Cognitive Behavioural Therapy | CBT - Counselling Directory
If you are a marriage and family therapist or couples counselor, consider sharing some of these activities and exercises with your clients. CBT is a highly structured and practical approach to relationship problems. To talk to one of our qualified and experienced Cognitive Behavioural Therapists, call. Relationship counselling or couples counselling (these terms often mean the same thing) differs from individual counselling, psychotherapy, CBT or coaching in.
Unlike some of the passive approaches to relationship therapy, CBCT focuses directly on the attitudes, skills, behaviours and emotional responses found in adaptive, fulfilling and resilient relationships. These benefits are not just anecdotal, extensive research conducted over the last twenty years has consistently demonstrated that CBCT can provide a practical and reliable approach for dealing with relationship disatisfaction, conflict, poor communication, emotional distress and crisis resolution in relationships.
How Relationship Problems Arise Individual differences and disagreements are common in most relationships and the potential for friction and conflict is ever present. Where these relationship differences are not respectfully and assertively managedcommunication breaks down, a negative emotional tone sets in and the focus shifts from partnership to resistance or withdrawal.
This can be maintained by a number of factors in the relationship. Unhelpful relationship demands or expectations from one or both partners. Communication difficulties and unhelpful communication patterns. Emotional or physical abuse. Resistance patterns involving cycles of persue-withdraw, attack-withdraw and withdraw-withdraw. Distructive or adictive individual behaviours that damage the relationship.
Inappropriate relationship behaviours and infidelity. This is based on the presence or absence of four types of hostile or destructive behaviours. These are referred to as the "Four Horses of the Apocalypse. Seeing one's self as the victim and continuously warding off a perceived attack. Withdrawing from the relationship as a way to avoid conflict. Where Relationships Work Despite the high potential for conflict however, healthy relationships persist in the majority.
This cyclic relationship is illustrated in the diagram. In CBT, the client and therapist work together toward understanding difficulties in terms of the relationship between thoughts, feelings, body responses and behaviour.
CBT helps clients break the vicious circle of altered and unhelpful thinking and behaviour. The therapy focus on the thoughts, images, beliefs and attitudes that we hold, the personal meaning we associate with these and how this relates to our behaviour.
Couples counselling - First Psychology Glasgow
We work to help clients learn more useful ways of thinking and coping. CBT is effective for a wide range of emotional problems from relationship problems, substance abuse, obsessive-compulsive disorder, social phobia, anxiety, depression, compulsive gambling and eating disorders.
Its efficacy has been proven through major research studies. The CBT process is usually of week duration. Her mood and emotions include feelings of being depressed, guilt, irritability, inadequacy, and suppression from having any feeling.
The unhelpful behaviours that she engages in are her inactivity, the suicide attempt she made earlier in the year, not eating, and avoiding her feelings. The Treatment Plan [ TOP ] In working with Noluthando, I experienced difficulty in following a treatment model strictly, and this will further be elaborated on through the discussion on what happened in therapy, below.Couples in Counselling 1
The reasons that I found implementing the therapy model difficult at times, was that often Noluthando was in an uncommunicative state and I feared developing a further barrier between us, and at times, it felt inappropriate and damaging to the relationship. However, the treatment plan was followed and was often naturally integrated into therapy. I battled at times this was part of my process of integration of using CBT and focusing on the therapeutic relationship, and seeing them as separate constructs to find the balance of the implementation of the therapeutic relationship and using technique.
When applying this treatment model to Noluthando, I tried to work with the automatic negative thinking cycle, by testing negative thoughts and beliefs. This involved confronting her negative beliefs, the way she thinks about things, and testing them against reality and other viewpoints. When working with her ruminations and the self-attacking cycle, I used problem-solving and the development of compassion.
Developing compassion would be important for Noluthando, as she frequently believed that she was a failure and needed to learn to be gentler with herself. In approaching the withdrawal and avoidance cycle, I suggested that Noluthando start to slowly engage herself in activities again and to start opening up, rather than isolating herself.
