SUMMARY AND EVALUATION REBT has evolved into a comprehensive and integrative approach that emphasizes thinking , judging , deciding , and doing . Therapy begins with clients' problematic behaviour and emotions and disputes the thoughts that directly create them. to block the self defeating beliefs that are reinforced by a process of self-indoctrination ,REBT therapists employ active and directive techniques such as teaching , suggestion ,persuasion, and homework assignment and they challenge clients to substitute a rational belief system for antirational one. therapist demonstrate how and why dysfunctional belief lead to negative emotional and behaviour results. they teach clients how to dispute self-defeating beliefs and behaviours that might occur in the future .REBT stresses action-doing something about the insights one gains in therapy .change comes about mainly by a commitment to consistently practice new behaviours that replace old and ineffective ones. Rational emotive behaviour therapists are typically eclectic in selecting thematic strategies . they have the latitude to develop their own personal style and to exercise creatively; they are not bound by fixed techniques for particular problems. EEBT is the forerunner of other cognitive behavioural approaches ,especially Beck's cognitive therapy and Meichenbaum's cognitive behaviour modification. All of these approaches stress the importance of cognitive process and determinants of behaviours .they maintain that how people feel and what they actually do is largely influenced by their by their objective assessment of situations .Because this appraisal of life situations is influenced by beliefs ,attitudes ,assumptions, and internal dialogues ,such cognations become the major focus of therapy.
Contributions of the Cognitive Behavioural Approaches Most of the therapist discussed in this book can be considered "cognitive," in a general sense, because they have the aim of changing clients' subjective views of themselves and the world. But the cognitive behavioural approaches focus on undermining faulty assumptions and beliefs and teaching clients the coping skills needed to deal with their problems. ELLIS'S REBT I find aspects of REBT very valuable in my work because I believe we are responsible for maintaining self-destructive ideas and attitudes that influence our daily transactions. I see value in confronting clients with questions such as “What are your assumptions and basic beliefs?” and “Have you really examined the core ideas you live by to determine if they are your own values or merely introjects ?” REBT has built on the Adlerian notion that events themselves do not have the power to determine us; rather, it is our interpretation of these events that is crucial. The A-B-C model simply and clearly illustrates how human disturbances occur and the ways in which problematic behaviour can be changed. Rather than focusing on events themselves, therapy stresses how clients interpret and react to what happens to them.
Another contribution of the cognitive behavioural approaches is the emphasis on putting newly acquired insights into action. Homework assignments are well suited to enabling clients to practice new behaviours and assisting them in the process of their reconditioning. Adlerian therapy, reality therapy, and behaviour therapy all share with the cognitive behavioural approaches this action orientation. It is important that homework be a natural outgrowth of what is taking place in the therapy session. Clients are more likely to carry out their homework if the assignments are collaboratively created. One of the strengths of REBT is the focus on teaching clients ways to carry on their own therapy without the direct intervention of a therapist. I particularly like the emphasis that REBT puts on supplementary and psycho educational approaches such as listening to tapes, reading self-help books, keeping a record of what they are doing and thinking, and attending workshops. In this way clients can further the process of change in themselves without becoming excessively dependent on a therapist. A major contribution of REBT is its emphasis on a comprehensive and eclectic therapeutic practice. Numerous cognitive, emotive, and behavioural techniques can be employed in changing one’s emotions and behaviours by changing the structure of one’s cognitions. wide range of clinical populations Beck did not originally believe were appropriate for this model, including treatment for schizophrenia, delusional disorders, bipolar disorder, and various personality disorders (Leahy, 2002). According to Weishaar (1993), Beck demonstrated that a structured therapy that is present-centred and problem-oriented can be very effective in treating depression and anxiety in a relatively short time. In fact, Beck considers cognitive therapy to be the integrative psychotherapy because it draws from so many different modalities of psychotherapy (Alford & Beck, 1997). One of the contributions of cognitive therapy is that it focuses on developing a detailed case conceptualization as a way to understand how clients view their world. Thus, cognitive therapy shares the phenomenological perspective with the Adlerian, existential, person-centred, and Gestalt approaches. Cognitive therapy provides a structured, focused, active approach that focuses on the client's inner world. According to Weishaar (1993), one of Beck’s major theoretical contributions has been bringing private experience back into the realm of legitimate scientific inquiry. A key strength of cognitive behaviour therapy is that it is an eclectic psychotherapy. (2002a) advocates using cognitive behavioural techniques within an existential framework. Thus, a client with panic disorder might well be encouraged to explore existential concerns such as the meaning of life, guilt, despair, and hope. Clients can be provided with cognitive behavioural tools to deal with events of everyday living and at the same time explore critical existential issues that confront them. Grounding symptomatic treatment within the context of an existential approach can be most fruitful.
