Cognitive Behavior and Reality Therapy

Cognitive Behavior Therapy

        

The best years of your life are the ones in which you decide your problems are your own. You do not blame them on your mother, the ecology, or the president. You realize that you control your own destiny. ~ Albert Ellis

•   Albert Ellis (1913-2007) – Psychologist that developed an approach to psychotherapy that he called rational therapy and later rational emotive therapy.  It is now known as rational emotive behavior therapy (REBT)
•   Aaron Temkin Beck (b. 1921) – He holds the position of University Professor (Emeritus) of Psychiatry.  He is an innovating figure in cognitive therapy and one of the most influential and validated approaches to psychotherapy.  He continues to be active and has published 21 books and more than 450 articles and book chapters.
•  Judith S. Beck (b. 1954) – Her and her father, Aaron Temkin Beck, opened the nonprofit Beck Institute for Cognitive Therapy.  The Institution is devoted to national and international training in cognitive therapy.  She is also the Clinical Associate Professor at the University of Pennsylvania.  She has written nearly a hundred articles and chapters on a variety of CT topics and authored several books on cognitive therapy.
•  Donald Meichenbaum (b. 1940) – He is the recipient of a Lifetime Achievement Award from the Clinical Division of the American Psychological Association for his work on suicide prevention.  He is also the research director of the Melissa Institute for Violence Prevention.  He has published extensively, lectured and consulted internationally, and presents workshops at professional conferences.

Key Concepts

Although psychological problems can stem from childhood they are bolstered by the way the client presently thinks.  The way a person believes is the main cause of disorders.  The things that a client says to himself or herself, (“I am worthless.”) plays a key role in their behavior.  Clients replace misconceptions about self with effective beliefs.

Ø  View of Human Nature – People are born with rational and irrational thinking.  People have predispositions for self-preservation, happiness, thinking and verbalizing, loving, communion with others, and growth and self-actualization.  The also have the propensities for self-destruction, avoidance of thought, procrastination, endless repetition of mistakes, superstition, intolerance, perfectionism, and self-blame, and avoidance of actualizing growth potentials.

Ø  View of Emotional Disturbance - People learn illogical beliefs from significant people in their childhood.  They have a tendency to recreate these beliefs throughout their life.  People reinforce their self-defeating beliefs through autosuggestion and self-repetition.  Because we behave in the way we believe about ourselves it keeps the dysfunctional attitudes active and operant within us.

Ø  A-B-C- Framework – A is the activating event.  B is the belief.  C is the emotional and behavioral consequence.  D is the disputing interventions.  E is the effect.  And F is the new feelings.  It is not the experience itself that causes the depressive reaction, but instead the person’s beliefs about the experience.  An emotional disturbance is fostered by the self-defeating sentences clients continually repeat to themselves.  Cognitive restructuring is the main technique of cognitive therapy that teaches people how to replace the illogical beliefs with the logical beliefs.  This involves assisting clients with learning to be aware of self-talk, identify illogical self-talk, and substitute logical self talk for their illogical self-talk.

Therapeutic Goals

Ø  To show clients how they created the irrational beliefs early in life.

Ø  To show clients how they are keeping their irrational beliefs and disturbances active.

Ø  To assist clients in modifying the way they think and how to minimize their irrational ideas. 

Ø  To achieve unconditional self-acceptance.

Techniques Used

Ø  Cognitive Methods – Disputing irrational beliefs-clients go over a must, should, or ought until they no longer hold that illogical belief or until it is diminished.  Doing cognitive homework- Clients make lists of their problems, look for illogical beliefs, and dispute the beliefs.  The REBT Self-Help Form is often used.  When doing this homework clients are asked to put themselves in situations that will challenge their self-limiting beliefs.  Clients are asked to take record and think about how their personal beliefs about themselves contributed to their problems.  Bibliotherapy- An adjunct form of treatment.  This is seen as an educational process because clients are asked to read REBT self-help books.  Changing one’s language- “Musts”, “oughts”, and absolute “should” can be replaces with preferences.  Language that reflects helplessness and self-condemnation can learn to incorporate new statements.  Psychoeducational methods- Clients are introduced to different educational material.  Therapists educate clients about how their problems and treatment will most likely proceed.

