Author: Shumaiza Iqb
In Cognitive Behavioral Therapy (CBT) therapist have
to care about the good ‘Therapeutic Alliance’ that play a great role in the
treatment of the client. For therapeutic alliance therapists should care about
their good counselling skills and understandings with the client’s problem,
sharing the conceptualisation of the client’s problem and treatment plan with
them as well as making collaborative decisions with them (Williams et al.,
2017).
Effectiveness of the CBT based on the through
assessment or evolution from the birth to the current state of the client.
Therapist’s formulation of the problem, case conceptualisation and the
treatment plan all depends on the assessment sessions. Once a therapist went
through all the phases of the client’s history deeply, then it’s easier to
manage a client effectively. Therapeutic alliance palys more important role in
taking a history from the client as it was more personal and not easy to share
more crucial things of once life with anyone else. The assessment process is not
restricted to the initial sessions, but it continues in all the sessions as
with more therapeutic alliance a client able to open up their more problems
with the therapist then these will be added into the client’s formulation, case
conceptualisation and treatment plans(Khanna & Kendall, 2010).
CBT mainly
based on the ‘Cognitive Model’ by which a therapist assess the people emotions,
behaviour and physiology depend on its perception or response of events.
Cognitive Model
In the cognitive model, the interpretation of the situation is much
more important as in the same situation every person interpret the situation in
different ways, and this interpretation leads the person to react emotionally,
behaviorally and physically different. Sometimes, people’s reaction did not
depend on the exact situation, but it depends on the perception of that
situation that already has it in their mind. CBT practitioners mainly were
interested in particular level of thinking-automatic thoughts(Real images,
actual words that a person have in his mind about a particular situation are
known as automatic thoughts) and worked on that thinking level for dealing a
person’s problem(Wright, Basco&Thase, 2016).
Besides, automatic thoughts people develop certain images or ideas
about themselves, others and about the world that is mostly linked from their
childhood. These ideas or beliefs are worked for the person as absolute truth,
and the person did not want to articulate these beliefs. These beliefs known as
central or core beliefs as these are more rigid, universal and overgeneralized
for the person. Automatic thought arises from these core beliefs. As core
beliefs developed in childhood and it leads to some rules and assumptions about
a particular situation. These assumptions are common beliefs that exist between
core beliefs and automatic thoughts (Williams et al., 2017).
CBT helps
the person to think about these construct, and when a person able to know about
their beliefs, they can understand and interpret about the threatening
situation or their problem in a more reasonable way. After assessing the
person’s problem, a CBT therapist works on these beliefs for increasing the
efficacy of the problem. As when a person himself know about the main cause of
this problem, he can understand the onset of a problem and deal with it quickly
and with more mannerable way. Through repeated experiences of getting relief by
working on their beliefs, a person able to work and evaluate deeply on their
beliefs and change their perceptions with the help of CBT therapist. Deeply
evaluation and change of the beliefs makes the person to relapse into their
problem less frequently(Wright, Basco&Thase, 2016).
Cognitive conceptualisation can be thought
by the therapist by explaining the hierarchy of the relationship of the
behaviour to the automatic thoughts.
In CBT, Structure of the sessions also took an important part in
treating the client effectively. Initial therapy sessions will be different
from the management therapy session because initially, the main therapist
focuses on the assessment and evaluation of the client while the management
therapy session emphasis on treating the client effectively. Session’s duration
will be 40-45 minutes that is divided into three parts. Agenda setting, mood
check of the client, obtaining an update, disusing the diagnosis and
psychoeducation, homework checking includes in the first part of the therapy
session. In central part problem, identification, goal settings, discussion on
the problem will be included whereas in the end part therapist provide a
summary of the session to the client, review of the homework assignment and
then getting feedback from the client. Collaborative work between the therapist
and the client and the home assignments are crucial parts in CBT
treatment(Kuyken, Padesky, & Dudley, 2009).
Cognitive model based on the cognition of a person, so it’s important
to teach thought process so that the person can easily elicit their automatic
thoughts that leads them to specific psychological problems. CBT therapist
collaboratively works with the person to teach how they can elicit their
automatic thoughts and how automatic thoughts lead the change in behaviour,
emotions and physiology. Sometimes clients easily understood their automatic
thoughts and elicited them, but sometimes it’s the most difficult task for the
CBT therapist. To teach the clients how they can elicit their problematic
automatic thought therapist use different ways like role-playing, asking about
specific situations, imaginary, changing questioning techniques etc.
Evaluations and differentiation of the emotions from automatic thoughts is the
next step in the cognitive model(Clark & Beck, 2010).
Evaluation of the automatic thoughts comes after the differentiation of
the emotion. Teaching cognitive errors, self-closure and using alternative
questionings are the techniques that a therapist used to teach the evaluation
of the client. After the evaluation either client’s automatic thoughts are true
or not CBT therapist teach them identifications cognitive errors, i.e. all and
none thinking, metal filter, personalization, labelling, magnification, mind
reading, catastrophizing, discontinue the positives etc. by which the clients able to understand where their
automatic thoughts are to be distorted and how they can manage these thoughts.
Once clients competent to evaluate the true automatic thoughts, then
problem-solving techniques will be thought to the clients so that they can
quickly evaluate their thinking in future if their thinking will be problematic
(Kuyken, Padesky, & Dudley, 2009).