Integrating Cognitive Behavioral,
Solution Focused and Some Aspects of Person Center Therapies.
By:- Alazar Kassahun, Teacher at Asella College of Teachers Education.
1.
Introduction
Since the
late 20th century,
psychotherapy has been
described as an
important aspect in
the study of
psychology. Due to its
importance, psychologists have been
actively involved in the
identification of the
critical approaches in
counselling and psychotherapy
(Corey 2009). Psychologists have
come up with
different theoretical models of
counselling that are applicable
at different situations during psychotherapy. The application of these theoretical models of counselling have
helped in overcoming the impact
of several emotional as well as
psychological difficulties such as stress, depression, anxiety, anger, and
other emotional problems. However, despite the universal application in solving
similar problems in human beings, these theoretical models of psychotherapy
possess distinct differences as well as similarities.
An
integration of the major theoretical models in counselling
is therefore critical in understanding
of various psychological
problem from wide
perspectives in inclusive manners (Corey 2009). For integrating purposes, the paper has identified
three main modalities:- Cognitive Behavioral
Therapy, Solution focused Therapy and
some aspects of
Persons centered therapies . This paper
will describe the underpinning assumptions of each
model, the goals of therapy in relation
to each model, the therapeutic
relationship including the role of the counsellor and the client, the key
techniques of each model in relation to
each particular model. The paper
will describe each theoretical model of counselling with the purpose of
integrating them and widening the scope of various pathological abnormalities
from the view of these three models of psychotherapy theories.
2.
Over
View and My Reflection on the New Integrated Theories of Psychotherapy.
Though integrating
theories need to be supported by research findings and in-depth inquiry; before
that it’s also good to hypothesize which psychotherapeutic theory will be
integrated and used as one model to help client with different problem from
various viewpoints of therapeutic process. I believe human have to be defined
from the view of as they are capable, abled, and good in nature and factors of maladjusted behavior arises both from theenvironment
, internal self’s, poor knowing of self’s, lack of structured thinking and
cognition of outer world and inner self’s.And the pathological aspects of human
behaviors will be defined from the view of both internal and external behaviors
influences.
Goal of therapy is also designed by the
client and are unique based up on the client. And therapist encourages client
to explore well beings, his oneself and make realization of his own emotional
and psychological growths. The goals are aimed at finding the root causes,
setting future solutions, exploring the clients own self-awareness, training
new behaviors, thoughts, belief and norms at all.
The counselor has to give
an emphasis for his clients to explore his own self. In addition to that
irrational thoughts of the client which needs a rational and logical discussion
will have to be blocked and therapist can have a role of encouraging, assessing
and challenging theclients’ negative thoughts. When we come to see the
applications of therapeutic techniques in this integral model, the therapist is
waited to explore both the root causes of problemand future solution with a
therapeutic relation of unconditional patterns and accepting genuinely and also
settingcriterion,rules, practical techniques like ABCmodel,questioning, giving
homework’s, asking what if questions, miracles question and giving continuous tasks.
Also change over the client’s problem is determined by their relationships
between client and therapist.
The therapeutic
relationships between clients and counsellor tends to be collaborative,
congruent, opened and clients are active to become aware of what is going on
their behavior and cognition after making a self-evaluative tasks.
3.
Historical
Foundation of CBT, SFT and PCT Psychotherapy Theory
CBT, SFT and Person Centered Therapy arethree theoretical models that
have been applied in psychotherapy for many years. Despite their some
similarities and use in counselling, this three theoretical models hold
distinct similarities helps to integrate each other. These differences are
realized especially in regard to the assumptions, the goals of each,
therapeutic relationship, key techniques of each and limitations. Being one of the most preferred theoretical
models in counselling, CBT has
demonstrated explicit justifications as well as definite rates of success in
most of the instances where it has been applied .The diversity of its
applications in major psychological and emotional problems has also encouraged
most psychotherapists to utilize it in therapeutically sessions In contemporary
psychotherapy.
Aron Beck, A
graduate of Brown University and Yale School of Medicine, Beck initially practiced
as a neurologist, but he switched to psychiatry during his residency. Beck is
the pioneering figure in cognitive therapy, one of the most influential and
empirically validated approaches to psychotherapy. Beck’s conceptual and
empirical contributions are considered to be among the most significant in the
field of psychiatry and psychotherapy. Cognitive behavioral
therapy has been integrated with other theoretical models due to its
multidimensional nature. CBT has
been applied in clinical psychology and other psychological therapies on the
basis of its premise of the importance of thinking about individual actions and
feelings in relation to psychological and emotional health.
The
foundation of SFT goes back to the 1980s with the enthusiast De Shazer
collaborated with a number of therapists, who each wrote extensively about
solution-focused therapy and started their own solution-focused training
institutes. De Shazer (1988, 1991) suggests that it is not necessary to know
the cause of a problem to solve it and that there is no necessary relationship
between the causes of problems and their solutions.
