child and adolescent counseling chapter 13

Chapter 13

Cognitive Behavior
Therapy
Nothing is so terrible as activity without thought.
Johann Wolfgang von Goethe

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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
© 2011 Brooks/Cole, A


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
Pennsylvania where the Beck Institute for Cognitive
Therapy and Research is housed
© 2011 Brooks/Cole, A


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.

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Beliefs
• 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.
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Four levels of cognition
• automatic thoughts,

• intermediate beliefs,
• core beliefs, and
• schemas.

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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.

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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.

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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


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
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Counselor
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.

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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.
© 2011 Brooks/Cole, A


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

Session outline
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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
© 2011 Brooks/Cole, A


Counseling Session Four Steps

1

2
3
4

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
Set agenda for current session based on 4 point
quadrant
Clarify and set specific behavioral goals for next
week
Have client summarize session as bridge to next
week: review new homework, anticipate obstacles,
evaluate session

© 2011 Brooks/Cole, A


Stress inoculation
CBT technique that includes
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Self talk

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Practice tests

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Visualization

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Relaxation training

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Deep breathing exercises

© 2011 Brooks/Cole, A


Stress inoculation
Michenbaum’s 4 categories of self-talk
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Preparation: what do you have to do

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Confrontation: you can handle it

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Coping: keep stress manageable

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Reinforcing: I did it

© 2011 Brooks/Cole, A