EmpathicPivot

CBT is based on the idea that maladaptive behaviour is learnt, rather than being the result of an underlying or unconscious psychodynamic conflict or condition, and that education can therefore be used to achieve change (Powers & Kalodner, 2016).

CBT is a combination of two approaches, Behaviour Therapy—broadly based on Pavlov’s classical conditioning (learning through association) and Skinner’s operant behaviour (the reinforcing of the stimulus for a behaviour)—and the subsequent application of research by Beck and Meichenbaum on the impact of cognitive processes on behaviour (Johnson, 2015).  

CBT supports social justice through promotion of empowerment and self-determination, reflected in education, skills building and collaborative practice, that provides the person with skills to work towards social and political change (Johnson, 2015). 

CBT also recognises that maladaptive thoughts and behaviour may be the result of a person’s ecological systems—social disadvantage, discrimination or trauma—and that thoughts and schema could arise through a variety of cultural factors including ethnicity, gender and spirituality or belief system (Johnson, 2015). 

Respect for persons is reflected in the importance of the therapeutic relationship and collaborative practice (Wright et al., 2017).

CBT is problem-orientated and can be delivered in a limited number of sessions depending on the issue (Wright et al., 2017). According to Wright et al. (2017) an overview of typical CBT methods is: 

• Determine the duration and format of sessions in the context of the person’s presenting issue—longer more frequent sessions for PTSD, OCD and anxiety and shorter where impaired concentration is a factor.
• Focus on current functioning—what events, cognitions, feelings and behaviours are happening now.
• Develop case formulation that includes historic factors—such as childhood, family, work, trauma, social influences, health—so as to gain complete understanding for current interventions. For Johnson (2016) case formulation is a problem list from approximately 8 areas in the person’s life that are currently affecting them, along with diagnosis, working hypothesis, protective factors and a plan for change.
• Develop an open, trusting and empathetic therapeutic relationship that is collaborative, work-orientated and pragmatic.
• Involve the person in the structuring of sessions, including agenda setting and routine feedback. 
• Involve the person in the change process through Socratic questioning and ‘guided discovery’ (pp. 95-98) to help them identify and change maladaptive thoughts, schemas and behaviours using homework and repeated real-world practice.
• Use behavioural techniques such as exposure/desensitisation, activity scheduling, breathing and relaxation techniques.

The practitioner is a collaborator in a therapeutic relationship but also an educator and coordinator of a practical activity-focused program designed to change thoughts and behaviour. (Cottone, 2017). 

They are expected to take a directive role in identifying appropriate assessments and interventions, and to collaborate with the person to establish goals that are significant, attainable, and realistic (Cottone, 2017).

The person is a collaborator in a therapeutic relationship who is required to do significant work including set goals and session agendas, complete homework and develop skills (Wright et al., 2017). 

Anxiety and depressive disorders, chronic depression, eating disorders, substance abuse, post-traumatic stress disorder, obsessive-compulsive disorder, bipolar disorder, and certain personality disorders (Wright, Basco, & Thase, 2017).

Improved emotional regulation, more adaptive and realistic thinking patterns, and enhanced behavioural coping skills (Wright, Basco, & Thase, 2017).

The highly structured nature of CBT provides a goal orientated focus that builds skills and is empowering (Cottone, 2017). 

CBT offers people practical tools to modify their maladaptive thinking and behaviour through a collaborative therapeutic process (Wright, Basco, & Thase, 2017).

From a psychoanalytical point of view CBT does not consider unconscious factors to explain behaviour and is focused on the present (Powers & Kalodner, 2016). 

Some behaviours may be so ingrained in a person when practiced habitually over time that they resist change through CBT (Bolton, Hall & Lehmann, 2022). 

The highly structured nature of CBT could limit the ability of a person to explore their grief or trauma and may create distance between the person and practitioner that hinders the therapeutic relationship. 

CBT can also be limited by its reliance on the person’s motivation and cognitive ability (Wright, Basco, & Thase, 2017).

Bolton, K., Hall, C., & Lehmann, P. (2022). An overview of and rationale for a generalist-eclectic approach to direct social work practice. In K. Bolton, C. Hall & P. Lehmann, Theoretical perspectives for direct social work practice: A generalist-eclectic approach (pp. 26-65). Springer Publishing. https://ebookcentral.proquest.com/lib/UWA/detail.action?docID=6608308

Cottone, R. (2017). Theories of counseling and psychotherapy: Individual and relational approaches. Springer. http://ebookcentral.proquest.com/lib/uwa/detail.action?docID=4857220.

Johnson, B. (2017) Cognitive-behavioral approaches in counselling and psychotherapy. In H Tinsley, S. Lease, & N. Giffin Wiersma (Eds.), Contemporary theory and practice in counseling and psychotherapy (pp. 356-389). Sage Publications. http://ebookcentral.proquest.com/lib/uwa/detail.action?docID=5945514.

Powers, Y., & Kalodner, C. (2016). Cognitive behaviour theories. In C. David & M. Stauffer (Eds), Counseling and Psychotherapy : Theories and Interventions (pp. 284-311). American Counseling Association. http://ebookcentral.proquest.com/lib/uwa/detail.action?docID=4461604.

Wright, J., Brown, G., Thase, M., & Basco, M. (Eds). (2017). Learning cognitive-behavior therapy: An illustrated guide (2^nd ed.). American Psychiatric Association Publishing.