“Critically discuss the contribution of CBT to
Word Count: 2,041
“Critically discuss the contribution of CBT to Counselling /Psychotherapeutic practice.”
Human suffering has preoccupied thinkers for centuries, from philosophers and scientists to artists and writers. Over the last 100 years a medical approach has dominated, in which human suffering is seen as a “mental health problem”; and so a ‘helping profession’-Counselling and psychotherapy was developed to work with people who were troubled by difficult emotional experiences (Barker, Vossler & Landridge, 2010).
“Neurosis is a high-class word for whining”, (Albert Ellis, p. , 1958).
Albert Ellis (1958) believed irrational ways of thinking brought about most psychological conditions and that to get better, patients needed to tackle these skewed ways of thinking, correcting them and developing new ones. He believed that psychotherapy should be short-term, goal oriented and efficient and so he developed a technique called Rational Emotive behaviour therapy (REBT).
REBT is one of the foundations for Cognitive Behavioural Therapy (CBT) today.
... Being one of the most preferred theoretical models in counselling, CBT has demonstrated explicit justifications as well as definite rates ... My essay compares and contrasts three theoretical models of counselling. For comparison and contrasting purposes, my work has identified ... for many years. Despite their similarities and use in counselling, the three therapies hold distinct differences from each ...
CBT is a psychotherapeutic approach that aims to teach individuals new skills for solving problems concerning dysfunctional behaviours, cognitions and emotions through a systematic goal-oriented procedure (Barker et al., 2010).
The core idea of CBT is that individuals’ behaviour and emotional reactions are strongly influenced by their thoughts, beliefs and interpretations about themselves and situations. Therefore, changing what you do (behaviour) is often powerful enough to change these emotions and thoughts. The development of CBT has made many contributions to counselling and psychotherapeutic practice. This essay aims to examine these contributions and discuss the impact these have had on counselling and psychotherapy. The essay will look at how CBT has contributed through its role in health services and how it has helped psychotherapies in becoming widely accepted as therapeutic interventions, by being measurable, an affordable means of treatment and through providing evidence of being one of the most effective means of treating unwanted thoughts, feelings and behaviours.
Accountability, cost effectiveness and continuous quality improvement are essential features of all managed health care systems (Burlingame, Lambert, Reisinger, Neff & Mosier, 1995).
Psychological therapies increasingly form an integral part of government planning for mental health care, and CBT tends to be seen as the first line treatment for many psychiatric disorders. CBT became successful as it was able to provide concrete evidence of effectiveness in treating different ‘problems’ like anxiety and phobias. CBT is also a very economical treatment compared to other psychodynamic interventions, typically taking between six and twelve sessions. Dealing with the ‘here and now’ made CBT the preferred choice for services like the NHS who wanted a ‘quick fix’ for people. CBT put counselling and psychotherapeutic practice in the frontline for treatment interventions. Mental health care had in the past rested on the assumption that pharmacotherapy was cheaper and was at least as effective as psychotherapies in the treatment of most conditions (Barlow, 1994).
The evidence from CBT showed that this was not the case, resulting in CBT being used to treat a range of psychological problems over the past 25 years, from eating disorders to trauma to relationship difficulties, anger, psychosis, substance misuse and more.
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The health-care trend of evidence-based treatment has favoured CBT over other approaches; this in turn has resulted in funding being given to conduct research (Lambert, Bergin & Garfield, 2004).
Mental health care programmes are continuing to shift from a focus on cost to a focus that requires treatment interventions to prove themselves empirically (Aaron, 1996).
CBT has ‘lent’ itself well to this as it is easily measurable (e.g. behavioural experiments, rating scales,) and can produce empirical evidence contributing to wider acceptance of psychotherapeutic practice.
CBT is one of the most researched types of therapy, in part because treatment is focused on a highly specific goal and results can be measured relatively easily (e.g. rating scales).
There is an overwhelming quantity of published research on CBT (Roth & Fonagy, 2004).
