Running head: A COGNITIVE-BASED FRAMEWORK FOR COUNSELING
A Cognitive-Based Framework for Counseling
Patricia L. Lindsay
University of Calgary
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Running head: A COGNITIVE-BASED FRAMEWORK FOR COUNSELING
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Table of Contents
Philosophical Assumptions ............................................................................................................. 4
Human Nature ............................................................................................................................. 4
The Nature of Healthy Functioning ............................................................................................ 5
The Major Causes of Problems ................................................................................................... 5
The Nature of Change ................................................................................................................. 6
The Counseling Experience ............................................................................................................ 7
What is Counseling?.................................................................................................................... 7
Establishing the Client-Therapist Relationship ........................................................................... 7
Establishing Goals ....................................................................................................................... 9
Roles of Client and Counselor .................................................................................................. 10
The Particulars of the Counseling Sessions .............................................................................. 11
Emphasis on the Past, Present and Future ................................................................................. 11
Beliefs, Emotions and Behaviors .............................................................................................. 13
Dealing with Resistance ............................................................................................................ 13
Interventions .............................................................................................................................. 15
Interventions to promote awareness. ..................................................................................... 15
Interventions to promote acceptance. .................................................................................... 16
Interventions to promote active change. ................................................................................ 17
Meichenbaum’s CBM............................................................................................................ 18
Coping statements.................................................................................................................. 18
Homework, manuals and bibliotherapy. ................................................................................ 19
Behavior experiments. ........................................................................................................... 20
Success .......................................................................................................................................... 20
Contextual Factors..................................................................................................................... 21
Reflection ...................................................................................................................................... 22
The Weaknesses of a Cognitive-Based Approach .................................................................... 22
The Appeal of a Cognitive-Based Approach ............................................................................ 23
Conclusion .................................................................................................................................... 25
References ..................................................................................................................................... 26
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A Cognitive-Based Framework for Counseling
Establishing a theoretical orientation early in the training process is a challenging task for
a counseling student. When approaching this task, it is important for a student to understand that
theoretical orientation is something that will grow and change over the their years of study and
practice, and that by stating an early affiliation to a theory does not foreclose the student’s later
integration of alternative approaches and techniques (Orlinsky & Ronnestad, 2005). On the
other hand, it is imperative that a student selects an orientation early so there is a foundation
from which to begin clinical work and to assess other approaches. In the long term, a
counselor’s commitment to a theoretical orientation is directly related to career performance and
satisfaction. Those with no salient orientation were less likely to show signs of progress when
compared to their theoretically committed peers. In addition, the uncommitted counselors
showed greater incidences of perceived stagnation and regression in their effectiveness as
therapists (Orlinsky & Ronnestad, 2005).
There is little debate about the importance of committing to a theoretical stance. Studies
show that nearly half of therapists describe their approach as being influenced by two or more
theoretical orientations and that integrated and eclectic approaches are extensive (Orlinsky &
Ronnestad, 2005). The approach presented here aligns with this trend in that it is based primarily
on cognitive theory, including REBT, with behavioral and Gestalt influences. This declaration
by no means precludes the ability of the counselor to experiment with other approaches or the
openness to integration of other theories and techniques.
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Philosophical Assumptions
Human Nature
As suggested by proponents of REBT and CBT, humans are born with an innate drive
towards growth and self-actualization. Unfortunately, humans are also born with the capacity for
negative drives including self-destruction, self-blame, perfection and avoidance of nurturing our
potential (Corey, 2005). In addition to this, humans are “self-talking, self-evaluating and selfsustaining” (Corey, 2005, p. 273). Often, we become our own worst critics by evaluating
ourselves against faulty beliefs and thought patterns we have developed over our lifetime. We
are prone to polarized thinking where we tell ourselves we must do certain things or we are
failures. We also mistake our faulty thoughts and beliefs for facts which in turn lead us down the
road of emotional dysfunction.
Humans are thinking beings whose feelings and behaviors are greatly influenced by their
thought processes, even from our earliest days of life (Corey, 2009). For example, when the
mother enters the nursery, the infant believes it will be picked up, fed and as a result, feels
happy, smiles and reaches up to its mother. When the mother leaves the nursery at nap time, the
infant knows they will be left alone, feels sad and cries. The child’s emotions stem from what
they believe will happen in their world and is a simple example of the connection between
cognitions, feelings and behaviors.
