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Key People
Albert Ellis (1913-2007) Rational Emotive Behavior Therapy (REBT)
Aaron Temkin Beck (1921-) Cognitive Therapy (CT) Founded Beck Institute
Judith S. Beck (1954-) Daughter of Aaron Beck; Co-Founder/President Beck
Institute Donald Meichenbaum (1940-)
Cognitive Behavior Therapy (CBT) Constructivist Narrative Therapy
All Cognitive Behavior Therapies Share:
Collaboration between therapist and clientIdea that psychological distress is caused by
disturbances in cognitive processesFocus on changing cognitions to produce
desired changes in affect and behaviorPresent-centered, time-limited focusAn active and directive stance by the
therapistEducational treatment focusing on target
problems
Ellis’s Rational Emotive Behavior Therapy
First of the cognitive behavior therapies (1955)
Peoples beliefs about events shape their emotions and irrational beliefs contribute to problems
Cognitions, emotions, and behaviors have a cause-and-effect relationship
Therapy is educational: therapist is teaching healthy thinking skills, client is practicing in homework/life
Focus on thoughts and actions rather than emotion
Key Concepts
View of Human Nature People born with potential for rational and irrational
thinking Have positive and negative predispositions People are encouraged to accept their imperfections
View of Emotional Disturbance People blame themselves when they do not fulfill the
irrational beliefs internalized in childhood. “Shoulds” and “musts” --three basic musts Learn to be less emotionally reactive—sad but not
depressed
A-B-C Framework
A person’s beliefs about an event rather than an event itself shapes their emotional reaction
Detect, debate, discriminateCognitive restructuring: replace irrational beliefs with
rational beliefsDisputing irrational beliefs leads to a new, effect
philosophy
A (activating event) B (belief) C (emotional and behavioral consequence) D (Disputing intervention) E (effect) F (new feeling)
The Therapeutic Process
Therapeutic Goals Separating evaluation of behaviors from evaluation of
self Unconditional Acceptance of Self and Others (USA/UOA)
Therapist’s Function and Role Therapist teaches client to modify irrational thinking and
develop a sustainable rational philosophy and skills for future
Client’s Experience in Therapy Focus on present ability to change irrational patterns Homework
Relationship Between Client and Therapist Self-disclosure, acceptance, egalitarianism
Application
Cognitive Methods: dispute irrational beliefs, do cognitive homework, bibliotherapy, change one’s language, psychoeducational methods
Take risks to challenge self-limiting beliefsEmotive Techniques: Rational emotive
therapy, humor, role playing, shame-attacking exercises
Behavioral Techniques: homework—client desensitizes themselves through real-world practice
Beck’s Cognitive Therapy
Came out of research on depressionSimilarities with REBT and Behavior TherapyProblems come from: faulty thinking, failure
to distinguish between fantasy and reality, making false assumptions
Schema restructuring based on cognitive content of stream of thoughts surrounding upsetting events
Theoretical underpinnings: Introspection, beliefs with personal meanings, discovery and interpretation of meaning by client
Key Concepts
Automatic thoughtsCognitive distortions—arbitrary inferences,
selective abstraction, overgeneralization, magnification and minimization, personalization, labeling and mislabeling, dichotomous thinking
What is the evidence for _____?Therapist teaches client to identify
dysfunctional thinking, evaluate and replace with rational thought
Focus on present problems Collaborative empiricism
Compare to REBT
Similar emphasis on reality-testingTeacher/student (REBT) vs. Socratic dialogue
(CT) REBT is directive, persuasive, confrontational CT helps clients self-reflect and make their own
conclusionsIrrational, non-functional thoughts (REBT) vs.
Inaccurate thoughts (CT) REBT uses rational disputation CT therapist suggests alternate “rules”
Application
CT has been applied to a wide variety of disordersUse of alternative interpretationsApplications to Depression
Cognitive triad: negative view of self, negative interpretation of experiences, negative projection of the future
Selective abstraction Beck Depression Inventory (BDI)
Applications for Family Therapy Schema (core beliefs) – “family schemata” Family relationships, cognitions, emotions, and behavior
exert mutual influence on one another
The Beck Institute
http://www.beckinstitute.org/Aaron and Judith Beck’s CBT training and
resource center, located in PhiladelphiaMission: “To encourage the growth and
dissemination of CBT throughout the world through leadership in the field and through the provision of professional training, outpatient clinical services, and research”
Soldier Suicide Prevention ProgramThe Beck Diet Solution
Meichenbaum’s Cognitive Behavior Modification
Focus on changing self-verbalizations, which affect behavior as much as others’ comments
Self-instructional training: Help clients become aware of self-talk, self-instruction, and the stories they tell about themselves
Behave our way into a new way of thinkingPractice in role-play situations of daily
problemsBehavior change: Self-observation, start new
internal dialogue, learn new skills
Stress Inoculation Training (SIT)
Gradually develop a tolerance for stress stimuli
Modify our beliefs and self-statements about our performance in stressful situations
Conceptual-educational phase: Teach clients to be aware of their own role in their stress; self-monitor
Skills acquisition and consolidation phase: Acquire and rehearse new self-statements and behavior
Application and follow-through phase: Practice increasingly demanding “homework”; relapse prevention and follow-up sessions
The Constructivist Approach to CBT
Constructivist narrative perspective (CNP): Focus on stories people tell about significant life events
Clients construct their own realitiesEmphasis on past development, deep core
beliefs, and behavioral/emotional impactClients’ stories show how they view
themselves, their world, and their futureTell the “rest of the story” – survival and
copingUse positive metaphors to describe self
Multicultural Perspective
Strengths: Use individual’s belief system for self-exploration Individualized, structured, active, and participatory Learn practical skills for daily life Focus on influence of external environment
Limitations: REBT’s negative view of interdependence Therapists may be too direct or confront too quickly Too much focus on present, not enough on past Emphasis on assertiveness and change (instead of
acceptance)
Compare/Contrast
In contrast to Psychoanalytic: No free association or emphasis on dreams, less focus on past history, & no significant exploration of feelings and transference
Comparison to Person-Centered & Existential: Focus on the here and now
Comparison to Person-Centered: Unconditional positive regard
Summary
Cognitive processes determine behaviorClients’ feelings and behavior influenced by
their subjective interpretation of eventsReorganization of one’s self-statements will
result in reorganization of one’s behaviorInterconnectedness of thinking, feeling, &
behavingClient assumes active roleEmphasis on homework and practice
Strengths
Changes clients subjective views of themselvesClients identify and challenge basic beliefsHomework—putting change into actionCollaborative therapist-client relationshipDemystification of therapy processREBT: teaching clients to carry on their own
therapy Tapes, self-help books, workshops, behavior/thought records
Beck: wide range of clinical populations, bringing private experience into realm of scientific inquiry
Meichenbaum: self-instruction, stress-innoculation
Limitations
Practice is especially vulnerable to therapist’s skill level and techniques
Limited focus on past experiencesREBT: confrontational style difficult w/out
rapportCT: too strong on positive thinking, too
superficial and simplistic, eliminating symptoms w/out looking at root causes
Meichenbaum: Is teaching a client less effective than allowing them a process of self-discovery?
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