Today, the most common form of psychotherapy is cognitive psychotherapy.
It is based on the assumption that the causes of human mental problems are erroneous thoughts. If they are detected and eliminated, then you can not only get rid of various mental disorders, but also prevent their occurrence in the future. Cognitive psychotherapy pays little attention to a person’s childhood memories, focusing on current problems, his inner world, thoughts, desires and fantasies. This is the main difference between this method of treating mental disorders and other popular types of psychotherapy: psychoanalysis and behavioral therapy.
The founder of cognitive therapy is Aaron Beck. Initially, he was engaged in psychoanalysis, but gradually became disillusioned with it and began to look for new methods of treating depression and affective disorders. Beck argued that the world around us is not bad, it is negative views of it that shape negative emotions and actions. Distortion of external circumstances in consciousness leads to the development of mental pathology, for example, depression.
Albert Ellis, the developer of the method of rational-emotive psychiatry, which has much in common with cognitive psychotherapy, worked independently of Beck. Today, cognitive therapy is a component of the cognitive-behavioral (behavioral) theory used by psychotherapists in their practice.
Goals and methods of cognitive psychotherapy
The main goal of cognitive psychotherapy is to identify dysfunctional thoughts in the patient and their subsequent transformation. But, besides this, experts identify five goals of cognitive therapy:
- complete elimination of the symptoms of the disorder or reduction in the manifestations of the pathology;
- prevention of relapse after correction of mental state;
- improving patients’ perception of other types of therapy, including medications;
- resolution of a person’s psychological and social problems that may arise against the background of the disorder or immediately before its manifestation;
- elimination of the prerequisites that gave impetus to the development of the disorder.
During treatment, the therapist helps the patient understand the extent to which his thoughts influence his behavior, emotions, and physical condition. After a full course of cognitive therapy, a person can independently identify thoughts that negatively affect his psychological state. And most importantly, change dysfunctional beliefs into more rational thoughts.
The main methods of cognitive therapy include combating negative thinking, using alternative strategies for perceiving problem situations, re-experiencing events from the past, and imagination. Each of these methods is aimed at giving the patient the opportunity to relive and forget negative experiences, as well as acquire new learnings.
Cognitive psychotherapy is often complex. In addition to cognitive methods, psychotherapists in their work use various behavioral techniques that successfully complement each other.
What is the essence of cognitive behavioral therapy?
The essence of CBT cannot be understood without its basic concepts, among which the most important are: • Schemas, which are deep mental attitudes responsible for a person’s attitude towards himself and the realities of life. They can be adaptive and non-adaptive (the whole world is a mess, and there is no point in trying to figure it out), positive and negative, idiosyncratic (individual) or universal. • Automatic thoughts are conclusions that form in the mind so quickly that they do not have time to be fully comprehended, but they manage to influence emotions, the adoption of one decision or another, and the behavioral response of the individual. Usually these are frequently repeated thoughts when communicating with people around you - parents, children, bosses, friends and colleagues. After automation, the brain gets used to not thinking about thoughts, but simply “retrieving” them from memory along with the emotions and action patterns they previously evoked. If the experience of an automatic thought has brought positive results, then it can be useful in making a quick decision, but if the automatic thought was initially incorrect, then following it can only do harm. That is why identifying such thoughts, extracting them from the subconscious and convincing counterargumentation makes it possible to rewrite erroneous mental attitudes and accordingly change behavior patterns. • Cognitive errors, or otherwise distorted thought patterns that incorrectly reflect existing reality. • Arbitrary conclusions are conclusions made without confirmation by facts or in the presence of facts that contradict this conclusion. • Overgeneralization. Occurs when comprehensive conclusions are drawn from a single episode. • Exaggeration and understatement of one's role and the significance of ongoing events. By exaggerating the complexity of the situation, the individual underestimates his capabilities in resolving it. • Personalization - observed when the patient considers certain external events as relevant to him, when in fact they do not concern him at all. • Maximalism - putting forward excessive demands on oneself or the world around us in the form of opposing attitudes. For example, “if I don’t make a million, then I’m a complete insignificance,” “if I don’t become famous, then this life will be a swamp,” etc. • Obligation is an overdeveloped sense of duty and responsibility, often imposed from the outside and not allowing for alternative behavior. It can seriously poison a person’s life and prevent him from self-realization. The psychotherapist faces the difficult task of determining the predominant motive that led to mental disorder and irrational behavior, especially since there may be several of them. The doctor should find out all this and develop a treatment plan already in the first sessions, and the patient’s task is to help him with this. First of all, when preparing for the visit, it is advisable for the patient to think through and formulate the final goals of treatment in advance, i.e. what he would like to achieve and/or get rid of.
The most popular cognitive psychotherapy techniques
Treatment of mental disorders using cognitive psychotherapy is not just a way to combat a specific disease. This approach to therapy gives the patient a special perspective on everything that happens in his life. Thus, it is possible to prevent the development of relapses and other mental disorders. A person trained in the basics of cognitive psychotherapy is able to systematically monitor his own negative emotions and transform them into rational thoughts. This method is especially effective in combating panic attacks.