As we proceed through life, our belief systems, or the meanings we attach to events in
our environment, become increasing complex and ingrained and are strongly influenced by
messages we receive as children and by our own irrational interpretations (Corey, 2005). The
cognitive view of human nature, submits that our individual personalities reflect the basic beliefs
and thought patterns that we have developed in response to our environments (Beck & Weishaar,
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2011). Our innate tendencies, both adaptive and maladaptive, influence our construction of
those beliefs and thoughts. Spanning the spectrum between positive and productive, to negative
and self-defeating, these schemas influence our very nature and behavior as individuals.
The Nature of Healthy Functioning
Within the cognitive framework of human nature, a well-adjusted individual is one who
has cultivated a predominantly adaptive belief system that in turn activates adaptive responses.
The well-adjusted individual has rational and realistic belief systems that subsequently allow
them to navigate the world without the impediments caused by irrational, faulty and negative
cognitions. They understand that as a human, they are fallible and are able to accept themselves
as they are and live in emotional peace (Corey, 2005). Because their nature is inherently
positive, their thoughts, feelings and behaviors are generally adaptive and serve them well.
The Major Causes of Problems
Contrary to healthy functioning, those who function in an unhealthy manner are driven by
negative belief systems. Negative, faulty or irrational beliefs are accepted and perpetuated by the
individual, and give rise to feelings and behaviors that are generally maladaptive. Operating
from the philosophy that an individual’s cognitions determine their feelings and behaviors, it
follows that emotional disturbances are not caused by the environmental event itself, but the
beliefs a person attaches to it. Albert Ellis’ REBT approach speaks of the ABC model where he
submits that, contrary to what we may think, A (the activating event) does not cause C (the
emotional consequence). It is B (the belief/schema) that determines the reaction or C (the
emotional consequence).
The problem lies with the individual’s belief systems. Similarly,
from a cognitive therapy perspective, a person’s “automatic thoughts” – or beliefs that are
triggered by an environmental event – dictate the emotional response to a given situation. Aaron
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Beck submits that those with emotional difficulty commit errors in logic that skew their world
view towards the negative. These faulty assumptions and misconceptions, termed cognitive
distortions, are many including, arbitrary inferences, overgeneralization, polarized thinking and
selective abstraction (Corey, 2005). Maladaptive functioning stems from negative belief
systems and thought patterns which lead to erroneous interpretations of situations and subsequent
maladaptive responses. Biases in information processing characterize most psychological
disorders (Beck & Weishaar, 2011).
The Nature of Change
Dysfunctional emotions, thoughts and behavior are typically the result of maladaptive
cognitions, therefore corrective action must be aimed at modifying inaccurate and faulty
thinking. Change occurs when a client learns to correct their cognitive distortions and substitute
effective cognitions and belief systems for the maladaptive ones. In other words, “patients
change by recognizing automatic thoughts, questioning the evidence used to support them, and
modifying cognitions” (Beck & Weishaar, 2011, p. 295). If we change the way we think, we can
change the way we feel and act – a basic premise of cognitive therapy (Corey, 2009).
In accordance with the approach presented here, change requires a client to move through
three basic phases: awareness, acceptance and action. Movement is not restricted to a linear
progression, and the client will likely vacillate in and out of each phase throughout therapy,
completing the cycle for one issue and repeating it again for another. However, basic awareness
is required to start the change process as the client must first recognize where change is needed.
Once awareness of problematic cognitions and beliefs is established, a client may proceed
through an acceptance phase where the origins of their maladaptive thoughts and beliefs are
uncovered, worked-through and ultimately accepted. Whenever appropriate, and preferably as
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early as possible, the client and therapist can begin to initiate the action phase by applying
techniques, engaging in activities and agreeing on homework that will change dysfunctional
cognitions and beliefs.
The Counseling Experience
What is Counseling?
Counseling is a relationship between a therapist and client that provides the conditions
for safe exploration of clients’ maladaptive feelings, thoughts and behaviors and teaches
techniques to change them. The client seeks counseling because one or more aspects of their life
are unsatisfactory. Ultimately, they are looking for ways to make changes and return to a state of
satisfaction. The desire to change is the motivation to initiate counseling, and achieving change
is the ultimate outcome the client is strives for. To be successful, a client must be prepared to
take an active role in their therapy and accept that therapy is, in essence, the initiation of an
action plan for change (Amundson, 1995).
