Louisa Baker Worth Worth 3A12 Word Count ??“ 2843
???How can modern behavioural therapies help a client accept the uncertainty of their future???
In order to evaluate whether modern behavioural therapies can assist a client in accepting the uncertainty of their future, I am going to look at 2 modern behavioural therapies ??“ CBT ??“ Cognitive Behavioural Therapy and REBT ??“ Rational Emotive Behavioural Therapy.
CBT is the term used for a group of psychological treatments that are based on scientific evidence. These treatments have been proven to be effective in treating many psychological disorders by addressing dysfunctional emotions, maladaptive behaviours and cognitive processes through a number of goal orientated, explicit systematic procedures.
CBT focuses on the way people think and act to help them with their emotional and behavioural problems. It is a practical approach to helping people overcome problems and has straightforward and clear principles. A central concept of CBT is that you feel the way you think. Therefore, CBT works on the principle that you can live more happily and productively if you are thinking in healthy ways.
A central message of CBT is that the thoughts, attitudes and beliefs you hold have a big effect on the way you interpret the world around you and how you feel. So, if you are feeling excessively bad then chances are you are thinking badly or at least in an unhelpful way. People don??™t intend to think badly and mostly, people are unaware that they do.
CBT is a short term therapy that revolves around solving problems that a client presents with. It works by asking the client to take part in the therapy and actively work on changing their negative thought processes. The client and therapist will identify the individual issues that the client wishes to work on and goals are identified. The client and the therapist then work together, focusing on specific skills that empower the client to harness their own internal resources to maintain the changes they make. Homework is given to a client to use the skills that have been discussed in the sessions in everyday life and note the changes they produce compared with previous cognitions and behaviours.
REBT is a form of psychotherapy created by Albert Ellis in the 1950??™s. Its central premise is that events alone do not cause a person to feel enraged or highly anxious. Rather, it is ones beliefs about the events which contribute to unhealthy feelings and self defeating behaviours.
REBT teaches the client to identify, evaluate, dispute and act against their irrational self defeating beliefs, thus helping the client to not only feel better but to get better.
It is a practical and action led approach to therapy and personal growth. It focuses on the client??™s present behaviours but also provides techniques that will help them solve future problems and understand the behaviour of others.
REBT does hold with the fact that we are influenced by the past but contends that the past manifests in our present in our current beliefs and behaviours. Therefore, this model works with current beliefs whether they are formed in the deep past or more recently picked up. It proposes that we cannot change the past but we have the ability to change the future. The process of change is one that restores emotional balance by recognising the involvement of negative emotions and how they change the rational way in which we think.
The methods used in REBT provide ways in which we can learn to think in a more realistic way about our total environment. Although some negative emotions are natural and in some cases beneficial, they should be dealt with rather than festering away by the processes of internalisation or displacement.
REBT argues that at the core of emotional disturbance lies a set of irrational beliefs that people hold about themselves, other people and the world.
Ellis proposed 12 irrational beliefs that cause and sustain neurosis ??“
The idea that it is a dire necessity for adults to be loved by significant others for almost everything they do–
Instead of their concentrating on their own self-respect, on winning approval for practical purposes, and on loving rather than on being loved.
The idea that certain acts are awful or wicked, and that people who perform such acts should be severely damned —
Instead of the idea that certain acts are self-defeating or antisocial, and that people who perform such acts are behaving stupidly, ignorantly, or neurotically, and would be better helped to change. Peoples poor behaviours do not make them rotten individuals.
The idea that it is horrible when things are not the way we like them to be–
Instead of the idea that it is too bad, that we would better try to change or control bad conditions so that they become more satisfactory, and, if that is not possible, we had better temporarily accept and gracefully lump their existence.
The idea that human misery is invariably externally caused and is forced on us by outside people and events
Instead of the idea that neurosis is largely caused by the view that we take of unfortunate conditions.
The idea that if something is or may be dangerous or fearsome we should be terribly upset and endlessly obsess about it–
Instead of the idea that one would better frankly face it and render it non-dangerous and, when that is not possible, accept the inevitable.
The idea that it is easier to avoid than to face life difficulties and self-responsibilities
Instead of the idea that the so-called easy way is usually much harder in the long run.