All techniques used in cognitive psychotherapy can be divided into two large groups:
- techniques aimed at identifying automatic thoughts of a negative nature. The main way to achieve this goal is to interview the patient, but the therapist can also use role-playing techniques. After the automatic thought is found by the patient, the therapist must check it with behavioral factors, as well as logical analysis. In some cases, the identified beliefs turn out to be a mythologem, but most often such thoughts nevertheless take place in reality, although they are not realized by the patient. The therapist must identify the relationship between the automatic thought and the traumatic situation and pathological emotional reactions;
- techniques that allow you to identify the unreasonableness of an automatic thought and cognitively reconstruct it. A person will be able to abandon a maladaptive thought only if he is completely sure of its “wrongness.” First of all, the validity of such thinking can be verified by its consequences. This technique is called decatastrophizing or “what if.” The patient imagines the consequences of the situation that frightens him, and understands that in fact nothing terrible will happen. You can push a person to check irrational thoughts with real actions. If the patient suffers from depression, believing that he is not capable of anything, then he can be given small tasks. Their successful implementation will restore a person’s faith in his own strength. The psychotherapist can also invite the patient to compare his situation with another case from his practice. By feeling sorry for a patient with similar problems, the patient automatically feels sorry for himself. As a result, the negative attitude towards oneself changes into pity and sympathy. A similar result can be achieved using the catharsis method, when the therapist encourages the patient to speak out and cry. In addition, there are a large number of other methods that allow you to change cognitive attitudes.
Throughout the course of therapy, the patient receives homework. He must track automatic thoughts and record his feelings in a special notebook. A psychotherapist may recommend reading certain literature and listening to recordings of psychotherapy sessions.
Most often, psychotherapy is individual, but group work can also be used. In the latter case, not the relationships between its individual members are examined, but the rationality of their thinking and behavior is assessed.
A. Beck's cognitive model in psychological counseling: essence, goals, objectives.
The main principles of cognitive psychotherapy were formulated by A. Beck independently of the rational-emotional therapy of A. Ellis. In contrast to the rational-emotional approach of Ellis, who based his model on the leading role of absolutist demands of obligation in the formation of neuroses, the author of the cognitive model A. Beck sees their causes in violations of information processing. He identifies three main groups of mechanisms in which disturbances are possible: cognitive elements, cognitive processes and cognitive content.
Cognitive elements are divided into basic premises (which contain the individual’s deep ideas about the world around him, other people and himself) and automatic thoughts (which accompany the processing of information at a given moment in time). Examples of basic premises: “Trusting people is dangerous,” “Nobody needs me and therefore no one loves me.” Automatic thoughts get their name due to their involuntary, transient and unconscious nature. A person does not select information for reflection, but focuses on it involuntarily. These thoughts differ sharply from conscious ones, in which one or another degree of control over the subject is maintained, but subjectively they are experienced as plausible.
Cognitive processes are the connecting link between basic assumptions and automatic thoughts, ensuring that information newly entering consciousness corresponds to previous ideas. For example: “Nobody likes me because I’m fat. And if someone falls in love, I won’t have anything to do with him - he has bad taste.” Cognitive content combines elements and operations around a specific topic (“I am sexually inferior,” “I will never get married,” and the like).
Among the main logical violations that accompany automatic thoughts are arbitrary inference, selectivity and overgeneralization, “black and white” thinking (the tendency to think in categories like “wonderful - terrible”, personification (the desire to attribute personally neutral events to oneself), downplaying or exaggeration of the importance of individual events or actions.
Cognitive psychotherapy also assumes that perception is mediated by thinking, and if this middle link is realized, then the emotional and behavioral aspects of a person’s reaction can be understood. At the cognitive stage, Beck identified the following disturbances in information processing that distort the vision of an object or situation and are the cause of false ideas: designation, selection, integration and interpretation.
Therefore, the goal of cognitive counseling is to correct inadequate cognitions, and at the same time to understand the rules of inadequate information processing and replace them with correct ones. It is considered highly desirable to use the experience that the client has in positively solving life problems and transferring the rules for solving them to problem areas. The client and consultant must at the very beginning reach agreement on the purpose of counseling - the central problem to be corrected, the means of achieving it, the possible duration of counseling. Establishing contact can begin with the consultant accepting some of the client’s ideas about the problem with a gradual rational transfer of him to the position of cognitive counseling.
At the initial stage, it is important to reduce problems - identifying problems that have the same causes and grouping them. Another option is to find the first link in the “chain” of symptoms that starts the whole chain.
The task of the next stage is the awareness and verbalization of non-adaptive cognitions that distort the perception of reality. The term “maladaptive cognition” applies to any thought that evokes inappropriate or painful emotions and makes it difficult to solve a problem. The counselor may encourage the client to focus on thoughts or images that cause discomfort in or are similar to the problem situation. Maladaptive cognitions are in the nature of “automatic thoughts” that arise without preliminary reasoning and for the client themselves have the character of plausible, unquestionable thoughts. They guide his actions, although they are involuntary and do not attract his attention. By focusing, the client can recognize them and fixate them. Repeatedly approaching or immersing yourself in a situation allows you to first realize, collect them, and then present them in full detail.
