Form A -‐ Peter ‘Max’ Quinn Critical Evaluation Format CN528 Counseling & Development Professor Ciri -‐ November 21, 2011 Theory: Cognitive Behavior Therapy KEY Concepts of Cognitive Behavior Therapy: View of Human Nature / Basic Assumptions Underlying Approach • REBT -‐ Rational Emotive Therapy -‐ Help students restructure their life styles • Irrational beliefs are learned from childhood on to adulthood (lead to self-‐defeat) o “I must always do well and win the approval of others for my performances or else I am no good; o Other people must treat me considerately fairly, kindly, and in exactly the way I want them to treat me. If they don’t, they are no good and they deserve to be condemned and punished; o I must get what I want, when I want it; and I must not get what I don’t want. If I don’t get what I want, it’s terrible, and I can’t stand it; o I must do what I want; People must like me” • Thinking & Feeling are connected • People are creative • A reorganization of one’s self-‐statements will result in a corresponding reorganization of one’s behavior • Operant conditioning, modeling, behavioral rehearsal techniques are commonly used • Human beings are born with a potential for both rational or “straight” thinking and irrational or “crooked” thinking • People have predispositions for self-‐preservation, happiness, thinking and verbalizing, loving, communion with others, and growth and self-‐actualization, self-‐destruction, avoidance of thought, procrastination, endless repetition of mistakes, superstition, intolerance, perfectionism and self-‐blame, and avoidance of actualizing growth potentials • Humans are fallible, REPT attempts to help them accept themselves as creatures who will continue to make mistakes yet at the same time learn to live more at peace with themselves MOST Important Concepts • Humor is a good trait to have/use • A-‐B-‐C Framework o Actual event (Activity, Event or Adversity) o Belief system (What students believes about A) o Consequence (emotional or behavioral consequence o Disputing -‐ Application of methods to help students challenge their irrational beliefs § Detecting -‐ Detect their irrational beliefs § Debating -‐ Debate their dysfunctional beliefs by learning how to logically and empirically question them and vigorously argue themselves out of an act against believing them § Discriminating -‐ Discriminate irrational beliefs from rational beliefs o Effect -‐ A new and effective belief system consists of replacing unhealthy thoughts with healthy ones o F (New Feeling) -‐ If we are successful, we create a new set of feelings • Philosophical Restructuring o Fully acknowledge that we are largely responsible for creating our own emotional problems o Accept the notion that we have the ability to change these disturbances significantly o Recognize that our emotional problems largely stem from irrational beliefs o Clearly perceive these beliefs / See the value of disputing such self-‐defeating beliefs o Accept the fact that if we expect to change we had better work hard in emotive and behavioral ways to counteract our beliefs and the dysfunctional feelings and actions that follow o Practicing REBT methods of uprooting or changing disturbed consequences for the rest of our lives • Cognitive Restructuring o Central technique that teaches people how to improve themselves by replacing faulty cognitions with constructive beliefs • Emotional problems are the result of one’s beliefs, which need to be challenges by SA Professional • Cognitive restructuring -‐ Help student dispute their irrational beliefs • Help student to become aware of inaccurate or negative thinking • Allow student to view challenging situations more clearly and respond to them in more effective ways • Effective for treating anxiety & depression & to help anyone learn how to better manage stressful situations • Operant conditioning, modeling, behavioral rehearsal techniques are commonly used
Therapeutic Process: Most important Therapeutic Goals • Students must choose & want to live differently • SA Professionals help student identify, test, & evaluate their belief systems • Warm relationship between students and SA Professional o but not too warm, we want them to be independent • Student needs to feel unconditional & positive regard • Collaborative relationship between students and SA Professional • Psychological distress is largely a function of disturbances in cognitive processes • Focus on changing conditions to produce desired changes in affect and behavior • Generally time-‐limited and educational treatment focusing on specific and structured target problems • Structured psychoeducational model • Emphasis on homework • Draw from a verity of cognitive and behavioral strategies to bring about change • Teach students how to separate the evaluation of their behaviors from the evaluation of themselves o Their essence and their totality o And how to accept themselves in spite of their imperfections • Collaborate on choosing realistic and self-‐enhancing therapeutic goals • Assist students in the process of achieving unconditional self-‐acceptance and unconditional other acceptance and to see how these are interrelated • The more a student can accept themselves, the more likely they can unconditionally accept others Functions and Role of the Student Affairs Professional • Acts as a teacher • Needs understanding of cultural backgrounds • Teach students how to feel un-‐depressed even when they are unaccepted and unloved by significant others • Encourage students to experiences healthy feelings of sadness over being unaccepted • It attempts to help them find ways of over-‐coming unhealthy feelings: o depression, anxiety, hurt, loss of self-‐worth, and