Sunday, July 22, 2012

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 (9th 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 (9th ed.). Belmont, CA: Brooks/Cole.

Test your knowledge and learn more about reality therapy:

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