Model Description: Cognitive Behavioral Therapy, Essay Example

Cognitive Behavioral Therapy (CBT) is an umbrella model that corrects relationship dysfunction by addressing dysfunctional emotions and behaviors. Although CBT can be used for individual therapy and group therapy as well, it is effective as a method for couple’s therapy due to its ability to allow both partners to modify their emotions in behaviors with respect to one another. In this therapy method, the role of the counselor or therapist is one of support. Of primary importance, the therapist is expected to gain the trust of either the individual or couple being counseled so that they may work together to identify what is causing distress. Ultimately, the therapist’s goal is to allow the client(s) to understand the connection between beliefs, feelings, and thoughts, and the effects that these can have on emotions and behaviors. By allowing the client(s) to recognize these connections, they can recondition responses to certain stimuli. By removing the undesirable responses, they will be able to strengthen their relationships.

Since CBT can be used to resolve many different kinds of psychological issues depending upon the type of therapy that is needed, the therapist may need to understand a variety of tools and approaches in order to implement a successful therapy session. Evidence has shown that CBT is an effective method for treating individuals in couple and marital therapy as well as those with a variety of psychological disorders. However, it is important for therapists in a relationship restorative role to behave differently than one would in diagnosing and treating a psychological disorder. In this situation, the therapist would act as a facilitator between the couple while continuing to provide the supportive role that is expected in other types of CBT.

Couples that seek a therapists help for relationship problems will likely complete a total of 6-18 CBT sessions that will be offered either weekly or biweekly. It is important to allow the couple time to apply what they learned about themselves during therapy in their daily life in order to determine how the sessions should progress. Additionally, the therapist should make him or herself available to their patients. For a couple to come in to therapy, they must have recognized they had a problem and wish to resolve it. Therefore, it is the therapist’s responsibility to ensure the couple has the proper information to be able to do so. A good therapist should be somewhat available outside the therapy session to answer questions or to resolve potential emergencies. Therefore, the job of the therapist never truly ends until the couple is healed.

An additional consideration for the role of the therapist in CBT is that the therapist exists primarily to provide clarity on the issue at hand and to provide goals to the patient(s) that should continue to be worked on outside of therapy. As such, the patient does a majority of the work in the therapist-patient relationship. However, the therapist exists to ensure that the patient remains on track and to initiate and facilitate conversations when necessary. The input offered typically prompts rather than directs conversation.

The theory of change is essentially a model of performance readiness, which indicates how and one is ready to change oneself. Ultimately, when individuals enter therapy initially, they are resistant to change. The first CBT session is therefore used primarily to allow the couple to define the problems they have been having and later sessions will be used to allow them to recognize the impacts of their emotions and behaviors. This state of therapy marks resistance to change because the couple recognizes that they have an issue that must be resolved, but they are not yet willing to work together in order to come to the actual resolution. As the couple continues to identify the effects of their behaviors, they will become more willing to accept the change because they see how it will benefit them. According to a study conducted by researchers at the University of Victoria, “critical variables to the change readiness process are appraisal, focus, and perceived control” (Walinga, 2008). Once the couple recognizes this, they will be able to accept change in their lives and learn to grow from it.

In CBT, the target of intervention is the behaviors and emotions of the individual, group, or couple. It is essential for the patient(s) to determine what they believe impacts them emotionally and to determine how and why they react the way they do. Occasionally these responses are inappropriate, and it is necessary to allow the individual come to the understanding that this is the case. Ultimately, the way that an individual thinks about his or herself can impact their complete mindset. Thinking negatively, for example, can make an individual feel completely worthless, to the extent that they become depressed or start experiencing additional psychological abnormalities. Therefore, a target of this intervention is in part “unhelpful thinking styles”. In a relationship, a couple may be impacted due to trauma that one or both individuals have experienced. In this situation, they may feel down about themselves, which results in a lack of physical intimacy. CBT can help the couple reverse the association of these thoughts with feelings, which will allow them to overcome past trauma and restore their relationship.

