Thursday, 16 July 2015

Cognitive Behavioural Therapy

Cognitive Behavioral Therapy is a useful therapy I practice to some degree with almost every client I see. I studied this in my Psychology degree and Counselling diploma and am also completing a diploma specifically in this subject. CBT is based on the idea that it is our destructive thoughts about a situation which lead to us therefore feeling unhappy and unable to do the things we want to do. In Cognitive therapy we therefore examine what these thought patterns are which are causing us to feel unhappy or like we can't function and to challenge these to see how grounded in reality they really are. By doing this we are often able to take an edge off our anxiety to allow us to do more quite quickly, or to atleast take that step forward we need. It can easily be incorporated into therapy for various issues such as dealing with depression, grief counselling or relationship counselling. My putting things into a real clearer perspective and overcoming irrational thinking it can help us to understand that whereas things may seem bad now they often aren't as bad as they seem and even if things are really bad it doesn't mean that nothing will ever change.
The founder of CBT therapy was Albert Ellis. He referred to the process of us making these destructive thought patterns as 'awfulising'. When we are feeling anxious about a situation and examine the thoughts we are often able to see how irrational what we are thinking really is. For example, an anxiety around being in a crowded space when examined can expose itself through CBT as ultimately being a thought that we fear we may get crushed by the other people there. When truly examining the thoughts scientifically we are often able to see that there isn't a foundation in reality for that thought so consequentially the anxiety can decrease.
A common exercise I use with clients is to describe a situation and then to discuss the feelings associated with it and the percentage these feelings are dominating them in the situation. e.g. situation: going to the mall, feelings: anxiety, dread 90%. After this we then look at the thoughts associated with it. It is often difficult for clients to really get into the thoughts as we often go hard on ourselves and dont like to acknowledge that our thoughts are in fact irrational. In my practice I encourage that whatever it is we are thinking and feeling is real at that time for us and that is our reality and the only thing we can work with to make progress. By going into the thoughts they may be something like: 1. There are too many people. 2. People will walk into me. 3. People will get angry with me. 4. It is all too much. 5. I can never be in a mall. These thoughts may also be dominating the consciousness at 90%.
We take each of these statements and really look at them and what they actually mean and of their truly is any foundation. Starting with:
  1. There are too many people.
    Our rational may be: - It may be very busy, I don't know yet. If it is very busy I can leave and come back when quieter. If I decide to go in there is no reason I wouldnt be able to leave at any time.
  2. People will walk into me.
    Our rational may be: It is unlikely that someone would walk into me but if they did it wouldn't be the end of the world. Either one of us could say sorry. It is unlikely anything truly harmful would come of this.
  3. People will get angry with me.
    Our rational may be: It is unlikely that anyone would get angry with me but if they did I would be able to leave or be calm enough to manage their anger. If it is really so busy where people will be bumping into one another I could choose not to go in and come back another day.
  4. It is all too much.
    Our rational may be: If it truly feels too much I can leave at any time.
  5. I can never be in a mall.
    Our rational may be: I feel like I can't be in a mall now but there is no reason why this would be the case for all of time.
After this we then re-rate the original emotions and the original thoughts
Often through doing some cognitive behavioural therapy at the start we are able to take an edge off and also in noticing the 'awfuling' thoughts we are often able to see where this has come from. In the case of the client above this could come from a memory for example of being in the mall on a very busy day near christmas with parents and being very crowded and being shouted at by someone for walking into them.
Through CBT we can realise what the dysfunctional thoughts are and challenge them to take the anxiety off. It can also enable us to go deeper as we realise where these thoughts may have come from. More work in Counselling can go into more emotional depth in talking about the original stress of where it came from. Through the supportive environment and empathy given clients are able to let go of this and move forward.
A challenge is CBT can often be clients stress of where they are at and where they want to be which can seem miles away. It is always important in the whole Counselling process to practice your own compassion for yourselves which often we have lost. It can be useful to think about what you would say to a good friend who is feeling this same way. It is really important that wherever you are at to be able to nurture yourself at that space and then to look what is the way forward to make that one step.
In CBT we often work on SMART goals. This is about making goals of where you would like to be in the future in different areas of your life. The letters stand for SPECIFIC, MEASURABLE, ACHIEVABLE, REALISTIC, TIME FRAMED. We can create goals in our therapy sessions and then break down to be able to make that first step. Everyone can always find a goal and make a first step to get there.
Sometimes people just don't know what they want or just come to Counselling with a feeling that things aren't how they want them to be and with that feeling we can more empathically explore it and look at what it means. Through these feelings we can find a deeper self understanding then over time perhaps link this understanding with CBT and more forward planning.

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