After the stage of teaching the client the ability to identify his maladaptive cognitions, he must be taught to consider them objectively. This process is called distancing in cognitive counseling. The client views his maladaptive cognitions and automatic thoughts as separate psychological phenomena isolated from reality. Distancing is important because, firstly, it helps the client to increase the ability to distinguish between those opinions that need to be substantiated and irrefutable facts, and secondly, it allows differentiation (discrimination) of the external world and their attitude towards it.
The next stage is conventionally called the stage of changing the rules of behavior regulation. According to cognitive psychotherapy, people use rules (instructions, formulas) to regulate their lives and the behavior of others. This system of rules largely determines the designation, interpretation and evaluation of events. Rules for regulating behavior that are absolute in nature entail regulation of behavior that does not take into account the real situation, causing problems for a person; therefore, the client needs to modify these rules, make them more flexible, less generalized and more realistic. The content of the rules for regulating behavior revolves around two axes: danger - safety and pain - pleasure. A well-adapted person has a fairly flexible set of rules that allows him to relate them to reality. In situations of psychological or psychosocial threat, it is difficult to assess the existing degree of risk.
For example, a person who is guided by the rule “If I don’t rise to the occasion, it will be terrible” experiences difficulties in communication due to an unclear definition of the concept of “being on top,” and his assessment of the effectiveness of his relationship with his partner is associated with the same uncertainty. The client projects his assumptions about failure onto others’ perceptions of him. The consultant’s task is to change the rules related to the danger/safety axis, restoring broken contact with the avoided situation.
An example related to the pain-pleasure axis: a person who follows the rule “I cannot be happy unless I am famous.” Here, the hypertrophied pursuit of some goals harms others. The client dooms himself to ignore other areas of his relationship in favor of the rule. Having identified such a position, the consultant will help him realize the flaw of such a rule, and explain that the client would be much happier if he were guided by more realistic rules (which the client must find himself with the help of the consultant).
Changing the attitude towards the rules of self-regulation, teaching the client to see hypotheses in thoughts instead of facts, checking their truth and replacing them with more flexible ones - this is the next task of counseling. The consultant uses the client’s already existing “resources” (that is, skills for productive problem solving in other areas), and then helps to generalize and transfer them to the problem area.
Example: depression and neuroses
Cognitive psychotherapy is based on the assumption that depression or neurosis is a consequence of irrational and unrealistic thinking. A person's feelings and behavior are highly dependent on his opinions, beliefs, thoughts and ideas. A. Ellis and A. Beck call this cognition. Thoughts and opinions can be divided into several groups: descriptive (descriptive), evaluative, cause-and-effect (causative) and prescriptive (prescriptive). All of them are strictly connected to each other, forming a kind of system of life rules, living by which means inevitably being unhappy. According to A. Beck, the list of these neurotic rules (a kind of “moral code of a neurotic”) can be as follows:
1. To be happy, I must be successful in all my endeavors.
2. To feel happy, I must be loved (accepted, admired) by everyone and always.
3. If I make a mistake, it means I'm stupid.
4. If I haven't reached the top, then I've failed.
5. How wonderful it is to be famous, rich, popular, and how terrible it is to be an ordinary, mediocre person.
6. My value as a person is determined by what others think of me.
7. I can't live without love. If my boss (wife, child, mistress) doesn’t love me, it means that I’m good for nothing.
8. If someone doesn't agree with me, it means he/she doesn't love me.
It follows that events in themselves mean little; true feelings are evoked only by a person’s opinions and assessments. He feels what he thinks about what he perceives. At the same time, they can also contradict each other - and the person still feels unhappy.
Absolutist, dogmatic thinking underlies a depressive perception of the world. A neurotic person seems to close his eyes to the positive aspects of the world around him and his own life and sees only the negative ones. Ellis draws a clear line between those emotions that he calls “adequate negative emotions” (sadness, resentment, fear, grief, frustration, regret and anger) and neurotic, depressive experiences. From his point of view, people naturally become upset when their plans or intentions do not come true, when others evaluate them lower than they should, when they get sick or lose loved ones. “However, when they turn (consciously or unconsciously) their desires or goals into unconditional demands and orders, beginning to convince themselves that they must, simply must, in any conditions and under any circumstances, achieve success and satisfy all their desires, then then they plunge into depression,” as A. Ellis himself writes in one of the articles.
Another cause of depression is a specific self-attitude in which a person tends to punish himself more for failures than to praise himself for successes, or when the praise he receives seems less than deserved. In itself, self-punishing behavior can be perceived as strong-willed, courageous, or character-building, but in order for the desire for self-punishment to become a transition to neurotic depression, an unconscious (and irrational) transition from observation, wishes to prescription and evaluation is necessary. For example: “I see how terrible it is to be (short, fat, poor with a higher education, provincial),” etc.