Establishing the Client-Therapist Relationship
Creating an environment that is construed as safe by the client is largely a function of the
client-therapist relationship and must be established if therapy is to be successful. Clients arrive
at the counseling session with some sense of what they’d like to accomplish with the therapist,
and the therapist comes to the session with conceptions of how they may help the client. From
the first encounter, the therapist must begin establishing a climate of acceptance in which the
client can safely explore the nature of their problems (Amundson, 1995). The Rogerian
principles of congruence, accurate empathy and unconditional positive regard will be of
paramount importance in establishing, and maintaining, the client-therapist relationship.
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To establish congruence or genuineness, a therapist must behave authentically by openly
discussing their feelings, thoughts and reactions with the client (Corey, 2005). The primary way
to show congruence is through self-disclosure, which must be delivered tactfully and only when
the timing is right for the client to hear such disclosures. If used well, displays of genuineness
will increase trust between therapist and client and begin to set the scene for therapy to begin.
Along with congruence, accurate empathy is necessary to build a thriving client-therapist
relationship. Accurate empathy requires the therapist to submerge themselves into the client’s
world, enough to get a profound understanding of their subjective reality, without becoming lost
in it. Empathy can be expressed by verbally reflecting the feelings of the client, but is often
something that is just “sensed” between the client and therapist. Ideally, empathy should be
developed to the point that the therapist can reflect feelings that are not entirely known to the
client. In doing this, the therapist models a more self-reflective approach in hopes of increasing
the, “client[‘s] self-understanding and clarification of their beliefs and worldviews” (Corey,
2005, p. 173).
The final factor in maximizing the client-therapist relationship is unconditional positive
regard. This requires the therapist abstain from any judgments of their client’s thoughts, feelings
or behaviors and to accept the client just as they are, with no conditions. Behaving in this
manner allows the client to feel secure enough in the relationship to share their deepest
experiences without fear of losing their therapist’s acceptance. This is not to say that the
therapist must approve of the client’s thoughts and behaviors, but it does imply that the client is
free to feel, behave and think in any way they choose (Corey, 2005). The client’s ultimate right
to choose must always be honored.
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While a strong client-therapist relationship is needed for the work of counseling to
unfold, it is not sufficient to bring about significant amounts of client change. Following a
process, establishing goals, and utilizing specific techniques and exercises to achieve change, is
also required.
Establishing Goals
Therapy, as stated above, is the initiation of an action plan for change. A plan must be
laid in accordance with the end goals, or changes, a client wishes to achieve. Goals will largely
be determined by the client, as they enter counseling with some sense of what they wish to
achieve. When developing appropriate goals, the client and therapist should work together to
describe goals in terms of action, using action verbs like increasing, decreasing, reworking, etc…
This assists the client to identify what behaviors they wish to change with goal statements like,
“Decreasing angry outbursts and increasing patience”. Goals for cognitive therapy are most
useful when they are aimed at a specific behavior or thought pattern, so the therapist should work
with the client to home-in on their desired outcomes and translate them into specific, detailed and
measurable goals. Finally, it is beneficial to use the client’s language when stating goals,
including their own metaphors and statements. Following these guidelines allows the client to
feel ownership and commitment to the agreed upon goals (Amundson, 1995).
It is important to appreciate that a client may not know the goals they have for therapy,
and in severe cases of depression or anxiety, the therapist may need to take a more directive role
in these cases (Beck & Weishaar, 2011). Goals for therapy may change and should be reassessed
with the client often.
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Roles of Client and Counselor
The counselor assumes many roles in this approach. First, the counselor must embody
and demonstrate the three core conditions as described by Rogers: congruence, accurate
empathy and unconditional positive regard. In so doing, they create the safe and trusting
environment that is essential for therapeutic work. Therapists also assume the role of teacher in
that they are seeking to reeducate their clients on alternate, healthier thoughts, feelings and
behaviors by using a learning approach to psychotherapy (Beck & Weishaar, 2011).
Furthermore, as the client struggles to achieve awareness of their belief systems and thought
patterns, the therapist assumes the role of interpreter insofar as they can assist the client in
making, and validating, links between current conditions and behaviors and past events, or the
meanings of their current thoughts, feelings and behaviors. Also, the therapist acts as somewhat
of a critic in the sense that they critically evaluate, and attempt to undermine, the schemas,
automatic thoughts and thought patterns of the client. Note that the criticism is always done
within the parameters of congruence, empathy and unconditional positive regard. Criticism is
meant to be constructive, delivered in a non-confrontational, even humorous, way and used to
gently increase the client’s awareness of their dysfunctional beliefs.