Person-Centered Therapy
was developed by Carl Rogers in the 1940's, and has been a critical theoretical
model in counselling. This theory of counselling developed in three different
phases. In the first phase, the theory "focused on how the nondirective
counsellor's conduct differed from that of more "directive"
psychotherapists such as psychoanalysts and behavior therapists.
The second phase focused
"away from the counsellor and firmly onto the client as a responsible
agent whose nature provided the rationale for the counsellor's therapeutic
conduct" . The third phase emerged when the theory included past
counselling philosophies which formed major requirements of conventional psychology.
4.
Key
Concepts
Beck
contends that people with emotional difficulties tend to commit characteristic
“logical errors” that tilt objective reality in the direction of
self-deprecation. The following are some of basic concepts which explained as a
source of distortion and behavioural maladjustment.
•
Arbitrary inferences: - Refer to making conclusions without supporting
and relevant evidence. This includes “catastrophizing,” or thinking of the
absolute worst scenario and outcomes for most situations.
•
Selective abstraction: - Consists of forming conclusions based on an
isolated detail of an event. In this process other information is ignored, and
the significance of the total context is missed. The assumption is that the
events that matter are those dealing with failure and deprivation.
•
Overgeneralization: -Is a process of holding extreme beliefs on the
basis of a single incident and applying them inappropriately to dissimilar
events or settings.
In solution-focused therapy(SFT) focus on
what is possible, and they have little or no interest in gaining an
understanding of the problem. De Shazer (1988, 1991) suggests that it is not
necessary to know the cause of a problem to solve it and that there is no
necessary relationship between the causes of problems and their solutions.
Therapy
tends to be brief and addresses the present and the future. The person is not
the problem; the problem is the problem. The emphasis is on externalizing the
problem and looking for exceptions to the problem. Therapy consists of a
collaborative dialogue in which the therapist and the client co-create
solutions.
5.
Psycho-pathology
The underlying assumption of my integrative
therapy is built up on the paralogues that human being have the ability to resolve the challenges life
bring , influenced by external faulty cognition of own
self and world yet at times
we may
lose our sense of direction or awareness of our competencies. My integrative model requires a therapist who
believe in philosophical stance of accepting people where they are and
assisting them in creating solutions rather than spending much time exploring
the pathological history.
The
emphasis is on how clients act in their world with others, how they can move
forward in constructive directions, and how they can successfully encounter
obstacles (both from within themselves and outside of themselves) that are
blocking their growth. Therapist encourage their clients to make changes that
will lead to living fully and authentically
6.
Basic
Assumptions of CBT, SFT and PCT
Cognitive
Behavioral Therapy (CBT), Solution
focused therapy and Person- Centered Therapy havedifferingunderpinning
assumptions that make each therapy integrate. CBT assumes that the occurrence
of behavioral and emotional problems in most individuals is due to the nature
of people incorporating faulty thinking (Dryden & Bond 2000). Also assumes
that the manner in which individuals perform and believe is determined
andinfluenced by individualcognition. The counselling is therefore focused
towards the cognition and behavior of the individual. During CBT,
the importance of decision making, thought, questioning and action is stressed.
CBT assumes that counselling is a
process that entails learning, acquisition of novel talents as well as learning
new coping mechanisms for common psychological and emotional problems (Corey
2009,).
SFTas a model that explains how people changeand how
they can reach their goals. And view Individuals who come to therapy do have
the capability of behaving effectively, even though this effectiveness may be
temporarily blocked by negative cognitions.
Problem-focused thinking prevents people from recognizing effective ways
they have dealt with problems.
In PCT,
it is assumed that humans are positive and due to this positivity, they tend to
be inclined towards the achievement of complete functionality of both their
bodies and minds. In applying this model
in counselling, it is assumed that the immediate experiences in an individual
have occurred due to lack of past awareness about the problems. The theory has
it that after therapy, the individual will possess actualization that will
impact on his or her potential to move from being unaware to being aware of his
or her feelings, and will have self-trust and think positively in relation to
his or her life (Rennie 1998).
Therefore when I try to combine the assumption of those three
theories of psychotherapy as an integrative approaches its good to think human
nature from the humanistic aspects. Human have to be defined from the view as they are capable, able, and good in nature
and factors of maladjusted behavior may
arises both from the environment ,
internal self’s, poor knowing of self’s, lack of structured thinking and
cognition of outer world and inner self’s.
7.
Goals
of Therapy
CBT challenges individuals to face the behaviors, norms, and
beliefs that affect their psychological and emotional health (Dryden & Bond
2000). CBT also encourages clients
to be more aware of their thoughts therefore encouraging clients to change
their feelings.
