This document discusses the author's emerging theoretical orientation of cognitive behavioral therapy. The author describes how their experiences volunteering with therapeutic horseback riding influenced their belief that people are goal-oriented and strive for acceptance. The author favors CBT because it is practical, structured, and goal-oriented. CBT views thoughts, feelings and behaviors as connected, and aims to identify and replace negative thoughts with positive self-talk. Key CBT techniques include thought records and homework assignments to help clients gain skills to cope with stress independently.

1. EMERGING THEOERTICAL ORIENTATION 1
Emerging Theoretical Orientation: Cognitive Behavioral Therapy
Final Paper
Katie Murrell
Hunter College

2. EMERGING THEOERTICAL ORIENTATION 2
Every counselor begins to recognize aspects of a preferred theoretical orientation in the
beginning of their training. This identification is influenced by ideals, values, and morals that the
counselor already has established. These morals and values have developed for the counselor
through their family life, their childhood experiences and events that have happened throughout
their personal and professional lives. This interaction of nature and nurture has a significant
impact on the counselor’s chosen therapeutic approach. Identification is also an ongoing process
that will continue to develop as counselors begin to work with different populations.
My work with individuals with disabilities has strongly influenced my philosophy on
people, personality, and health. I agree with theorist Carl Rogers in that people have a strong
tendency towards realization and fulfillment (Corey, 2013). People have a natural desire for
belonging and acceptance within a community. Every person strives to achieve a goal, such as a
high work status or financial success. This goal is viewed as the person's meaning in life. Every
choice a person makes, regarding a professional career or family, is made to accomplish one or
more steps on the path to achieve that goal. Personality is developed through a person’s culture,
family dynamic, and moral code. A person’s culture could include their ethnicity, geographic
location, or religious background. Culture could also be determined by a career or activities, such
as members of the armed forces.
I have volunteered at several therapeutic riding facilities, which teach horse-back riding
lessons to people with disabilities. I learned about the characteristics of numerous disabilities,
what challenges people may face and how to individually support each student. This
environment promoted acceptance and tolerance of people with disabilities. I helped the students
in the program reach their goals each week and helped some achieve independence. I became a
certified Therapeutic Riding Instructor in college. I learned how to teach students with

3. EMERGING THEOERTICAL ORIENTATION 3
disabilities to ride horses, to care for the animals and how to persevere when facing obstacles.
This job is extremely goal-oriented. In the struggle to be accepted by insurance companies and
the worldwide health community, leaders put an emphasis on goals and results to prove the
validity of each lesson. This practical, structured, and goal-oriented approach to life and work
leads me to closely favor cognitive behavioral therapy.
A person’s health is largely based on the health of their relationships. A healthy
relationship could be with an intimate partner, a professional colleague, or a classmate. A person
can become depressed or anxious if his or her relationships have been negative or they do not
trust other people. A person’s health is also based upon their view of themselves. People often
take on more responsibility than they can handle at work or in their family because they feel that
it is expected of them. A person becomes stressed when they feel that they cannot live up to
these expectations.
Change is a process that occurs over a period of time. Change is fostered when a person
feels comfortable enough in their environment to step out of his or her comfort zone. A fear of
failure is frequently what stops a person from trying something different. Change will happen
with the help of a counselor when the client is set up for success. A counselor helps the client
learn within the session and then how to apply skills in everyday life. Change starts small, with
behaviors or thoughts changing gradually until many aspects of a person’s life are different.
According to cognitive behavioral therapy, personality is developed through a unique
combination of inherited dispositions and the environment (Hoermann, Zupanick & Dombeck,
2013). Individuals are the products of their childhood experiences. A negative experience will
foster anxiety or negative responses. A positive experience will enforce a warmth and empathy

