MIKI 5113

COUNSELLING AND PSYCHOTHERAPY THEORIES IN CONTEXT

AND PRACTICE
(Cognitive Theory And Therapy)

NURULHADI BIN MOHAMAD

M1420286M05

HASLINA BINTI JUNID

M1420240M05

WAN

MUAMMAR

SYAZNI

BIN

WAN

CHEE

M1510767M05

CRITICAL CORNER
The following comments about cognitive therapy represent both real
and exaggerated criticisms. Theyre offered to stimulate your thoughts
about cognitive therapy.

Please read the comments and then write

your thoughts and reactions to the criticisms.

1. Some critics, especially humanistic and existential therapists,

contend that cognitive therapy is too intellectual.

They

emphasize that most clients actually need to more deeply feel,

experience, and understand their emotions, rather than using
cognitive tactics to talk themselves out of important emotional
states.

What are your thoughts on this criticism?

need to be intellectual or more emotional?

Response:

Do clients

The answer is yes and no. There are the situations when a counselor
need a client to be intellectual and emotional, depends to the clients
ability to talk of something.

A normal person (client) may be can

express his or her feeling intelligently, but how about people with
learning disability? We cannot insist them to express their feeling by
using a complete sentence.
According to Mac Millon dictionary, intellectual is relating to ability to
think in an intelligent way and to understand things, especially difficult
or complicated ideas and subjects.

Intellectual is often used to

describe intensive reasoning and deep thinking, particularly in relation

to subjects that tend to spark deep discussion, such as literature or
philosophy.

An intellectual is also a noun for a cerebral or brainy

person who engages in deep thinking, like Plato, Albert Einstein, or

someone who can speak at length about the relationship between
French existentialism and ice hockey.
Emotions how to understand, identify and release your emotions
different people define emotions in different ways.

Some make a

distinction between emotions and feelings saying that a feeling is the

response part of the emotion and that emotion includes the situation
or experience, the interpretation, the perception, and the response or
feeling related to the experience of a particular situation.

For the

purpose this article, I use the terms interchangeably.

The only person who can change what you feel is you.

A new

relationship, a new house, a new car, a new job, these things ca

memontarily distract you from your feelings, but no other person, no
material possession, no activity can remove, release, or change how
you feel.
Positive emotions it is crucial that you identify your positive emotions
during these exercise.

You are probably very loving, caring,

2

compassionate, trusting, forgiving, generous, many times in each day.

Be certain to include the wonderful and good things about yourself as
you identify your emotional self. This provides a realistic picture. If
you record only negative emotions, your picture of yourself will quite
distorted and lacking in reality.

Each one of us is born with all

emotions and each emotion needs to be seen in its full and loving
energy.
On my point of view, I would like to suggest that people with
learning disabilities are often unable to express their feelings in words,
and use behavior to communicate with others.

The emotional

experience the person with a learning disability has is often most

obvious in its behavioral correlate.

It is, therefore critical to take

behavior as well as mood into account these clients. Sudden changes

in behavior (or mood) and/or a clients inability to engage in activities
he or she could previously accomplish are important signs that the
client may be depressed.
People with learning disabilities have complex communication
needs. Clients may have difficulty forming sentences, have a reduced
understanding of key and abstract concepts, his or her speech may be
unclear, or the client may need increased time to process and retrieve
information. Furthermore, a person with learning disabilities is likely to
have reduced vocabulary (Bumip, 2002), and he or she will probably be
more susceptible to suggestibility and may tend to change his or her
answer to questions when provided with negative feedback (Clare &
Gujonsoon, 1993; Everington & Fuller, 1999).

This is all further

complicated by the fact that linguistic and cognitive abilities vary

considerably from person to person within this population.

2. The foundation of all cognitive therapies is the same:

As an

expert, the therapist first demonstrates to the client that the

latter is thinking in a way that is either irrational or maladaptive,
and then the therapist teaches the client new and better ways to
think. When you consider this fact, isnt it true that all cognitive
therapies are a bit presumptuous? Then, when you consider this
presumptuous assumption even

further, doesnt it make you

want to become a more sensitive cognitive therapist-perhaps a

constructivist who honors clients experiences and helps them
rewrite their personal narratives in a more positive and strengthbased manner? Its no wonder that Mahoney and Meichenbaum
have moved on.

