Cognitive Behavioral Therapy for Treatment-Resistant Cases

Introduction

Over the last several years, a variety of treatment options have emerged for a host of psychological illnesses. In most cases, mental health professionals will often prescribe some kind of medication in association with various forms of therapy. This is part of an effort by primary care doctors to tackle underlying known conditions with some of the most common drugs, such as Prozac. A study conducted at a major university found that the number of adult Americans receiving prescription medications to treat various mental disorders increased by 73% since 1996. At the same time, the number of children taking these drugs rose by 50% (Steenhuysen, 2009). This is significant because it shows how a variety of treatment options are often reliant upon these different drugs to address the underlying symptoms affecting the patient.

The problem is that many of these approaches take a one-size-fits-all approach to therapy, relying too heavily on prescription medication. Once this begins to occur, it can have an adverse impact on the patient. In the case of Margarita, she has been through a similar kind of approach in college: she underwent limited amounts of therapy and was immediately given Prozac, which produced a negative reaction. This is troubling, because it allowed her symptoms to become so extreme that she is beginning to have thoughts of violence and has grabbed various weapons on several occasions. All of this occurred against a backdrop of her not receiving any kind of effective therapy to address her underlying situation.

As a result, Margarita needs to undergo a change in how she interprets various events. The best option would be cognitive behavioral therapy (CBT). To fully understand how this approach can address Margarita's underlying conditions requires examining the origins of the therapy, its basic philosophies, intervention strategies, limitations, legal and ethical considerations, and how it aligns with a therapist's personal philosophy. Together, these different elements will provide the greatest insights into how CBT can address the underlying symptoms affecting Margarita and those individuals who may not respond to traditional treatment options.

Origins of CBT

Cognitive behavioral therapy is concerned with how an individual's thoughts affect their feelings and, ultimately, their behavior. It was developed in the early 1960s by a psychiatrist named Aaron Beck. During his many counseling sessions with a host of patients, he observed that most of the feelings they were having were associated with various thoughts. This connection meant that when someone was feeling upset, it was because they were thinking negative thoughts that triggered emotional outbursts. The basic theory was developed by observing connections between different events and the underlying behavior of the individual (Martin, 2011).

At the same time, other leading thinkers in the field began to draw upon their own life experiences to illustrate how thoughts and behaviors are interconnected. Viktor Frankl was a renowned Viennese psychiatrist until the Nazi annexation of Austria, at which point he was sent to a concentration camp because he was Jewish. During his experience, he observed how the overall state of mind determined which individuals were able to survive the Holocaust, as their underlying thoughts were reflected in their behavior and how they reacted to different events that occurred in their lives. This had an important impact on the development of CBT, as Frankl shared these experiences with others. Throughout the 1950s and into the 1960s, these ideas influenced a host of mental health professionals who had similar observations. This is important because it highlights how these ideas helped to shape CBT by showing patients the different ways they can overcome their condition through changing their thoughts (Frankl, 2004).

Core Philosophy and the Counselor's Role

The basic philosophy of CBT is that the individual controls the thoughts occurring in their own mind. For most patients this can be a difficult concept to embrace, because it requires everyone to take responsibility for their own actions to some degree. This means that the person does not continually dwell on past events and how bad they feel. Instead, there is a shift in focus: the patient concentrates on those thoughts that are most empowering. At the same time, everyone has the ability to change their underlying situation by taking control of their thoughts. This means working with counselors who can help identify possible challenges the patient may be experiencing. This kind of therapy requires the individual to consciously and consistently address the underlying thoughts they are having on a regular basis (Branch, 2010, pp. 39–61).

During therapy, the counselor plays a role of intervening at times when the patient may not be aware of what is happening with their thoughts. For example, when an individual is letting negative emotions run away with them, the therapist will intervene through a pattern interrupt, at which point they refocus the patient on more empowering thoughts. The counselor also plays the role of advisor and confidant: listening to the various challenges the individual is facing and discussing their thoughts with them. For ideas that could be disempowering, the therapist helps to teach the person how to identify and redirect them. This shows how the therapist acts as both confidant and coach while simultaneously serving as a foundation of support that gradually pushes the individual to change (Branch, 2010, pp. 39–61).

References

Branch, R. (2010). Cognitive Behavioral Therapy. New York, NY: Wiley.

Frankl, V. (2004). Man's Search for Meaning. New York, NY: Ridder.

Martin, B. (2011). Cognitive behavioral therapy. Psych Central. Retrieved from

Roth, D. (2010). Making Cognitive Behavioral Therapy Work. New York, NY: Guilford Press.

Steenhuysen, J. (2009). More Americans taking drugs. Reuters. Retrieved from http://uk.reuters.com/article/2009/05/05/us-mental-drugs-idUKTRE5440V120090505

Whitfield, G. (2007). Cognitive Behavioral Therapy. Oxon: Radcliffe.