Cognitive Behavioural approach to Psychotherapy

Learning CBT with Training Alliance Group:

Our full diploma course covers the basic aspects of CBT to a depth where you will be able to actively engage with your clients, elicit information and formulate your responses and strategies in such a way as to empower the client to start to generate more helpful thoughts, beliefs and behaviours thus freeing them from long held un-helpful thinking and allow them to grow into a far more enjoyable lifestyle.

On completion of our 20 day practitioner course you will have an understanding and hands on experience using and developing cognitive techniques and be able to apply these with comfort and ease.

Cognitive-Behavioural Therapy…

You have possibly read or heard about this therapeutic style, it’s benefits and claims made about the efficacy of cognitive behavioural therapy, but what exactly is this process?

Cognitive behavioural therapy is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.

Cognitive-behavioural therapy does not exist as a distinct therapeutic technique. The term “cognitive-behavioural therapy (CBT)” is a very general term for a classification of therapies with similarities.  There are several approaches to cognitive-behavioural therapy, including Rational Emotive Behaviour Therapy, Rational Behaviour Therapy, Rational Living Therapy,  and Cognitive Therapy

However, most cognitive-behavioural therapies have the following characteristics:

1. CBT is a go forward therapy…. in CBT we look at the “hear and now”, how that impacts you and how we change unhelpful aspects to release and go forward. Unlike other therapies the past is not as important as the future, time is not dedicated to looking back we are solely forward thinking in CBT therapy.

2. CBT is based on the Cognitive Model of Emotional Response.
Cognitive-behavioural therapy is based on the idea that it is our thoughts
that cause our feelings and behaviours, not external things, like people, situations,
and events.  The benefit of this fact is that we can change the way we think to
feel / act better even if the situation does not change.

3. CBT is Briefer and Time-Limited.
Cognitive-behavioural therapy is considered among the most rapid in terms of
results obtained.  The average number of sessions clients receive (across all
types of problems and approaches to CBT) is only 16.  Other forms of
therapy, like psychoanalysis, can take years.  What enables CBT to be briefer
is its highly instructive nature and the fact that it makes use of homework
assignments.  CBT is time-limited in that we help clients understand at the
very beginning of the therapy process that there will be a point when the formal
therapy will end.  The ending of the formal therapy is a decision made by the
therapist and client.  Therefore, CBT is not an open-ended, never-ending
process.

4. A sound therapeutic relationship is necessary for effective therapy, but
not the focus.
Some forms of therapy assume that the main reason people get better in
therapy is because of the positive relationship between the therapist and
client.  Cognitive-behavioural therapists believe it is important to have a good,
trusting relationship, but that is not enough.  CBT therapists believe that the
clients change because they learn how to think differently and they act on that
learning.  Therefore, CBT therapists focus on teaching rational self-counselling
skills.

5. CBT is a collaborative effort between the therapist and the client.
Cognitive-behavioural therapists seek to learn what their clients want out of life
(their goals) and then help their clients achieve those goals.  The therapist’s
role is to listen, teach, and encourage, while the client’s roles is to express
concerns, learn, and implement that learning.

6. CBT uses the Socratic Method.
Cognitive-behavioural therapists want to gain a very good understanding of
their clients’ concerns.  That’s why they often ask questions.  They also
encourage their clients to ask questions of themselves, like, “How do I
really know that those people are laughing at me?”  “Could they be laughing
about something else?”

7. CBT is structured and directive.
Cognitive-behavioural therapists have a specific agenda for each session.
Specific techniques / concepts are taught during each session.  CBT
focuses on the client’s goals.  We do not tell our clients what their goals
“should” be, or what they “should” tolerate.  We are directive in the sense that
we show our clients how to think and behave in ways to obtain what they
want. Therefore, CBT therapists do not tell their clients what to do — rather,
they teach their clients how to do.

8. CBT is based on an educational model.
CBT is based on the scientifically supported assumption that most emotional
and behavioural reactions are learned.  Therefore, the goal of therapy is to
help clients unlearn their unwanted reactions and to learn a new way of
reacting.

Therefore, CBT has nothing to do with “just talking”.  People can “just talk”
with anyone.

The educational emphasis of CBT has an additional benefit — it leads to
long term results.  When people understand how and why they are doing
well, they know what to do to continue doing well.

9. CBT theory and techniques rely on the Inductive Method.
A central aspect of rational thinking is that it is based on fact. Often, we
upset ourselves about things when, in fact, the situation isn’t like we think it
is.  If we knew that, we would not waste our time upsetting ourselves.

Therefore, the inductive method encourages us to look at our thoughts as
being hypotheses or guesses that can be questioned and tested.  If we find
that our hypotheses are incorrect (because we have new information), then we
can change our thinking to be in line with how the situation really is.

