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Cognitive Behavior Therapy and Narrative Approach Research Paper

Overview of the Theories for Practice

Theories Used for Assessment

The most preferred theories for assessment of patients are Cognitive Behavior Therapy and the Narrative Approach. The integrated approach is critical when handling traumatized patients because it enables the counselor and the patient to play a critical role in assessing and addressing the underlying problem. When it is possible to use the two approaches, finding a lasting solution cannot be a big challenge.

Major Concepts and Assumptions Associated with the Theories

It is important to understand that each of these two theories is unique in terms of the concepts and assumptions embraced. A therapist should understand when only one of the approaches should be used and when it is possible to apply both based on the state of the patient (Cherkin et al., 2016).

Cognitive behavior therapy

Cognitive-behavioral therapy (CBT) is an evidence-based practice that is widely used to improve mental health of patients (Poulsen et al., 2014). The primary concept of this theory is often referred to as vivo exposure. It involves a direct confrontation of the situation, object, or activities feared by the patient. With the assistance of the therapist, one is aided to face and overcome their fear as a means of fighting off the mental torture. The main assumption of this theory is the absence of free will. It assumes that the will of people is determined by various cognitive processes influenced by different external stimuli (Ebert et al., 2015).

The narrative approach

The theory focuses on helping people to identify their unique skills, knowledge, and values that can enable them to overcome challenges they may face. The concept in this theory is that one’s identity can change based on the choices that are made. In this therapeutic process, the counselor will help the patient to co-author a new narrative about the self that is positive and proactive. The main assumption is that the narrative of people shapes their identity. What they profess defines their actions and eventually what they become.

How the Chosen Theories Define Goals and Plans for Intervention

The goals and plans of intervention define the choices of therapeutic theories to be embraced. Cooper and Lesser (2014) argue that the chosen theories must make it possible to achieve the set objectives in the best way possible. The choice of cognitive behavior therapy and the narrative approach means that the goal is to ensure that the patient plays a critical role in the intervention process to overcome their fears and mental trauma. The use of cognitive behavior therapy will involve helping patients face the fears in their lives, while the narrative approach will involve them making a concise decision to redefine their purpose and path in life.

The Role of the Worker in the Theories for Practice

When using both cognitive behavior theory and the narrative approach, the role of the therapist will be that of an invoker and a motivator. The therapist is expected to invoke the hidden strength, knowledge, and capabilities in a patient to overcome their fears (Fernandez, Selem, Swift, & Ramtahal, 2015). Other than taking center stage in the described processes, the therapist will work side by side with the patient in addressing the identified problems.

Social Work Values Contained in the Code of Ethics Consistent With the Theories

The Code of Ethics of the National Association of Social Workers outlines the best practices expected of officers working for the social benefits of the society. One of the work values contained in the code of ethics and consistent with both the cognitive behavior therapy and the narrative approach is self-determination. Just as stated in the code of ethics, both theories allow patients to be active participants in solving problems that affect them. The two theories are about avoiding conflict of interest by allowing patients to take the lead in solving the mental problems they face. Commitment to a patient is another common code of conduct in both theories. The social worker must remain committed to helping the patient to overcome their fear.

How the Theories Address Clients’ Oppression

Both theories focus on enabling patients to overcome their mental oppressions by facing them directly and changing their life narrative. Instead of trying to avoid and forget about the problem, cognitive behavioral therapy seeks to empower the client to face and overcome it. One must accept that although the traumatizing incident happened, he will overcome it. The narrative approach, on the other hand, seeks to change the negative story that a client may have about their self into a positive one. The client is reminded of the unique capabilities that can be used to overcome oppression.

Strengths and Limitations

Strengths of the Theories

It is important to look at the strengths of these two theories that make them effective in managing patients.

Cognitive behavior therapy

It is an evidence-based approach that has been tried and tested for years and many experts are in agreement that it is an effective tool. It seeks to empower clients by enabling them to avoid unhelpful thoughts, beliefs, attitudes, and behavior to overcome their condition.

The narrative approach

It is an approach that focuses on enabling clients to rediscover themselves. When used effectively, it helps patients to use their strength, knowledge, experience, and beliefs to address their mental problems.

Weaknesses of the Theories

Both theories have some weaknesses that should be noted when they are used to manage mental problems of patients.

Cognitive behavior therapy

One of the main criticisms leveled against this theory is the reducing effectiveness because of some of its assumptions. The high rate of dropout among patients receiving this therapy also shows that they consider it less effective in addressing their problems.

The narrative approach

The theory has been criticized for embracing a social constructionist belief, which argues that there are no absolute truths (Cully et al., 2017). Some have criticized it for the lack of empirical and clinical studies to support its validity.

Cross-Cultural Considerations

Modifications Needed in the Theories When Working With Diversified Clients

The two theories are effective in enabling the patients with posttraumatic stress disorder or other mental challenges to overcome their problems. However, it is possible to modify them when working with people from different socio-cultural backgrounds.

Cognitive behavior therapy

When using cognitive behavioral therapy, one should take into consideration the religious beliefs of a patient to avoid suggestions that they may find offensive. The gender, age, and sexual orientation of a person should also define the therapeutic approach language used.

The narrative approach

When using this approach, the main modification that should be considered is the main interests of a patient based on age, religion, class, gender, class, or any other demographic factor. The approach that is suitable for a 24-year-old keen on pursuing a career in a given field should be different from that used when handling a 65-year old who wants to focus on their life after retirement.


Cherkin, D., Sherman, K., Balderson, B., Cook, A., Anderson, M., Hawkes, R. … Hansen, K. (2016). Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back paina randomized clinical trial. JAMA, 315(12), 1240–1249.

Cooper, M., & Lesser, J. (2014). Clinical social work practice: An integrated approach (5th ed.). New York, NY: Pearson.

Cully, J., Stanley, M., Petersen, N., Hundt, N., Kauth, M., Naik, A., … Sorocco, K. (2017). Delivery of brief cognitive behavioral therapy for medically ill patients in primary care: A pragmatic randomized clinical trial. Journal of General Internal Medicine, 32(9), 1014–1024.

Ebert, D., Zarski, A., Christensen, H., Stikkelbroek, Y., Cuijpers, P., Berking, M., … Riper, H. (2015). Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: A meta-analysis of randomized controlled outcome trials. PLOS, 10(13), 1-15.

Fernandez, E., Selem, D., Swift, J., & Ramtahal, N. (2015,). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108-1122.

Poulsen, S., Lunn, S., Daniel, S., Folke, S., Mathiesen, B., Katznelson, H., … Fairburn, C. (2014). A randomized controlled trial of psychoanalytic psychotherapy or cognitive behavioral therapy for bulimia nervosa. The American Journal of Psychiatry, 171(1), 109-116.

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