The credibility of the cognitive model grows out of the fact that many of its propositions have been empirically tested. According to Leahy (2002), “Over the past 20 years, the cognitive model has gained wide appeal and appears to be influencing the development of the field more than any other model" (p. 419). Leahy identifies several reasons this approach has found such wide appeal: It works. It is an effective, focused, and practical treatment for specific problems. It is not mysterious or complicated, which facilitates transfer of knowledge from therapist to client. It is a cost-effective form of treatment. MEICHENBAUM'S COGNITIVE BEHAVIOR MODIFICATION Meichenbaum’s work in self-instruction training and stress inoculation training has been applied successfully to a variety of client populations and specific problems. Of special note is his contribution to understanding how stress is largely self-induced through inner dialogue. He has gone beyond simply adding a few cognitive techniques to behaviour therapy and has actually broadened its theoretical base through his demonstration of the importance of self-talk (Patterson & Watkins, 1996). Meichenbaum (1986) cautions cognitive behavioural practi tioners against the tendency to become overly preoccupied with techniques. If progress is to be made. he suggests that cognitive behaviour therapy must develop a testable theory of behaviour change. He reports that some attempts have been made to formulate a cognitive social learning theory that will explain behaviour change and specify the best methods of intervention. A major contribution made by both Beck and Meichenbaum is the demystification of the therapy process. Both of these cognitive behavioural approaches are based on an educational model that stresses a working alliance between therapist and client. The models encourage self-help. provide for continuous feedback from the client on how well treatment strategies are working. and provide a structure and direction to the therapy process that allows for evaluation of outcomes. Clients are active. informed, and responsible for the direction of therapy because they are partners in the enterprise. The cognitive behavioural approaches may well be the treatment of choice in the current rent managed care environment.
Limitations and Criticisms of the Cognitive Behavioral Approaches ELLIS’S REBT REBT is a confrontational therapy, which provides both advantages and disadvantages. Some clients will have trouble with a confrontive therapist before he or she has earned their respect and
trust. If clients feel they are not being listened to and cared about, there is a good chance they will terminate therapy. I value paying attention to a client’s past without getting lost in the past and without assuming a fatalistic stance about earlier traumatic experiences. I question the view of most cognitive behavioral therapists that exploring the past is ineffective in helping client’s change faulty thinking and behavior. In some cases not enough emphasis is given to encouraging clients to express and explore their feelings. I believe the cognitive behavioral approaches can work best once clients have express their current feelings, which often occurs when they relive and work through earlier emotional issues in the here-andnow. Past unfinished business and childhood experiences can have a great deal of therapeutic power if they are connected to our present functioning. From my perspective, some painful early experiences need to be recognized, felt fully, reexperiences, and worked through in therapy before people can free themselves of restrictive influences. REBT therapists can misuse their power by imposing their ideas of what constitutes rational thinking. Ellis (2001b) acknowledges that clients may feel pressured to adopt goals and values the therapist sells rather than acting within the framework of their own value system. Due to the directive nature of this approach, it is particularly important for practitioners to know themselves well and to take care nor to impose their own philosophy of life on their clients. Because the therapist has a large amount of power by virtue of persuasion, psychological harm is more possible in REBT than in less directive approaches. Furthermore, this power imbalance may disrupt the collaborative and cooperative client-therapist relationship essential to a successful outcome. The therapist’s level of training, knowledge, skill, perceptiveness, and judgment is particularly important. It is essential that the therapist be aware of when and how much to confront clients. An untrained therapist who uses REBT might view therapy as wearing down a client’s resistance with persuasion, indoctrination, logic, and advice. Thus, a practioner can misuse REBT by reducing it to dispensing quick-cure procedures-that is, by telling clients what is wrong with them and how they can best change. It is well to underscore that REBT can be effective when practiced in a style different from Ellis’s. Because Ellis has so much visibility, it is worth distinguishing between the principles and techniques of REBT and his very confrontational tactics. Indeed, a therapist can be soft-spoken and gentle and still use REBT concepts and methods. At times inexperiences REBT practitioners may assume that they must follow the fast pase of Ellis. Therapists who employ REBT techniques can use different degrees of directiveness, can vary the amount of activity, and can be themselves by developing a style that is consistent with their own personality.