The client, on the other hand, assumes the role of a student who is open to learning and
taking an active role in therapy to do the work needed to achieve their goals. In addition to this,
to ensure a satisfactory experience, a client must also strive for congruence in the relationship,
just like the therapist, by remaining genuine and authentic during the session and openly
expressing reactions and feelings that are present in the relationship with the therapist. It is also
necessary for the client to be open to interpretation and possible explanations for their thoughts,
feeling and behaviors. Clients must also strive to explore alternative ways of thinking that would
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be more personally satisfying. Not unlike the therapist, the client must also become a critic of
their own schemas, automatic thoughts and thought patterns and actively utilize tools to uproot
them.
The Particulars of the Counseling Sessions
Therapy sessions should run approximately 45 minutes, one time per week (Beck &
Weishaar, 2011). In some cases, one session biweekly would be acceptable. The number of
sessions a client requires will vary from individual to individual, and some will be mandated by
their insurance plans. If a client is restricted by their insurance plan, the maximum allowable
sessions will likely be used. In all other cases, sessions may number from 5 to 20, which align
with the typical duration of most CBT treatments (Royal College of Psychiatrists, n.d.). Because
the client and therapist will have established goals for their collaborative work, frequent
assessment of progress made towards goals will be a gauge as to how many more, or less,
sessions will be required. Each treatment plan will be different and reflect the needs of the
individual client.
Emphasis on the Past, Present and Future
In this cognitively-driven approach to counseling, all three timeframes will be explored
beginning with the present, moving to the past and finally considering the future. Congruent
with the three phase approach to change described above, the first step is establishing awareness
by focusing the client on the present and drawing out the reasons why they came to counseling.
The therapist would further sharpen the focus on the present by asking the client how they are
feeling at the exact moment they are speaking. Initially focusing on the present increases the
client’s overall awareness of their thoughts, feelings and behavior and helps the therapist detect
the underlying messages the client lives by. Awareness of a client’s internal dialogue and
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thinking processes allows both client and therapist get a detailed view of their current
functioning and to understand what specific material client and therapist are working with. In
order to change maladaptive thoughts and beliefs, we have to know the present state of those
thoughts and beliefs first.
Once a sufficient amount of awareness is established, counseling will move towards the
acceptance and action phase. The focus will naturally shift to the past as the client strives to
understand where their schemas, automatic thoughts and beliefs originated. Focusing on the
past is not normally an explicit part of cognitively based therapies, however many core beliefs,
or Early Maladaptive Schemas, are established from early life experiences with others and the
environment (Beck & Weishaar, 2011). In addition, contemplation of early life experiences and
their effect helps the client reduce self-blame, helps them see the logical basis for their
maladaptive thoughts and proves that there is a legitimate reason for their problematic
cognitions. Comfort is gleaned from knowing there is a basis to their troubled thoughts and that
they are not “crazy”.
The value of exploring the past is validated by Corey who states that,
“present beliefs about self and the client’s current problems are often related to past hurt. Unless
clients come to terms with these past traumas, the vestiges of these traumas tend to linger in the
background and influence their current ways of being” (2009, p. 61). In addition, working
through past traumas allows the client to recognize that while their current thought patterns are
attributable to significant others in their lives, they are ultimately responsible for perpetuating the
faulty thinking. Once this realization is made, and the client assumes responsibility for their
thoughts and behaviors, they are ready to commit to change and the work involved in achieving
it.
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With a readiness to assume work, the client and therapist can launch actions to change
maladaptive thinking. While predominantly present focused, in that the client is working with
current situations, beliefs and thought patterns, the changes and outcomes are future focused as
the client is striving towards a better set of cognitions to live by.
Beliefs, Emotions and Behaviors
Clearly, this approach to counseling adheres to the theory that thinking is the basis of
emotional and behavioral disturbances and the key to their treatment. Thoughts, feelings and
behaviors are deeply interconnected and each generates the other. Describing a female client,
Corey explains this succinctly by saying, “When she thinks, she also feels and acts. When she
acts, she feels and thinks. When she feels, she thinks and acts. Cognition, emotion and behavior
are not separate human functions, rather, they are interactive and integrated” (2009, p. 62). The
three phase process of change proposed here seeks to first create an awareness of cognitions,
emotions and behavior, secondly to enable acceptance of those cognitions, emotions and
behaviors, and lastly, to engage in actions aimed at changing those cognitions, emotions and
behaviors from problematic to productive.