10. Homework is a central feature of CBT.
If when you attempted to learn your multiplication tables you spent only one
hour per week studying them, you might still be wondering what 5 X 5
equals.  You very likely spent a great deal of time at home studying your
multiplication tables, maybe with flashcards.

The same is the case with psychotherapy.  Goal achievement (if obtained)
could take a very long time if all a person were only to think about the
techniques and topics taught was for one hour per week.  That’s why CBT
therapists assign reading assignments and encourage their clients to
practice the techniques learned.

Cognitive Behavioural Therapy & The ABC Model

The ABC Model is one of the most famous cognitive behavioural therapy techniques for analysing your thoughts, behaviour and emotions.

The Basis of CBT

Cognitive behavioural therapy or CBT works on the assumption that your beliefs influence your emotions and your behaviour and that by identifying and addressing problematic thoughts you can help to change your behaviour and experiences for the better.

The ABC Model of CBT

The ABC Model asks you to record a sequence of events in terms of:

A – Activating Event (also sometimes described as a ‘Trigger’)

B – Beliefs (for example, the thoughts that occur to you when the Activating Event happens)

C – Consequences – how you feel and behave when you have those Beliefs (consequences may be divided into two parts: your actions and your emotions)

Set out as a table, the ABC Model might look like this:

A – Activating EventB – BeliefsC – Consequences
Write down the event or situation that triggered your thoughts and feelings.Write down the thoughts that went through your head when the activating event occurred (or after it)ActionsHow did you act then?EmotionsWhat did you feel then?

ABC Model – Example

An example of how the model might be used to describe a particular situation is given below:

A – Activating EventB – BeliefsC – Consequences
My boss asks me if I have completed a piece of workI think:- “she thinks I am not working hard enough”- “she is trying to catch me out”ActionsI say defensively that I have nearly finished the work, although in fact I still have some way to goEmotionsI feel annoyed, angry and resentful

Thinking Errors and Assumptions

Looking at the example above you can then ask whether the beliefs highlighted are justified by the Activating Event. One of the approaches of CBT would be to ask you to reflect on whether the beliefs are justified or are based on erroneous assumptions or thinking errors.

In this particular example, the beliefs” She thinks I am not working hard enough” and “She is trying to catch me out” might be examples of what is sometimes called ‘Mind Reading’ – i.e. making assumptions about what other people are thinking. Your beliefs may be justified and accurate beliefs but they may not. It is important to clarify whether the situation and the evidence justifies your beliefs and then decide how you want to act once you have done that.

Balancing Statements in CBT

If on reflection you consider that the Beliefs are not justified, then you might think of some Balancing Statements which you can remind yourself of when the activating event occurs to help keep what is happening in perspective. In the example given above, possible Balancing Statements might be:

“It is possible that she thinks I am not working hard enough, but it is also possible that she is simply enquiring about the work because there is a deadline coming and she does not mean it personally” or

“I may be jumping to conclusions here because I am anxious about falling behind and feel I need more support. It would be better for me to voice my concerns and seek some more help or more time rather than to try to pretend I am coping better than I am.”

NB. Note that the important thing about Balancing Statements is that, as the name implies, they seek to be balanced and accurate. If you do, in the above example, feel that there is genuine evidence to indicate that your boss thinks you are not working hard enough or is trying to catch you out then it is not the role of Balancing Statements to ignore that evidence but to reflect on it in a balanced way and then decide how that will influence your choice of actions.

You can find a further example of a balancing statement in my Balancing Statements Form.

One technique that you can use to help you reach a balanced view is to ask yourself what a neutral person or a trusted reliable friend might say or think in the same circumstances.

Exploring Your Options

CBT encourages you to think about what your options are for dealing with negative or imbalanced thoughts both by using balancing thoughts to address your thought processes and by thinking about practical actions that you might take to improve or cope with a problematic situation you find yourself in.

Making Practical Decisions

Once you have introduced sensible balancing thoughts into your thinking processes, the idea is that you then make considered practical decisions about how you will act or respond in the situation.

In the situation given above using the ABC Model, this could help you to react in a more constructive way – for example rather than responding defensively to your boss’s statement, you might:

Try to explain to your boss the difficulties that you are having with the work and seek support, or

If for some reason that is not possible or practicable then you might decide to try to speak to someone else appropriate within the organisation to help deal with the issue, or

If you feel that neither of those is a realistic option then you might explore avenues outside the organisation where you can gain personal support or wind down from work pressures,

Or you might even consider whether to try to change jobs or roles if your genuine conclusion is that for whatever reason this particular role is not something that you want to stay in in the medium term.

CBT in a Nutshell

CBT is about making a sensible assessment of your situation and making the most constructive choices that you can to improve it or cope with it.

Training Alliance Group offer fully accredited, certficated training in Hypnosis, Hypnotherapy, NLP, Cognitive Behavioural Psychology and more in Brighton, London and Milton Keynes.