In this essay I will discuss the Cognitive Behavioural Therapy, then I will critically evaluate the approach, with strengths and limitations, give an example of an episode that , I tried to use this approach, give the reasons in which situations I would use it. And finally what I had learned from this research and how it impacted me for future practice.
Cognitive Behavioural Therapy, have roots in behaviourism, as well as Cognitive therapy. In our days many cognitive behavioural therapist follow the principles from both these schools. In the beginnings of 1970s, Professor Aaron T. Beck developed a theory of depression, which promotes the importance of peoples depressed style of thinking. Becks work has changed the nature of psychotherapy , not just for depression , but for a range of psychological problems such as , phobias, anxiety, depression, anger, sexual and relationships problems, drugs and alcohol abuse, obsessive compulsive disorder, I just mention a few of them. For a successful treatment is necessary that the patient work together with therapist, and is willing to change, is vital that patient is able to recognise his abnormal thinking or behaviour. CBT is a short -term therapy normally between 10 to 15 sessions and lasts for an hour. With the help of the therapist the patient will tackle these abnormal thinking or behaviour, by learning a different range of techniques to combat them.
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Abnormal behaviour is caused by maladaptive thoughts that a person can internalise in its self, this maladaptive behaviour does not allow the patient to have a normal life. As above referred CBT is mixed with cognitive and behavioural therapy
They are combined because how we behave often reflects how we think about certain things or situations. The emphasis on cognitive or behavioural aspects of therapy can vary, depending on the condition being treated. For example, there is often more emphasis on behavioural therapy when treating an eating disorder because repetitive actions are a main problem. On the other hand, the emphasis may be more on cognitive therapy when treating depression. In this type of therapy the patient have to talk about his feelings, the way they see the world, and also other people. The two main techniques of CBT in a session is to the patient discuss with , the therapist about his evidence for and against negative beliefs, the second one the therapist will ask to the patient for him to test his beliefs , and change the way that he reacts to them and see what happens. The therapist helps the patient to understand his actual thought and patterns. In particular, to identify any harmful, unhelpful, and false ideas or thoughts which he may have, that triggers his health problem, or makes it worse. The aim is then to change his ways of thinking to avoid these ideas. Also, to help his thought patterns to be more realistic and helpful.
The treatment with the patient is based in talking , both therapist and patient will work together to identify and understand the reason , for the patient abnormal behaviour , or thought . CBT does not rely on the past, but in the present here and now, therapist and patient will look at patient problem in different perspective more healthy and positive. The therapist will set goals and assignments. Strategies which are monitored and evaluated, in-between the sessions. With the techniques and the homework that the therapist had planned for him , in a situation of abnormal behaviour , or thought the patient , will recognise what trigged the situation, and how he have to behave to overcome that situation. It is important that the patient recognise what trigged the situation, and put in practice the techniques set by the therapist that will help him to change that. This therapy will make the patient more aware. The patient is also asked to maintain a diary to write down the way he thinks, feels and behaves in daily situations, emotions, automatic thoughts, logical response and outcome is also another helpful technique. It will be then more easily to break the maladaptive pattern.
However as any approach in the human behaviour it has strengths, and limitations. CBT is not suitable for everyone, only helps certain conditions, it had been shown good results in treating anxiety and depression Eysenck, P.286, 1997 "but is especially effective with panic disorder.
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Rachman (1993, p.279), "As far as anxiety disorders are concerned, the greatest theoretical and clinical progress has been made in applying cognitive-behaviour therapy (CBT) to the...treatment of panicky." People who take medicines are a greater risk to relapse , when they stop taking them , I agree because they didn't learn to identify what triggers their maladaptive behaviour , and didn't challenge them in trying new behaviours, it is like they are frozen by the medicines, and when they stop taking them , they defrost and everything will start again . CBT is claimed to treat schizophrenia that is a very serious disorder, and that is extremely difficult to treat, and medicines are necessary for the patient, in my opinion this disorder cannot be treated by CBT. In other side CBT is extremely structured and does not focus in the past, but in "here" and "now".
However studies had shown that patients after 2 years of therapy has finished, do better than those using other type of treatments, however every individual is unique, two patients with same disorder may have different results because the degree of the extension of the disorder may differ.
CBT does not take in account genetic factors, also does not take in consideration interpersonal factors like his social role, life experiences that can produce mental disorders. Another aspect is that is not clear if the abnormal thoughts can be the cause of the disorder. Secondly is unfair to blame the patient for their mental disorder, because it may be other people the responsible an example is the case of bullying is not the victim fault. Also the patient must be willing to change; he may find boring the homework, and the diary sheet. Also disrespects the patient intelligence by making the therapist, rather that the patient unconscious wisdom, the source of clear intelligence about the problem. Also the therapist encouragement to tackle this abnormal behaviour is vital interpersonal skills like warmth, acceptance and empathy will make the CBT more successful. Overall this approach is positive but is effectiveness will depend in factors, such , type of disorder , willing to change by the patient, support of the therapist, commitment to do the homework, and attend the sessions.
If in my practice I'm working with a service user that have a problem in low self esteem, problems in relationship, I would use this approach to set goals for the user confront his fears, in other situations like eating disorders, depression, panic attacks, the help of a qualified therapist is essential, because he will know better than me how the user is progressing, his evaluation also will more accurate, because I don't hold a degree or a masters in that area.
I have a couple of friends, who had marital problems such as verbal abuse towards each other, both of them asked to talk with each other, accusing one another for the failure of the relationship. I spoke with both of them together, and asked about their negatives attitudes, and asked them why they couldn't do things in another way, that wouldn't hurt the partner. But they were both resilient to change, and admit their mistakes , in this situation I thought they needed the help of a professional, I didn't had the skills and techniques that a therapist would have, and maybe because I was a friend, they may had felt uncomfortable talking with me, in this case the commitment of the couple to recognise their abnormal attitudes was imperative, to try ad change them, my friend was stressed, anxious and depressed because of the marital problems, and she was pregnant at the time. I advice her to book an appointment with her GP expose the situation, and try counselling and because she was pregnant, this would affect the unborn child.
I now understand that in practice , I can approach a service problem with different theories , that can help me to decode and assess the user situation in a constructively perspective, if a I just rely in one single approach, I will miss other underlying problems, in the case above there was other theories that could explain certain behaviours and attitudes. Coulshed (1991.p.8) " Theoryless practice does not exist ; we cannot avoid looking for explanations to guide our actions , whilst research has shown that those agencies which profess not use theory offer a non problem solving wooly and directionless service".
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CBT and social work. both have the aim to empower the user to control his life, in my view in certain situations, I would use this approach of course that, I need more training and skills to work effectively. Having researched this approach I learned that in certain situations with users we can use techniques and skills from different approaches, and analyse the service user situation with different approaches. I believe that will bring a deeper insight into the service user assessment of needs and resources to help him to be in control of his life again.