child and adolescent counseling chapter 13

Chapter 13Cognitive Behavior Therapy Nothing is so terrible as activity without thought.. © 2011 Brooks/Cole, A Division of Cengage Le arning Chapter Objectives After reading this chapt

Chapter 13

Cognitive Behavior

Therapy

Nothing is so terrible as activity without thought.

Johann Wolfgang von Goethe

© 2011 Brooks/Cole, A Division of Cengage Le arning

Chapter Objectives

After reading this chapter, you should be able to:     

•Outline the development of cognitive behavioral therapy

•Explain the theory of cognitive behavioral therapy

•Discuss the counseling relationship and goals in cognitive behavioral therapy

•Describe assessment, process, and techniques

•Demonstrate some therapeutic techniques

•Clarify the effectiveness of cognitive behavioral therapy

Aaron Beck

• Childhood fears were handled with reasoning

• Likely motivated his work with cognitive therapy

focusing on anxiety and depression

• Graduated from Brown University and Yale Medical School

• Studied psychiatry and was trained as a

psychoanalyst

• eventually his research led him to formulate cognitive therapy, the focus of his career at the University of

© 2011 Brooks/Cole, A Division of Cengage Le arning

Aaron Beck

Beck contended that various mental

disorders have particular cognitive

patterns and that the most effective and lasting therapy involves intervention into those patterns.

• People are not passive victims of their inborn

tendencies

• People are actively creating and moving

toward goals that are vital to them

• Distress occurs when people experience a

threat to their interests

• The more crucial a person considers the goal

to be, the greater the response

© 2011 Brooks/Cole, A Division of Cengage Le arning

Four levels of cognition

• automatic thoughts,

• intermediate beliefs,

• core beliefs, and

• schemas.

Cognitive distortions

• Distortions convert incoming information to keep

cognitive schema intact

• They use the assimilation process to maintain

homeostasis

• The information contrary to core belief is cancelled

out by the distortion process, and the person cannot identify any disconfirming evidence from his

environment

© 2011 Brooks/Cole, A Division of Cengage Le arning

Three assumptions

1 Cognitive activity impacts behavior

2 Cognitive activity can be monitored and

changed

3 A desired change in behavior can be

accomplished through changing

cognitions.

Cognitive distortions

associated with distress and maladaptive behaviors

• Catastrophizing: expecting disastrous event

• Mental filtering: seeing an entire situation

based on one detail with all else ignored

• Blame or assigning internal responsibility

entirely to external events

© 2011 Brooks/Cole, A Division of Cengage Le arning

Cognitive distortions

associated with distress and maladaptive behaviors

• All-or-nothing thinking: the person thinks in

terms of two opposite categories

• Discounting the positive: person says

positives do not count

• Overgeneralization: a sweeping negative

conclusion that goes beyond facts

Both a guide to help the client understand how

beliefs and attitudes interact with emotions and behavior, and a catalyst promoting

corrective experiences, leading to cognitive change, and building skills

© 2011 Brooks/Cole, A Division of Cengage Le arning

Case formation

• Dynamic process

• Requires the counselor to generate and test

their hypotheses

• Five parts:

1 problem list,

2 diagnosis,

3 working hypothesis,

4 strengths and assets, and

5 treatment plan

Fundamental concepts

Collaborative empiricism - the cooperative working

relationship of jointly determining goals and seeking feedback

Socratic dialogue - a type of questioning designed to

promote new learning

Guided discovery - when the counselor coaches the

child in a voyage of self-discovery in which the child does his or her own thinking and draws his or her own conclusions

© 2011 Brooks/Cole, A Division of Cengage Le arning

Session outline

• Build an agenda that has meaning for the client

• Ascertain and measure the intensity of the person’s mood

• Identify and review presenting problems

• Ask about the client’s expectation for counseling

• Teach the person about cognitive therapy and the client’s role in it

• Give information about the person’s difficulties and

diagnosis

• Establish goals

• Recommend homework

• Summarize

• Obtain the client’s feedback

Counseling Session Four Steps

1

Review progress bringing counselor and client up to date Homework assignments checked for

completion.

Four quadrants for last week 1.List high points

2.Low points 3.How week could have been better 4.Plans for next week

2 Set agenda for current session based on 4 point quadrant

3 Clarify and set specific behavioral goals for next week

4

Have client summarize session as bridge to next week: review new homework, anticipate obstacles, evaluate session

© 2011 Brooks/Cole, A Division of Cengage Le arning

Stress inoculation

CBT technique that includes

• Self talk

• Practice tests

• Visualization

• Relaxation training

• Deep breathing exercises

Stress inoculation

Michenbaum’s 4 categories of self-talk