Pragmatic Approaches Continued – CBT and REBT
Cognitive Behavior Therapy
Cognitive behavior therapy (CBT) was developed as an integration of behavioral therapy and cognitive therapy. It is based on the principle of recognizing the relationship between thoughts and behavior. Cognitive behavior therapists focus on the present rather than on the past. The basic assumption of CBT is that all behavior (including problem behavior) is learned and is maintained by external reinforcements that are developed based on personal history and experiences. CBT goals are based on the client understanding their problem from a cognitive perspective. CBT counselors use behavioral and cognitive interventions with clients such as:
• Reinforcement (positive and negative).
• Thought stopping.
• Cognitive restructuring.
• Risk-taking exercises.
• Role playing.
Rational Emotive Behavior Therapy
Rational emotive behavior therapy (REBT), developed by Albert Ellis, is a popular approach to counseling that uses affective and cognitive-behavioral methods as change agents. The goal of this theory is to teach clients that their feelings are derived from thoughts rather than from events. Ellis developed the A-B-C-D model to explain the construct of this theory. The activating (A) event can be a positive or negative experience that can help or hinder a client from achieving their goals. The activating event creates the beliefs (B) that people have about the event. The consequences (C) are often the negative emotional and behavioral actions that occur (this is usually when a client comes to counseling). Finally, disputation (D) occurs when the client learns how to challenge their irrational or rigid belief system and can create various alternatives.
Corey, G. (2013). Theory and practice of counseling and psychotherapy (9th ed.). Pacific Grove, CA: Cengage-Brooks/Cole.
To successfully complete this learning unit, you will be expected to:
1. Compare cognitive-behavioral theory with rational emotive behavior theory.
2. Apply key concepts and interventions based on CBT or REBT to a given case study.
Learning Activities Studies
Use your Theory and Practice of Counseling and Psychotherapy text and the library to complete the following:
• Read and review Chapter 10, “Cognitive Behavior Therapy,” pages 287–323.
• Read Tursi and Cochran’s 2006 article “Cognitive-Behavioral Tasks Accomplished in a Person-Centered Relational Framework” in the Journal of Counseling and Development, volume 84, issue 4, pages 387–396.
• Read Mobley’s 2008 article “College Student Depression: Counseling Billy” in the Journal of College Counseling, volume 11, issue 1, pages 87–96.
The following article is recommended but not required for this unit:
• Jenkins, D., & Palmer, S. (2003). A multimodal assessment and rational emotive behavioural approach to stress counselling: A case study. Counseling Psychology Quarterly, 16(3), 265–287.
Discussion 1: 1 page needed with 2 references.
CBT and REBT Comparison
CBT and REBT share some similarities, but they diverge in philosophy and approach. Discuss the similarities in the philosophical assumptions of Ellis’s REBT and Meichenbaum’s CBT. Then discuss how the theories differ in philosophy and approach.
Discussion 2: 1 page needed with 2 references.
CBT and REBT Theory Application
Case Study Application
For this discussion, you will apply either CBT or REBT to the case of Henry (see the case study narrative The Case of Henry in the Resources). Specify how the theory conceptualizes Henry’s problem, identify the key concepts that can be applied, and discuss two specific interventions you would use with Henry. Identify a limitation of applying the theory to this case. Be specific in your discussion.
Case Study: The Case of Henry
Presenting Information: Henry is a 46-year-old Japanese man. He was born in Japan and moved to the United States by himself when he was in his early 20s to go to college and work. He presents to counseling with multiple complaints of depressive symptoms, anxiety about being in social situations, relationship problems, and financial challenges. He reports feeling irritable and down most of the time but continues to go to work even though he does not have the energy. He also states that he experiences nervousness when he is around people at work and socially, so much so that he has begun to isolate himself. He feels afraid to talk to people because he thinks, “They will look at me like I am stupid and just walk away. So I just don’t talk to people. I am better off that way anyway because nobody understands my situation.” He states that it is difficult for him to come to counseling because his Japanese beliefs do not support counseling. Strong encouragement from o ne of his American friends convinced him to come.
Social History: Henry states that he was engaged to be married but his fiancée left him for another man about six months ago. They were together for about three years. Henry says, “I came home from work one day and she had all of her stuff packed. She told me she did not love me anymore, and then she left. I just did not know what to say or do, and ever since then I have been stuck.” His fiancée was Japanese, too, but was more Americanized than Henry feels he is. Even though he has lived in the United States for many years, he states that he tries to remain close to his cultural roots. Henry has never been married and does not have any children. He has a few friends but says that he does not spend much time with them anymore. He feels like they see him as weak because he cannot move on from the breakup. He was also involved in karate as a four-time black belt but has dropped out of the dojo.
Mental Health and Addictions History: Henry states that he has never been to counseling and has never abused any substances.
Family History: Henry’s family still live in Japan, and he feels that they have a close relationship. His parents are elderly and are very traditional in their Japanese ways, so he does not talk to him about his problems or about seeking counseling. He is an only child. Henry reports that while in high school he was bullied a lot by other students and frequently physically harmed. He tried to talk to his father, but his father said that he had to be a man and stand up for himself. Henry continued to be bullied but never spoke of it again. He said he had forgotten about the incidents for many years but has now begun to think about it more. He reports that he has even had nightmares about his coworkers and friends bullying him.
Occupational and Educational History: Henry has a bachelor’s degree in business and computer technology and is the information technology specialist at a local company. He is currently having financial problems due to his fiancée moving out and taking a substantial amount of money from their joint savings account.