Cognitive Behavior Therapy
Key concepts Cognitive behavior therapy is a method that looks into the patient’s thoughts, assumptions and beliefs in order to help him identify maladaptive thinking patterns and gain control over them (Dobson, 2001). Cognitive behavior therapy – also known as CBT – is designed to help patients who are constantly overwhelmed by intense anxiety over matters which are usually imagined or exaggerated rather than real but which strongly affect their daily lives (Dobson, 2001). The theory works on the premise that cognition can be assessed and modified, and behavioral change can occur through cognitive change (Dobson, 2001). For instance a woman who thinks she is overweight when she is not operates on the mindset that she is fat, worthless and unattractive, creating problems such as under-eating, feeling depressed and refusing to socialize at work. Cognitive behavior therapy works by helping such individual to recognize the core issue of the anxiety via biases thinking or image distortion, and then helps the patient to overcome the racing thoughts that feed on the anxiety (Borcherdt, 1996).
View of human nature Unlike behavioral therapy that focuses on changing behavior patterns, cognitive behavioral therapy is a proactive solution constructed to help people overcome repetitive thoughts that haunt them so much that it deprives them of leading a healthy lifestyle (Beck, 1995). Freud contended that human beings are neither free of neurosis nor mental disorder. He claimed that we are all neurotic and perverted in various degrees. He stressed as humans our inherent hamartia is to never be fully satisfied with ourselves. The glass will always be half empty rather than half full, the grass greener on the other side, and the rear view mirror perpetually cracked because of someone else’s fault (Clark, 1995). Due to this, man will constantly be living in denial, phobia and anxiety, although Freud describes this as “normal” (Kazantzis, 2005). The root to all our anxiety problems is the idealism that life has to be fulfilled in such a way in order for it to be perfect, denying the reality that life is anything but. And when life does not turn out the way we think it should, we punish ourselves with diseased thoughts which gradually take toll on the whole body (Kazantzis, 2005). This understanding creates the framework for the primary characteristics of the theory.
A model therapy was developed by Aaron T. Beck for the treatment of depression in the 1950s and though it has been questioned on its effectiveness, the model has been used as the “standard form” of cognitive behavioral work (Kazantzis, 2005). In terms of therapeutic process, homework assignments are the core features of cognitive behavioral treatment or rather, “planned therapeutic activities taken by clients between therapy sessions” (Kazantzis, 2005). Based on the work of Judith Beck (1995), the content of the homework is based on individualized conceptualization. The homework represents “the main process by which clients experience behavioral and cognitive therapeutic change, practice and maintain new skills and techniques, and experiment with new behaviors” (Beck, 1995). The therapist will also include asking rational questions to prompt them into their thoughts, emotions and feelings. The patient, on the other hand, needs to learn to be capable of being his “own best therapist” so that, in time, by being able to answer his own questioning, he can expose his own solutions (Borcherdt, 1996). The relationship is more similar to a mentor and a student rather than a therapist and patient, with the significant role of the therapist is to help their clients pass their hesitations, anxieties, avoidances, overreactions and other personal conflicts that are mentally “restraining” (Borcherdt, 1996). A distinct aspect of the therapy is where the patient – or rather client – replaces the pronouns of “I”, “me”, or “my” with “you”, or “your” in their self-questioning confrontations (Borcherdt, 1996). Depending on the problem or its severity, a few other techniques within cognitive behavioral therapy, or as some call it Rational Emotive Behavior Therapy (REBT), have been constructed to target specific disorders. For instance, panic control treatment, sensation-focused intensive therapy and pharmacotherapy. Others include, imagery methods, time projection imagery methods, as well as emotive techniques (Dobson, 2001). The goal of therapy is to enable patients to transfer the skills and ideas from therapy to the everyday situations in which their problems usually occur (Clark, 1995). The treatment has been used on many psychological problems such as depression, anxiety, anger, marital conflict, fears, eating disorders, substance abuse, psychotic and personality disorders.
However, there are a few discrepancies. Cognitive behavior therapy is described as a short-term technique similar to providing brief outpatient treatments for obsession neurosis. Many argue it is ineffective and improbable for change to occur within such a short period of time. According to Beck (1995) “there is robust evidence that longer therapies give better outcomes, regardless of treatment method, which has largely been ignored”. Many research show beneficial effects that increase with time in treatment (Beck, 2005) challenging the reliability of cognitive behavior therapy and its short doses of therapy. In the light of the theory, every problem has its solution and with substantial amount of ‘homework”, the problem can be, and will be, encountered. But in my opinion, psychological problems are not as easy to solve as mathematical equations. First, there is a tremendous amount of attention to detail that is required in order to reach the root of the matter. Second, there is the issue of building trust, comfort and understanding between therapist and patient. Third, for individuals with deep-seated and scarring psychological issues such as trauma or rape, it may take years or with different stages of recovery. Lastly, not every problem can be discussed into healing. Certain mental disorders could require a lifetime of pharmaceutical dependency.