hatred • Help students differentiate between realistic and unrealistic goals and also self-‐defeating and self-‐enhancing goals • Teach students how to change their dysfunctional emotions and behaviors into healthy ones • Show students how they have incorporated may irrational “shoulds”, “oughts”, and “musts” • Demonstrate how students are keeping their emotional disturbances active by continuing to think illogically and unrealistically • Help students modify their thinking and minimize their irrational ideas • Challenge students to develop a rational philosophy of life o so that in the future they can avoid becoming the victim of other irrational beliefs • Teach students about the cognitive hypothesis of disturbance and showing how faulty beliefs lead to negative consequences • Unconditionally accept students and teach them to unconditionally accept others and themselves • Open and direct in disclosing their own beliefs and values • Start with students distorted feelings and intensely explore these feelings in connection with thoughts and behaviors • Flexible and creative when using methods, making sure to tailor techniques to the unique needs of the student • Rely on thinking, disputing, debating, challenging, interpreting, explaining, and teaching • Unconditional acceptance, rational emotive role playing, modeling, rational emotive imagery, shame-‐attacking exercises The students’ role in the Therapeutic Process • Needs to actively practice changing their self-‐defeating behavior and convert it into rational behavior • Responsibility on student to assume an active role both during and outside of sessions • Participate effectively in the cognitive restructuring process • Focus on the students experiences in the present • Emphasize the here-‐and-‐now experiences • Focus on students present ability to change the patterns of thinking and emoting that they constructed earlier • Homework is designed to get students to carry out positive actions that induce emotional and attitudinal change
Applications: Techniques and procedures of Cognitive Behavior Therapy-‐ -‐Techniques and Methods of Cognitive Behavior Therapy incorporated into counseling practice in Student Affairs-‐ • Albert Ellis’s Rational Emotive Behavior Therapy o Rational Emotive Behavior (REBT) and its Practice in Student Affairs § Cognitive Methods • Disputing irrational beliefs; Doing cognitive homework; Changing one’s language; Psychoeducational methods § Emotive Techniques • Rational emotive imagery; Using humor; Role playing; Shame-‐attaching exercises; Use of force and vigor § Highly directive & confrontational (Not Mean/Nasty) § Stresses thinking, judging, deciding, analyzing, and doing § People contribute to their own psychological problems § Cognitions, emotions, and behaviors interact significantly and have a reciprocal cause-‐and-‐effect relationship § Encourage students to do the very things they are afraid of § “People are disturbed not by events, but by the views which they take of them” -‐ Epictetus § Our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations § Although we originally learn irrational beliefs from significant others during childhood, we create irrational dogmas by ourselves • We do this by actively reinforcing self-‐defeating beliefs by the process of autosuggestion and self-‐repetition and by behaving as if they are useful § People do not need to be accepted and loved, even though this may be highly desirable § Blame is at the core of most emotional disturbances § It is important that students learn to fully accept ourselves despite our imperfections § We have tendencies to escalate our desires and preferences into dogmatic “shoulds”, “musts”, “oughts”, demands and commands § We have a strong tendency to make and keep ourselves emotionally disturbed by internalizing self-‐ defeating beliefs o Application of REBT to Students § Through the therapeutic process, students learn skills that give them tools to identify and dispute irrational beliefs that have been acquired and self-‐constructed and are now maintained by self-‐ indoctrination § Learn how to replace such ineffective ways of thinking with effective and rational cognitions, and as a result they change their emotional reactions to situations § Allow students to apply REBT principles of change not only to a particular presenting problem, but also to many other problems in life or future problems they might encounter § The student in a learner who practices the newly learned skills in everyday life § Applied to treat: Anxiety, Hostility, Character Disorders, Psychotic Disorders, Depression, problems of Sex, Love, and Marriage o REBT as a Brief Therapy § The focus is on working with thinking and acting rather than primarily with expressing feelings § Educational process § Collaborate with the student on homework and in teaching strategies for straight thinking § Learn how to apply REBT techniques their present as well as future problems § 1 -‐ 10 sessions & practiced at home o Application of REBT to Group Counseling § Active role in getting members to commit themselves to practicing in everyday situations what they are learning in the group § Consistent work between group sessions is crucial § Group provides members with tools they can use to become self-‐reliant and to accept themselves unconditionally as they encounter new problems in daily living § Teach members to apply principles to one another in the group § Emphasis placed on education & prevention