People also become depressed, angry, or furious when there are few unexpected joys, good fortunes, and random successes in their lives, and especially if, from their point of view, a neighbor or rival is “luckier.” A lack of positive reinforcement, speaking in behaviorist terms, creates tension that can be discharged in any negative emotional state. From the point of view of M. Seligman and L. Abramson, the basis of neurosis may be the anticipation of future troubles. At the same time, there is a tendency to attribute internal, stable and global causes to negative external events, and yet if something good happens, it is only by chance, and also passes quickly. Unrealistic expectations of future disasters are especially characteristic of our unstable times.
To summarize, it can be noted that in rational-emotive therapy, depression and neurosis are considered as a product of the following life attitudes:
* the individual has developed a negative self-esteem along with the belief that you cannot have serious shortcomings, otherwise you will be good for nothing, inappropriate and inadequate;
* a person looks pessimistically at his surroundings; he is absolutely convinced that it must be much better, and if it doesn’t work out, it’s absolutely terrible;
* the future is perceived in a gloomy light, troubles are inevitable, and the inability to become happier makes life meaningless;
* a low level of self-approval and a high tendency to self-condemnation are combined with the idea that a person must be perfect and must receive approval from others, otherwise he does not deserve to be treated well and must be punished;
* the expectation of troubles presupposes their inevitability and the fact that a person is somehow obliged to cope with them, and if this does not happen, then he is the worst.
17. Rational Emotive Behavioral Therapy was developed by Albert Ellis.
It was called at different times and is called today by different specialists in different ways: RET (rational-emotive therapy), REBC (rational-emotive-behavioral counseling), REBT (rational-emotive-behavioral therapy).
Are we treating or teaching?
The main goal of REBT is to teach rational sociality.
REBT is not treatment, not psychotherapy, but behavior change: education and training. Training in scientifically (rationally) meaningful experience of coping with life’s problems, with one’s feelings and actions and training in thinking skills and rational behavior.
“REBT also contains preventive training and perhaps therefore can truly be called, instead of the fixed medical term psychotherapy, behavior change, or training.”
In this case, it is more appropriate to replace the traditional name “psychotherapist” with “trainer-consultant in the field of life (social) skills.” Or: socio-trainer, socio-consultant.
Theoretical concepts of REBT
REBT believes that virtually all people's problems are the result of irrational beliefs (mystical thinking, belief in uncritically learned “shoulds,” “shoulds,” and “shoulds”) and therefore can be directly and directly eliminated by strict adherence to empirical reality[2].
Basic premise: People first interpret situations according to their deeply held beliefs and then act on those interpretations.
“If beliefs don't change, there won't be any improvement. If beliefs change, symptoms change. Beliefs function as little operating units.” (A. Beck)
Three basic principles for working with beliefs:
People experience problems not because of events, but as a result of perceiving them through the prism of beliefs.
It doesn’t matter when you acquired a particular belief, you still adhere to it if you experience corresponding problems. This is the principle of the priority of the present time (it should not be confused with the Gestalt principle of “here-and-now”).
There's no other way to deal with this than to work and practice for the rest of your damn life! (There is no way but work and practice the rest of your damn life!) This is the principle of specific and regular work. In one of his speeches, A. Ellis said that the most important thing in the REPC is simply “work, work, work...”.
ABC model
The ABC model (sometimes “ABC”, in an expanded version “ABCDE”) is the core of the REBT theory. Other names: Therapeutic Change Model and ABC Theory of Personality. Describes not only the process of occurrence of erroneous emotions and behavior, but how to eliminate their causes.
“A” (activators, English activating events) are any current events or one’s own thoughts, feelings, behavior in connection with these events, and possibly memories or thoughts about past experiences.
“B” (English beliefs) - beliefs.
“C” stands for consequences.
In “A”, each person brings something of his own, namely his beliefs, goals, physiological predisposition, attitudes, views - “B” (English beliefs). And already “B” leads to precisely this and not another “C” - consequences.
"A", "B" and "C" are closely related, and none of these elements can exist without the others. To change “C”, you need to either change “A” directly (the shallowest level of psychotherapeutic changes), or realize that “B” leading to irrational “C” are irrational, test this in experience and accept instead of specific irrational “B” concrete rational. Or, ideally, in the case of the most profound and effective therapeutic change, to produce a philosophical restructuring of irrational views.
Rational and irrational beliefs
Rational views lead to productive behavior, while irrational beliefs lead to self-destruction and erroneous, irrational behavior. Namely, the following processes are launched:
(dramatization) - “A” is rated as more than 100% terrible. Starts with “it shouldn’t be that bad...”;
condemnation) - those who do not do what they “should” (including in relation to myself) - “bad”, “unworthy”, “subhuman”, etc.
Three root irrational beliefs according to A. Ellis: “It all comes down to three things:
—· I have to do everything well.
·—Everyone should treat me well.
- The world should be easy for me.
In a particular case, this is the replacement of absolutist requirements (“must” and “must” - “oughtism”, the philosophy of absolute obligation) - with rational relative preferences in a given specific situation. In general, this is the adoption of a flexible attitude towards life events in general.
What beliefs do we not touch?
Any specific ideological, political or religious beliefs remain a private matter for both client and consultant.
In the West, many representatives of various faiths turn to REPC both as a tool for pastoral counseling and as a method of self-help, without sacrificing their faith itself.