The solution-focused therapist believes people have
the ability to define meaningful personal goals and that they have the
resources required to solve their problems. Goals are unique to each client and
are constructed by the client to create a richer future (Prochaska&
Norcross, 2007).
Person-Centered therapy aims at providing
individuals with an environment that is safe and favorable for exploring their wellbeing
(Rennie 1998). By encouraging clients to explore wellbeing, Person-centered
therapy ensures that clients recognize all the challenges that they have faced
in their emotional and psychological growth. Further,this therapy enables
clients to realize aspects of self-worthiness that had been imprecise during their
past.
Therefore goal of therapy for the integrative model of these
therapy can also designed by the clients and are unique based up on the client.
And therapist encourages clients to explore well beings, his oneself and make
realization of his own emotional and psychological growths. The goals are aimed
at finding the root causes, setting future solutions, exploring the clients own
self-awareness, training new behaviors,
thoughts, belief and norms at all.
8.
Therapeutic
Relationship and Process
The therapeutic relationship
in cognitive behavioral therapy, resembles the relationship between a teacher
and a student. The therapist acts as the teacher and the client as the student.
In relation to therapeutic relationship, the role of the counsellor and client
becomes critical in ensuring that the outcome of the therapy is desirable.
The role of the therapist
is to give therapeutically instructions to the client who listens and does what
the counsellor says. In this relationship, the counsellor employs directive
structures to direct clients on behavior changes. In this case, the counsellor acts as the
focal point since he impacts much on the cognitive and behavioral changes in
the client. However, for desirable results, collaboration is ensured during
therapy. The counsellor utilizes the
Socratic dialogue that is critical in supporting clients in tenets such as the
identification of the beliefs, norms and values that have impacted on the
psychological and emotional functionality.
Further, the counsellor encourages the client to change these beliefs as
well as identify an unconventional rule for present and future living. In this
case, the counsellor helps in promoting the adoption of remedial skills of
learning.
In this relationship, the
client always gets new insights in relation to the problems he/she is
experiencing and therefore decides on efficient and effective means of
acquiring change.
In
solution focused therapy counsellors must create a climate of mutual respect,
dialogue, inquiry, and affirmation in which clients are free to create,
explore, and co-author their evolving stories. The main therapeutic task consists of helping
clients imagine how they would like things to be different and what it will
take to bring about these changes. And also the attitudes of the therapist are
crucial to the effectiveness of the therapeutic process. It is essential to
create a sense of trust so clients will return for further sessions and will
follow through on homework suggestions.
Beside the person centered
therapy, the therapeutic relationship is distinct from CBT and SFT. In PCT, the relationship between client
and counsellor is crucial because therapy is centered towards the client as the
client is the focal point of the therapy. Due to this, the counsellor must
ensure that respect, genuineness, and empathy towards the client are
maintained. Further, communication is also critical in this model especially
between the client and the therapist. The relationship must equal as it is
crucial in aiding behavior change in the client.
Finally the
therapeutic relationships between clients and counsellor tends to be
collaborative, congruent, opened and clients are active for a changes, well
prepared to learn new behavior and cognition by active engagement in the therapy
process and tasks.
9. Roles of Counselor
The first step of CBT therapist duties are disputing clients’ irrational beliefs
and encourages clients to engage in activities that will counter their
self-defeating beliefs and to replace their rigid “musts” with
preferences. A second step in the
therapeutic process is to demonstrate how clients are keeping their emotional
disturbances active by continuing to think illogically and unrealistically. To get beyond mere recognition of irrational
thoughts, the therapist takes a third step—helping clients modify their
thinking and minimize their irrational ideas. Although the therapist confronts
clients with the beliefs they originally unquestioningly accepted and demonstrates
how they are continuing to indoctrinate themselves with unexamined assumptions.
The fourth step in the therapeutic process is to challenge clients to develop a
rational philosophy of life so that in the future they can avoid becoming the
victim of other irrational beliefs. Tackling only specific problems or symptoms
can give no assurance that new illogical fears will not emerge. It is
desirable, then, for the therapist to dispute the core of the irrational
thinking and to teach clients how to substitute rational beliefs and behaviours
for irrational ones.
The solution focused model casts the role and
function of a therapist in quite a different light from traditionally oriented
therapists who view themselves as experts in assessment and treatment. Therapists
have expertise in the process of change,but clients are the experts on what they
want changed. The therapist’s task is topoint clients in the direction of
change without dictating what to change.
