The current theoretical approach is primarily manifested in the active use of cognitive-behavioral therapy (CBT) in rehabilitation counseling by deploying techniques, such as cognitive restructuring and roleplaying. The theoretical basis for CBT-based counseling is centered around the notion of problem-solving, where the emphasis is primarily put on the present moment rather than past experiences. It is important to point out the fact that a wide range of methods can be effective and plausible for rehab counseling processes or sessions, but CBT was selected due to its effectiveness in addressing the key issues head-on without unnecessary endeavors. The core theoretical framework of CBT is based on the theory that thoughts, feelings, and behavior are tightly interlinked, which means that one’s behavior can only be altered by influencing one pattern of thinking. It is important to point out the fact that the feelings or emotions are more challenging to control since they are mostly visceral responses to an individual’s interpretation of a situation or object. Thus, the most actionable element of CBT is behavior, where the emphasis is put on ensuring that a client has a positive type of thoughts to invoke positive emotions. Such an approach will be helpful and useful for introducing changes in one’s behavior, which will ultimately lead to a desirable outcome.
CBT is a short-term, structured psychotherapeutic method, and the method was developed in the 1960s by the American psychotherapist Aaron Beck based on clinical experience, introspection, and analysis of his neurotic problems (Sommers-Flanagan & Sommers-Flanagan, 2018). CBT is not just talking with the patient about the disease but informing him about the causes of pain and a favorable prognosis. It is important to distinguish CBT from other therapies, such as patient education programs and rational psychotherapy that are ineffective in treating chronic pain. CBT is a systematic technique that uses cognitive restructuring and behavioral experimentation techniques to address a problem.
Cognitive-behavioral psychotherapy is a psychosocial therapeutic method aimed at the patient’s awareness of the characteristics of the current state, determining the most significant goals for changing well-being, and forming a specific psychotherapeutic program with the help of specialists. In this regard, cognitive-behavioral programs provide for clarification of the characteristics of the patient’s psychological state and assistance in their awareness, a brief appeal to the origins of the formation of the patient’s psychological problems, providing him with information about the essence of the disease and ways to overcome it; learning new ways of thinking and behavior. In general, in psychotherapeutic practice, the integration of cognitive and behavioral approaches is increasingly observed since any psychotherapeutic influences to one degree or another inevitably affect all areas of a person’s response, causing interrelated changes in them. The theory is based on the proposition that after the perception of an external influence, its mental analysis is carried out, and only then – is an emotional response. Accordingly, the emotional response to a situation depends on what perceptions and assumptions are associated with it. Refraction of the perception of information from the outside world through a system of flexible value judgments, devoid of strict requirements and forecasts, generates a state of emotional balance and prevents the occurrence of a protracted conflict in difficult situations.
Both reframing and role play approaches are highly effective at ensuring that a client’s thought processes are altered to a more positive area, whereas the latter measure ensures that one can create a behavioral foundation and familiarity during the sessions. A study conducted on people suffering from chronic pain revealed that CBT could greatly reduce the level of pain experienced by these individuals through the reframing measures (Knoerl et al., 2016). In other words, depending on the CBT dosage and strategies, the given therapy was almost as effective as medications, such as painkillers. The key emphasis needs to be put on the reframing measures, which were the core element of the therapy. Two areas of the target were through processes and behaviors, which were gradually altered to reduce the feelings of pain.
It is also stated that auto relaxation helps to reduce the patient’s level of anxiety and increase his resistance to stress (Knoerl et al., 2016). Relaxation techniques that provide emotional and muscle relaxation are most commonly referred to as autogenous training, progressive muscle relaxation, functional relaxation, and special breathing exercises. Most relaxation techniques are combined with the introduction of the patient into a hypnotic state, accompanied by the concentration of attention on certain stimuli. Suggestion or self-hypnosis helps to relax and achieve a hypnotic state, and a hypnotic state, in turn, facilitates the unhindered assimilation of beliefs and thoughts that in another state of consciousness would be subject to analysis and criticism. At the beginning of a session, self-hypnosis can be used to induce emotional and muscle relaxation and then to form certain beliefs that reduce the importance of painful manifestations, increase confidence in their ability to cope with illness, and create a mood for conducive healing behavior. However, the combination of self-hypnosis with self-hypnosis increases its effectiveness.