Constructive and non-constructive emotions
REBT distinguishes between constructive and non-constructive emotions: for example, anger is non-constructive, while dissatisfaction is a stimulus to change an undesirable state of affairs and is thus constructive.
Stages of working with beliefs that interfere with clients:
Analytical diagnosis of beliefs.
Shaking and softening the client's beliefs
Method of critical discussion.
A. Ellis conducts only 30-minute sessions.
When the client begins to realize and record his pathogenic thoughts in words, each of them is asked the question: “On what basis do you consider this thought to be true?” This question arises from the assumption that all an individual's beliefs exist in his mind due to some kind of justification. A. Ellis emphasizes: “What I try to show throughout the session is that there is always a “justification” for a certain belief.” The predominant part of these justifications rests in the form of cognitions that are not in demand for awareness, since in established cultures and in the system of modern education there are practically no situations in which many of the key ideological beliefs of an individual would be consciously questioned and analytically formulated.
Replacing them with more flexible and rational ones.
Instilling a new habit: long-term and regular training in suppressing the recurrence of false beliefs and in the application of rational beliefs.
This work, provided in REPC with a large number of forms and practical exercises, is done by the client mainly independently in the form of diaries and homework. During sessions, the consultant checks the results of the training, helps correct mistakes and develop new programs. In some cases, the consultant may act as a game coach, that is, advise a client with claustrophobia right in the elevator, and attend public events or popular pubs with a client with a fear of crowded places.
Teaching the client to do all this work with himself - independently.
Preparing the client to become their own therapist in the future. Individual REBT ends not when the client has solved all of his problems, but when he feels ready to deal with the remaining problems on his own and is confident in his ability to deal with any difficulty in the future.
Additional tools
REBT uses many useful techniques and techniques: rational, irrational, emotional, behavioral, imaginative (visualization), linguistic (semantic), logical, experimental (testing solutions to specific problems in practice), biblio-, audio- (special ironic-humorous songs and poetry), visual (caricatures) and video therapeutic and many others. R. McMullin’s work “Workshop on Cognitive Therapy” describes over 100 individual techniques that are “in service” with a cognitive consultant.
“REBT represents...a form of eclecticism known as “theoretically consistent eclecticism” in that techniques are freely borrowed from other therapeutic systems but are applied for purposes consistent with the basic theory of REBT. In particular, REBT therapists are concerned with the short-term and long-term effects of specific therapeutic techniques: they will rarely use techniques that have immediate positive results but negative long-term consequences.”
Techniques not used or avoided in REDT
A. Ellis and W. Dryden directly list the techniques that are avoided in REPC:
-techniques that make clients more dependent (for example, excessive warmth of the therapist as strong reinforcement, creation and analysis of replacement neurosis);
-techniques that make people more gullible and suggestible (for example, perceiving the world through “rose-colored glasses”);
- techniques that are verbose and ineffective (for example, psychoanalytic methods in general and free association in particular, which encourage the client to give lengthy descriptions of the activating experience, or “A”);
-methods that help the client feel better in the short term, but do not guarantee lasting improvement (for example, some experiential techniques in which the full expression of feelings in a dramatic, cathartic and abreactive manner are some of the methods and basic techniques of Gestalt therapy; the danger here is is that such methods can encourage people to put into practice the philosophy underlying emotions such as anger);
-techniques that distract clients from working on their dysfunctional worldview (for example, relaxation, yoga and other cognitive distraction methods). These methods can, however, be used together with cognitive challenge to give way to some shifts in philosophy;
-methods that may inadvertently reinforce a philosophy of low frustration tolerance (for example, gradual desensitization);
-techniques that contain anti-scientific philosophy (for example, treatment by suggestion and mysticism);
-techniques that attempt to change the Activating Event (“A”) before demonstrating to the client how to change their irrational Beliefs (“B”) (for example, some family therapy techniques);
-techniques that do not have sufficient empirical support (for example, neurolinguistic programming, non-directive therapy, rebirthing).
Depth of work
REPC necessarily begins with persistent attempts to encourage the client to radically reconsider his worldview, since only such a fundamental restructuring can heal a person from unhealthy thinking and destructive emotions in the most fundamental way and for the rest of his life - so that he no longer has the need to seek outside help again . If the client in one form or another refuses this option, then the consultant moves on to symptomatic help, that is, to eliminating and replacing the client’s private irrational beliefs concerning certain aspects of his life or a specific type of situation.
“If suggestion therapy is the only way to prevent a client from harming himself, then the REBT therapist may use this method himself or, more likely, refer such a client to a healer.” If the client's cognitive mechanisms turn out to be susceptible only to shamanism, then the shamans will honestly earn their bread, but the priority of rationalism will not suffer at all. As J. Swift noted: “I am convinced that the existing definition of “man is a rational animal” is false and somewhat premature. It would be more correct to formulate: “man is an animal susceptible to reason.”