• Aaron Beck’s Cognitive Therapy (CT) o Basic Principles § Socratic dialogue § Help the student discover their misconceptions for themselves § We have the capacity significantly change our cognitions, emotions and behavior § Active, directive, time-‐limited, present-‐centered, problem-‐oriented, collaborative, structured, empirical, make use of homework, require explicit identification of problems and the situations in which they occur § Problems stem from commonplace processes such as faulty thinking, making incorrect inferences on the basis of inadequate or incorrect information, making incorrect inferences between fantasy and reality § Insight-‐focused therapy that emphasizes recognizing and changing negative thoughts and maladaptive beliefs § Theoretical rationale that the way people feel and behave is determined by how they perceive and structure their experience • People’s internal communication is accessible to introspection • Students’ beliefs have highly personal meanings • These meanings can be discovered by the students rather than being taught or interpreted by the SA Professional § Automatic Thoughts -‐ Personalized notions that are triggered by particular stimuli that lead to emotional responses § Cognitive Distortions • Arbitrary Inferences; Selective Abstraction; Overgeneralization; Magnification and Minimization; Personalization; Labeling and Mislabeling; Dichotomous Thinking § The most direct way to change dysfunctional emotions are behaviors is to modify inaccurate and dysfunctional thinking § After they have gained insight into how their unrealistically negative thoughts are affecting them, students are trained to test these automatic thoughts against reality by examining and weighing the evidence for and against them. They can begin to monitor the frequency with which these beliefs intrude in situations in everyday life § Critically examining core beliefs • Actively engage in Socratic dialogue • Carry out homework • Gather data on assumptions made • Keep record of activities • Forming alternative interpretations • Guided discovery about insight • Connection their thinking and the way they act and feel o Applications § Cognitive Restructuring • Student observes & monitors their own behavior • Student identifies negative thoughts & feelings • Help to create NEW internal dialogue by substituting positive self statements • Students will acquire effective coping skills that they can practice in and out of sessions • Helping students learn to monitor their self-‐talk, identify maladaptive self-‐talk, and substitute adaptive self-‐talk for their negative self-‐talk § Used to treat: phobias, psychosomatic disorders, eating disorders, anger, panic disorders, and generalized anxiety disorders, posttraumatic stress disorder, suicidal behavior, borderline personality disorders, narcissistic personality disorders, and schizophrenic disorders, substance abuse, chronic pain, medical illness, crisis intervention, couples and families therapy, child abusers, divorce counseling, skills training, and stress management § Alternative interpretations -‐ Help students… • Become aware of the distortions in thinking patterns by examining automatic thoughts • Learn about the process of magnification or minimization of their thinking • Learning how to disregard important aspects of a situation; engage in overly simplified and rigid thinking; and generalize from a single incident of failure § Treatment: Cognitive Triad & Selective Abstraction § Emphasis on Schema or core beliefs § Self-‐criticism -‐ “If I were to make a mistake the way you do, would you despise me as much you do yourself?”
• Donal Meichenbaums’s Cognitive Behavior Modification (CBM) (VERY USEFUL FOR STUDENT AFFAIRS) o Eclectic -‐ “I focus on using a variety of cognitive, affective, and behavioral techniques to help students grow” o Disputing irrational statements; homework; changing one’s language; role playing; humor; self management strategies; Social Skills Training; Assertiveness Training; Relaxation Techniques; Behavior Modification Contracting o Change the students’ self-‐verbalizations o Self-‐statements affect a person’s behavior in much the same way as statements made by another person o Students, as a prerequisite to behavior change, must notice how they think, feel, and behave and the impact they have on others o Self-‐instructional Training § Focus more on helping students become aware of their self-‐talk § Teaching students to make self-‐statements § Training students to modify the instructions they give to themselves so that they can cope more effectively with the problems they encounter § Collaborate on in practice of the students self-‐instructions and the desirable behaviors in role-‐play situations that stimulate problem situations that stimulate problem situations in the students’ daily life § Emphasize on acquiring practical coping skills for problematic situations • E.g.) Impulsive and aggressive behavior, fear of taking tests, and fear of public speaking § Cognitive Structure • The organizing aspect of thinking, which seems to monitor and direct the choice of thoughts • An “executive processor” which “holds the blueprints of thinking” that determine when to continue, interrupt, or change thinking o How Behavior Changes § Behavior change occurs through a sequence of mediating processes involving the interaction of inner speech, cognitive structures, and behaviors and their resultant outcomes § For change to occur, students need to interpret the scripted nature of their behavior so that they can evaluate their behavior in various situations § Distressing emotions are typically the result of maladaptive thoughts § Three-‐Interwoven-‐Phase processes of Change • Self-‐Observation -‐Students must learn to observe their own behavior o Students must develop a willingness and ability to listen to negative self -‐ statements, imagery, and internal dialogue o Increased sensitivity to their