It is important to note that CBT measures can be effective in a non-face-to-face setting, such as telephone-delivered therapies. A study shows conducted on parents with children suffering from abdominal pain shows that the given approach can be highly effective to the extent of regular face-to-face CBT measures (Levy et al., 2017). In other words, key role-play techniques of CBT can be deployed a wide range of mediums with an inclusion of the therapist’s competence factors. In addition, CBT was also effective at reducing the abdominal pain among children of these parents, and the results were comparable to bringing a child to a therapist in person (Levy et al., 2017). Roleplay measures can be delivered orally without any need for visual elements, where a therapist can effectively guide and set the role-playing format for the parents and their children to be able to properly handle pain. Another study confirms the previous supporting points by indicating that these types of interventions can lead to major improvements in one’s “well-being through positive activities combined with cognitive-behavioral therapy” (Marrero et al., 2016, p. 728). Therefore, evidence supports the fact that reframing and role play approaches can be highly useful in ensuring that patients or clients experience improvements, which can range from mild to serious.
A study conducted on children with obsessive-compulsive disorder, who underwent CBT, indicates that dysfunctional beliefs are the major factor in the development of OCD-based behaviors (Wolters et al., 2018). In other words, reframing methods utilized by the researchers show the fact that such an approach can be highly effective at altering one’s processes through dismissal or disintegration of the damaging or unsubstantiated beliefs. Some of these issues can be eliminated through the active implementation of psychoeducation, whereas others can be within the areas of highly sensitive subjects, which require more deliberate and intricate approaches. Obsessions relate to the fear of causing harm to others by her negligent actions, that is, the fear that the remnants of her medications, through her negligence, may harm others and, first of all, lead to the poisoning of children, in connection with which taking medications is strictly ritualized as in everyday activities, and in a complex of cognitive-imaginative rituals of the patient (Wolters et al., 2018). In the course of cognitive conceptualization, the patient revealed all the above-described irrational cognitions and erroneous beliefs.
Considering the duration of the illness, the severity of clinical symptoms, and the patient’s socio-psychological maladjustment, the researchers can face all the difficulties presented in the treatment of OCD. The patients were extremely emotional, reacted with exacerbations of symptoms to the slightest therapeutic progress, and worried that they should be treated and help themselves more effectively. There were expressed doubts about oneself, about the prospects of therapy. After ten sessions, there is a reduction in the severity of obsessive disorders both in duration and in intensity, anxiety has significantly decreased, the mood is stabilized, and the patient has become more active and self-confident. There is good compliance, high adherence to CBT, and motivation for recovery, which allows one to count on the successful continuation of therapy (Wolters et al., 2018). The specificity of obsessional-dominated OCD suggests significant difficulties in therapy and rehabilitation. The developed psychotherapeutic program, based on CBT techniques, a detailed study of the phenomenology of the disorder, allows one to successfully overcome all difficulties and achieve effective results.
Since the very first class-related paper, my approaches changed drastically from guided psychoeducation to more proactive reframing and role-play techniques. Throughout the course, I learned that CBT is not a one-dimensional approach, where one needs to identify problems and find potential solutions. I learned that CBT is a highly complex and delicate approach, which is based on a multifaceted theoretical basis (Sommers-Flanagan & Sommers-Flanagan, 2018). Although CBT’s core principles were known to me before the class, I did not know the depth of cognitive-behavioral therapy’s methods. However, it is important to point out that I still maintained my psychoeducation-centered measures as a complementary technique, but my core approach shifted towards reframing and role play.
My new approach is based on identifying a client’s issue first by giving him or her the freedom to express himself or herself. Although I used to do it before, it lacked structure and organization in terms of keeping the session highly focused on a specific problem rather than the general well-being of a client. My current approach is highly focused on a certain problem, which needs to be identified at the beginning of the therapeutic session. After learning a wide range of aspects of CBT during the course, I am now more aggressive in terms of preserving the focus of the session, where I am less hesitant to allow a client to drift away from the subject at hand. Therefore, the session became more effective since the bulk of the time is not spent on identifying all of the issues but rather on addressing and solving a single problem. My new approach also has more clarity in categorizing three key elements of CBT, which are behaviors, feelings, and thoughts (Sommers-Flanagan & Sommers-Flanagan, 2018). The class improved my capability to quickly determine the category and root cause of the problem.
