Therapy is seen as an educational process where clients learn to identify and dispute their irrational beliefs, replace ineffective thinking with rational cognitions, and stop absolutistic thinking and blaming. The main goals are helping clients achieve unconditional self-acceptance and acceptance of others. Therapists play an active role by encouraging clients to discover their irrational beliefs, modeling rational thinking, and using techniques like cognitive restructuring to change dysfunctional emotions and behaviors.
5. B.F. Skinner
• Skinner championed radical behaviorism, which places
primary emphasis on the effects of environment on behavior.
Skinner was also a determinist; he did not believe that
humans had free choice. He acknowledged that feelings and
thoughts exist, but he denied that they CAUSED our actions.
Instead he stresses the cause and effect links between
objective, observable environmental conditions and
behavior. Environmental factors can be directly observed and
changed. In 197 Skinner wrote a book “Beyond Freedom and
Dignity”.
6. 4 Areas of Development
• Classical Conditioning
• Operant Conditioning
• Social Learning Theory
• Cognitive Behavior Therapy
7. • Classical Conditioning- (respondent conditioning)- refers to
what happens prior to learning that creates a responds
thought, pairing. Example- knee jerks, salivation
• Operant Conditioning-most of the significant responses we
make in everyday life. Examples are reading, writing, driving
a car and eating with utensils. Positive and negative
reinforcement, punishment and extinction techniques,
illustrates how operant conditioning in applied settings can
be instrumental in developing prosocial and adaptive
behaviors.
8. • Social learning theory is interact ional, interdisciplinary and multimodal. It
involves a triadic reciprocal interaction among the environment, personal
factors (beliefs, preferences, expectations, self-perception and so forth),
and individual behavior. A basic assumption is that people are capable of
self-directed behavior change.
• Cognitive behavior Therapy-this approach offers various action-oriented
methods to help people change what they are doing and thinking.
9. View of Human Nature
• The person is the producer and the product of his or her
environment
• Developing producers that actually give control to acts and
thus increases their range of freedom
• It aims to increase peoples skills so that they have more
options for responding
• Given the techniques and skills of self change, people have
the capacity to improve their lives by altering one or more of
the various factors influencing their behavior
10. Basic Characteristics and Assumptions:
• Behavior therapy are based on the principles and procedures of the scientific
method. Experimentally derived principles of learning are systematically applied to
help people change their maladaptive behavior
• Behavior therapy deals with the clients current problems and the factors
influencing them as opposed to an analysis of possible historical determinants. At
times understanding of the past may offer useful info. About the environmental
events related to present behavior
• Clients involved in behavior therapy are expected to assume an active role by
engaging in specific actions to deal with their problems. Rather than simply talking
about their condition they are required to DO something to bring about change.
Behavior therapy is an action-oriented approach, & learning is viewed as being at
the core of therapy. Although referred to as “therapy” this is an education
approach in which clients participate in a teaching-learning process.
11. Cont..
• The Behavioral approach emphasizes teaching clients skills of self-management
with the expectation that they will be responsible for transferring what they
learn in the therapist’s office to their everyday lives. Behavior therapy is
generally carried in the clients natural environment as much as possible.
• The focuses is on assessing overt and covert behavior directly, identifying the
problem, and evaluating change. Therapists also assess their clients culture as
part of their social environments, including social support networks relating to
target behavior.
• Behavior therapy emphasizes a self-control approach in which clients learn self-
management strategies. Therapists frequently train clients to initiate, conduct,
and evaluate their own therapy. Clients are empowered through this process of
being responsible for their changes.
12. Cont..
• Behavioral treatment interventions are individually tailored to specific problems
experience by clients. “What treatment, by whom, is the most effective for this
individual with that specific problem and under which set of circumstances?