Dealing with Resistance
Most experts agree that resistance is a common and normal part of therapy (Meara &
Patton, 1994). Understandably, therapy can be construed by the client as threatening,
particularly if their treatment is mandated, and their natural reaction is to resist the process.
While it can prove challenging for the therapist, resistance can provide excellent material for
counseling.
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In order to use resistance in a productive way and ensure that it does not erode the clienttherapist relationship, or lead to the termination of therapy, it is helpful to understand some of the
reasons it occurs, how it manifests and how a therapist can support the client through resistant
behavior. Though written with career counseling in mind, Meara and Patton (1994) suggest that
client resistance is often caused by a fear of counseling that presents in three ways: fear of the
counselor, fear of the counseling process and fear of discovering something unpalatable about
oneself.
Therapists should be watchful for indications of resistance which include, lateness and
cancellation of appointments, attempts at early termination, avoidance of significant material,
refusals to cooperate, intellectualizing, frequent switching of topics, incomplete homework
assignments, and so on (Meara & Patton, 1994). If the client-therapist relationship is established
early and well, resistance will be minimized because of it. If a safe, genuine and empathetic
environment is created, the fears associated with counseling may not escalate to a level of
resistance that impedes the work of therapy. However, if resistance is noticed, it should be
explored. As a therapist committed to genuineness, it would be important to share one’s sense of
the client’s resistance and bring it forth for discussion. Acting from a place of unconditional
positive regard, resistance would be approached with concern and respect, therefore increasing
the likelihood the client will explore their resistant behavior in session (Corey, 2009). Client and
therapist can arrive at mutually acceptable solutions to work through the obstacles associated
with resistance.
If resistance is profound, a critical evaluation of the client-therapist relationship is
needed. The therapist and client should honestly assess their relationship and see if the problem
lies there. Also, the therapist may consider whether their process is incompatible with the
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client’s preferences, or if they are pushing an agenda that is more theirs than the client’s. If
resistance remains insurmountable than this particular pairing of client and therapist, and this
approach to counseling, may not be viable.
Interventions
Interventions will be selected according to which phase of counseling the client is in. For
each of the three phases, awareness, acceptance and action, different interventions would be
appropriate. Whatever the intervention used, the counselor will provide the client with an
explanation for it. This is necessary as it “demystifies the therapy process, increases patients’
participation and reinforces the learning paradigm in which patients gradually assume more
responsibility for therapeutic change” (Beck & Weishaar, 2011, p. 291).
Referring back to the
discussion of resistance, “demystifying” may also reduce the client’s potential fear of the
counselor and the counseling process and strengthen the client-therapist bond.
Interventions to promote awareness.
At the outset, Socratic dialogue, or open-ended questions, would be used to promote
awareness. As explained by Beck and Weishaar, Socratic dialogue is used to, “(1) clarify or
define problems (2) assist in the identification of thoughts, images, and assumptions, (3) examine
the meanings of events for the patient, and (4) asses the consequences of maintaining
maladaptive thoughts and behaviors” (2011, p. 292). Questioning can be used to generate a lifestyle summary including effects of the family constellation, early recollections and basic
mistakes. Though Adlerian in their origin, these methods are appropriate in this cognitive
approach. The information generated from this dialogue provides the material for therapy as it
helps to expose the origins of faulty cognitions and provides a basis for their acceptance. As a
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prerequisite to behavior change, a client must notice how they think, feel and behave (Corey,
2005).
Early in therapy, a problem list should be generated. The list should include symptoms,
behaviors and problems that are persistent and pervasive. When goals are established, the client
and therapist can use this list as a way to prioritize and direct therapy (Beck & Weishaar, 2011).
Interventions to promote acceptance.
Once the details of the patient’s difficulties are revealed, there is a need to come to terms
with those revelations. This part of the change process may not be applicable in all cases. Some
clients may have a distinct need to understand the origins of their schemas, core beliefs and
automatic thoughts as part of the acceptance and healing process, and some may not. For clients
with this need, several interventions can be helpful. Guided visualizations, where the therapist
takes the client back to a traumatic scene in their childhood can be fruitful, albeit very emotional.