“The main goal of preference REBT is quite ambitious - to encourage the client to significantly change their worldview in two main areas related to ego concerns and discomfort. This involves helping the client, as far as possible, to rid himself of his irrational thought process of the shouldnanism type and to replace it with rational, non-absolutist thinking. ...With most clients, from the first session, REBT therapists prefer to use strategies designed to bring about a fundamental change in worldview. The therapist begins preference REBT with the assumption that a particular client is capable of making such a change, and ends it after sufficient evidence has been collected to refute the initial hypothesis.
…Although REBT therapists prefer to help their clients achieve profound changes in philosophy through “B,” they do not insist that their clients do so. If it becomes obvious that the client cannot or will not change his irrational beliefs at any given time, then the REBT therapist will try to help him either directly change "A" (by avoiding difficult situations or changing behavior) or change his distorted conclusions about situations.
REBT objectives
“Instead of interpreting to the client the historical cause of his deviations, the rational therapist shows him that he has power, that he has allowed the initial maladaptive reactions to failure and frustration to take hold of him. So he continues to react in the same manner that he chose years ago. The therapist fully recognizes that the client's biological heritage and social environment make it very easy for him to fall into some dysfunctional habitual patterns and return to self-destructive behavior. But it shows the client that difficult does not mean impossible; that he can change through active work on himself; and that he had better force himself to do so if he wanted to live with a minimum of anxiety and hostility.
In other words, the rational therapist explains to the client the essential duality that underlies his past, present, and future behavior. On the one hand, it demonstrates that the client is biologically and socially predisposed to neurotic deviations. On the other hand, the therapist shows that a person has unique abilities that are developed through effort and practice and with the help of which he can overcome his excessive suggestibility, strong hedonism and rigid thinking. He explains to the client how he became the way he is and the types of irrational beliefs he uses to stay the way he is. At the same time, he also explains how the client can logically dismantle, thoughtfully challenge, and mercilessly eradicate these beliefs. Therefore, his explanations are much deeper and have a stronger impact on clients with emotional or behavioral disorders than the interpretations of therapists from many other schools.
The rational-emotive therapist teaches his clients the basic principles of the scientific method. It shows them that incorrect conclusions about objective reality or the self arise from incorrect premises and subsequent reasonable conclusions from those premises or from correct premises and subsequent illogical conclusions. He shows his clients what their incorrect premises are and their illogical conclusions from correct premises. It trains them to accept hypotheses as hypotheses and not as facts, and to claim observed data as real, independent of the evidence of those hypotheses. He also shows how to experiment (as much as possible) with their own desires and activities to discover what they would truly like to have in life. The therapist is in many respects a scientific interpreter who teaches his clients, who in many cases resemble students of other sciences, how to follow the hypothetical-deductive method and apply it more accurately to their value systems and emotional problems.
Application of REBT
...Rational-emotive psychotherapy has a wider range of applications than other types of psychotherapy. Robert Harper, Cecil H. Patterson, and others have shown that many techniques, such as classical psychoanalysis, can produce measurable effects only for a relatively small number of clients and are rejected by other people (such as schizophrenics). However, rational-emotive therapy can be used to work with almost any type of person who comes to psychotherapy, including those who are conventionally considered psychotic, people in “borderline” states, psychopaths and the mentally retarded. This does not mean that equally good results are obtained when RET is used with difficult clients and with mildly neurotic clients. But the basic principles and methods of RET are so simple and effective that even people with very serious problems who have undergone years of intensive therapy with other methods to no avail can achieve significant improvement after using RET.
Effectiveness of REBT
…Is REBT actually more effective than other forms of psychotherapy? The question is not to prove it. Clinical results would seem to indicate that it benefits more people than most other methods; that through RET positive results are achieved in a surprisingly short time; that the improvements achieved after a course of RET are more lasting and profound than the results obtained through other methods. But this clinical evidence has been collected haphazardly, and controlled studies of therapeutic outcome are now being conducted. My hypothesis is that REBT is a more effective procedure for clients and therapists because it is active-directive, comprehensive, unusually clear and precise, sober and practical.
It is also very important that rational-emotive therapy is philosophically unambiguous, logical and empirically oriented.
18. Humanistic-oriented counseling
This direction in practical psychology arose as a reaction to the costs of psychoanalytic, behaviorist and cognitivist approaches to personal difficulties. In psychoanalytic approaches, what is unacceptable for representatives of this direction is the determinism of human behavior by lower drives, similar to the drives of animals, and the predetermination of individual behavior in adulthood by the characteristics of socialization in childhood.
In behaviorist approaches, what is unacceptable for representatives of this direction is the almost unambiguous determination of human behavior by the features of the social context, the analogy between the behavior of humans and animals.
In cognitivist approaches, what is unacceptable for representatives of this direction is the interpretation of a person as a device for collecting and processing information, an analogy between the realities of a person’s mental life and the work of a computer.
The main provisions of this approach:
Personality is not something uniquely given by nature or the educational environment, but is always an open possibility of free development based on internal choice.
Each person is unique, so you should not adjust your personality to the results of statistical studies. An analysis of individual cases is nonetheless warranted.
A person has a certain degree of freedom from external determination due to meanings and values.
The analogy between animal behavior and human behavior is unjustified.
Man is integral by nature.