Does this published research wrongly give CBT greater credibility than other approaches? The majority of approaches on the list of empirically supported treatments produced by the American Psychological Association’s Division 12 Task force were in the CBT family. These were supported as treatment of choice because of the quality and quantity of research rather than because they were the superior treatment (Chambless & Hollon, 1998).
CBT is therefore making psychotherapeutic practice the first choice for treatment; but is CBT being over sold?
A study by Holmes (2002) argues that CBT has been oversold, particularly within the British NHS. The study argues that CBT is clearly effective but that its dominance may be more of a function of differential research attention than evidence of effectiveness. Clark, Beck & Alford believe that treatment efficacy in CBT is due to a combination of factors. Are individuals then really receiving the best possible treatment intervention available? Research by Cooper (2008) showed that people who have counselling or psychotherapy are less distressed than those who do not, that therapy is as effective as drug treatment and that there are only small differences in the effectiveness of the different therapeutic approaches, with the strongest evidence at present for CBT. CBT stands out because it is amenable to scientific study. However, the effectiveness of CBT in some areas remains undisputed, such as specific phobias and OCD. CBT has been found to be successful as an independent intervention (e.g. anxiety, phobias, trauma) and also as an adjunctive intervention (e.g. in the treatment of depression alongside medication).
The major Mental Disturbances and Abnormal Behaviours listed in the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders) and their treatments are as follows: 1. Anxiety disorders It is the disorders characterized by anxiety and avoidance behaviour. Anxiety is a vague, general uneasiness or feeling that something bad is about to happen. It can be associated with a particular situation ...
CBT continues to be a successful intervention for psychotherapeutic practice due to its measurable efficacy and effectiveness and continues to expand and develop.
CBT is used with children, adolescents, adults, older adults and people with learning disabilities. The versatility of CBT has contributed to individuals choosing psychotherapeutic practice over other methods. Scientific comparisons of psychotherapeutic and psychopharmacological treatments have been favourable to psychotherapy when long-term costs and benefits are considered (Evans, Hollon, DeRubeis, Piasecki, Grove, Garvey & Tuason, 1992).
The National Institute for Clinical Excellence states that psychological therapies are as effective as drug treatments in the short term but superior in the long term (NICE, 2009).
Treatment programmes have been evaluated for their efficacy and effectiveness and studies have shown that CBT is undoubtedly an effective treatment for many problems. Once again this comes back to the question of whether this is fact or if these findings are due to CBT being the only therapy that can measure treatment outcomes in this way?
In the past three years NICE has produced guidelines for the NHS which recommends CBT as the intervention to treat a range of disorders from schizophrenia to post-traumatic stress disorder. The support of the NHS choosing CBT as the treatment of choice had a very positive effect on psychotherapeutic practice, CBT became the gold standard. Although CBT is the golden psychological treatment for various disorders, overall, about 30–40% of the patients are still non-responsive to these interventions (David & Szentagotai, 2006).
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CBT received its golden standard as it had both a well-defined theory and well-supported effectiveness, however these aspects can be challenged. There are more than ten types of CBT schools such as dialectic behavioural therapy; meta-cognitive therapy; REBT; schema focused therapy to name a few. Each school insists that the cognition it focuses on as the most important. This can sometimes result in repetitions, conflicts, confusion and in some cases re-inventions. For example schema focused therapy uses the concept of schema but the meaning ascribed is different to the schema construct in cognitive therapy (Young, 1994).
When CBT itself is not yet well integrated it is unlikely that CBT can be the platform for psychotherapy integration.
CBT is promoted as the therapy of choice and so the NHS and other health services cite CBT as the first line treatment, due to the CBT practice of classifying quality of evidence (Holmes, 2002).
CBT is an attractive and efficient therapy that produces good results in many circumstances. CBT researchers have set standards and produced manuals tailoring treatments to specific disorders, this has had a major contribution to psychotherapeutic practice and research. Through CBT, counselling and psychotherapeutic practice has been able to provide concrete evidence of effective interventions; show that there are economical treatment options available for individuals and that the area of counselling and psychotherapeutic practice is versatile and continues to expand and develop.
