1 Theoretical Models of Counseling and Psychotherapy, 3rd Edition Chapter 9: Cognitive CounselingMario De La Garza, M.Ed., and Janice Miner Holden, Ed.D. University of North Texas

2 Historical Context Following World War II, people in the United States were optimistic because of economic expansion as well as anxious because of the Cold War. 1950s: conformity and social conservatism 1960s: valuing independence of thought and intellectual integrity In psychology, clinicians found psychoanalysis limited, behaviorism too narrowly focused, and client-centered therapy inefficient.

3 Aaron T. Beck Suffered from anxieties and phobias that originated with a traumatic childhood surgery and extensive recovery period. Fell behind in school due to illness and concluded he was stupid; devised a plan to catch up, succeeded, and reformulated his belief about his intellect. Learned to be sensitive to others’ emotions through his relationships with his emotionally erratic mother and an emotionally abusive first grade teacher.

4 Aaron T. Beck Psychoanalytically trained psychiatristWanted to provide research showing efficacy of Freudian method Found that psychoanalytic concepts neither predicted nor explained how depressed patients were functioning Found that depressed patients had formulated a distorted view of reality Went on to create a cognitive therapy treatment for depression, anxiety, and other mental disorders

5 Philosophical UnderpinningsPhenomenology One’s reality is subjective and an interpretation; therefore, it is only an approximation of reality. Hierarchical structuring of cognition Kant’s concept of schemas Freud’s primary and secondary processes Empiricism Evidence leads to a conclusion. If an idea (cognition) is not supported by evidence, it needs to be rejected and replaced. Scientific method

6 Nature of Humans: Function of the PsycheHumans possess the innate motive of survival. Infants are endowed with the functions of sensation, emotion, memory, and increasing voluntary motor movement. An individual processes information (using the above functions) and determines whether the innate motives are being served. Pleasure usually means yes; pain usually means no.

7 Nature of Humans: Structure of the PsycheMode System Anxiety Anger Sadness Joy Cognitive Perceived danger Perceived violation Perceived loss Perceived gain Emotional Fear Happiness Behavioral Shaking Scowling Crying Smiling Physiological Sweaty palms Increased heartbeat Tears Dilated pupils Motivational Escape/ Avoid Lash out Grieve Seek and approach Schemas

8 Nature of Humans: Structure of the PsycheOrienting Mode – scanning the environment for threats or opportunities related to one’s interests Minor Modes – activated when one perceives only minor threats to/opportunities related to one’s vital interests: working, conversing, driving, etc.; characterized by emotions of minor intensity: scared, mad, sad, glad Major Modes – aka primal modes, activated when one perceives major threats/opportunities to vital interests; characterized by intense emotions: anxious, enraged, depressed, manic

9 Nature of Humans: Structure of the PsycheConscious control system – the system able to de-energize modes through cognition and behavior Minor modes characterized by cognitive flexibility Major modes characterized by cognitive rigidity

10 Nature of Humans: Structure of the PsycheLevels of cognition: Automatic thoughts Words and images about specific situations Intermediate beliefs (Assumptions) Rules If-then propositions and shoulds Cognitive schemas Core beliefs about self, world, and future Most formed during early childhood when an individual is more likely to make reasoning errors

11 Role of the EnvironmentEnvironment: both physical and social Environment is believed to have a greater influence on personality development than one’s innate predisposition (genetics). Family environment is highly influential on schema development. Cognitive therapists do acknowledge genetics as influencing how one perceives one’s environment.

12 Healthy Functioning Relative absence of bias in core beliefsBeliefs correspond to evidence Support survival Most of one’s time is spent in minor modes Easy accessibility to one’s conscious control system. Modal flexibility

13 Unhealthy FunctioningModal rigidity Most of one’s time is spent in major/primal modes with difficulty accessing one’s conscious control system. Distorted schemas are exaggerated and persistent. People respond to them with overcompensation or avoidance.

14 Unhealthy FunctioningCognitive distortions: Aaron Beck David Burns Arbitrary inference Jumping to conclusions Selective abstraction Mental filter Overgeneralization Magnification/minimization Magnification or minimization Discounting the positives Personalization Personalization and blame Dichotomous thinking All-or-nothing thinking Emotional reasoning “Should” statements Labeling

15 Personality Change ProcessNeutralizing (reducing energetic charge of) dysfunctional modes through use of the conscious control system Motivational and emotional components of a mode are less accessible to direct influence than the cognitive, behavioral, and physiological components. Effective, lasting change occurs through a fundamental shift in the cognitive component of a mode.

16 Client’s Role Distress in one’s life is usually the motivator for change. Clients are expected to join the counselor in sharing equal responsibility for client change. Ideal clients can tolerate anxiety of trying different behaviors and are able to recognize the relationships between thoughts, feelings, and behaviors. Clients are emotionally engaged in therapy and provide information about distressing emotions and behaviors as well as improvement.

17 Client’s Role Learn how to convert convictions into hypotheses and apply the scientific method to test their validity. Learn how to modify invalid hypotheses. Complete homework. Give honest feedback about counseling sessions.

18 Resistance (better known as “not changing”)Client may not perceive a problem. Client may not be able to tolerate discomfort of change. Dysfunctional beliefs about therapy (requires no effort; therapist will be controlling) Therapist may have not developed working relationship. Therapist failed to explain reasoning for activity, and/or activity is too difficult. Client and counselor not in agreement on goals of counseling.

19 Counselor’s Role To be warm, empathic, and genuineTo be an expert in cognitive theory and techniques, having received formal, supervised training To engage the client’s conscious control system so that client can avoid or modify problematic mode(s) To teach a client how to identify cognitions and test their validity To be observant, flexible, and able to respond to clients’ needs To be open to client feedback

20 Stages and Techniques Relationship establishment and maintenance skills Nonverbal attending Reflecting Open-ended questioning Specific change strategies Socratic questioning Designing behavioral experiments Assigning relevant homework

21 Techniques Interview as well as various assessments/inventoriesSocratic dialogue Scaling Cost/benefit analysis Semantic method Double standard technique Reattribution Externalization of voices Downward arrow technique

22 Interface with Recent Developments in Mental HealthNature/Nurture Incorporates recent developments in genetic research, but still places greater emphasis on environment influencing personality development. DSM 5 Diagnosis Cognitive therapists explicitly reference DSM-IV-TR diagnoses. Pharmacotherapy Affirms the use of psychotropic medications for some conditions

23 Interface with Recent Developments in Mental HealthManaged Care/Brief Therapy Favored because it is inherently a brief, problem-focused approach Technical Eclecticism Any technique consistent with the cognitive theory of emotional disorders can be used. Diversity Issues Takes clients’ individual perspectives into account Much attention to various diverse populations Effectiveness of Psychotherapy Research has shown efficacy for various disorders

24 Limitations With the addition of modes and charges, theory became less elegant. Useful thinking rather than positive or even realistic thinking

25 Contributions Combined humanity and respect of person-centered approach with structure and efficacy of behavioral approach Cognitive profiles Treatment manuals Extensive research

26 References Fall, K. A., Holden, J. M., & Marquis, A. (2016). Theoretical models of counseling and psychotherapy (3rd ed.).New York: Routledge.