The client can travel back in time, via their imagination, and stage a conversation between their
adult self and child self. Here the client can reassure their young self, acknowledge the hurt and
promote healing at the source of the pain. Imagery work is used in many theoretical approaches
and is a testament to its usefulness as a way for the client to deal with unfinished business,
assuage past hurts and increase self-support and acceptance.
Gestalt-based interventions like focusing, enactment and empty-chair techniques would
be used as well. When a client reports a difficult or disturbing feeling, asking them to stay with
it, “encourages the patient to continue with the feeling being reported and builds the patient’s
capacity to deepen and work through a feeling” (Yontef & Jacobs, 2011, p. 365). The idea of
working through a feeling is necessary for acceptance. Similarly, enactment asks the client to
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put their feelings into action, offering another way to deepen and work through a feeling.
Enactment can take many forms like role-playing, psychodrama, journaling, poetry, art or
movement, so the therapist and client can select which form feels most comfortable for the
client. Whatever the form selected, experiencing negative emotions in a profound way helps to
reduce their power in the client’s life.
The Gestalt-based empty-chair technique may be the most common form of enactment
and involves the client staging an imaginary interaction with a person from their past or an aspect
of themselves. The client alternates between being themself and the other. In doing this, the
client can experience the unresolved conflict more fully. The goal of this exercise is to achieve a
higher level of acceptance and integration of the conflicts and resulting maladaptive beliefs.
“The aim is not to rid oneself of certain traits but to learn to accept and live with the polarities”
(Corey, 2009, p. 216).
Interventions to promote active change.
At the discretion of the therapist, and agreement of the client, actions aimed at uprooting
maladaptive beliefs and thoughts, and replacing them with more adaptive ones, can begin. The
three elements of change proposed here do not occur in a predictable way, and the client and
therapist should be willing to apply the interventions associated with each phase when it is
appropriate, regardless of the stage of counseling they are in. Interventions based on action can
be implemented as early as the first session and in fact is preferable that way.
The repertoire of
action-based interventions is large for cognitive-based approaches, so the therapist and client
have much freedom in selecting which method works best for the client. Regardless of the form
the activity takes, its purpose is to acknowledge current beliefs, thoughts and schemas in action,
and deactivate them by modifying their content and structure and considering new, healthier
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ways to think and respond (Beck & Weishaar, 2011). Charts are often used as a way to track and
rework cognitions and reactions.
Meichenbaum’s CBM.
Addressing the idea that, as Beck contends, we are “self-talking” individuals,
Meichenbaum’s CBM approach would be useful (Corey, 2005). CBM, or cognitive behavior
modification, submits that a person’s self-statements affect their behavior in much the same way
as statements made by other people. Meichenbaum believes that clients need to interrupt the
self-talk and, by extension, the scripted behavior that results (Corey, 2005). If a client learns to
question their self-talk and override it with more self-affirming statements a change in feeling
and behavior would result. This kind of work is aligned closely with the idea of coping
statements as outlined next.
Coping statements.
Polarities in thinking, or the idea that we must do, or feel, something or we are a failure,
is a common form of biased thinking. Humans fall prey to accepting their beliefs and thoughts
as facts when really they are preferences. Helping a client to recognize their rational beliefs, and
distinguish them from irrational beliefs, polarities or musts, and then teaching them to dispute
the demands, and change them to more appropriate preferences, is a necessary intervention
(Corey, 1991). This approach stresses the creation of coping statements such as, “I want to be a
good mother and yelling at my children on occasion does not make me a bad mother”, versus, “I
am a bad mother because I yelled”. Or, “It would be better if I did not lose my patience with my
children”, versus, “I must never lose my patience with the children”. Repeatedly reminding the
client of these rational statements, and encouraging them to recall them during times of distress,
will eventually help remold their thinking and promote self-acceptance.
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Homework, manuals and bibliotherapy.
Cognitive-based activities often involve “homework” where the client completes
assignments or does experiments between therapy sessions. An example of an early homework
activity, that can be assigned immediately, is to have the client recognize the connection between
thoughts, feelings and behavior. Explaining the A-B-C theory and asking the client to create a
list of their automatic thoughts during distressing situations helps them become accustomed to
monitoring their thoughts and completing assignments (Beck & Weishaar, 2011). “[Clients]
learn that reading, writing, thinking, and carrying out activity-oriented homework assignments
are part and parcel of this therapeutic approach” (Corey, 1991, p. 210).
As therapy progresses, homework becomes more detailed and begins to involve thought
records and behavior experiments.