• The practice of behavior therapy is based on a collaborative partnership between
therapist and clients and every attempt as made to inform clients about the
nature and course of treatment
• The emphasis is on practical applications. Interventions are applied to all facets of
daily life in which maladaptive behaviors are to be increased
• Therapists strive to develop culture specific procedures and obtain their clients
adherence and cooperation
13. Therapeutic Goals
• The general goals of behavior therapy are to increase personal choice and to
create new conditions for learning
• The clients with the help of the therapists defines specific goals at the outset of
the therapeutic process
• The counselor provides rationale for goals, explain role of goals, purpose of
goals, and the clients participation in the goal-setting process
• Client identifies the outcomes specifying the positive changes that he and she
wants from counseling
• Client is the person seeking help, and he or she can only make the changes in
their life
• The benefit effect of all identified goals are explored and counselor and client
discuss the possible advantages and disadvantages of these goals
• Client and counselor then decide to continue pursuing the selected goals, to
reconsider the clients initial goals, or to seek the services of another
practitioner
14. Therapeutic techniques and procedure
• Client keeps record of intensity or occurrences to devise if the therapy is
working
• Some assessment instruments including; self-report inventories, behavior
rating scales, monitoring self form, and simple observation techniques
• Treatment outcomes are multifaceted, changes are all or nothing
• Behavior therapy is used for a specific person not some random therapy
• Behavioral therapy can be incorporated into other approaches
• Some approaches of the behavioral therapy ranges from behavioral analysis,
functional assessment model, relaxation training, systematic desensitization,
exposure therapies, eye movement, assertion training, self-management
programs, self-direct behavior, and multimodal therapy
15. Operant conditioning Techniques
• Some key principles of operant conditioning are: positive reinforcement,
negative reinforcement, extinction, positive punishment and negative
punishment
• Positive reinforcement involves the addition of something of value to the
individual as a consequence of a certain behavior
• Negative reinforcement involves escape or avoidance of unpleasant stimuli.
Individual motivated to exhibit a desired behavior to avoid the unpleasant
condition
• Extinction can be used for behaviors that have been maintained by positive
reinforcement or negative reinforcement. Doing so can eliminate certain
behaviors.
• Positive punishment aversive stimulus is added after the behavior to decrease
the frequency of a behavior
• Negative punishment id reinforcing stimulus is removed following the behavior
to decrease the frequency of a target behavior
• Both kinds of punishment, the behavior is less likely to happen again
16. Functional Assessment Model
• The first step is to conduct a functional assessment using both indirect and
direct observation, and information about antecedent events, including the
time and place of the behavior and the people present when the behavior
occurs
• The therapist develops hypotheses about the nature of the problem behavior
and the condition contributing to this behavior
• Hypothesized to be maintaining the problem behaviors
• Negative punishment procedures may be used to decrease problem
• After treatment methods have been used it’s very important to develop
strategies to maintain behaviors
17. Relaxation Training
• Clients are given a set of instructions that ask them to
relax in a quite environment and taking deep and regular
breathing patterns
• Clients are suppose to “let go”
• Clients are encouraged to actually feel and experience
the tension building up, to notice their muscles getting
tighter and study the tension, to hold and fully
experience the tension
• A normal relaxation practice lasts for 20 to 25 minutes
• It helps relieve stress and anxiety
18. Systematic Desensitization
• Clients are to imagine successively more anxiety arousing situations at the same time that
they engage in a behavior that competes with anxiety
• Gradually clients become less sensitive to the anxiety arousing situations
• The therapist conducts an initial interview to identify specific information about the
anxiety and to gather relevant background information about the client
• Background information gives the therapist a good understanding of the client
• Find out under what circumstances does the clients have anxiety
• Therapist conducts a relaxation training before going to therapy,
• Conducts anxiety hierarchy which stimuli that elicit anxiety in a particular situation such as
rejection, jealousy, criticism, disapproval, or any phobia
• Desensitization begins after several sessions, client reaches complete relaxation with eyes
closed, then imagine the least anxiety arousing scene, therapist moves progressivly up the
hierarchy until the client signals anxiety, relaxation is introduced again until little anxiety is
experienced
19. Exposure Therapies
• Exposure therapies are designed to treat fears and other negative emotional
responses by introducing client to the situation that contributed to such
problems
• In Vivo desensitization involves the client exposure to the actual feared
situation in the hierarchy in real life rather than simply imagining situations
• Flooding which refers to either in vivo or imaginal exposure to anxiety-evoking
stimuli for a prolonged period of time
• Allows the anxiety to decrease on it’s own
