaneous and one-of-a-kind.  The experiment are designed to bring out internal conflict by making the struggle an actual process to help the clients gain fuller awareness, experience internal conflict, resolve inconsistencies, and work through an impulse.
•  The Internal Dialogue exercise may also be called the empty chair exercise.  The therapist asks the client in one chair to portray one personality, while moving to the other chair to become the opposite personality while verbalizing.  This helps the client to accept and integrate both sides of the issue.  This helps clients get in touch with feelings that they may be denying.  
• Making the Rounds exercise involves going around the room and speak to or do something to or with each person in the group.  The purpose is to confront, risk, disclose themselves, experiment with new behavior, and to grow and change. 
• The rehearsal exercise addresses the need to be approved, accepted, and liked.  Speaking out loud the silent rehearsal that we sometimes go through in our heads.
•  The reversal exercise is basically grabbing the bull by the horns and taking a plunge into the very thing that is creating the anxiety or that is being denied.
• The exaggeration exercise focuses on body movements, gestures, postures, and movements that may communicate significant meaning.  They are asked to exaggerate the action and repeat it over and over which usually intensifies the feeling attached to the bahavior thus making it easier for the client to grasp and understand.
• Staying with the feeling is encouraging clients to dive deep into fearful stimuli and unpleasant feelings.  Facing and experiencing feelings takes courage and is a mark of willingness to endure the pain necessary for personal growth.
• Gestalt theory does not interpret dreams but brings dreams to life, and walks through them, and helps the client to experience the feelings the dream caused and understand the feelings they have.  The dream is assumed to be a projection of oneself, it is talked through as though it is currently occurring in the present to help the client actively and presently deal with the feelings they have.