BECK’A COGNITIVE THERAPY
Cognitive therapy has been criticized for focusing too much on the power of positive thinking; being too superficial and simplistic; denying the importace of the clien’s past; being too technique-oriented; failing to use the therapeutic relationship; working only on
eliminating symptoms, but failing to explore the underlying causes of difficulities; ignoring the role of unconscious factors; and neglecting the role of feelings (Freeman & Dattilio, 1992; Weishaar, 1993). Freeman and Dattilio (1992, 1994; Dattilio, 2001) do a good job of debunking the mytha and misconceptions about cognitive therapy. Weishaar (1993) concisely addresses a number of criticisms leveled at the approach. Al-though the cognitive therapist is straightforward and looks for simple rather than complex solutions, this does not imply that the practice of cognitive therapy is simple. Cognitive therapists do not explore the unconscious or underlying conflicts but work with clients in the present to bring about schematic changes. However, they do recognize that clients’ current problems are often a product of earlier life experiences, and they do not ignore unconscious content such as dreams (Frank Dattilio, personal communication, June 25, 2002). A criticism of cognitive therapy, like REBT, is that emotions tend to be played down in treatment. Both approaches draw on emotional techniques, along with cognitive and behavioral strategies, to bring about client change, but neither encourages emotional ventilation or emotionally reexperiencing painful events. Although Dattilio (2001) admits that CBT places central emphasis on cognition and behavior, he adds that emotion is a byproduct of cognition and behavior and is addressed in a different fashion. In fact, in his discussion of the case of Celeste, Dattilio (2002a) shows how he worked with this client to identify and express her emotions fully. Dattilio does not assume that problematic emotions are simply the result of faulty thinking; rather he contends that emotions have independent, adaptive and healing functions of their own. Dattilio (2000a) puts the limitations of this approach nicely into perspective: “While CBT does have its limitations, it remains one of the most efficacious and well-researched modalities in existence” (p.65). Leahy (2002) cautions against the tendency to pontificate rest than test out new ideas, and he endorses an openness to ideas advocate by other therapists: “It may be that ‘true-believers’ in cognitive therapy find themselves starting with a devotion to a for maleic modal but will move toward integrating cognitive therapy with more awareness of the complexities and limitations of the model” (p.432).
MEICHENBAUM’S COGNITIVE BEHAVIOUR MODIFICATION
In their critique of Meichenbaum’s approach, Patterson and Watkins (1996) raise some excellent questions that can be asked of most cognitive behavioral approaches, the basic issue is discovering the best way to change a client’s internal dialogue. Is directly teaching the client the most effective approach? Is the client’s failure to think rationally or logically always due to a lack of understanding of reasoning or problem solving? Is learning by self-discovery more effective and longer lasting than being taught by a therapist? Although we don’t have definitive answers to these questions yet, we cannot assume that learning occurs only by teaching. It is a mistake to conclude that therapy is mainly a cognitive process. Experiential therapies stress that learning also involves emotions and self-discovery.