thoughts, feelings, actions, physiological reactions, and ways of reacting to others. o Students must realize that they are not “victims” of negative thoughts and feelings o They contribute to their depression through the things they tell themselves • Starting a New Internal Dialogue -‐ Students learn to notice their maladaptive behaviors and begin to see opportunities for adaptive behavioral alternatives o New behavioral chain emerges through wanting to change and becomes incompatible with prior maladaptive behaviors o Students then can change their internal dialogue which serves as a guide new behavior • Learning New Skills -‐ Teaching students more effective coping skills o Students need to practice new skills in real-‐life situations o Help to change their negative view, making them more willing to engage in desired activities o Focus on telling themselves NEW sentences and observing and assessing the outcomes o As they behave differently, the will get different reactions from others o The stability of what they learn is greatly influenced by what they say to themselves about their newly acquired behavior and its consequences o Coping Skills Programs § Students can acquire more effective strategies in dealing with stressful situations by learning how to modify their cognitive “set”, or core beliefs § Expose students to anxiety-‐provoking situations by means of role-‐playing and imagery § Requiring students to evaluate their anxiety level § Teach students to become aware of the anxiety-‐provoking cognitions they experience in stressful situations § Help students examine these thoughts by revealing their self-‐statements § Have students note the level of anxiety following this reevaluation
§ Stress Inoculation Training (SIT) Procedures • Individuals are given opportunities to deal with relatively mild stress stimuli in successful ways, so that they gradually develop a tolerance for stronger stimuli • We can affect our ability to cope with stress by modifying our beliefs • Used to prepare students for intervention and motivate them to change • Deals with issues such as resistance and relapse • Combination of information giving, Socratic discussion, cognitive restructuring, problem solving, relaxation training, behavioral rehearsals, self-‐monitoring, self-‐instruction, self-‐ reinforcement, and modifying environmental situations • Designed to teach coping skills that can be applied to both present problems and future difficulties • The Conceptual Education Phase -‐ o Focus on creating a working relationship with students o Help them gain a better understanding of the nature of stress and re-‐conceptualizing it in social-‐interactive terms o Rethink the nature of the problem, collaboratively o Provide student with conceptual framework in simple terms that educates them about ways of responding to a variety of stressful situations o Help them to learn the role that cognitions and emotions play in creating and maintaining process through didactic presentations, Socratic questioning, and by a process of self-‐ discovery o Help students learn the role they play in creating their own stress o Systematically observe the statements they make internally and monitor the maladaptive behaviors that flow from this inner dialogue o Keep and open-‐ended diary to systematically record their specific thoughts, feelings, and behaviors o Strive to be flexible when using techniques and be sensitive to the individual, cultural, and situational circumstances of each student • Skills Acquisition, Consolidation, and Rehearsal Phase -‐ o Give students a variety of behavioral and cognitive coping techniques to apply to stressful situations o Direct actions; gathering information about their fears; learning specifically what situations bring about stress, arranging for ways to lessen the stress by doing something different’ and learning methods of physical and psychological relaxation o Cognitive coping; students are taught adaptive and maladaptive behaviors are linked to their inner dialogue o Students acquire and rehearse a new set of self-‐statements (See pg. 299) o Students must make lifestyle changes: Re-‐evaluating priorities, developing support systems, and taking direct action to alter stressful situations o Teach students variety of methods of relaxation to gain skills to decrease arousal due to stress • The Application and follow-‐through Phase -‐ o Focus on carefully arranging for transfer and maintenance of change from the session to everyday life o Practice self-‐statements and apply their new skills in real-‐life situations o Imagery, behavior rehearsal, role playing, modeling, and in vivo practice o Practice behavioral assignments, which should become increasingly demanding o Write down homework assignments, if homework is not completed, collaborate consider the reasons for the failure o The Constructivist Approach to CBT § Constructivist Narrative Perspective (CNP) -‐ Focuses on the stories students tell about themselves and others regarding significant events in their lives § There are multiple realities -‐ Help students appreciate how they construct their realities and how they author their own stories § The Constructivist Approach -‐ Discovery-‐oriented -‐ More emphasis to past development -‐ Targets deeper core beliefs -‐ Explores the behavioral impact and emotional toll a student pays for clinging to certain root metaphors • Are students able to tell a new story about themselves and the world? • Do students use more positive metaphors to describe themselves? • Are students able to predict high-‐risk situations and employ coping skills in dealing with emerging problems? • Are students able to take credit for the changes they have been able to bring about?