4. EMERGING THEOERTICAL ORIENTATION 4
towards other people. Individuals inherit many traits from their parents and make decisions later
in life, such as a career choice, that encourage personality development.
Psychopathology develops because of a person’s dysfunctional core beliefs. Core beliefs
are what a person assumes about themselves, the environment, and other people (Corey, 2013).
When these assumptions are negative or incorrect, a person reacts in a consistent similar manner
that creates stress. These interpretations lead people to behave in ways that unknowingly provoke
reactions from people that demonstrate their interpretations.
A cognitive behavioral therapist has several goals throughout each session. A therapist
strives for a client’s awareness of dysfunctional core beliefs and helps him or her evaluate their
validity. A therapist also encourages a client's independence so that he or she has the confidence
to face challenges independently in the future. Clients must learn how to restructure their
thoughts. For example, a counselor will help a client automatically think "I can do this" instead
of "I can't do this" when faced with a challenge at work or school. Additionally, a therapist helps
a client realize their personal strengths as well as the strength of a support system in the family or
in the community.
A cognitive behavioral counselor promotes change within a client by teaching the client
how cognition affects emotions and behaviors (Corey, 2013). Clients must learn how to identify
distorted thoughts, as well as how to distinguish between a thought and reality. A counselor
teaches the client how to recognize distorted behavior and monitor his or her own thoughts.
Negative or incorrect thoughts are replaced with positive self-talk. This identification and
monitoring technique is a skill that a client will use outside of the session to deal with stress and
negative emotions. These are skills that a client can use once therapy is over and throughout their
lives to be successful personally and professionally.

5. EMERGING THEOERTICAL ORIENTATION 5
According to cognitive behavioral therapy, thoughts, feelings and behaviors are all
strongly connected. “The manner in which we think about, perceive, interpret and/or assign
judgement to situations in our lives affects our emotional experiences” (Wenzel, Brown &
Carlin, 2011). Negative and unrealistic thoughts cause distress and challenges. When a person
suffers distress, how they interpret a situation is skewed and consequently has a negative impact
on his or her actions. Cognitive behavioral therapy frequently focuses on the here and now. The
therapist will acknowledge in a session that the client’s past shapes his or her current behaviors,
but the therapist will not dwell in the past. The therapist seeks to restructure negative thoughts so
the client can use these skills in the future.
In cognitive behavioral therapy sessions, a counselor has many roles. One role is a
teacher to the client. The client learns how to effectively dispel harmful thoughts, apply logical
thinking and cope with future stressful situations. The client is viewed as a partner with the
therapist because the client contributes to the session structure. For example, a client will help set
the agenda for the session and develop homework assignments. The counselor possesses
unconditional positive regard for the client and teaches the client how to accept themselves as
well as other people. The counselor is open and direct when disclosing his or her own beliefs and
values to the client. The counselor is willing to share his or her own imperfections to dispute the
client’s potential notion that the counselor is flawless (Corey, 2013).
Several principles guide cognitive behavioral therapists in their practice. One principle is
that a strong therapeutic alliance is essential. Counselors focus on demonstrating a genuine
empathy. They are also direct when sharing observations about how the client reacts in the
present. For example, a counselor may tell the client that she observes tension in the client’s
shoulders and hands when the client discusses a confrontation at work. Counselors must

6. EMERGING THEOERTICAL ORIENTATION 6
understand and discuss with the client the goal-oriented nature of therapy because the client must
be a willing and collaborative partner. The counselor must also ensure the client is aware of the
time-sensitive nature of cognitive behavioral therapy. Most cognitive behavioral therapeutic
alliances last between ten and twenty sessions (Hoermann, Zupanick & Dombeck, 2013). Lastly,
counselors emphasize psychoeducation and relapse prevention in their sessions.
Cognitive behavioral therapy utilizes numerous techniques, methods, and strategies to
achieve the goals of the client. Many methods, such as thought records, homework assignments
and relaxation training can be done from the beginning sessions to increase the client’s self-
confidence and mindfulness. More demanding techniques, such as behavioral experiments,
require more trust in the counselor and must be done later in the sessions.
A thought record is a type of journal where clients will record an event or situation, and
subsequent emotions, thoughts, and outcomes. A thought record helps a client identify negative
automatic thoughts and replace them with rational thinking. For example, a college student with
depression will describe what happened when he cancelled plans with his friends. He will record
how intense his depression was and where he felt it in his body. Then he will record any
unhelpful thoughts, such as that his friends will have more fun without him. Next, he will record
facts that support the unhelpful thought, such as he was not in a good mood all day. In the next
section, he will describe the facts that disprove the unhelpful thought. This could be that his
friends want to celebrate passing their semester classes. Finally, the student will record his idea
that he will enjoy celebrating with a group of friends. This will lead to an outcome, such as an
increased confidence the next time he receives an invitation.
Relaxation training can reduce a client’s stress and physiological symptoms of anxiety.
There are many techniques for relaxation training, such as autogenic training and mindfulness