• Flooding can be used for many fearful anxieties such as flying, riding in
subways, riding in elevators and phobia of certain animals
• Because of the discomfort in this treatment with intense exposure some
clients may not elect these exposures
20. Eye Movement Desensitization and Reprocessing
EMDR
• EMDR is a form of exposure therapy that involves imaginable flooding, cognitive
restructuring, and the use of rapid, rhythmic eye movement and other bilateral
stimulation to treat clients who have experienced traumatic stress
• EMDR is applied to many populations that deal with posttraumatic stress disorders,
sexual abuse victims, combat veterans, victims of crime, rape survivors, accident
victims, children, couples
• It also deals with individuals that have anxiety, panic, depression, grief, addictions and
phobias
• The client is instructed to visually track the therapist’s index finger as they move it back
and forth 12 to 24 times
• Client is instructed to block out negative experience momentarily and breathe deep
and to report what he/she is imagining, feeling and thinking
• Client is asked the positive cognition and identify and body tension
• Do reevaluation in next session
21. Assertion Training
• Useful for people who can’t express anger or irritation, difficult to say no,
people who are overly polite and allows others to take advantage of them,
people who find it difficult to express affection and other positive responses,
people who feel they have no right to express their thought beliefs, and
feelings and people who have social phobias
• The assumption underlying assertion training is so clients can have the right
to express themselves
• A goal in assertion training is to teach clients to express themselves in ways
that reflect sensitivity to the feelings and rights of others
• Clients have the CHOICE of whether to behave assertively in certain
situations
• Assertion does not mean aggression, assertive clients don’t stand up for their
rights at all cost, ignoring the feelings of others
22. Self Management & Self Direct Behavior
• Involves psychologists being willing to share their knowledge so that
consumers can increasingly lead self-directed lives and not be dependent on
experts
• Therapist teach clients skills that they will need to manage their own lives
effectively
• Clients have a direct role of their own treatment, techniques aimed at self-
change tend to increase involvement and commitment to their own
treatment
• Self management strategies include but limited to, self monitoring, self
reward, self contracting, stimulus control and self as model
• Five characteristics are combination of self management, engage regularly
over period of time, client make self evaluation, use self reinforcement and a
degree of environmental support
23. Multimodal Therapy: Clinical Behavior Therapy
• Multimodal therapy is a comprehensive, systematic, holistic approach to
behavior therapy develop
• This model implies that we are social beings who move, feel, sense, imagine
and think
• Multimodal is an open system, that encourages technical eclecticism
• New techniques are being introduced constantly and existing techniques are
refined
• Therapist take great plain to determine what relationship and what
treatment strategies will work best with each individual in a particular
situation
• Assumption of this approach is that because individuals are troubled by a
variety of specific problems it is appropriate that multitude of treatment
strategies be used in bringing about change
24. Technical Eclecticism
• Therapist borrow techniques from many other therapy systems
• Therapist recognize that many clients come to therapy to learn skills, and
therapist are willing to teach, coach, train, model and direct their clients
• Main function is provide information, instructions and reactions
• Therapist challenge self defeating beliefs, offer constructive feedback,
provide positive reinforcement and are appropriately self disclosing
• Failure to apprehend the clients situation can easily leave the client feeling
alienated and misunderstood
26. Role of Therapist
• Therapist are very active during therapy sessions, educators,
consultants, and role models
• Therapist provide information, instructions and feedback as well as
modeling assertive behaviors, challenging self defeating beliefs,
offering constructive criticism and suggestions, offering positive
reinforcement and being appropriately self-disclosing
• Therapists need to make choices regarding different styles of relating
to clients
• Over the years has been learning to blend appropriate and effective
techniques with the most suitable relationship style
28. Rational Emotive Behavioral Therapy
(REBT)
• Stresses thinking, judging, deciding, analyzing, and
doing
• Assumes that cognitions, emotions, and behaviors
interact and have a reciprocal cause-and-effect
relationship
• Is highly didactic, very directive, and concerned as
much with thinking as with feeling
• Teaches that our emotions stem mainly from our
beliefs, evaluations, interpretations, and reactions to
life situations
29. View of Human Nature
• We are born with a potential for both rational and
irrational thinking
• We are self-talking, self-evaluating, and self-
sustaining.
• We have an inborn tendency toward growth and
actualization
• We learn and invent disturbing beliefs and keep
ourselves disturbed through our self-talk
• We have the capacity to change our cognitive,
emotive, and behavioral processes
30. View of Emotional Disturbance
• We learn irrational belief from significant other during
childhood
• Teach clients to feel undepressed even when they are
unaccepted and unloved by significant others.