Noluthando could deal with her unhelpful behaviour cycle by not avoiding her feelings, eating when it is difficult, and to rather engage in problem-solving and reaching out to someone for help when things do become too difficult.
Psycho-education aided in this. In terms of the motivation and the physical symptoms cycle, it benefited her to become aware of her symptoms, to keep healthy through exercise, and sleeping and eating in a healthier way. It is of value to create awareness of this for Noluthando and for her to come to an understanding of how to live in her environment and possible alternatives to this.
Therapy Narratives [ TOP ] The description of the sessions below provides the details and reflections of 11 therapy sessions, to outline what happened in therapy and to provide a narrative of the therapeutic relationship that developed between Noluthando and myself. The sessions are divided into four themes regarding the development and changes in therapy and the therapeutic relationship.
After a description of what happened in therapy sessions, under each theme, the therapeutic relationship, its value in therapy, and my experience of the therapeutic relationship are discussed. In the first session, Noluthando was extremely quiet, her voice was strained and she spoke very little, and she seemed to find the experience difficult. She had a depressed mood and displayed low energy throughout the session. She spoke of the problems that she experiences when she lives at home with her family and how she has been experiencing this for a number of years.
I spoke about the suicide attempt with her and she provided little detail other than the method that she used drinking a poisonous substanceand that she left no suicide note.
I asked Noluthando to make a commitment to therapy and we signed a contract that detailed our working together in therapy. Both Noluthando and I kept a copy of this contract. During the session, I asked her about what she would like to gain from therapy and what her goals were. Noluthando reported having difficulty trusting people as they have broken her trust in the past. We worked through the questions together, which aided me in understanding some of her symptoms. She obtained a score of 16 points.
This score is indicative that the client is on the borderline between a mild mood disturbance to clinical depression. Therefore, I made plans to be more practical in Session 2 and introduced the idea of a timeline. Noluthando seemed willing to give the exercise a try, which involved placing a horizontal line across a page and placing dates as we worked collaboratively in collecting her history.
She wanted me to write, and looked at the page whilst dates and events were added. When she spoke of her mother and father, she recalled how she has never experienced her mother not drinking alcohol.
However, through the timeline, she was able to speak about hopes for her future and a possible career in drama. I noted how her posture and voice changed to being upright and more assertive, revealing an uplifted mood when speaking about drama. In fact, I felt that I did most of the talking in the session, as Noluthando would not answer questions in more than a few words. How would you describe yourself?
Is there anyone that you like to talk to?
Cognitive Behavioural Therapy (CBT)
It may be quite difficult for you to be here, because in therapy you will do a lot of the talking. This is the reason I want to come here.
I want to overcome that. Maybe that can be a goal in therapy, something we can work and challenge together? Yes quiet short laugh.
I felt that it would possibly take time for her to develop trust with me as she has difficulty with trust in her other relationships. In the second session, I noted that by me being more practical in the session by working on a timeline together, allowed more information to be shared between Noluthando and myself.
This could be because the focus appeared to not be on her but rather on the task. I reflected on how difficult it was for Noluthando to openly communicate and how I could try to create a space in therapy where she could begin to open up more. This would entail moving at a pace, which would be comfortable for her. I felt that she might have difficulty speaking in the session because of the emotional content, as shown in the transcript below.
It sounds like quite a few people in your family do not get along. What is that like for you?
Couples Therapy - Marriage Counselling - CBT Psychology
It is hard, silence because now you have to choose between family members. What do you think of your family not getting along? He is not open to talking about it. How often is your mother drunk? I felt that the collaborative relationship in CBT may help her to feel responsible for therapy and may assist in her working together with me. Belsher and Wilkes believe collaboration in CBT to be one of the key therapeutic principles when working with adolescents. I was concerned that the techniques of CBT may break down communication in therapy and that the therapeutic relationship may not develop.