According to “A cognitive–behavioural therapy assessment model for use in everyday clinical practice”, people who are depressed and anxious, “overlook their strengths, become very self-critical and have a bias against themselves, thinking that they cannot tackle difficulties” (Williams & Garland, 2002). This is particularly challenging in relationship difficulties because one or both members of the couple cannot foresee a resolution and believe that their relationship problems may be their own fault. CBT helps overcome these difficulties because it allows both members of the couple to react differently towards their thoughts. When doubts of depression come around, being honest about these feelings to a partner is more beneficial than being a recluse. Furthermore, it will allow the other partner to act as a means of support. Furthermore, when this occurs, a primary problem in the relationship may be that the partner without depression isn’t sure how to react and believes that their partner is withdrawn because of something they did or said. It is important for both partners to be aware of these problems because it will strengthen their bond. Therefore, CBT indirectly targets a couple’s communication because strong communication skills will allow the couple to continue to resolve their problems in this manner independently after their therapy sessions come to a close.

The purpose of CBT is primarily to assess life situation, relationships and practical problems, altered thinking, altered emotions, altered physical feelings/symptoms, and altered behavior or activity levels. Ultimately, the purpose of this method is therefore to assess these conditions and determine how they are negatively impacting relationships, whether they are romantic, familial, or others. Assessment occurs at two stages of this approach. At the beginning of CBT, the couple is assessed to determine the issue that is plaguing them, which could be either emotionally difficulty or a psychological disorder. The last stage will assess the couple again to determine their improvement and to provide them with information they can use to ensure that their relationship continues to improve. In the intermediate stages of treatment, patients are asked to reconceptualize their thoughts and behaviors, acquire the necessary skills to handle these thoughts and emotions, identify when these new reactions and emotions should be applied depending on the situation, and to learn to maintain these skills (Gatchel & Rollings, 2008).

This approach is useful for identifying the normalcy, health, and pathology of a psychological state. Firstly, it is ideal in assessing the psychological or emotional problems that an individual is having that contributes to problems in a relationship. Therefore, CBT helps assess the pathology of a psychological illness because it can help diagnose and treat an individual with a variety of problems, as mentioned earlier. Some of the psychological disorders that CBT is used to treat includes anxiety, schizophrenia, and aging disorders. By talking to a patient frequently, it is simpler to diagnose their risk for certain disorders. For example, while it is likely that a majority of individuals who enter therapy at a young age suffer from anxiety and depression, which is the root of their need for counseling, these sessions can help elucidate their risk for developing more severe psychological disorders. Many patients who enter therapy for depression treatment have suicidal thoughts, which can be considered relatively normal because many people think about death. However, this does not necessarily indicate that they will take their own lives. On the other hand, individuals who have attempted suicide in the past are clearly at risk for repeat behavior. Offering therapy such as CBT is essential to these individuals because it will allow a therapist to identify individuals who are depressed who are also at risk for suicide. Furthermore, this therapy will help these individuals learn how to deal with their emotions in a manner that will allow them to recognize their suicidal tendencies and to not act on it.

CBT is also beneficial for disorders that naturally occur due to aging. Many aging disorders, such as Alzheimer’s, are difficult to treat due to the patient’s inability to remember many things. As a consequence, these patients often become frustrated when they recognize they are having memory difficulty, which can result in additional psychological issues. Therefore, CBT can be adjusted to assist with individuals who are above a certain age who are dealing with these types of problems. CBT can therefore be used to help with the symptoms of Alzheimer’s, unrelated to memory. Rather, it can be used to help elderly populations understand that what is occurring to them is a normal process and that others are going through it too. Rather than becoming angered about their problems, elderly patients can be benefitted by CBT to keep themselves otherwise psychologically stable, which will allow them to live as happy and healthy a lifestyle as possible.

It is essential to consider that CBT is used in couple’s therapy primarily as a means to restore destructive relationships to healthy ones. A healthy relationship is typically defined as one in which each partner feels comfortable communicating with the other about their emotions and behaviors. In a healthy couple, when a problem arises, the two are able to resolve the issue because they value their relationship and understand that the resolution will benefit them more greatly than the conflict. An unhealthy relationship is one in which this does not occur. For some reason, one or both partners holds back information that is essential in resolving the conflict and typically results in the blame of one or both parties. To restore the health of the relationship, it is identify for one or both partners to modify their emotions and actions. In this situation, it is clear that the thoughts of an individual are controlling how they act, which results in a negative experience. Therefore, CBT attempts to modify these emotions and behaviors so that couples react properly and can maintain their connection with one another.