The key concepts of my theoretical approach are manifested in the fact that an individual’s behavior is tightly connected and influenced by his or her thoughts. The mode of control lies in the thought patterns and processes, and feelings are mostly uncontrollable. Therefore, the framework emphasizes the overall importance of working on the thinking patterns of a client rather than emotions and actions. By changing one’s outlook on the problem, he or she will be able to change the general emotional background towards a more productive and positive one, which can also lead to a more improved behavior with less risky or damaging outcomes.
The role of therapists under CBT’s framework is to identify the problems and cooperate with a client to find potential solutions. In most cases, a therapist needs to be aware that a client is more knowledgeable on how he or she can resolve the issue but lacks organization in thought processes and structure. Therefore, a counselor’s role is to guide a client to find the most effective and plausible solutions. In addition, a therapist needs to be willing to provide psychoeducation to reduce ignorance and misinformation by revealing the important pieces of knowledge to a client.
The goal of the current therapeutic process is to help and assist a client in the process of finding the most effective and suitable solution to an identified issue. In other words, the objectives revolve around equipping a client with the necessary knowledge and skills to be able to cope with a problem or stressor by setting proper thought processes and patterns, which can effectively influence the behaviors.
The techniques revolve around utilizing cognitive reframing questions and role-play methods to comprehensively target both thoughts and behaviors, respectively. In other words, since thoughts, behaviors, and feelings are intertwined, the former needs to be addressed by setting a positive and productive mindset through reframing measures. It is important to note that feelings comprise the domain with the least mode of control, which means that behaviors can also be targeted. Role-play techniques are highly effective at ensuring that the recommended behaviors are experienced and acted upon within the safe environment of therapeutic sessions, where a therapist can spot the issues and propose solutions through guidance or exchange.
In conclusion, the current theoretical approach is a highly effective approach suited for the professional environment of a rehabilitation counselor. CBT can be mistakenly viewed as a highly one-dimensional approach where the central focus lies on finding a solution to a problem, but the course allowed me to learn that it is an intricate and multifaceted measure, which is based on a complex theoretical basis or framework. Although psychoeducation is among the key pillars of CBT, cognitive reframing and role play can be highly powerful tools to aid a client in identifying the source of the issue and determining the correct course of action to ensure a positive outcome. The plan is centered around expanding the knowledge and expertise in CBT by regularly and consistently analyzing the literature and latest advancements in this area. By referring to studies and their findings, I will be able to become more knowledgeable on a wide range of aspects of CBT by understanding when and when not it is effective and applicable. In addition, I will actively implement new information in my practice to become more experienced with CBT.
References
Knoerl, R., Lavoie Smith, E. M., & Weisberg, J. (2016). Chronic pain and cognitive behavioral therapy: An integrative review.Western Journal of Nursing Research, 38(5), 596–628. Web.
Levy, R. L., Langer, S. L., van Tilburg, M., Romano, J. M., Murphy, T. B., Walker, L. S., Mancl, L. A., Claar, R. L., DuPen, M. M., Whitehead, W. E., Abdullah, B., Swanson, K. S., Baker, M. D., Stoner, S. A., Christie, D. L., & Feld, A. D. (2017). Brief telephone-delivered cognitive behavioral therapy targeted to parents of children with functional abdominal pain: a randomized controlled trial.Pain, 158(4), 618–628. Web.
Marrero, R. J., Carballeira, M., MartĂn, S., MejĂas, M., & Hernández, J. A. (2016). Effectiveness of a positive psychology intervention combined with cognitive behavioral therapy in university students.Anales de PsicologĂa, 32(3), 728-740. Web.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2018). Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques (3rd ed.). John Wiley and Sons.
Wolters, L. H., Prins, P. J. M., Garst, G. J. A., Hogendoorn, S. M., Boer, F., Vervoort, L., & de Haan, E. (2018). Mediating mechanisms in cognitive behavioral therapy for childhood OCD: The role of dysfunctional beliefs.Child Psychiatry & Human Development, 50, 173–185. Web.