-‐Major strengths of Cognitive Behavior Therapy from a diversity perspective-‐ • Culturally sensitive because it uses the student’s belief system or worldview • Ideal for working with students from diverse backgrounds • Short term approach • Addresses the role of environment (where the students ‘lives’) • Strive to be flexible when using techniques and be sensitive to the individual, cultural, and situational circumstances of each student • Seek to understand the core values of their culturally diverse students, SA Practitioners can help students explore these values and gain a full awareness of their conflicting feelings, they can work collaboratively to modify these feelings • Group living and the students happiness depends largely on the quality of their functioning within their community • Stresses the relationship of individuals to the family, community, and other systems • Values diversity and the interdependence of being an individual and a productive member of the community • Collaborative nature of the approach allows students to structure the relationship the way they want, as the SA Practitioner enlists students’ active cooperation and participation • Inherently suited to treat diverse students -‐ Individualized treatment, focusing on the external environment, active nature, emphasis on learning, reliance on empirical evidence, focus on present behavior, and brevity -‐Evaluation as applied to Student Affairs Practice-‐ • Empirically valid • REBT is aimed at inducing students to examine and change some of their most basic values • Modifications in the SA Practitioners style need to be made depending on the students culture • Comprehensive and integrative approach the emphasizes thinking, judging, and doing • The interconnectedness of thinking, behaving, feeling are endemic to the work done in Student Affairs • Active and directive techniques -‐ Teaching; suggestion; Persuasion; “homework” assignments; Challenging students to substitute a rational belief system for an internal one is a major aspect of the daily interaction a SA Professional has with students • SA Professionals demonstrate how and why dysfunctional beliefs lead to negative emotional and behavioral results • SA Professionals teach students how to dispute self-‐defeating beliefs and behaviors that might occur in the future • SA Professionals explain to students how change comes about mainly by a commitment to consistently practice new behaviors that replace old and ineffective ones • Personal style plays a major positive role • Creativity is a must! • Integrative approach, using many methods to assist students in modifying their self-‐talk • Collaborative-‐partnership is crucial for student growth • Cognitive processes are determinants of behavior, once students learn this, the possibilities are endless -‐The most significant contributions of Cognitive Behavior Therapy applied to Student Affairs-‐ • Individualized treatment, focusing on the external environment, active nature, emphasis on learning, reliance on empirical evidence, focus on present behavior, and brevity • Aim to change students’ subjective views of themselves and the world • Undermining faulty assumptions and beliefs and teaching students the coping skills needed to deal with their problems • We are responsible for maintaining self-‐destructive ideas and attitudes that influences our daily transactions • Confronting students with questions such as “What are your assumptions and basic beliefs” • Interpretation of events is crucial • Human disturbances can occur, but problematic behavior can be changed (A-‐B-‐C Framework) • Emphasis on putting newly required insights into action • Homework assignments are well suited to enable students to practice new behaviors and can assist them in the process of their re-‐conditioning -‐ A natural outgrowth of what is taking place • Collaboration is stressed • Emphasis on a comprehensive and integrative practice • Present-‐centered and problem-‐oriented • Focus on a detailed case conceptualization as a way to understand how students view their world • Effective, focused, and practical treatments for specific problems • Not complicated, it simply facilitates the transfer of knowledge from SA Professional to the student(s) • Students are active, informed, and responsible for the direction of therapy because they are partners in the enterprise • Encouragement of self-‐help provides for continuous feedback from students on how well treatment strategies are working, and provide a structure and direction to the therapy process that allows for evaluation of outcomes
-‐The most significant limitation(s) of Cognitive Behavior Therapy-‐ • Negative view of dependency (REBT -‐ Diversity) -‐ Many cultures view interdependence as necessary to good mental health -‐ Students with certain long-‐cherished cultural values pertaining to interdependence are not likely to respond favorly to forceful methods of persuasion toward interdependence • SA Professionals level of training will have an impact on their knowledge, skill, and perceptiveness • Misuse of SA Professionals power by imposing ideas of what constitutes irrational thinking • Students may feel pressured to adapt goals and values the SA Professional sells rather than acting within the framework of their own value system • SA Professionals must have a high emotional intelligence so that they avoid imposing their own philosophy of life on students • Some students may have trouble with a confrontational style