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.