• Blame is at the core of most emotional disturbances
• Irrational idea (e.g., I must be loved by everyone)
internalize self-defeating
• We have a tendency to make ourselves emotionally disturbed
by internalizing self-defeating beliefs
32. Case discussion 1
• Tom, a college sophomore, want to overcomes his
shyness around women. He doe not date and even
des his best to keep away from women because he is
afraid they will reject him. But he want to change
this pattern.
– Using A-B-C-D-E-F to analyze and help Tom
33. Case discussion 2
• Mary would like to take a course in creative
writing, but she fears that she has no talent.
She is afraid of failing, afraid of being told that
she is dumb, and afraid of follow through
with taking the course.
– Using A-B-C-D-E-F to analyze and help Mary
34. Case discussion 3
• Each week John comes to his sessions with a new excuse for
why he has not succeeded in following through with his
homework assignments. Either he forgets, gets too busy, gets
scared. Or puts it off—anything but actually doing something
to change what he says he wants to change. Instead of really
doing much of anything, he whines each week about how
rotten he feels and how he so much would like to change but
just doesn’t know how.
– What are the possible irrational beliefs, which keep John
from taking actions
– What homework assignment might you suggest?
35. Case discussion 4
• Brent feels that he must win everyone’s approval. He
has become a “super nice guy” who goes out of his
way to please everyone. Rarely does he assert
himself, for fear that he might displease someone
who then would not like him.
– What are the possible irrational beliefs?
– How do you help Brent?
– If Brent is Asian American, what cultural components you
might take into account?
36. Irrational Ideas
• Irrational ideas lead to self-defeating behavior
• Some examples:
– “I must have love or approval from all the
significant people in my life.”
– “I must perform important tasks competently and
perfectly.”
– “If I don’t get what I want, it’s terrible, and I can’t
stand it.”
37. The Therapeutic Process
• Therapy is seen as an educational process
• Clients learn
– To identify and dispute irrational beliefs
– To replace ineffective ways of thinking with
effective and rational cognitions
– To stop absolutistic thinking, blaming, and
repeating false beliefs
38. Therapeutic Goals
• A basic goal is to teach clients how to change their
dysfunctional emotions and behaviors into health
ones.
• Two main goals of REBT are to assist clients to
achieving unconditional self-acceptance and
unconditional other acceptance.
– As clients become more able to accept themselves, they
are more likely to unconditionally accept others.
39. Therapist’s function and Role
• 1. Encouraging clients to discover their irrational
beliefs and ideas
• 2. Making connection of how these irrational beliefs
lead to emotional disturbances
• 3. Challenging clients to modify or abandon their
irrational beliefs.
• 4. Dispute the irrational beliefs and substitute
rational beliefs and behaviors.
40. Client’s Experience in Therapy
• A learner---learn how to apply logical thoughts,
experiential exercises, and behavioral homework to
problem solving and emotional change.
• Focus on here-and-now experiences
• Not spend much time to exploring clients’ early
history and connecting present and past
• Expect to actively work outside the therapy sessions.
41. Relationship Between Therapist and Client
• Intensive therapeutic relationship is not required. But,
REBT unconditionally accept all clients and teach them to
unconditionally accept others and themselves. (accept
them as persons but confront their faulty thinking and self-
destructive behaviors)
• Ellis believes that too much warmth and understanding
can be counter-productive, fostering dependence for
approval.
• Therapists shows great faith in their clients’ ability to
change themselves.
• Open and direct in disclosing their own beliefs and values
• Transference is not encouraged, when it occur, the
therapist is likely to confront it (e.g., clients believe that
they must be liked and loved by their therapists.)
42. Therapeutic techniques and procedures
• Cognitive methods
– Disputing irrational beliefs
• If I don’t get what I want, it is not at the end of the world
– Doing cognitive homework
• Applying ABC theory in daily life’s problems
• Put themselves in risk-taking situations to challenge their self-
limiting beliefs.