Finally when I
come to my reflection with the integrative
roles of therapist in combining the three counselling theories as one therapy; can
helps better in understanding the client’sproblem. I believe counselor has to give an emphasis for his
clients to explore his own self. And
simultaneously when the client faces an irrational thoughts which needs a
rational and logical discussion its must to encourage clients engage in
activities that will assess and challenge the clients’ negative thoughts using
different methods or tools and sequential tasks
10. Key Techniques
There are
different techniques applicable in this three models of counselling described
in this paper and integrated as one therapeutic model. CBT utilizes techniques aimed at personal counselling. The theory
utilizes the Socratic model that entails several questions to be answered by
the client. Corey (2009) denotes that "therapists utilize a variety of
cognitive, emotive, and behavioral techniques; diverse methods are tailored to
suit individual clients. Specifically
techniques like De-catastrophizing asking a patient to ponder "what if" scenarios about feared
consequences is known as De-catastrophizingreattribution , alternative explanations systematically
explained Redefining help client define the problem differently e.g., “Nobody ever talks to me” becomes “I need to try to initiate conversations so
other people become interested in me. However, the client is also allowed
to ask the counsellor some questions. Further, the theory employs the aspect of
homework that encourages the clients to practice the skills learnt. Therefore
the majortechnique of CBT is the ABC technique that utilizes the
Socratic model. It is important that
therapists actually believe that their clients are the true experts on their
own lives.
All of the techniques discussed here are about SFTand
must be implemented from the foundation of a collaborative working
relationship.
1.
Exception
questions
Solution-focused therapists ask exception questions
to direct clients to times when the problem did not exist, or when the problem
was not as intense. The therapist asks
clients what has to happen for these exceptions to occur more often. In
solution-focused vocabulary, this is called change-talk..
2. The miracle question
Thetherapists asks, “If a miracle happened and the
problem you have was solvedovernight, how would you know it was solved, and
what would be different?”Clients are then encouraged to enact “what would be
different” in spite of perceivedproblems. This process of considering hypothetical
solutions reflects the perceived problem changes the problem.
3.
Formula
first session tasks
Is a form of homework a therapist might give clients
to complete between their first and second sessions.This kind of assignment
offers clients hope that change is inevitable. It is not a matter of if change
will occur, but when it will happen.
It is important that clients feel understood before they are directed to
make changes.
4.
Therapist feedback for a clients
Solution-focused practitioners generally take a
break of 5 to 10 minutes toward the end of each session to compose a summary
message for clients. Finally the above all techniques will be applied as an integral parts
of assumption to help clients who comes with various psychological problems.
In general when I
try to combine or integrate the applications of therapeutic techniques in this
integral model the therapist is waited to explore both the background problem
and future solution with a therapeutic relation of unconditional patterns and accepting
genuinely and also setting criterion, rules, practical techniques like ABC
model, questioning, giving homework’s, asking what if questions, miracles
question and giving continuous tasks. The change over the client’s problem is
determined by the relationships between client and therapist.
11. My Integrative Therapy Applicability and its Contribution to
Multicultural settings
There
are several strengths of my integrative approaches from a diversityperspective.
In this integral therapy the therapist needs to understand the core values of
their culturally diverse clients, they can help clients explore these values
and gain a full awareness of their conflicting feelings.
Here
also in this approach client and therapist can work together to modify selected
beliefs and practices.By focusingon breaking cultural
barriers and facilitating open dialogue among diverse cultural populations.
Main strengths are respect for clients’ values, therapist need to makes every effort to enlist clients’ active
cooperation and participation, welcoming of differences, understanding,
willingness to allow clients to determine what will be explored in sessions,
and prizing cultural pluralism are the major things that have to be considered
in the integral models of psychotherapy.
12.
Conclusion
This paper has described
three theoretical models including CBT,
SFT and PCT. The paper has explored the underpinning assumptions of each
model and try to combine as one integrative model of psychotherapy. It has also
identified the goals of each therapy aswell as the therapeutic relationships.
The paper has also combine the key techniques, role of counselor, goal of therapy,
relationships between client and counselor, utilized in the three models.
13.
Reference
COREY, G.
(2009). Theory and practice of counselling and psychotherapy (8th ed.).
Belmont, CA: Thomson Brooks/Cole.
COREY, G.
(2008). Theory and practice of group counselling (7th ed.). Belmont, CA:
Brooks/Cole.
RENNIE,
D. L. (1998). Person-centered counselling: An experiential approach. London:
Sage.
WATSON,
J. C. (Ed.). (2003). Client-centered and experiential psychotherapy:
Advances in theory research, and practice. Ross-on-Wye: PCCS ;Books.
DRYDEN,
W. & BOND, T. (2000). Rational
emotive behaviourtherapy. In W. Dryden (Ed.), Handbook of individualtherapy(4th ed., pp. 347–372). London: Sage
DE
SHAZER, S. (1988). Clues: Investigating solutions in brief therapy. New
York: Norton.
PROCHASKA,
J. O., & NORCROSS, J. C. (2007). Systems of psychotherapy: A trans
theoreticalAnalysis (6th ed.). Belmont, CA: Brooks/ Cole.
GUTERMAN,
J. T. (2006). Mastering the art of solution-focused counselling. Alexandria,
VA:American Counselling Association.