Man is endowed with the potential for continuous development and self-realization, which are part of his nature.
The most well-known approaches in this area are:
Carl Rogers' client-centered approach.
The existential approach of Irvin Yalom and Rollo May.
Logotherapy by Viktor Frankl.
Some are inclined to include Frederick Perls's Gestalt therapy here, but this is partly hampered by its body-centeredness, the determinism of mental processes by the functions and needs of the body.
Basic principles of humanistic psychology
Humanistic psychology, which is the theoretical basis of the humanistic direction in psychological counseling, is a special direction that differs from other schools in a number of fundamentally important provisions for understanding human nature. It traditionally includes such concepts as G. Allport’s theory of personality traits, A. Maslow’s theory of self-actualization, K. Rogers’ theory and instructive psychotherapy, S. Buhler’s ideas about the life path of an individual, R. May’s ideas.
Each of these theories uses its own conceptual apparatus, creates original ideas about the inner world of a person and its development in the process of life, verifies and substantiates data obtained in the course of empirical research and in the process of psychotherapeutic work with clients. The differences that exist between theories, however, are not an obstacle that would not allow us to consider them from the perspective of general methodological principles.
These principles are:
· The principle of development, which means that a person constantly strives for new goals, self-improvement due to the presence of innate needs - the desire for self-realization, the need for self-actualization, the desire to carry out continuous progressive development.
· The principle of integrity, which allows us to consider a person as a complex open system aimed at realizing all its potentials.
· The principle of humanity, which means that a person by nature is kind and free, and only circumstances that prevent the revelation of his true essence make him aggressive and alienated.
· The principle of goal determinism, which involves studying personality characteristics in the aspect of a person’s orientation to the future, i.e. in terms of his expectations, goals and values, while rejecting the idea of causal determinism.
· The principle of activity, which allows you to accept the subject as an independently thinking and acting being, in whose life another person (for example, a psychotherapist) can play the role of a supportive, unconditionally accepting partner, creating favorable conditions for his development of a partner. The psychotherapist changes the client’s attitudes, helps him take responsibility, but does not teach or instruct.
· The principle of non-experimental personality research, which is based on the idea of integrity, and accordingly the impossibility of adequately studying personality in separate fragments, according to
When can cognitive psychotherapy help?
Cognitive psychotherapy is used in the correction of most mental and psychoemotional disorders. But most often this type of therapy is used to treat depression. A depressed person experiences an exaggerated sense of loss, which may be real or imaginary.
Depression is characterized by the presence of negative thoughts of several directions. First of all, the patient develops a negative image of himself; he considers himself a loser, an inferior person. At the same time, they are given a negative assessment of the world around them and passing events, as well as their own future. Experts call this the cognitive triad of depression. To overcome this psycho-emotional disorder, it is necessary to work in each of these directions, replacing dysfunctional thoughts with rational thinking.
In addition to treating unipolar depression and increased anxiety, this type of therapy is also used to eliminate obsessive-compulsive disorder, various phobias, eating disorders, migraines, anxiety and anger attacks, and other personality and behavioral disorders.
Cognitive methods can be part of complex therapy in the treatment of schizophrenia and bipolar affective disorder. The combination of psychotherapy with medication can eliminate hallucinations in patients with schizophrenia and mitigate other symptoms of this pathology. Researchers have proven its effectiveness in the correction of many somatic diseases.
During therapy, the therapist works to solve the problem; he does not change the patient's personality characteristics or shortcomings. From the very beginning, the patient and therapist must come to some kind of agreement, outline the range of problems on which they have to work. It is possible to eliminate the manifestations of the above-mentioned disorders with the help of experimental testing of disaptive thoughts.
Brief Biography of Aaron Beck.
Aaron Temkin Beck was born in 1921 in Providence, USA, into a Jewish family that emigrated in 1906 from western Ukraine.
Three years before the birth of their son, his parents lost their daughter, who died of the flu, and Aaron's mother never recovered from this loss. This led to the fact that the boy was brought up and grew up in an atmosphere of hopelessness and constant depression, in which his mother constantly remained. Perhaps it is for this reason that, after graduating from school, he entered the Department of Psychiatry at the University of Pennsylvania.
After graduating from university, Beck begins his own practice and works for quite a long time within the framework of the psychoanalytic concept in which he was educated. Over time, he becomes disillusioned with psychoanalysis and begins to look for his own path, which leads him to a very original theory for that time, which explains the origin of psychological problems in a different way.
In psychoanalysis, the main cause of an individual’s neurotic manifestations is considered to be factors of the unconscious, which, entering into an obvious or hidden contradiction with the super ego, give rise to neurotic manifestations (frustrations that appear as a result of destructive reactions to the world around us). The solution to the problem within the framework of this school is seen as the therapeutic method of psychoanalysis, which consists in the patient’s awareness of his unconscious manifestations and the direct connection of neurosis with early traumatic experiences. The key to successful psychoanalysis is the subsequent reappraisal of the initially traumatic event and the reduction of its significance for the patient.