7. EMERGING THEOERTICAL ORIENTATION 7
meditation. Autogenic training "uses both visual imagery and body awareness to move a person
into a deep state of relaxation" (Relaxation Techniques, 2015). In mindfulness meditation, clients
focus on sensations in the body while breathing deeply.
A behavioral experiment is a planned activity to test out the client’s thoughts in everyday
situations (Chellingsworth & Ferrand, 2011). A counselor uses this to help the client recognize
disruptive thinking and test the accuracy of automatic thoughts. The first step is to describe what
the thought is and how definitively the client believes in this. Then the client and counselor
create an experimental plan, identify the worst-case scenarios, and establish ways to overcome
potential obstacles. After the experiment, the client and counselor compare the original
predictions with what did happen and come up with plans for future situations.
One research study compares the effectiveness of prolonged exposure to present-centered
therapy in women returning who have served in the armed forces. The results of the study
showed that prolonged exposure decreased the symptoms of Post-Traumatic Stress Disorder
more significantly than present-centered therapy (Schnurr, Friedman & Engel, 2007). The
therapy of prolonged exposure demonstrates how the cognitive behavioral principle of core
beliefs can affect an individual’s behavior and thoughts. Prolonged Exposure seeks to decrease
symptoms of Post-Traumatic Stress Disorder by encouraging positive core beliefs and automatic
thoughts so that people can respond to adverse situations in a confident manner.
A second research study compares results of therapies such as prolonged exposure, stress
inoculation training and cognitive processing therapy. Overall, cognitive behavioral interventions
lead to better Post-Traumatic Stress Disorder outcomes than supportive counseling does
(Vickerman & Margolin, 2010). These studies support the principles of how thoughts, behaviors
and emotions are interwoven. Cognitive behavioral therapy focuses on developing awareness and

8. EMERGING THEOERTICAL ORIENTATION 8
developing alternate ways of thinking. The results "support the superiority of treatments that
focus on the memory of a trauma and its meaning, rather than coping skills, support or non-
trauma focused techniques" (Vickerman & Margolin, 2010).
Cognitive behavioral therapy has proven successful in the treatment of Post-Traumatic
Stress Disorder, anxiety, depression, and addiction. These are a few of the disorders that veterans
of the armed forces may face when discharged from service. A Rehabilitation Counselor working
for the Department of Veterans Affairs office will help a client appropriately interview for jobs,
communicate with supervisors, and resolve interpersonal conflicts to successfully maintain
employment. For example, at the Institute of Career Development, Job Developers help veterans
“define themselves and their abilities so they can present with confidence during the interview
process” (Institute for Career Development, 2015). This knowledge will help restructure their
current way of thinking so that they can transition safely both in the present and in the future to
civilian life.
The veteran population seeking help from a cognitive behavioral therapist is diverse.
Veterans of wars, such as World War II, the Vietnam War or Operation Enduring
Freedom/Operation Iraqi Freedom, face different challenges upon discharge from service.
“Grossman (1996) points to the lack of social support encountered by Vietnam veterans in their
homecoming in comparison to the veterans of World War II, where society deemed it was a
justified war” (Weiss & Cole, 2011). The political, social, and economic environment to which
the veterans returned has a significant impact on how the veterans view both themselves and
other people.
Another diverse population in this setting is women veterans. Women veterans
experience different issues than their male counterparts, including a higher rate of Military

9. EMERGING THEOERTICAL ORIENTATION 9
Sexual Trauma. “Studies have shown that military women are much more likely than military
men to experience all forms of sexual harassment,” which include unwanted attention,
comments, or advances (Boucher, 2014). Most studies conducted on cognitive behavioral
therapy for veterans focus only on men or both men and women. The lack of research completed
may be for many reasons, including the relatively recent integration of women into combat roles.
“Although women have only recently been authorized to hold combat positions they have been
exposed to combat directly and indirectly in OIF and OEF, more than in any other war in the
past” (Boucher, 2014). The effects of Post-Traumatic Stress Disorder and Military Sexual
Assault have yet to be thoroughly researched in female populations only.
There are several ways to address the multicultural implications in cognitive behavioral
therapy practice. One way is to integrate family systems therapy and person-centered therapy
into work with both women and older veterans. “Given the nature of contemporary military life
and the seriousness of the mental health issues discussed previously, family life may be
compromised for women both during and after their active service” (Strickel, Calloway &
Compton, 2011). Using strategic or structural family therapy, counselors help women veterans
change disruptive patterns and reorganize the structure of the family. Person-centered therapy
techniques of accurate empathic understanding will help the therapist “sense clients’ feelings as
if they were his or her own without becoming lost in those feelings” (Corey, 2013). This will
help counselors address the emotional consequences of older veterans’ challenges.
One strength of cognitive behavioral therapy is that it emphasizes individualized
treatment. The therapist completes a case conceptualization. This diagram outlines the client’s
core beliefs, conditional assumptions, compensatory strategies, automatic thoughts, and