CBT is commonly used when individuals have low self-esteem, which impacts relationships and other parts of their lives. To do so, the therapist would first identify his or her negative health patterns, which are also known as cognitive distortions. In this initial stage, the functional analysis, the therapist listens to the patient to determine the feelings that he or she has about his or herself. Feelings of worthlessness are typically indicated of low self-esteem, and this is what the therapist should be looking for during this identification process. The next step is to help the patient remove the thoughts of worthlessness by replacing it with one that has a more positive value. As these negative patterns are identified, they should be replaced. After several sessions, the patient should begin to think more positively.

A similar example can apply to CBT in couple’s therapy. In a situation in which one member of the couple believes that he or she is worthless, it could take a toll on the other member of the couple. Therefore, after identifying the cognitive distortions that one or both members of the couple have, it is essential for the counselor to implement a functional analysis that pertains to both partners. Although one individual may be experiencing worthlessness due to thoughts, it is possible that the second partner feels worthless or that there is something else wrong with them because of the way that their partner is acting. Therefore, in addition to replacing the thoughts that the partner that feels worthless is exhibiting, it is the role of the therapist to also confer positivity to the second partner as well.

Although the example discussed above is a more simplistic case of CBT for couple’s, this is generally how the methodology works. In other situations, it is possible that each partner has a unique problem. Otherwise, it is possible that the problem that one partner is experiencing causes a different problem for the second partner. Couple’s therapy is interesting because it involves the interacting feelings of two individuals and uses the relationship to form a foundation that is capable of solving future problems. Therefore, it is necessary for the therapist to work harder when assessing a couple for CBT, but the payoff and longevity of the treatment can be potentially greater due to the nature of the problem.

The ethical and legal implications that arise when working with couples pertain primarily to the fact that a majority of ethical rules have been set in place according to therapy that pertains to working with individuals. The information that a therapist collects becomes more complicated in couples therapy because two individuals are being counseled rather than one. Therefore, a therapist needs to balance the confidentiality of information that is obtained from one patient while caring for another, even though this information may help solve the first patient’s problem. Ultimately, in a session in which two patients seek counseling together, this is not problematic because of the compact they form by approaching the counselor with a similar problem. However, if the couple is seen separately, this becomes challenging because the counselor must address each partner separately as if he or she has not heard any information from the other partner.

In CBT, it is essential to stress partnership between the members of the couple to address their problems. It is necessary to stress that information learned from both partners is necessary to use in addressing the relationship as a whole. Furthermore, since the couple needs to work together to achieve treatment, it may be necessary to sign information waivers at the beginning of the process. Therefore, the therapist will be able to disclose treatment methods and strategies to both members of the relationship in a manner that benefits them. Occasionally, this information may be considered sensitive but it is essential to stress that sharing feelings is a necessary part of CBT. Couples should be encouraged to share how they feel about emotions and how they react as a consequence, and therapy will help them alter these behaviors. Essentially, even though there may be legal implications about sharing this information, it is essential for the therapist to determine how it may be shared legally before the beginning of the session.

In conclusion, CBT is a helpful method to allow individuals and couples to modify their emotions and behaviors. It is useful for both individual therapy and couples therapy and can be used for a variety of situations. It is important to understand that the information obtained during therapy sessions are confidential and should not be used to take legal action against the individuals involved. Ultimately, CBT should be used to modify behaviors that are detrimental to a relationship and to improve upon how people react to emotions. In doing so, it is expected that behaviors and relationships will improve for the better. The skills that are obtained during CBT will help individuals and couples benefit throughout their lives if it is done properly. Therefore, CBT can be used as a model to benefit the lives of many.

References

Gatchel, R.J., Rollings, K.H. (2008). Evidence-informed management of chronic low back pain with cognitive behavioral therapy. The Spine Journal, 8(1): 40–4.

Walinga, J. (2008). Toward a Theory of Change Readiness. Journal of Applied Behavioral Science, 44(3): 315-347.

Williams, C. & Garland A. (2002). A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8: 172-179.