Bibliotherapy can be incorporated here and a good manual
to start with is Mind Over Mood, by Greenberger and Padesky. It contains explanations,
instructions and blank templates of thought records that can be completed by the client between
sessions and reviewed later with the counselor. Step-by-step instructions to uncover hot
thoughts, beliefs and core assumptions are given. The purpose of these exercises is to expose
irrational thinking and beliefs, and change them by treating them as testable hypotheses, to be
examined, replaced, or by proved irrational by gathering evidence against them.
If manual-based exercises are agreeable to the client, many excellent books are available
including Reinventing Your Life by Young and Klosko. This book gives the client an
opportunity to uncover their core schemas, or “life traps”, and offers practical techniques for
overcoming those strongly rooted biases. Since this book helps clients change their major life
patterns, it is also complementary to the approach proposed here. Furthermore, for those clients
who are inclined to more academic, scientific reads, The Brain that Changes Itself, by Norman
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Doidge, offers a fascinating and applicable read about the plasticity, or changeability, of the
human brain. It’s relevance to cognitive-based therapy is obvious.
Behavior experiments.
Another effective challenge is asking the client to perform behavior experiments. Here
the client and therapist choose a behavior or feeling that needs to be tested and overturned. For
example, the client’s hypothesis that their self-worth is connected to how clean they keep their
house could be tested by asking them to refrain from cleaning their house before guests arrive.
Intentionally setting up the situation where the house remains uncleaned and guests arrive, helps
the client see that they are still accepted by others. Client and therapist can review the thoughts
and feelings that occurred during the experiment and discuss the outcomes and ramifications of
not cleaning the house. Hopefully, the client will eventually conclude that they were still loved,
accepted and valued in a messy house, their worst predictions did not occur, and their self-worth
is not reliant on a clean house. Their hypothesis is ultimately disproved.
Success
Rather than needing a therapist’s support when problems arise, successful therapy equips
the client to manage challenges using insights and techniques learned in therapy. Ultimately, the
client should leave counseling prepared to be their own therapist and have strongly internalized
the following main insights, loosely based on those Gerald Corey (1991) suggests:
1. Most of my emotional and behavioral dysfunction is a result of how I interpret the
conditions of my life. My interpretations can be faulty, biased, based on rigid belief
systems, past experiences and my core beliefs about myself. I am equipped to combat
those maladaptive thoughts and behaviors.
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2. Regardless of the historical origins of my maladaptive beliefs and thought patterns, I have
accepted their origins and healed the past hurt. I recognize that it is in my control to
change the beliefs that were once adaptive but are now outmoded.
3. Life will present constant emotional challenges, and I will need to keep working to
dispute irrational and dysfunctional beliefs from my past and prevent any new ones from
taking root.
4. Returning to therapy for additional assistance does not make me a failure. It makes me a
more aware person who is open to personal change and betterment.
Contextual Factors
A strong suit of this cognitive-based approach is that it focuses on the client’s beliefs,
thoughts and behaviors which inherently include their cultural background. It is up to the client
to determine if their cognitions are helpful for them or lead to dysfunctional behavior. The
therapist is not in the business of prescribing new thoughts or behaviors, but allows the client to
assess whether their thinking is producing positive or negative effects on their life. The client’s
personal assessment will be influenced by their own values, beliefs and cultural systems.
Therefore, a cognitive-based approach is suitable for clients from vast and varied cultures. Beck
and Weishaar support this view by saying, “Sometimes people’s personal beliefs are at odds with
the cultural values around them. Other times, a person’s beliefs may be changing with culture
change ... and discrepancies may cause distress. In these cases, cognitive therapy may help
patients think flexibly in order to reconcile their beliefs with environmental constraints or
empower them to find solutions” (2011, p. 301).
Similarly, Ellis himself described REBT as “intrinsically multicultural” in that it does not
question the goals and values of the client, but only asks them to challenge their rigid and
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absolutistic demands on themselves and others (Corey, 2005, p. 300). The client decides which
values to adopt and the therapist teaches them ways to become more flexible in their thinking
and behavior (Corey, 2005).
