Introduction
In contemporary clinical psychology, a large variety of methods and strategies are used to treat mental health disorders and complications. Depending on the complexity and type of the problem, the experts choose diverse theoretical approaches, such as humanistic or psychodynamic orientations. Evidently, each school of therapy has its advantages and disadvantages, and, therefore, psychiatrists require a comprehensive understanding of the methods to choose the appropriate strategy. Additionally, the general theoretical orientations are classified into diverse sub-categories and frameworks, which further complicate the choice of the approach. The current paper compares cognitive-behavioral therapy (CBT) and person-centered therapy and attempts to critically evaluate the differences between the two methods.
Theoretical Background
Before conducting the analysis of CBT and person-centered therapy, it is essential to briefly discuss the underlying principles and schools of thought in clinical psychology. The primary theoretical orientations in psychotherapy include psychodynamic, cognitive behavior, and humanistic approaches (Holm, Bevly & Prosek, 2018). According to the research, the mentioned orientations provide similar clinical outcomes with no significant differences in the general treatment (Holm et al., 2018). However, many researchers have found that each of the schools of thought might be particularly effective when applied to specific mental health disorders (Holm et al., 2018).
For instance, the cognitive behavioral approach is frequently utilized to treat depression with great success (Holm et al., 2018). Therefore, while the said theoretical orientations are all relevant tools in contemporary psychotherapy, some show better results in specific scenarios.
Cognitive Behavioral Therapy
As seen from the name, cognitive behavioral therapy belongs to the category of cognitive behavior orientation and is one of the most prominent models in contemporary psychotherapy. In general, CBT refers to a set of techniques and strategies aimed to alter thought processes, attitudes, and behaviors (Ackerman, 2021). CBT is widely used to treat substance use disorders, anxiety, insomnia, psychotic disorders, and even chronic fatigue (Riopel, 2021).
Many experts consider CBT the gold standard of clinical psychology, transparently indicating the effectiveness and prominence of the model (David, Cristea & Hofmann, 2018). Furthermore, modern CBT is the most researched form of psychotherapy framework with no apparent drawbacks (David et al., 2018). Many experts note that CBT is engaging, fast, time-cost effective, and appropriate to treat a vast range of mental health disorders (Riopel, 2021). Aaron Beck is considered to be the first psychiatrist to implement CBT in clinical practice (Ackerman, 2021). At present, there are many branches and sub-categories of CBT; however, they all share the underlying principles of cognitive behavior orientation.
Person-Centered Therapy
Person-centered therapy is a sub-category of the humanistic theoretical orientation, which emphasizes the experience and feelings of the patient. The underlying principle of the treatment is unconditional positive regard (Ackerman, 2021). The technique implies that the psychiatrist does not judge or interrupt the patient in any way during the session, allowing for complete freedom of thought and speech (Ackerman, 2021).
In person-centered therapy, the expert needs to establish a deep connection with the patient and provide support regardless of the problem (Ackerman, 2021). As a result, genuineness and empathy are the focus of the treatment and allow the patient to feel safe and emotionally protected during the treatment. Person-centered therapy was first implemented in clinical practice by Carl Rogers to oppose behavioral and psychodynamic methods (Ackerman, 2021). This model was designed due to the idea that every individual is unique and requires a distinguished approach, and is still relevant in contemporary psychotherapy.
Therapy Process
CBT and person-centered therapy belong to diverse theoretical orientations of clinical psychology and, therefore, differ significantly in terms of the therapy process. The standard steps of the treatment, such as conceptualization of the problem, goals assessment, establishment of the therapeutic relationship, interventions, and therapeutic change, are unique for the two models. Therefore, it is essential to compare CBT and person-centered therapy based on each of the mentioned constituents.
Conceptualization of the Problem
The conceptualization of the problem differs significantly, depending on the psychopathological disorder, the patient, the chosen psychotherapy model, etc. Case conceptualization is a complex notion that commonly refers to the clinician’s evaluation of the problem and interrelated elements (Philippot et al., 2018). In person-centered therapy, observation is the primary type of conceptualization technique (Ackerman, 2021). Non-directiveness is one of the underlying principles of person-centered treatment; therefore, the psychiatrist allows the patient to talk freely on various topics (Ackerman, 2021). At the same time, the expert actively listens to the client and observes their actions, behavior, and mannerisms to understand and conceptualize the problem.
On the other hand, CBT combines observation and interaction methods to identify the source of the problem. In CBT, the psychiatrist and patient actively work together; therefore, the role of the expert is much more direct and authoritative compared to the person-centered approach (Ackerman, 2021). CBT acknowledges the unique nature of each case and individual, indicating the relevance of the conceptualization-driven approach to the model (Waltman & Sokol, 2017).
As a result, the generic CBT requires a comprehensive evaluation of the client’s problems and associated maladaptive behaviors before conducting the therapy course (Waltman & Sokol, 2017). Ultimately, while the conceptualization patterns of person-centered therapy and CBT differ in terms of techniques and interference of the expert, the evaluation of the problem is the critical part of the treatment.
Goal Assessment
While the general goals of psychotherapy, such as personal growth or distress mitigation, are common for most models, CBT and person-centered theory have different perspectives on goal assessment. As mentioned briefly before, the person-centered model is non-directive, and, thus, the therapist cannot set goals for the patient (Ackerman, 2021). In this framework, the client posits the objectives, and the expert only regulates the flow of the session and provides unconditional positive regard (Ackerman, 2021). In CBT, the clinician and the patient unite their efforts to conceptualize the problem and, consequently, assess the goals of the treatment. However, it is necessary to mention that CBT generally emphasizes short-term objectives, such as unraveling cognitive distortions or nightmare prevention, rather than long-term goals (Ackerman, 2021). As a result, CBT and person-centered therapy have distinct perspectives on goal assessment.
