Understanding current Cognitive Behaviour Therapy (CBT)
The 18-year-old student from Illinois State High School, Kevin was referred to the student counselling service by his football coach. The concerns were that Kevin was having difficulties focusing and playing well, with generalised issues about low mood. Additionally, Kevin has a diagnosis of major depressive disorder where feelings of inadequacy and a perception of worthlessness are the presenting themes.
According to Maj and Satorius (2002) there is a likeness between normal sadness and a depressed mood, but often depressed people do not seek help on their own until the condition deteriorates. This is also true for Kevin, who ...view middle of the document...
According to Moore and Garland (2003) a relationship loss has been recognised as a trigger for depression, where, particularly for Kevin, self-esteem and happiness appear dependent on being liked or approved of. However, according to cognitive theory, it is not the actual event that triggers depression, but how the event is perceived and processed (Maj & Satorius, 2002). If these maladaptive perceptions persist, Kevin’s issues could prevent him from meeting normal developmental tasks such as school attendance and peer relationships, ultimately increasing the very isolation he fears (Carr, 2014). Moreover, the problem may lead to risky behaviours such as substance abuse, or an increase in the risk of self-harm or suicide (Nayar, 2012).
Klein and Wender (2005) states that often family and/or friends are available to provide support in challenging situations, with these relationships bringing joy and substance to their life. However, depression can sabotage these important relationships, resulting in a reinforced belief of rejection and loss (Klein & Wender, 2005). Rather than directly treating depression but instead, the negatively biased view caused by the depressive disorder, CBT acknowledges that depression is not imaginary. It is the additional negative bias associated with the clients’ problem that causes the limitations of having a view focused on the solution (A. Beck & Weishaar, 2008).
Possible Difficulties for a Counsellor
Adolescents like Kevin may be reluctant to discuss sensitive matters, confirming the importance of the establishment and maintenance of a safe therapeutic alliance (Nayar, 2012). Furthermore, avoidance behaviour tends to mask negative thinking patterns interfering with the application of the treatment (Moore & Garland, 2003). This also includes missed appointments, and disorganisation of time-management. Additionally, unrealistic expectations over how quickly a behaviour should change from either counsellor or client are likely to cause significant issues (A. Beck & Weishaar, 2008), and if a client has been led to believe that a treatment is effective but it proves otherwise, it affirms the client’s belief that things cannot ever get better leading to “an entrenched sense of hopelessness” (Moore & Garland, 2003, p. 52).
Guidelines provided by A. Beck, Rush, Shaw, and Emery (1979) include the importance of keeping a focused, problem-solving attitude that avoids stereotyping the client as being the problem, rather than having a problem, and enable counsellors to be more resourceful in their approach when working with a challenging client. Moreover, a counsellor should remain conscious of their own cognitions and attitudes, always staying optimistic for the client and avoiding blame (A. Beck et al., 1979).
An Explanation of CBT
The primary purpose of CBT aims to adjust information processing, and by acting through the cognitive system, positive change can take place (A. Beck & Weishaar, 2008). As our...