Ø  Emotive Techniques – Unconditional acceptance, role-playing, modeling, rational emotive imagery, and shame attacking exercises are used.  Clients are taught that putting themselves down is destructive.  The main goal of this technique is to dispute illogical beliefs about self.  Rational emotive imagery- Clients are asked to imagine one of the most horrible events that could happen to them.  Once the clients imagine themselves in the situation and the disturbing feelings arise they are shown how to train themselves to develop healthy emotions in place of unhealthy emotions.  Using humor- It is believed that if people take themselves too seriously that is when illogical thinking comes into play.  A better sense of humor is fostered and life is put into perspective.  It teaches client’s to laugh.  Role playing- Clients rehearse behaviors so that they can bring to surface their feelings.  Shame attacking exercises- This helps clients minimize shame and anxiety over acting certain ways.  Clients can refuse to be ashamed by telling self that it is not a big deal if someone thinks that they are foolish.  Clients are given homework that puts them in situations that they will act foolish on purpose.  These acts do not involve illegal activities or behaviors that result in people being harmed.

Ø  Behavioral Techniques – This includes operant conditioning, self-management principles, systematic desensitization, relaxation techniques, and modeling.  Clients are given homework assignments that will desensitize and give exposure in real situations.

Check out this video that can help your child feel confident and brave:

References

Albert Ellis Quotes. (2012). Retrieved from http://www.brainyquote.com/quotes/authors/a/albert_ellis_2.html

Corey, G. (2012). Theory and Practice of Counseling and Psychotherapy (9^th ed.). Belmont, CA: Brooks/Cole.

Reality Therapy

If you want to change attitudes, start with a change in behavior. ~ William Glasser

v William Glasser (b. 1925) He was initially a chemical engineer.  He then turned to psychology (MA, Clinical Psychology, 1948) and then to psychiatry, attending medical school (MD, 1953) with the intentions of becoming a psychiatrist.  In 1962 he began to give lectures on “reality psychiatry,” but there were few psychiatrists in the audience so he changed it to reality therapy.

v Robert E. Wubbolding, EdD (b. 1936) He received his doctorate in counseling and is licensed to counsel as well as a psychologist.  He is the director of the Center for Reality Therapy in Cincinnati and professor emeritus of Xavier University.  He is an internationally known teacher, author, and practitionaer of reality therapy.  He received the Gratitude Award (2009) for Initiating Reality Therapy in the United Kingdom and the Certificate of Reality Therapy Psychotherapist by the Erupean Association for Psychotherapy (2009).

Key Concepts

Ø  View of Human Nature – People are born with five genetically encoded needs that drives them their entire lives: survival, love and belonging, power, freedom, and fun.  Although all people have the five needs they vary in strength from person to person.  The brain acts as a control system.  It monitors feelings as to determine how the person is doing in the pursuit of satisfying these needs.  When a person feels bad then one of these five needs is not being satisfied.  Reality therapists teach clients choice therapy so that the client can identify and satisfy unmet needs.  Wants are called quality world.  This is at the core of the person’s life.  The picture album is specific wants and how those wants will be satisfied.

Ø  Choice Theory Explanation of Behavior – All humans do from birth to death is behave, rarely do they not choose their behavior.  Every total behavior is the pursuit to get what satisfies the need.  Total behavior teaches that all behavior is made up of four distinct components: acting, thinking, feeling, and physiology.  These components accompany all actions, thoughts, and feelings.  Behavior is on purpose because it fills the gap between the wants and what is perceived that the person is getting.  Because behaviors come from the inside we choose our destiny. 