Strunk and DeRubeis describe how the techniques of CBT may be experienced as boring and not age appropriate, by younger people, and I did not want her to have this experience. The Development of the Therapeutic Relationship: It was hoped that by doing this it may relieve some of the anxiety she may have been experiencing in sessions so that she may open up similar to the previous session with the timeline. Whilst drawing, she spoke about her father and how she learnt of his HIV positive status by reading about it in some notes he had made, which she had come across by accident.
She related how difficult it was for her as she did not know who to speak to about the information that she had learnt about her father. She described her father as not wanting to talk about his feelings. She described a family that does not communicate with one another. Although I experienced Noluthando finding the session difficult, I found her to open up more than the initial two sessions. Noluthando completed the BDI in this session and her score increased from 16 points to 19 points.
I was concerned about this and reflected about it after the session and discussed it with my supervisor. I thought that perhaps she under reports her experiences and feelings as, in this particular session, she shared how she often smiles even though she is not okay on the inside. Before the session ended, I provided her with an automatic thought record to start recording her thoughts. Thought records provide the client with the task of responding and challenging negative automatic thoughts in writing and the therapist can then help the client to find a more balanced or alternative thought.
I felt that perhaps she would not be accepting of completing the thought record on her own, and was interested to see if she would bring it with her to the following session. Session 4 [ TOP ] Noluthando started the session by saying she was very stressed about the examinations that she was presently busy with at school. That day, she had written her theoretical drama exam and was anxious about her performance, as she felt she had not done well.
This allowed us to explore what she often reported, on her BDI, as feeling like a failure. Noluthando reported how she feels like a failure not only in her studies, but also when her father beats her mother and she does not stand up for her. She said that being a failure is what she really believes about herself and may represent her core belief.
A core belief is described by Westbrook et al. We challenged this belief about being a failure by referring to how she has performed at school despite difficult circumstances. I also provided a space for her to reflect on what may happen if she did stand up for her mother when her father became violent. This was not easy for her and she became somewhat disassociated in the session when talking about the feeling and thoughts of being a failure.
In the session, I provided psycho-education about CBT and the hot cross bun that looks at five aspects of life that are interconnected, namely: Noluthando and I applied this to her belief of failure at school, and she then later said that she would like to try this in future sessions. The session closed with her speaking about a play that she was involved with as part of a school project, in which she was acting the part of a man who is a husband who fights with his wife.
I reflected on how this role may be difficult for her to act and how it is similar to her own life story with her father who abuses her mother.
Both Noluthando and I felt it was sad. Noluthando forgot her thought record form as she was busy with studying and said that she would bring it with her the following week.
In lieu of her being busy with examinations, I did not challenge her on not completing the thought record as I felt it to be inappropriate at the time and may close communication down between us. On reflection of her not completing her thought record, a possible explanation could be that due to the thought record only being introduced at the end of the session, it may have provided too little time to demonstrate its use effectively. However, she seemed to understand the thought record homework without any further explanation in the session, and therefore, her not completing her homework may have been a preoccupation with her examinations, which seemed appropriate due to her grade level and number of subjects she was writing at the time.
Further Discovery and Process [ TOP ] The significance of Sessions 3 and 4 was the beginning of the development of the therapeutic relationship. In Session 3, I found that our relationship was developing and Noluthando was beginning to open up. I felt that perhaps as she was beginning to develop a relationship with me, she may have felt more able and willing to disclose how she was feeling and, therefore, was able to report how she often smiles even when she is not feeling okay.
This was aided by the drawing that she completed, as it provided a space for her to communicate in an indirect way, as revealed in the below transcript. Like when I went home on the weekend, long pausewas it Monday, no Tuesday pause, silence and mumbled voice I got home and my mother and father were arguing about the chicken. They were both so angry strained voice and he just slapped her.
- Marriage Counselling
- Cognitive behavioural therapy
- Relationship counselling/couples counselling close to Glasgow’s city centre
I had to help carry her by her feet to the room. I thought she had taken the chicken. When my mother does something wrong she will cry and then stop.
Otherwise she cries and will talk about it. This time silentshe cried and went to the neighbours afterwards. In Session 4, I felt that the therapeutic relationship was growing and that Noluthando was becoming more communicative in the therapy setting.