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Cognitive behavioral therapy relies on the notion that as humans, our thoughts, emotions and behaviors are linked to one another. The aim of cognitive behavioral therapy is to identify the linkages between emotions, thoughts and actions, and work with clients to determine what is helpful or not helpful to their wellbeing according to that client’s values. This style of treatment is considered person-centered and focuses heavily on psychoeducation as well as a strong therapeutic alliance.
Cognitive behavioral therapy is actually the successor of an earlier talk therapy known as Rational Emotive Behavior Therapy (REBT), developed by the well-known psychologist Albert Ellis in 1955. This therapy was unique for its time, due to the fact that it strayed away from the psychoanalytic focus of maldaptions and childhood, and focused on the client’s current thoughts and if they are conducive to the life they’d like to live. According to Dr. Ellis, if these thoughts and associated emotions are not in alignment with what the client seeks to achieve, it is imperative that clients take the initiative to change these cognitions and following behavior. This form of therapy gave much power to the client, and no longer painted them as a victim of circumstance or their parents poor caregiving stills. Instead, it made clients take accountability and play an active role in making the change they wish to see in their lives.
The key concepts of this therapy include providing clients with the tools necessary to: examine the validity of their cognitions, measure/record experiences as it’s happening to the client and to make necessary changes to behaviors and/or beliefs in order to interrupt previous thought patterns. Key terms one might hear most in this type of therapy are cognitive distortions and homework. Cognitive distortions refer to beliefs a person has that are not rooted in absolute truth or objectivity but rather, they are based on client’s less than accurate perception of reality. Cognitive distortions include catastrophizing (making any event a huge ordeal, Ex: I’ve never been late to work and today I will be 15 minutes late! I’m going to be fired!), personalizing (taking an event or another person’s actions personally. Example: My supervisor didn’t say hi to me this morning so I must have messed up during my last shift.) and polarized thinking (otherwise known as black and white thinking. Example: If I do not get into Harverd, then my high school career has been worthless.) These distortions tend to affect a client’s judgement, and often lead to them acting out in ways that they feel will rectify the situation. On the treatment side of CBT, one will often hear the term “homework” which relates to the take-home assignment or task that a client and therapist work together to formulate for the purpose of either contributing towards explicit goals or to bring more awareness to daily cognitions in the client’s life.
In application, cognitive behavioral therapy can include restructuring, modifying behavior, and/or developing alternative coping skills. Within a session this might look like a client describing a particularly distressing scenario with their therapist, and going through what event leads to the thought, which leads to the belief, which eventually leads to the behavior that follows. The analysis helps the therapist to better understand what is going through the mind of their client while the event is unfolding, and is beneficial for the client to gain additional perspective and pinpoint any distortions they might be experiencing.
The considerable strengths of this approach include that CBT is considered to be rather brief and time-sensitive method of treatment, that is solution-oriented. This form of treatment encourages the client to increase their awareness of their daily cognitions and how it impacts them with the hope that one day, they will no longer need their therapist to walk through each scenario with them step by step, rather they will be able to go through the situation and acknowledge any beliefs that might be leading to unhelpful behaviors. Some considerable weaknesses of CBT are that this method focuses heavily on the individual’s ability to alter themselves or their habits, without much consideration for the environment they were exposed to when they first learned these initial ways to cope, or other forms of systematic oppression they may have been forced to adhere to. It is also a common criticism that CBT does not address the “root cause” of a person’s issues, rather it addresses the current challenge that a client is facing a result of a potentially deeper maladaptive behavior. For example: a client works with their therapist to address the need to please their employer, but never addresses the fact that this comes from their childhood need to please their caregivers.
Some would argue that in the long-term, this is not helpful to the client and is only offering a temporary fix. It might also be important to consider that as this is a very involved and collaborative approach to talk therapy, it requires a client who is very engaged and willing to participate in treatment which might be difficult for clients with low motivation for treatment or for clients who have various learning impairments.
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