Ø  Characteristics of Reality Therapy – Contemporary reality therapy focuses on the lack of or unsatisfying relationship.  This often is what causes the clients’ problems.  Reality therapy doesn’t allow for the client to blame others for causing them pain.  The reality therapist asks the client to consider their choices affect their relationships with the important people in their lives.  Emphasize Choice and Responsibility-What we choose, we must be responsible for that choice.  People are dealt with “as if” they have choices.  Therapists help clients focus on where they have choice and this helps get them closer to the people that they need.  Reject Transference- Whatever mistakes have happened in the past, they are not important in the presence.  The past contributed but it is never the problem.  Reality therapists will allow the client to talk a little about the past but there is not a lot of time spent on looking back.  Early on, therapists will tell clients, “What has happened is over; it can’t be changed.  The more time we spend looking back, the more we avoid looking forward.”  Avoid Focusing on Symptoms- The reality therapist spends very little time on symptoms.  Symptoms last as long as they are needed in order to deal with an unsatisfying relationship or the frustration of basic needs.  Going back to the past or focusing on symptoms causes lengthy therapy.  Therapy can be shortened if present day problems are focused on.

Therapeutic Goals

Ø  To help the client get connected or reconnected with the people they have chosen to put in their quality world.

Ø  To assist clients in learning a better way of fulfilling their needs.  This includes achievement, power, or inner control, freedom or independence, and fun.

Ø  To assist clients in making better and more responsible choices when related to their wants and needs.

Ø  To get connected with involuntary clients. (i.e. individuals who are violent and living with addictions)

Techniques Used

Ø  Creating the Counseling Environment – a challenging and supportive environment allows clients to begin making changes in their life.  The client/therapist relationship is the base for the therapy to be effective.  Therapists avoid behaviors such as arguing, attacking, accusing, demeaning, bossing, criticizing, finding fault, coercing, encouraging excuses, holding grudges, instilling fear, and giving up easily.  Clients learn how to create a satisfying environment that leads to successful relationships. 

Ø  Procedures That Lead to Change – Therapists begin by asking what the client wants from therapy.  They take any mystery out of therapy at the beginning.  They ask about how the client’s relationships are and what choices are they making in them.  The first session the wants are identified.  Then the therapist looks for unsatisfying relationships.  Initially, the question, “Whose behavior can you control?” is asked often.  The therapist encourages the client to look at their own behavior and to focus on what they can control.  Once the client realizes that they can only control self is when therapy starts.  The remainder of the therapy sessions focus on helping the client learn to make better choices.  When clients make a change it is their choice.  Through reality therapy clients can obtain and maintain healthy and successful relationships. 

References

Corey, G. (2012). Theory and Practice of Counseling and Psychotherapy (9^th ed.). Belmont, CA: Brooks/Cole.

William Glasser (2012). Retrieved from: http://www.quotesdaddy.com/quote/276087/william-glasser/if-you-want-to-change-attitudes-start-with-a-change

Test your knowledge and learn more about reality therapy:

http://quizlet.com/2551613/reality-therapy-flash-cards/

Gestalt and Behavior Therapy

Gestalt Therapy

      

   Gestalt Prayer

“I do my thing and you do your thing.

I am not in this world to live up to your expectations,

And you are not in this world to live up to mine.

You are you, and I am I, and if by chance we find each other, it's beautiful.

If not, it can't be helped.”

(Fritz Perls, 1969)

The founder of Gestalt therapy was Frederick S. (“Fritz”) Perls.  He was a German‐born psychiatrist. He had the reputation of being a bit faddish but in all reality he was a serious professional.  Laura Posner Perls also made contributions to Gestalt Therapy.  Fritz and Laura were married in 1930 and made their life work Gestalt therapy.

Key Concepts

Gestalt therapy stressed that clients need to grow up, stand on their own two feet, and deal with their life problems themselves.  Perls’ goal was to assist the client in being self-supportive and to work back in the parts of the personality the client disowned.  His approach was very confrontational and he often intentionally made clients frustrated to increase their awareness.  Present time Gesalt Therapy techniques and or principles are as follows:

•             Holism – interested in the whole person.  This principle focuses on the client’s thoughts, feelings, behaviors, body, memories, and dreams.  Cues such as physical gestures, tone of voice, demeanor, and other nonverbal content are observed.  This gives the therapist a look into how the client fits together with the environment. 
•        Field Theory – Therapist must see clients in their environment and they believe that everything relates to each other.
•       The Figure-Formation Process – How the client organizes their experiences from moment to moment.  This process tracks how some part of the environment emerges from the background and becomes the focal point of the client’s attention.
•       Organismic Self-Regulation – This principle is intertwined with the figure-formation process.  Balance is disturbed when there is a need, a sensation, or an interest.  Clients will do their best to regulate themselves with the resources and the capabilities that they have.  Clients can take action that will restore balance.
•       The Now – “Power is in the present.”  Therapists ask “what” and “how” questions to help the client be in the present moment.  Phenomenological inquiry pays attention to now and suspends any preconceived assumptions about the client’s experience.  Sadness, pain, and confusion are not talked about in the past.  The therapist asks the client to experience the present sadness, pain, and confusion.  When the past does creep back in into the present the therapist believes it is because there is a lack of completion of the past experience.  When the past is spoken about the therapist asks the client to talk about the experience as though it is in the present. 
•        Unfinished Business – When feelings are not completed or resolved.  Unfinished business can manifest in feelings such as resentment, rage, hatred, pain, anxiety, grief, guilt, and abandonment.  When feelings are not dealt with it results in them being carried into present day experiences.  These incomplete feelings seek completion the client experiences compulsive behavior, wariness, oppressive energy and self defeating behavior.  Unexpressed feelings can also result in physical sensations or problems.  There is also an impasse, or stuck point, when there is not external support or the way that the client has always behaved doesn’t work anymore.  The therapist’s job is to help the client experience the impasse and not rescue or frustrate the client.
•       Contact and Resistances to Contact – Contact is made by seeing, hearing, smelling, touching, and moving.  To contact effectively the client should be able to interact with nature and others and lose their individuality.  There are five kinds of resistances (contact boundary phenomena): Introjection – incorporates what the environment provides rather than identify what the person wants or needs.  Projection – disown certain aspects of ourselves by assigning them to the environment.  Retroflection – directing aggression inward out of fear or embarrassment, guilt, and resentment.  Deflection – the process of veering off with overuse of humor, abstract generalizations, and questions rather than statements.  Confluence – Blending in and getting along with everyone.  This results in absence of conflicts, slowness to anger, and a belief that all parties experience the same feelings and thoughts we do.
•       Energy and Blocks of Energy – Attention is given to where energy is located, how it is used, and how it can be blocked.  Blocked energy can be manifested by tension in the body, by posture, by the body being tight and closed, not breathing deeply, looking away to avoid eye contact, by speaking with a restricted voice, etc.  Clients might not be aware of blocked energy so the therapist assists them in recognizing it.

Therapeutic Goals

•        Assist the client to attain greater awareness and greater choice.
•     Assume ownership of their experience.
•     Develop skills and acquire values that will allow them to satisfy their needs without violating the rights of others. 
•     Become more aware of all of their senses.
•     Learn to accept responsibility for their actions.  This includes accepting the consequences of their actions. 
•     Be able to ask for, get help, and give help to others. 

Techniques Used

•        Experiments – The client “tries on” a new behavior.
•     Confrontation – sustained empathic inquiry with crisp, clear, and relevant awareness.
•     Exercises – Internal Dialogue Exercise—acceptance of aspects of one’s personality that has been denied.  A main division is between the “top dog” and the “underdog,” and therapy often focuses on the war between the two.  Making Rounds---This involves asking a person in a group to go up to others in the group and either speak to or do something with each person.  The Reversal Exercise---Clients take the plunge into the very thing that is fraught with anxiety and make contact with those parts of themselves that have been submerged and denied.  The Rehearsal Exercise---Internal rehearsal inhibits willingness to experiment with new behavior.  The client becomes more aware of how they try to please others by meeting their expectations.  The Exaggeration Exercise---The client is asked to exaggerate movements and gestures.  This normally intensifies the feelings that go with the behavior.  Once the client is exaggerating the movement the therapist will ask the client to put words to the movement.  Staying with the feeling---When a client is talking about a feeling that they want to ignore or avoid the therapist will encourage the client to stay with the feeling.  The Gestalt Approach to Dream Work---Dreams are brought back to life and they are relived like they are happening in present moment. 

