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CBT integrates theory, i.e. The tenets of psychotherapy, with practical, behavior modification exercises. This, in turn, creates real tangible results. As Cooper writes, "If, on the one hand, you look at the particular therapies that have been shown to be effective for particular psychological problems -- as advocates of empirically supported treatments have done -- there is no question that the evidence base is strongest for CBT. While, for instance, there are scores of high quality controlled trials demonstrating the effectiveness of CBT for depression17, there are just a handful of studies demonstrating the same thing for person-centred therapy. And while CBT has been shown to be effective for numerous psychological difficulties -- such as phobias, panic, PTSD, bulimia, sexual problems and deliberate self-harm -- there is little equivalent evidence for the vast array of non-CBT practices18 (2008).
CBT is an approach that has been empirically proven to be successful at helping clients, as Cooper has stated (2008), but is it more effective at treating some populations over other populations. Is there a corollary between socio-economic status (race, gender) and the efficacy of CBT? In a literature review published in the American Journal of Psychotherapy, this issue was obliquely addressed, the authors found, "CBT-trained therapists work with individuals, families, and groups. The approach can be used to help anyone irrespective of ability, culture, race, gender, or sexual preference. It can be applied with or without psychopharmacological medication, depending on the severity or nature of each patient's problem" (Gelso & Fretz, 2001). Here the authors intimate the CBT is a universal effective approach, which, in my experience it is. It is effective in a one-on-one scenario or in a larger group or familial setting. The majority of studies examining the overall efficacy of CBT do so from the vantage point of which disorders it is successful at treating as opposed to a meta-analysis of which socio-economic or racial or gender specific sub-groups are more or less receptive to CBT therapy. That said, one sub-group that has shown to be especially receptive to CBT therapy is children (notwithstanding the fact that "children" as a sub-group could be debated). In fact the Association for Behavioral and Cognitive Therapies heavily endorses CBT as a therapeutic treatment for children and adolescents, and on its website, issues this disclosure, "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 among children and adolescents, as well as adults" (2008).
The point is CBT is effective at treating a vast array of psychological problems in all people, young and old. However, and to circle back to the "knowing the limitations" aspect of this paper, CBT is not a magic elixir or a one-size fits all approach, which why one must integrate other theoretical approaches. One additional theoretical approach that works well with CBT is person-centered therapy, or PCT. Due to the fact that CBT efficacy is universal, there still -- in order to maximize the effect of CBT - needs to be a sensitivity to and acknowledgment of factors such as race, socio-cultural background, gender, etc. And PCT improves a therapist's ability to reach his/her client.
To explain the synergistic relationship between CBT and PCT would be to say that PCT is the appetizer that prepares one for the main course (CBT). PCT is an empathetic approach that allows the client/patient to feel completely comfortable as himself/herself. In a PCT environment the client/patient is not being impelled or coerced or manipulated into doing anything or saying anything that makes him/her feel uncomfortable. The client/patient is treated with unconditional positive regard which easies his/her transition into the session (Gelso & Fretz, 2001). he/she can then begin to delve into the issues that are important to him/her free of distraction. PCT tears down the wall of self-consciousness and removes labels that inhibit self-reflection. Once an individual is in engaged in the session, the therapist can then take a more CBT directed approach, which tends to be -- when compared to PCT -- overt in its methodology. CBT requires, at some level, there be homework involved, i.e. practices that lead to the attenuation of a maladaptive behavior.
No matter what the approach is, one must openly acknowledge some of the complications and controversies that occur when testing the efficacy of any form of psychological treatment, not just CBT. For example, the dodo bird effect, which seems to posit that all forms of therapy - CBT and otherwise - are only marginally different in their effectiveness. To explicate, CBT is only slightly more effective than say group therapy or strictly psychotherapy. So, currently, there is no clear-cut optimum form of therapy. What we do know is that almost all forms of therapy and counseling work to slightly varying degrees (Cooper, 2008).
If this doesn't blow one's mind, I don't know what will. And this is exactly what I mean regarding the notion that a great counselor or therapist must be comfortable in uncertainty. We're not on solid ground. At an elemental level, we know that therapy and counseling work but we're also aware that there is really no optimal form of therapy. Additionally, thanks to studies and clinical research, we know that there are several factors aside from the therapeutic model one adopts that impact the efficacy of treatment, for example, the disposition and predilections of the counselor/therapist can have an impact on treatment and so can the dynamic between the client/patient and the counselor/therapist (Cooper, 2008). If the therapist is encouraging, patient, and understanding, and the client is receptive to these attributes, which studies show are indeed the desired qualities for counselors/therapists, then the success rate of treatment tends to be higher
Even given all these factors, the type of therapy (in my case CBT mixed with PCT), the temperament of the counselor/therapist, and the client-counselor dynamic, the most important factor in determining the success of any type of treatment is whether or not the patient wants to and is willing to change. This is the most critical aspect of therapy, as Cooper writes, "for what the research suggests is that client factors are probably the most important determinants of therapeutic outcomes, accounting for 70% or more of the overall effectiveness of counseling and psychotherapy (2008). He concludes, "But the evidence suggests that the key predictor of outcomes remains the extent to which the client is willing and able to make use of whatever the therapist provides. The old joke, then, would seem to have got it right: how many therapists does it take to change a light bulb? One, but the light bulb has really got to want to change (2008)."
There is a lot being discussed in these passages, but what is most critical to the topic of treatment efficacy is the fact that roughly 70% is contingent on "client factors." This
means that, as was intimated by Cooper, you can lead a horse to water, but you can't make him drink. This is a key point in my integrated orientation to therapy, I am very aware that not everyone wants to change, that some people are not receptive to therapy and/or counseling. However, part of my job is -- to use a dirty word in the domain of psychology -- "sell" people on the idea of therapy and counseling
. And this notion of selling has to do with PCT. In order to be a good salesman one has to believe in his/her product (in this case, the chosen integrated therapy model -- CBT & PCT) and has to be attuned to the patient's (or patients) background. This implies PCT. Without making one's client/patient comfortable how can one expect him/her to buy the product? So, in selling, one must remember who his client/patient is and be prepared to change approaches on the fly. To give a concrete example, if a therapist or counselor is dealing with an affluent and erudite literature professor who is skeptical about counseling, the counselor/therapist might warm them up by prompting him/her to discuss Nabokov or Joyce or Melville until there's enough affinity and trust between the therapist and the client to continue into a more personal matters. Likewise, if a therapist/counselor is dealing with an economically disadvantaged single mother from a dilapidated urban area, the therapist/counselor might opt to use different prompts to get the client/comfortable, talking about Nabokov or Joyce or Melville might make the single mother feel ostracized and uncomfortable. But then again, a lot of this relies on assumption, and one must be cautious about the assumptions one makes concerning an individuals experiences, preferences, and even about their views of therapy.
And really, that's one of the biggest mistakes a therapist or a counselor can make, is to assume people have the same faith (there's that word again) that we do in therapeutic treatment. My personal experience has taught me that many patients, especially in the…[continue]
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