Reflection
The Weaknesses of a Cognitive-Based Approach
A cognitive-based approach like this one is most beneficial for people whose problems
can be defined and where cognitive distortions are apparent (Beck & Weishaar, 2011). If these
conditions are not present, than this approach may be less suitable. For example, in crisis
counseling, the exploration of belief systems and thought patterns would be an unlikely direction
for the session to take. Though benefits could no doubt be reaped by understanding how a
client’s cognitions have contributed to their current crisis, it is not suitable for a person in need of
a plan for immediate personal well-being or shelter. However, there may be value in helping a
client to reframe their current situation by discussing polarized thinking and REBT’S
“musturbatory” behavior.
Since this theory asks the client to challenge their beliefs and thoughts, and come up with
more adaptive ways of thinking, it requires a certain amount to insight and intelligence. Clients
with limited intelligence, or young children, may not be able to engage in a cognitive-based
change process (Corey, 1996).
Another potential weakness in this theory is born of the cognitive profiles that have been
developed to address specific psychological disorders. Cognitive therapists believe that
predictable biases in information processing exist with certain conditions. For example, those
suffering with depression have a strong bias to a negative view of self, experiences and their
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23
future (Beck & Weishaar, 2011). While this may be empirically supported, the therapist must
remain vigilant and avoid pushing people into a profile because they are diagnosed with a
specific disorder. Each individual is different and no one explanation can account for all client
experiences.
Cognitive profiles may tempt a therapist to jump to conclusions and fail to assess
the individual’s reality accurately.
The Appeal of a Cognitive-Based Approach
Shifting to a personal perspective, the appeal of this theory is closely connected with my
own personal therapy experiences. In my time as a client, I spent numerous years with therapists
whose attempts to help me ultimately failed. Two years ago, I began treatment with a therapist
who practiced CBT. The experience that ensued was life changing for me. As a result,
cognitive-based approaches have credibility for me.
What CBT offered, that other approaches did not, was a tangible, active, concrete and
comprehensive way to understand and change thought patterns and belief systems. Recognizing
that I had to take an active role in my therapy to produce change, inspired me to take
responsibility for my current state and strive towards a better version of myself. Being held
accountable for my own thoughts and behaviors changed me from a passive victim of my
thoughts and beliefs to an active critic and controller of them. CBT, “stresses the client’s
capacity to control his or her own destiny” (Corey, 1996, p. 178).
One area where the purely CBT approach disappointed me was the lack of strong focus
on past events and experiences in my life. For me, it was critical to bring forth painful
memories, understand how they impacted my cognitions and have a professional validate them
as legitimate causes of my dysfunction. Ultimately my therapist agreed to guide me through an
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exploration of the past, but felt that it was not necessary for change to occur. Because the value
of exploring the past was such a critical part of my acceptance, healing and change, I have
allowed for it in my personal approach.
Also appealing is that this cognitive-approach is fast-acting. Clients can immediately see
the value of challenging negative assumptions and beliefs and can put new thinking into practice
quickly. Though learning to challenge our thinking is a life-long venture, that improves with
practice, clients can experience positive reinforcement quickly, which increases their
commitment to personal change. It places value on actively practicing new behaviors so that
insight is applied to real life (Corey, 1996).
From the business perspective of a hopeful future counselor, the qualities of a cognitivebased approach may increase the chances of getting referrals from family doctors, EAP programs
and word-of-mouth referrals. Insurance companies may be more likely to cover therapy that has
a proven track record, like a cognitive-based one. The effectiveness of this approach, and the
ability to make changes fairly quickly, increases its viability in a business sense and may make it
a more prudent choice for professional practice.
Overall, a predominantly cognitive approach offers the client an opportunity to develop
awareness of their faulty thinking and learn methods to challenge and defeat illogical thinking
and replace it with more productive thinking. It teaches the client to discern the differences
between what is factual and what is tied to their values and choices (Corey, 1996).
It is
focused, understandable, practical, and effective and subscribes to explanations and techniques
that are not mysterious or complicated. These characteristics promote the successful transfer of
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knowledge and techniques from the therapist to the client, ultimately increasing the chances for
successful therapeutic outcomes (Corey, 1996).
Conclusion
The cognitive-based theoretical approach presented here seeks to help people change by
emphasizing the connections between thoughts, feelings and behaviors. The process provides a
framework for the client to gain awareness of their problematic cognitions, thoughts and beliefs,
an opportunity for them to work-through and accept the origins of their faulty thinking and
provides techniques to begin adopting new ways of thinking and responding. Offering high
applicability, comprehensive, “hands-on” activities, in a safe, authentic and collaborative
environment makes this cognitive-based approach an excellent starting point for the beginning
counselor and their clients.
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