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Cognitive behavioural theory
A video by Dr. Robert L. Leahy
Cognitive behavioural theory has developed out of two main theories which were the behavioural theory and the cognitive theory. Behavioural theory places emphasis on the biological and environmental aspects influencing learning. Behavioural therapists had developed techniques in order to help individuals learn new ways of behaving (learning theories), which were found to be very successful particularly with anxiety disorders (Westbrook, Kennerley and Kirk, 2010). However there was criticism made regarding a single behavioural approach, and psychology’s attention was drawn towards the importance of mental processes such as thought, beliefs, memory and in the 1970s cognitive therapy was developed (Beck et al., 1979) supporting that a person’s thoughts determined how they felt.
Over the years these two theories grew and influenced each other resulting in the development of cognitive behavioural theory. Whereas the person-centred approach to counselling places emphasis on exploring and understanding, the cognitive behavioural approach is concerned with the client’s action to produce change (McLeod, 2009). Thus, cognitive behavioural theory is concerned with the influence of internal and external factors on a person’s emotional, physical and psychological well-being. The changing of conceptualizations is the main feature of this theory.
Additionally, cognitive behavioural theory rests upon the belief that the way people structure and also interpret their experiences will determine the way they feel and behave (James and Gilliland, 2003). The perceptions, interpretations and assumptions which people make influences their emotions and behaviours while schemas also have a significant effect on the way they operate cognitively since schemas include a person’s core beliefs as well as their basic assumptions.
This theory therefore has been used effectively within therapy with individuals experiencing a wide range of issues (i.e. psychological, physical, emotional, relationship, sexual) such as anxiety and depression (Borkovec and Costello, 1993; Borkovek et al., 2002), chronic pain (Turner et al., 2007), psychosis (Khandpur and Singh, 2007). Within the counselling process of CBT (Cognitive behaviour therapy) there are a range of procedures and techniques offered to help a client change negative, self-defeating responses while the therapist can choose which one fits well with their client’s thought processes.
The basic criticism facing this approach however is “for being a rather simple-minded ‘cook book’ approach to therapy” (Westbrook et al., 2010, p.1).This is due to the different techniques applied to different problems. Some of these techniques are relaxation training, mental imagery, emotive imagery, cognitive modelling, cognitive restructuring, biofeedback and stress inoculation (James and Gilliland, 2003). Cognitive behaviour theory is mostly used within cognitive behaviour therapy, cognitive behaviour modification, and rational emotive behaviour therapy (Kottler, 2002).
Nevertheless, this approach is based on empirical research which has been carried out over the years (Barlow et al., 1989; Williams, 2001; Brown et al., 2004). Orlinsky et al. (1994) as cited in Westbrook et al. (2010) propose that the quality of the relationship between the therapist and client is vital for effective treatment to take place.
Therefore the therapist and client are both active within therapy with the therapist being able to provide ways to solve problems and the client being the expert of his or her own problems and of the ways used to overcome these (Westbrook et al., 2010). Working together they both help the client achieve cognitive and behavioural control over the problem he/she is faced with, explore different ways of behaving, analyse the thoughts and emotions, and recognise new cognitive as well as behavioural patterns (James and Gilliland, 2003).
The therapists' role
The therapists’ role within Cognitive behavioural therapy is mostly seen as educational (i.e. guide and mentor) conducting empathic and collaborative work in order to help the client engage in therapy. However, as there is a lot of training and skills needed, the therapist is required to understand a range of both cognitive techniques as well as behavioural and learning theories.
Cognitive behavioural therapy has been mostly effective with individuals who are not seriously disturbed. Thus it has a limited focus on exploring emotional issues or understanding the reason causing the client to think and behave in a certain way (Aldbridge and Rigby, 2004). This is due to its aim to control emotions instead of allowing them to be felt (McLeod, 2009). A possible danger within this approach could be that the therapist may be perceived as an expert with power who has all the answers even though dependency on the therapist is discouraged.