• Replace negative self-statement to positive message
– Changing one’s language
• It would be absolutely awful..It would be inconvenient
– Using humor
• Humorous songs
43. Therapeutic techniques and procedures
• Emotional Techniques
– Rational-emotional imagery
• Imagine the worst things that could happen to them
– Role playing
– Shame-attacking exercises
• Take a risk to do something that they are afraid to do because
of what others might think…until they realize that their
feelings of shame are self-created.
– Use of force and vigor
• From intellectual to emotional insight
• Reverse role playing
44. Therapeutic techniques and procedures
• Behavioral Techniques
– Use most of the standard behavioral therapy
approaches.
• Research Efforts
– Most studies focus only on cognitive methods
and do not consider emotive and behavioral
methods.
45. Applications of REBT
• REBT has been widely applied to several
areas: anxiety, depression, psychotic
disorders, problems of sex, love, and
marriage, crisis, couple and family therapy…
62. Donald Meichenbaum’s Cognitive
Behavior Modification (CBM)• Focus:
– Changing client’s self-verbalizations or self-statements
• Premise:
– As a prerequisite to behavior change, clients must notice
how they think, feel, and behave, and what impact they
have on others
• Basic assumption:
– Distressing emotions are typically the result of
maladaptive thoughts
63. Meichenbaum’s CBM
• Self-instructional therapy focus:
– Trains clients to modify the instructions they give to
themselves so that they can cope
– Emphasis is on acquiring practical coping skills
• Cognitive structure:
– The organizing aspect of thinking, which seems to monitor
and direct the choice of thoughts
– The “executive processor,” which “holds the blueprints of
thinking” that determine when to continue, interrupt, or
change thinking
64. How Behavior Changes?
• 3 Phases of Behavior Change
– 1. Self-observation
• Listen to themselves, realize they contribute to
their depression through how they think, and
develop new cognitive structures
– 2. Starting a new internal dialogue
• See adaptive behavioral alternatives
– 3. Learning new skills
• Teaching more effective coping skills
•
65. Coping Skills Programs
• Coping skills programs – Stress inoculation
training (3 phase model)
– 1. The conceptual phase
• Creating a working relationship with clients
– 2. Skills acquisition and rehearsal phase
• Giving coping skills to apply to stressful situations
– 3. Application and follow-through phase
• Transfer change to real world
66. From a multicultural perspective
• Contributions
– Diverse populationsappreciate the emphasis on
cognition and actions
– Challenge rigid thinking (e.g., “should”) instead of
questioning the values
– Stress the relationship of individuals to the family,
community, and systems
67. From a multicultural perspective
• Limitations
– Exploring core beliefs is important in CBT-needs to
sensitive to cultural background and context
• Value “working hard”feel ashamed for not living up to the
expectations; divorcebring shame to her family
– Diverse clients may be hesitant to question their basic
cultural values
– Diverse clients may value interdependence and may feel
difficult to be independent
Structural analysis- parent, child, adult what is their ego state
Transactional analysis what is the nature of their interaction- “I’m ok your ok”?
Script analysis what is the recurrent theme self narrative
Game analysis are they using games to wield attention what are the nature of the games
Dominant ego shaped through interaction with parents during childhood
Nurturing parent demonstrate care, concern, affection whereas critical parent constantly highlights faults, makes comparisons to other children, criticizes.
Adult- like a computer process environment makes decisions based on facts and logical outcomes
Child- represents our free spirited creative side- has split personality- natural child is the fun loving outgoing, impulsive, responsible for the creative and intuitive part of our personality. Represents the prince princess emblematic of of birth state. Adapted child is the overly socialized child and disposed towards passivity.
People play games to get strokes to earn recognition. They are dishonest, unfair and unethical in that they are not equal transactions only one person plays and the same person wins
Mine is better than yours
Human being need to be recognized, to obtain it they need to earn strokes
Racket- people hold grudges- keep score od everything that others are doing wrong to use against them later on
In TA Counselor works as a teacher to educate client about the different components of TA – posters pictures, and role playing are useful in teaching TA to children.
TA is the ideal system fro those who view counseling as a teaching process, as TA is replete with terms, diagrams, and models. Clients are taught the vocabulary so they can become proficientt in identifying ego states, games, transactions, and life scripts. The counselors role includes teaching, and providing a nurturing environment in which clients feel free to eliminate restricting injunctions, attempt new behavior, rewrite scripts, and move toward the “I’m Ok your Ok life position.