The idea that we absolutely need something other or stronger or greater than our self on which to rely —
Instead of the idea that it is better to take the risks of thinking and acting less dependently.
The idea that we should be thoroughly competent, intelligent, and achieving in all possible respects —
Instead of the idea that we would better do rather than always need to do well, and accept our self as a quite imperfect creature, who has general human limitations and specific fallibilities.
The idea that because something once strongly affected our life, it should indefinitely affect it —
Instead of the idea that we can learn from our past experiences but not be overly-attached to or prejudiced by them.
The idea that we must have certain and perfect control over things —
Instead of the idea that the world is full of improbability and chance and that we can still enjoy life despite this.
The idea that human happiness can be achieved by inertia and inaction —
Instead of the idea that we tend to be happiest when we are vitally absorbed in creative pursuits, or when we are devoting ourselves to people or projects outside ourselves.
The idea that we have virtually no control over our emotions and that we cannot help feeling disturbed about things —
Instead of the idea that we have real control over our destructive emotions if we choose to work at changing the ???musturbatory??? hypotheses which we often employ to create them.
In therapy, techniques would be used to challenge these irrational beliefs and as a therapist using REBT, we would use our interactive skills to argue against these. The best way would be to lead the client to make those arguments with themselves by asking questions such as ???is there any evidence for this belief??™ and ???what is the worst that could happen if you let this belief go??™
REBT and CBT are very similar in their approach although I personally have a preference to CBT so for this continuing purpose of this essay I will concentrate on one approach ??“ this being CBT.
So, how can CBT help a client accept the uncertainty of their future
CBT is a powerful treatment because it combines scientific, philosophical and behavioural aspects into one comprehensive approach to understanding and overcoming common psychological problems.
A defining characteristic of CBT is that it gives you the tools to develop a focused approach. CBT aims to help you move from defined emotional and behavioural problems towards your goals of how you would like to feel and behave.
The need for certainty is a very common contributing factor in anxiety.
As Benjamin Franklin said ???in this world nothing is certain but death and taxes???.
We actually live in an uncertain universe. Of course, some things are predictable and pretty sure bets like the sun rising in the morning and setting in the evening. However, other things in life are much more uncertain such as ???will I be rich??™ or ???will I grow to an old age and be surrounded by grandchildren??™
If you are intolerant of uncertainty, as soon as you quell one doubt another one is going to pop up. The idea with CBT is to find ways to tolerate doubt and uncertainty as they exist whether you like it or not.
Demands for certainty can be reflected in your behaviour as shown below.
Frequent requests for reassurance. Constantly asking yourself and other people questions are all efforts to find some reassurance in an uncertain world. Unfortunately, excessive reassurance seeking can reduce your confidence in your own judgement.
Repeated checking behaviours. Checking behaviours are actions you perform in an effort to create more certainty in your world. Such actions could include checking several times that your doors and windows are locked or going over conversations in your mind to be sure that you haven??™t said anything offensive. The irony is that the more you check the more uncertain you feel. You may feel temporarily better after your checks, but it??™s not long before you are compelled to carry out the checks again. Excessive checking can be very time consuming and tiring, and it can lower your mood.
Superstitious rituals. These are things that you do to try to keep yourself safe or to prevent bad things from happening. Typically, these rituals are not usually directly related to whatever it is that you fear most. Engaging in superstitious behaviours can lead you to conclude that the ritual has prevented bad things from happening, rather than help you understand that many bad events are unlikely to occur regardless of whether you perform a ritual or not. Superstitious thinking also involves making faulty links between your subtle behaviours or thoughts and what happens in reality. For example, if you had a vivid image or dream of a child being abducted then you may think if it happens, I made it happen by imagining it. In this case you would point out to your client that they don??™t make superstitious links anywhere near as readily about good stuff. For example, when was the last time they thought it??™s a beautiful day because they thought about the weather being nice this week. If your superstitious behaviour makes any real sense at all then it has to hold true for both good and bad events.