Within the framework of behaviorism, the cause of neurotic manifestations was considered to be the patient's maladaptive behavior, which was developed gradually in the course of personal history as a result of repeated influences (stimuli). The influences (stimuli) that gave rise to such behavioral strategies lay in the patient's past, but behavior therapy did not emphasize the importance of memories, as it did in psychoanalysis. Within the framework of the practical application of behavioral psychology, it was believed that a sufficient solution to psychological problems was the use of special teaching techniques to change the patient’s behavior, that is, changing a maladaptive strategy to an adaptive one. Behaviorists believed that developing correct behavior was the key to success.
As for Aaron Beck, his new concept lay beyond the mentioned methods and was very original for that time.
Special techniques
To treat some severe mental disorders, special cognitive therapy techniques are used. They are combined with medications and other types of mental health care. In this way, it is possible to reduce the severity of the symptoms of the disorder and increase the effectiveness of the main treatment.
Among the special methods of cognitive psychotherapy, the most popular are the methods used to treat such pathologies:
- Obsessive-compulsive disorder. When correcting this disease, the “four steps” method, developed by American psychiatrist Jeffrey Schwartz, is used. The goal of this treatment method is to change or simplify obsessive thoughts and “rituals” procedures, as a result they are reduced to a minimum. The patient must become aware of his illness and learn to resist its manifestations. The therapist explains to the patient which of his fears are real and which are caused by the disease. They are clearly differentiated, and the patient is shown a model of behavior of a healthy person. Typically, people who represent authority for the patient are chosen as examples. Work in this direction is being carried out in stages, in four steps. This is why the cognitive treatment method for OBD received its name.
- Schizophrenia. This type of disorder is incurable, as it is associated with changes in the cerebral cortex. But the use of cognitive and behavioral therapy methods allows people suffering from schizophrenia to accept their illness and learn to smooth out its manifestations. If the patient constantly conducts conversations with otherworldly entities or imaginary images, then the psychotherapist helps him understand that the conversations are not with living people. Gradually, the person with schizophrenia realizes that his interlocutor is a figment of his imagination, as a result of which such conversations are given less importance. Over time, the patient recalls the imagined image from memory less and less often.
- Addictions. Alcoholism and drug addiction are also caused by a person's incorrect automatic thoughts. A feature of the cognitive approach to treating these disorders is that the therapist must first talk with the patient about his long-term plans and life priorities. After all, a person’s short-term goals should depend on this. First of all, he needs to explain that the main goal of any living being is survival. All animals and people enjoy things that promote procreation and survival, such as food, sex, etc. Processes that harm life cause negative sensations (hunger, cold or heat). All these sensations are transferred to actions or situations associated with them. But a person suffering from some type of pathological addiction has a new source of pleasure that was not provided for by nature. As a result, the patient becomes unnecessary natural joys, he sets himself the goal of obtaining pleasure through artificial means, which is harmful to his health and survival. The therapist must convince the drug addict or alcoholic that with a certain desire he can achieve the right goals, which will allow him to get rid of depression and a painful return to reality. It is possible to lift your mood in a natural way if you improve the quality of your own life, increase your self-esteem and “rise” in the eyes of others. Psychotherapists draw up a “wish map” for patients with addictions. This is a diagram that indicates the relationship of basic values necessary for survival with instincts and complex summary associations. This card, among other things, indicates exactly how addiction harms long-term plans and prevents you from fully enjoying life. Using this technique, you can save the patient from most harmful habits, for example, gluttony, gambling or Internet addiction.
The effectiveness of cognitive psychotherapy in the treatment of these severe mental disorders is quite high, as confirmed by numerous studies in this area. Cognitive and behavioral therapy can reduce the likelihood of relapse of the disease several times.
Theoretical basis of cognitive therapy.
Beck considered the cause of patients' problems in the way in which they interpreted the events of the world around them. The scheme he proposed for human reaction to these events was as follows.
External event => cognitive system => mental interpretation (idea about what happened) => reaction to the event (feelings and (or) behavior).
If we remember the basic principles of behaviorism, then there, human consciousness was considered as a black box about which no conclusions should be drawn, because what is happening inside cannot be detected in an objective scientific way.
This was both a great advantage of the behavioral approach, since it transferred psychology into the category of a scientific discipline, and a great disadvantage, since it excluded from the stimulus => response such an obviously important component of the process as consciousness and what happened in it from the point of view of the individual (even if and subjective).
As for psychoanalysis, which was dominant at that time in Europe, the situation was exactly the opposite. This teaching took into account what was happening in the patient’s field of consciousness, based only on Freud’s scientific assumption about the structure of this consciousness, and even undertook to interpret the cause-and-effect relationships of these essentially virtual processes. The patient’s behavior itself was determined by his neurotic tendencies, which lay in his past history.
Aaron Beck was one of the first who complicated (expanded) the human behavioral scheme and introduced consciousness into it as a cognitive component of the stimulus => response , thus, in essence, improving the behavioral approach. Also, he approached human consciousness in a completely different way than in psychoanalysis (and much simpler), reducing it to purely cognitive processes and their results.
Even more important was the fact that Beck’s theory, due to its simplicity, made it possible to easily transfer it into the field of practical psychology and make it an instrument of psychological help to people.