CBT is seen as the optimum therapy for all psychological problems, yet is not accessible to all clients. Due to the structured nature of CBT it is not suitable for individuals who have more complex mental health needs or learning difficulties. CBT is often best suited for individuals’ who are comfortable with introspection. In CBT the individual must be willing to spend time and effort analysing their thoughts and feelings (British Association for Behavioural and Cognitive Psychotherapies (BABCP), 2005).
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There is no established permanent cure for Schizophrenia, but there are a variety of therapies which help prevent schizophrenic episodes and also help sufferers deal with their mental illness. One of the main types of therapy used is drug therapy. Drug therapy involves issuing a patient psychotherapeutic drug(s) which are used to alter the chemical functioning of the brain by affecting the action ...
CBT is also suited for individuals looking for a short-term treatment option. One of the greatest contributions CBT makes to psychotherapeutic practice is that it helps clients develop coping skills that can be useful both now and with stresses and difficulties in the future. CBT can also be provided in a number of different formats e.g. computer programmes and self-help books.
It is CBTs commitment to empiricism that has contributed to its widespread acceptance and support in psychotherapeutic practice. Some psychotherapists see CBT as too simplistic, that it is an approach that ignores the complexities of an individual’s problem. The therapy only addresses current problems, focusing on specific issues and therefore cannot address possible underlying causes of mental health problems (Barker et. al., 2010).
This ‘plastering’ over the problem without dealing with the underlying cause would then lead to ‘symptom substitution’. However, the evidence shows that not only does symptom substitution not take place but CBT also results in better treatment generalisation (Tryon, 2008).
While CBT is seen as the golden standard treatment many therapists today are instead choosing to use a combination of different therapies to suit an individual’s needs. Many psychotherapists & counsellors are ‘eclectic’ to some extent, because they have been influenced by various theories and practices that they have met over the course of their training and when working with colleagues from different approaches (Barker et. al, 2010).
In a study conducted by Holmes (2002) he found that some cognitive behavioural therapists themselves are beginning to question aspects of CBT and recognise some of its limitations. Patients with complex conditions such as borderline personality disorder are unlikely to find standard CBT effective (Linehan, 2003).
Instead Linehan (2003) argues that integrative therapy- dialectical behaviour therapy combined with CBT techniques for change is more effective. Teasdale (2000) questions the ‘zap the negative cognitions’ approach in major depressive disorder, believing that mindfulness techniques such as meditation are needed to help patients separate themselves from the emotional pain. Is CBT just viewed as the gold standard and therapy of choice for all disorders because of its research and a marketing strategy or because it is fundamentally superior to other therapies. CBT is putting pressure on counselling and psychotherapeutic practice to prove their worth.
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We have seen throughout the essay that CBT has made many positive contributions to psychotherapeutic practice: it is measurable; affordable; versatile; cost effective and a short-term option, this has meant that it has gained supported from NICE and the NHS resulting in CBT being promoted as the therapy of choice. On the other hand, no other therapeutic intervention is conducted in a systematic, goal-oriented procedure that can lend itself to provide empirical evidence in the same way CBT can; so how can one be sure that CBT should be the therapy of choice? Cooper (2008) found only small differences in the effectiveness of the different therapeutic approaches. Are economical reasons and ‘quick fixes’ good enough reasons for selecting a therapy? CBT has put pressure on psychotherapeutic practice to provide empirical support for other interventions so that CBT can be compared and the best treatment intervention identified. There is support for CBT theory and it is an effective treatment for many problems, however there is still room for exploring and developing further in some areas. CBT has brought psychotherapeutic practice into the present moment as the therapy of choice, but if psychotherapeutic practice wants to continue as the treatment of choice, it as a whole needs to step up and provide empirical evidence, as CBT has done.
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