10. EMERGING THEOERTICAL ORIENTATION 10
corresponding emotions. For example, Kate is a 40-year-old National Guard nurse who lost her
job upon return from deployment. “The case conceptualization helped Kate’s therapist to identify
the hypothesized cognitive and behavioral sources of her depression and anxiety” (Wenzel,
Brown & Karlin, 2011). This exercise helps the counselor understand how the client views the
world and decide which interventions and techniques to use during sessions.
Another strength is the general cultural sensitivity. The therapist uses the client’s belief
system to explore the strengths and assets that a client possesses. The goal of cognitive
behavioral therapy is to decrease stress and increase awareness of the client’s personal strengths.
The techniques and tools that a counselor teaches the client can be used to overcome challenges
in day-to-day life so that the client becomes independent.
Despite the many successes of cognitive behavioral therapy, there are limitations to the
theory. The clients and counselors’ exploration of personal strengths encourages assertiveness
and independence. These values may not be successful with clients from a collectivist culture.
For example, Asian American clients come from a culture that emphasizes success and
cooperation. A client from this culture “may feel guilty if she perceives that she is not living up
to the expectations and standards set for her by her family and her community” (Corey, 2013). In
this culture, the needs or desires of an individual may be put on hold in favor of the family or
community.
Another limitation of cognitive behavioral therapy is that the counselor may impose his
or her ideas of what is rational thinking. For example, a civilian counselor working with a
veteran of the armed forces may encourage rational thinking of individual needs. A veteran
however, instilled with military values of dedication to the group, will disagree, and may alienate
the therapist who does not understand. The active and directive nature of cognitive behavioral

11. EMERGING THEOERTICAL ORIENTATION 11
therapy implies that the therapist must know him or herself well to avoid imposing a personal
philosophy on the client.
One way to work through the limitations of cognitive behavioral therapy is to understand
my personal biases. Cognitive behavioral therapists strive to avoid imposing their own version of
rational thinking onto the client. For example, firearms are an important part of a veteran’s
culture even after they are discharged from service. I have not had a lot of exposure to firearms
because I grew up in New York City, an area that is liberal about gun policies. I must be aware
that owning and using firearms for veterans could be a way of life, so I must educate myself on
firearm safety and use. If I understand my personal feelings, I can avoid exposing my prejudices
about firearms.
The next step in my theoretical development is to obtain the Certified Rehabilitation
Counselor designation and receive training in cognitive behavioral therapy. I will attend
professional development about specific techniques, such as Exposure Therapy or Eye
Movement Desensitization and Reprocessing to discover what technique will best enhance my
counseling style. A third step is to obtain employment in the Department of Veterans Affairs
office as a Vocational Rehabilitation Counselor to gain experience and knowledge before
moving into private practice.
Supervision will be an integral part of my theoretical development. Throughout
practicum and internship during my Master’s program, supervisors will offer constructive
criticism while listening to recordings of my sessions. I will analyze my strengths and
weaknesses with the help of supervisors. I plan to attend professional development events, such
as seminars or workshops, that address my weaknesses and offer strategies for improvement.

12. EMERGING THEOERTICAL ORIENTATION 12
Once I obtain employment, I will reflect upon the cultural considerations of my clients. One
question I will ask myself is, "are these the best tools to use for this population?" This reflection
will assess the effectiveness of the orientation I use. If I decide that I am not the most effective
with this practice, I must decide what other aspects of different theories I can use.
Each counselor’s theoretical orientation provides the guiding principles to therapeutic
practice. Cognitive behavioral therapy is proven to treat the psychological and physiological
challenges that veterans face upon leaving the military. A successful counselor will use
techniques of cognitive behavioral therapy to address the client’s issues and may need to
incorporate techniques of other theories to best help him or her do well. There are many
specialties within the practice of cognitive behavioral therapy, such as Eye Movement
Desensitization Reprocessing and exposure therapy, that a counselor can use to help his or her
clients.

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14. Stickel, S. A., Calloway, Y. L., & Compton, E. A. (2011, March 11). Women veterans and their
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