Therapeutic Relationship
As seen from the previous steps, the majority of the differences between CBT and the person-centered approach stem from the nature of the therapeutic relationship. CBT is a mutual relationship between the psychiatrist and the client, and the benefits of the therapy stem from the active engagement of both parties (Riopel, 2021). Thus, the expert listens to the patient but also corrects the behavior, offers advice, speculates on the potential solutions to the problem, and takes the overall authoritative role in the dialogue (Riopel, 2021). The therapist suggests a large number of intervention techniques and regulates the recovery process (Ackerman, 2021). On the other hand, person-centered therapy implies that the client is always right, and the clinician should never be judgemental during the sessions (Ackerman, 2021).
The expert listens, observes, and occasionally provides feedback by paraphrasing the problems of the client (Ackerman, 2021). Therefore, in this model, the therapist takes the relatively passive role in the therapeutic relationship and only focuses on active listening and genuine support of the client.
Intervention Techniques
Derived from the therapeutic relationship roles, there are almost no specific intervention techniques in the person-centered approach, except for active listening and unconditional positive regard. However, CBT is one of the most researched psychotherapy frameworks and provides a large variety of intervention strategies. The primary techniques include journaling, cognitive distortion resolution, interoceptive exposure, cognitive restructuring, muscle relaxation, breathing techniques, nightmare exposure, and many others (Ackerman, 2021). CBT is a fundamental model that paved the way for a significant number of innovative therapies, such as positive CBT, behavioral activation, rational living therapy, etc. (Riopel, 2021). Therefore, the intervention techniques between CBT and the person-centered approach differ drastically based on the underlying objectives of the two models.
Therapeutic Change
Therapeutic change or the overall outcome of the clinical treatment is the most significant part of the therapy and is the ultimate goal of every psychotherapy approach. Evidently, all the variables of psychotherapy affect the clinical outcomes, including the theoretical framework, therapeutic relationship, intervention techniques, competency of the psychiatrist, etc. (Cameron, Rodgers & Dagnan, 2018). For instance, the research has found that the relationship between the clinician and the patient (therapeutic alliance) is one of the most significant factors in depression treatment in CBT (Cameron et al., 2018). In general, the therapeutic change mostly depends on the initial goals of the therapy; therefore, the conceptualization of therapeutic change differs slightly due to distinct approaches in CBT and person-centered therapy.
CBT is frequently utilized to help the patient in resolving certain cognitive distortions and maladaptive behaviors. As a result, the clinician assesses the therapeutic change by interaction with the client, including tests, surveys, and active discussion. On the other hand, person-centered therapy adheres to its primary principles and allows the client to evaluate the outcomes of the clinical treatment (Ackerman, 2021). According to this approach, only the patient can truly understand their problems, goals, needs, and whether the psychotherapy is effective (Ackerman, 2021). Therefore, CBT and person-centered therapy differ in the conceptualization of therapeutic change.
Clinical Discussion
As seen from the theoretical discussion, the differences between CBT and person-centered therapy reflect the underlying assumptions and objectives of each framework. The majority of unique points stem from the role of the clinician in the treatment and their attitude toward the patient. In CBT, the clinician utilizes a large variety of intervention techniques and actively interacts with the patient in order to achieve the established goals (Riopel, 2021). Therefore, the underlying principle of CBT is active engagement with an emphasis on goal assessment and problem-solving, and the therapeutic process transparently reflects it (Riopel, 2021).
Person-centered therapy, above all, focuses on the patient and their needs and desires (Ackerman, 2021). Thus, the underlying principle of the approach is that the client is always right, and the clinician only listens and provides unconditional positive regard (Ackerman, 2021). As a result, the therapeutic process is non-directive and emphasizes empathy, genuineness, and messages of encouragement (Ackerman, 2021). Ultimately, the two analyzed psychotherapy methods differ drastically in their therapeutic processes and underlying principles.
Nevertheless, the clinician should always be highly attentive to the problems of the patients and reflect on their responses regardless of the theoretical orientation. The establishment of the therapeutic alliance is highly significant to the application of CBT and is the utmost principle of person-centered therapy (Sutton, 2021). The clinician should always attempt to form a deep connection with the patient, understand the source of their problems, and identify the most appropriate type of psychotherapy (Sutton, 2021). Needless to say, it is impossible to achieve these tasks without active listening, observation, and reflection on the client’s responses (Sutton, 2021).
Therefore, clinicians need to improve their interpersonal skills, such as verbal fluency, concentration, empathy, and open-mindedness (Sutton, 2021). Summing up, both CBT and person-centered therapy are complex psychotherapy approaches and require the essential competencies of the practitioner.
Ultimately, the analysis of CBT and person-centered therapy transparently demonstrates the importance of reflective practice regardless of the approach. Psychotherapy is a complicated evidence-based treatment with a large variety of methods, strategies, and instruments. Furthermore, a practitioner’s mistake might be exceedingly costly and negatively affect the life of the patient. Therefore, it is the direct responsibility of the clinician to continually develop as a professional, understand the underlying principles of psychotherapy approaches, and be accountable for their work. Following these practices might significantly improve the productivity of the psychiatrist and enhance the clinical outcomes of the treatment.
References
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