Avoiding risks. Risks such as global tragedies, becoming ill, having an accident making poor decisions etc are unavoidable and ever present. You may be trying to eliminate risk by staying home or in a ???safe??™ place, never deviating from usual routines, over planning for trips away or over preparing for unlikely events such as war, plague or famine. In fact, risk is a part of life and can only be avoided to a limited extent. The more you try to eliminate all risk from your life; you are more likely to focus on all the possible things that could go wrong. You are fighting a losing battle and are likely to undermine your sense of security even further. Focusing too much on the risks inherent in everyday life will leave you chronically worried and cause you to overestimate the probability of bad things happening to you.
Trying to influence others. Examples of influencing others behaviour include encouraging your partner to socialise only with members of the same sex, persuading your children to stay at home rather than go out with their friends and asking your doctor to send you for more tests. Demanding that others act in ways to minimise your intolerance of uncertainty and risk can seriously damage your relationships. People close to you are likely to perceive you as controlling or suspicious.It is important that the client understands that uncertainty has always been a major feature of the world, and that people still manage to keep themselves safe and secure. The world doesn??™t need to change to feel secure; they simply need to accept that uncertainty exists and learn to live with it. You can happily co exist with uncertainty ??“ it??™s always been that way. Remind your client that most people cope with bad events every day and that they are likely to cope as well as others do if something horrible comes their way.
It is important through CBT that a therapist helps the client to challenge their negative automatic thoughts (NAT??™s) and help them build up their sense of self.
Negative automatic thoughts are a type of thinking that exists within a more obvious stream of thoughts. They are brief and tend to appear suddenly, and can occur in verbal and/or visual form. They are usually accepted as true, without contemplation or appraisal.
Negative thoughts can trap you in a vicious circle. The more depressed or anxious you become, the more negative thoughts you have, and the more you believe them. The more negative thoughts you have, and the more you believe them, the more depressed or anxious you become. The main goal of CBT is to help the client break out of this vicious circle. It is important to assist the client to learn to recognise when they are thinking negatively, to look for more positive and realistic ways of viewing their experiences and to test those out in action.
It may not be easy for a client initially to catch and answer their thoughts. Answering negative thoughts is like any other skill ??“ it takes time and regular practice to be able to do it with ease. It is important to encourage the client if they have difficulties to start with and ensure that they remain positive.
There are some various techniques currently used in CBT that are designed to aid in the identifying and evaluating process of NAT??™s. The therapist will employ one or all of these to help the client understand how their thinking has developed.
By following certain lines of questioning, a great deal of information about the clients NAT??™s can be quickly uncovered. Such questions might include the following :-
???What is the evidence that supports this idea??™
What is the evidence against this idea??™
Is there an alternative explanation??™
What is the worst that could happen??™
Could I live through it??™
What is the best that could happen??™
What is the most realistic outcome??™
The intention is to simply guide the client in the recognition and refutation of unhealthy thought processes, and towards a more rational, healthier perspective. The goal of this type of questioning is to have clients reflect upon and sort out all the presented material, rendering them more like to recall and employ it in their day to day life.
By using this technique, CBT therapists teach clients how to assess their NAT??™s as merely premises, which are meant to be tested, for once one realises that their automatic thoughts are not accurate, they are free to construct more stable and adaptive appraisals. Equally, the testing of assumptions may help create new solutions if the process corroborates ones original perception of an event.
Clients may also be helped to use imagery to discover their thinking patterns as many people experience automatic thoughts not only as unspoken words in their mind but also in the form of mental pictures or images. In order to teach clients how to recognise and intervene with their distressing images, the therapist attempts either to elicit a spontaneous image a client has had or to induce an image in session.
As a treatment, it helps the individual become aware of patterns and offers a framework both to pinpoint problematic emotions and to distance oneself from them in order to assess them in an unbiased manner.
The client needs to become aware of their negative thoughts and the effects these have on them. Negative thoughts can make you feel anxious, sad, depressed, hopeless, guilty and angry. Instead of being overwhelmed by these feelings, the client can learn to use them as a cue for action. They will learn to notice when their mood changes for the worse and look back at what was running through their mind at that moment. Over the course of time they will become more sensitive to changes in their feelings and the thoughts that spark them off.
In conclusion, I feel that CBT could be very helpful in assisting a client accept the uncertainty of their future. Although I accept it would not suit everyone, I certainly believe it has its place and could be very successful.
Louisa Baker Worth Worth 3A12 Word Count ??“ 2843