Personally, what I dislike about cognitive behavior therapy is the way it trivializes problems as if they can be solved within a deadline. The mind works in a far more complex manner than a monthly magazine that operates according to a production schedule. Also, not every method prescribed works with every individual. The therapist needs time to fully understand the patient and his problems before he can assign any homework or technique. In addition, not every patient cooperates, will abide by the method, let alone produce the desired affect. With very personality comes a different background; and with every history comes a different interpretation. And all of these cannot be compounded within a few brief therapy sessions. I also believe that not every problem can be solved. Some patients may insist that he is correct or that there is nothing wrong with him. What happens then?
In the light of the Scriptures
According to the Scriptures, mental weaknesses or inner weakness is a given to human beings. For an atheist, Freud had a biblical point when he stressed that humans are perpetually flawed and mentally fractured on differing severity. Many of the orthodox religion repeatedly remind us of the inner weakness God intentionally placed within us as a reminder of a higher Being that made us so that we will not forget Him. The way to overcome this is by surrendering ourselves to religious devotion and useful work that would benefit both the individual and his society. These activities will help strengthen one’s integrity and remove him from being narcisstic, selfish and self-engulfed by worldly distractions. Certain religious teachings recommend we abstain ourselves from certain activities such as sex and practice fasting to cleanse our thoughts, purify our minds thus strengthen our psyche. The Muslims, for example, practice the annual act of fasting from dust till dawn for a month during Ramadan similar to the Catholic’s forty-day Lent, while the Hindus will spend time reading or listening to their scriptures and meditate for hours. However by today’s standards we question its value: are people practicing these out of efficacy or tradition? Similar to cognitive behavior therapy, these customs are brief yet significant. But do they make any impact or leave deep impressions in our lives? I disagree that by performing certain acts – especially those that are expected every year – would be sufficient for people with deep-seated problems. How could restraining oneself from eating prevent him from a drug abuse habit? Therapeutic methods suggested in the Scriptures are too idealistic and can only be performed by one who already possesses a sound frame of mind. Also, the Scripture’s teachings are too predictable and over-rated: if one does X, he will be given Y. Unfortunately, not even in psychoanalysis therapy are results guaranteed as we desire. Perhaps the biggest contention I have between cognitive behavior therapy and the Scriptures is what lies at the end of the rainbow. According to the Scriptures, all our sacrifices, hard work and worldly struggles are for one reason: to be accepted by God in His kingdom. But to the common man, while he is still alive, he just wants therapy to enable him to make sense of his daily environment. To be able to pay bills, to be able to make friends, find love, have a family and feel appreciated at work, these are the guarantees that we need, and cognitive behavior therapy makes life more comprehensible than a book of verses.
References
1. Beck, J. S. (1995). Cognitive Therapy for Challenging Problems: What to Do when the Basics Don’t Work. New York. The Guilford Press.
2. Borcherdt, B. (1996). Fundamentals of Cognitive-Behavior Therapy: From Both Sides of the Desk. London. The Haworth Press.
3. Clark, D. A. (2001) Cognitive Therapy Across the Lifespan. Cambridge. Cambridge University Press.
4. Dobson, K. (2001). Handbook of Cognitive Behavioral Therapies (2nd Ed.). New York. Guilford Press.
5. Kazantzis, N. (2005). Using Homework Assignments In Cognitive Behavioral Therapy. New York. Routledge.
Reality Therapy
Key Concepts Reality therapy is a new technique that became famous in the 1960s based on a book of the same name. The author, William Glasser, made popular a contemporary method of psychoanalysis that was supposedly people-friendly, focused firmly on the present and constructed to meet the needs of the clients (Glasser, 1998). Reality therapy is derived from Choice Theory and is a far cry from other psychoanalytical ancestors that placed a necessary need to examine one’s past in order to move forward into one’s future (Glasser, 1998). The core principle is simple and lucid: to examine an individual’s current needs and find ways to meet them. According to the theory, every human shares and craves five common needs: power, love and belonging, freedom, fun, and survival. Problems arise when there are obstacles in our lives that prevent us from attaining those needs (Glasser, 1998).
View of human nature Echoing Abraham Maslow’s hierarchy of needs, reality therapists believe that despite our varied personalities, attitudes and desires, every person regardless of race, culture, or religion, crave for the same basic needs in order to attain a sense of achievement in their lives (Myers and Jackson, 2002). Our life’s journey is the struggle to meet these five basic needs. Primary characteristics Similar to cognitive behavior therapy, part of the reality method is to device strategy plans like homework assignments, geared towards helping the patient to make better choices (Myers and Jackson, 2002). More importantly, they need help to learn how to make choices that are within their control, not reaching for the ideals or the unattainable (Glasser, 2000). Once they have identified the ways, they will need to execute them. According to Choice theory, our behavior is composed of four aspects (or vectors): thinking, feeling, acting and physiology. Thinking and acting can be consciously manipulated but not feelings and physiology (Glasser, 2000). These two latter are alive and immediate and are the subconscious representation of what we are experiencing, be it happy or sad; pain or joy. Control is crucial to understand in this form of therapy. Glasser (1998) theorizes that control provides us with a sense of power – an extremely important value in our lives – and whether we realize it or not, every action that we do is a struggle to obtain power as a form of recognition within our social group. Drug abusers use substances to give them power but that, according to Glasser, is a form of “pseudo-control”, similar to people who bully, use aggression and violence on others. Other examples of fake control are people who use money and status as tools for prominence, adolescents using body piercing and gothic makeup to project a harder image, people who abide by regimented daily routines which others are forced to follow. All these are phenomenon when an individual is desperately seeking for control yet are employing ways that are out of their reach, and thus, reduce themselves to a certain lifestyle that deceives them and others. Another key issue to the therapy is focusing “here-and-now” (Glasser, 2000). Though the client can visit the past, he is not to dwell on them. The idea is to learn from the mistakes and to move forward and tackle current problems (Glasser, 2000).