Here are some fun brain stuff, Gestalt images, and backgrounds:

http://www.gestalt-institute.com/fun.html

References

Corey, G. (2012). Theory and Practice of Counseling and Psychotherapy (9^th ed.). Belmont, CA: Brooks/Cole.

(Frederick Salomon) Fritz Perls. (2011). Hutchinson's Biography Database, 1.

Fritz Perls Quotes. (2012). Retrieved from http://www.fritzperls.com/quotes/

Behavior Therapy

Society attacks early, when the individual is helpless. 

~ B.F. Skinner

•     B.F. Skinner (1904-1990) is considered the father of the behavioral approach to psychology. 
•     Albert Bandura (b. 1925) broadened the scope of behavior therapy by exploring the inner cognitive affected forces that motivate human behavior. 
•     Arnold A. Lazarus (b.1932) he is a pioneer in clinical behavior therapy and he developed multimodal therapy.  Multimodal therapy is a comprehensive, systematic, holistic approach to behavior therapy.

Key Concepts

•        Seven key characteristics of behavior therapy:

1.     Principles of learning are applied to assist clients to change behaviors.  Treatment goals are stated in clear-cut terms so that they can be replicated easily.  Evaluations are used to measure the effectiveness of the assessment and the treatment.  Revisions are made as needed.

2.     Behavior is not defined as actions that can be observed.  Behaviors can also include cognitions, images, beliefs, and emotions.

3.     Behavior therapy deals with current issues and why the issues are occurring.  Current environment is considered more than historical determinants.  Behavior therapy sees the importance of the client, their environment, and the way in which the client interacts with their environment. 

4.     Clients are expected to be active in dealing with their problems.  Simply talking about change is not enough.  Clients have to be willing to do something to make the change in behavior occur. 

5.     Change can happen without knowing the underlying dynamics and without understanding where the psychological problem originated.

6.     Assessment informs the treatment process.  Culture is taken into consideration when doing the assessment.  The assessment and evaluation includes the interventions used to determine whether the behavior change resulted from the procedure.

7.     Treatment interventions are specific to the client. 

Therapeutic Goals

•     To increase personal choice.
•     To create new conditions for learning.
•     The therapist assists the client in defining specific goals. 
•        Formal assessment takes place prior to treatment to determine behaviors that are targets of          change.
•     Continual assessment determines whether the goals are being met.
•     Clients are active in deciding on their treatment.
•      Goals must be clear, concrete, understood, and agreed on by the client and the therapist.

Techniques Used

•   Positive reinforcement – adding something of value to the client for a certain behavior.
•   Negative reinforcement – the escape or avoidance of unpleasant stimuli.
•   Extinction – withholding reinforcement from a previously reinforced response.
•   Punishment – the consequences of a certain behavior result in a decrease of that behavior.
•   Positive punishment – a stimulus is added after the behavior to decrease the frequency of a behavior.
• Negative punishment – a stimulus is removed after the behavior to decrease the frequency of a behavior.
• Progressive Muscle Relaxation – it achieves muscle and mental relaxation and is easily learned.
• Exposure therapies – designed to treat fears and other negative emotional responses.  It involves confrontation with a feared stimulus.
• Vivo Exposure – Clients are exposed to the actual events as opposed to imagining the situation.
• Vivo Flooding – Intense and Prolonged exposure to actual anxiety producing stimuli.
• Eye Movement Desensitization and Reprocessing – assessment, preparation, imaginal flooding, and cognitive restructuring the treatment of people wit traumatic memories.  The use of rapid, rhythmic eye movements and other bilateral stimulation to treat clients who have experienced traumatic stress.
• Social Skills Training – Deals with how the client is able to interact with others in different social situations.  Social skills is being able to communicate both effectively and appropriately.
• Assertion training – To teach people how to be assertive in different social situations.
• Self-management – This includes self-monitoring, self-reward, self-contracting, and stimulus control. 

References

Corey, G. (2012). Theory and Practice of Counseling and Psychotherapy (9^th ed.). Belmont, CA: Brooks/Cole.

B.F. Skinner Quotes (2012). Retrieved from: http://www.brainyquote.com/quotes/authors/b/b_f_skinner.html

Test your knowledge of behavioral therapy.  Take the quiz now:

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