The therapeutic process begins with the therapist helping to evaluate the current behavior of the client. The client is made clear of the situation, such as what are his strengths and weaknesses and what needs are not being met (Wubbolding, 2000). With the cooperation of the client, the therapist will identify what behavior would be more appropriate and be within the client’s control. For example, if the client has a communication problem with his spouse, he may need to take the initiative to talk to the spouse instead of waiting for her to make the first move (Wubbolding, 2000). Whatever that can be achieved by the client will be the recommended behavior. The client must then negotiate to stop finding excuses and instead make a commitment to execute the appropriate behaviors. As the client exercise the plan, the therapist will evaluate his progress and make any necessary adjustment. The role of the therapist is to be supportive, non-judgmental and to constantly ensure the client stays within focus of the recommended plan. There are to be no criticism or discouragement even if the client fails at any attempts. The client, on the other hand is to constantly be positive and avoid making any complaints or excuses to change. It is predicted that he may occasionally feel disheartened or require encouragement to feel reconnected with the plan (Myers and Jackson, 2002). The relationship between therapist and client has to be highly supportive, nurturing and constantly open to new ideas for adjusting the plan and helping client meet his needs.
Reality therapy’s straightforward and efficient manner has attracted counselors, educators, psychologists, psychiatrists, social workers, youth leaders, parents, and anyone interested in developing themselves or their helping skills (Myers and Jackson, 2002). Popular types of clients for this method include couples with marital problems, parents with problematic children, restless and aggressive adolescents, and adults with social skills issues. Reality therapy has been applied to many social group activities namely those for adolescents from motivational through to religious camps (Wubbolding and Brickell, 1999). It appeals to many people because of its social and historical relevance. Its technique makes it appear as if you are not undergoing a psychoanalysis session but rather a social skill workshop. This friendly feature creates lesser apprehension for people to seek “help” as it removes the lying-on-the-couch cliché imagery that often accompanies therapy sessions. The hands –on and equal-level cooperation of the therapist deconstructs the idea that therapists are serious and distant.
In the light of the Scriptures
It is interesting to point out as well that many religious sects are seeing reality therapy as a welcoming avenue for religious teachings. The human yearning for freedom, for instance, can be explored in the act of praying where one is completely liberated to be at peace with God. Another component that can be shared with religion is the human need for love and belonging. The Scriptures teach us that by submitting our undivided love for God, we carve a position beside Him, hence gaining a sense of belonging that nourishes us with faith and emotional stability. However, it needs to be argued here that man’s needs are far more complicated than mere devotion and submission to religion. For instance, love for God is not enough for the common man. Human beings need companionship that encompasses all platforms: emotional, spiritual and physical. The Scriptures describe man’s needs as too simplistic and that religion answers the call to all human problems. I have to disagree. Though I concur that religion plays a crucial role in providing faith and emotional shelter to some people, however, in modern societies where people are more skeptical and jaded than spiritual and pious, the teachings of the scriptures are no longer as powerful as psychoanalytical-based therapy. The fact that one can see and correspond with a therapist is far more appealing and tangible to submitting one’s entire mental psyche (and fate) to an entity that exists on hypotheses. Praying alone does not and will not solve man’s problems. I find that the Scriptures provide the kind of guidance and advice that are as useful as reading philosophy by Aristotle, Plato and Socrates: they make perfect sense, but are too idealistic and surface-level for the flawed and fractured man of the millennium to understand.
But all these, I believe, are subject to question as it depends on one’s personal level of religious conviction. Needless to say, reality therapy’s simplicity may be the type of therapy we need in today’s complex society as it seems accessible to almost every pockets of society.
Reference
1. Glasser, W. (1998). Choice Theory: A New Psychology of Personal Freedom. Harper Collins. New York City, New York.
2. Glasser, W. (2000). Counseling with Choice Theory. Harper Collins. New York City, New York.
3. Myers, L. ; Jackson, D. (2002). Reality Theapy and Choice Theory. American Correctional Association. Lanham, MD.
4. Wubbolding, R.E., (2000). Reality Therapy for the 21st Century. George H. Buchanan, Co., Philadelphia, P.A.
5. Wubbolding, R.E., ; Brickell, J., (1999). Counseling with Reality Therapy. Speechmark Publishing Ltd., Bicester, Oxon, UK.
;