Response:
What is cognitive therapy? It is

relatively short-term focused

psychotherapy for a wide range of a psychological problems including

depression, anxiety, anger, marital conflict, loneliness, panic, fears,
eating disorders, substance abuse, alcohol abuse and dependence and
personality problems. The focus of therapy is on how you are thinking,
behaving and communicating today rather than on your early
childhood experience. Cognitive Therapy also helps people to look at
their rules for living called schemas.

Schemas are cognitive

structures or templates that organize how we think, feel, act, relate

and understand and are typically referred to as our personality style.
Schemas are outside of conscious awareness and determine how we
interpret the world and respond to situations.

Whilst cognitive

structures can be adaptive, allowing us to process information rapidly,

the same rapid processing can result in entrenched maladaptive
structures.

This is because they are strong beliefs and assumptions

about how we should live our lives, which we develop whilst we are
4

growing up. The therapist assists the patient in identifying specific

distortions (using cognitive assessment) and biases in thinking and
provides guidance on how to change this thinking.
Cognitive therapy helps the patient learn effective self-help skills
that are used in homework assignments that help you change the way
you think, feel and behave now.

Cognitive-behavioral therapy is

action-oriented,

and

practical,

rational

helps

the

patient

gain

independence and effectiveness in dealing with real-life issues.

Many people wonder what to expect when they begin therapy,
such as:

Initial Assessment

Reading Material

Periodic Assessments

Plan of Treatment

Self-Help

Agenda-setting

Arent my emotions important?

Isnt Medication Important?

Why Cognitive Therapy?

Numerous outcome studies show that cognitive therapy is as or more

effective than medication in the treatment of depression, anxiety,
obsessions and other fears and does not have the negative-side-effects
of medications.

Cognitive therapy incorporates a variety of features that differ

from traditional psychotherapy and shorten the process of change.
Five of these elements are briefly described below:

Formulation of clients problems guides the treatment plan

The cognitive therapist actively directs clients to the

discovery of central thinking problems.

Cognitive therapist and clients actively work together to

resolve negative feelings, behaviors and functioning.

Cognitive therapy focuses on the resolution of current,

specific problems, providing a clear structure and focus to
treatment.

The therapist makes joint decisions with the client and

regularly asks for feedback to maintain a high degree of
collaboration and empathy.

The scientific research on the benefits of so-called expressive writing is

surprisingly vast. Studies have shown that writing about oneself and
personal experiences can improve mood disorders, help reduce
symptoms among cancer patients, improve a persons health after a
heart attack, reduce doctor visits and even boost memory.
Researchers believed that by writing and then rewrite their personal
narratives in a more positive and strength-based manner can lead to
behavioral changes and improve happiness.

Narrative therapy is a

form of psychotherapy that seeks to help people identify their values,

so they can effectively confront whatever problems they face.

The

narrative therapist focuses upon assisting people to create stories

about themselves, about their identities, that are helpful to them. This
work of re-authoring identity claims to help people identify their own
values and identify the skills and knowledge they have to live these
6

values.

Through the process of identifying the skills and knowledge

they have to live these values. Through the process of identifying the
history of values in peoples lives, the therapist is able to co-author a
new story about the person. The story people tell about themselves
and that is told about them is important in this approach which asserts
that the story of persons identity determines what they think is
possible for themselves.

The narrative process allows people to

identify what values are important to them and how they might use
their own skills and knowledge to live these values. Narrative therapy
can be used for individuals, couples, or families. In a couple or family
setting, the technique of externalizing a problems sets the stage for
creating

positive

interactions

and

transforming

negative

communication or responses into more accepting, nonjudgmental, and

meaningful exchanges.

Seeing a problem objectively helps couples

and families to reconnect with the heart of their relationship and

address the ways in which the problem has challenged that core
strength.
I would like to conclude that I have to become more sensitive
cognitive therapist as to direct clients to write and then rewrite on their
own way in order to express their feeling.
3. apabila terapi mahu menggunakan terapi, kebanyakan mereka
samada terapis kognitif atau tingkah-laku, pergi kepada terapis
psikodinamik
(experientially

atau

terapis

oriented).

berorientasikan
Mengapa

eksperiensial

begini?

Suatu

kemungkinannya ialah melibatkan pendekatan kognitif dan

tingkah-laku yang rigid itu akan menjadikan keadaan sangat
terdesak dan menyusahkan / menjemukan. Berapa ramai klien
yang boleh tahan / boleh menyesuaikan secara tepat akan
pelbagai prosedur dalam kognitif? Tidakkah anda fikir adalah
benar, iaitu terapis berorientasi-pemahaman dan tanggapan itu
7

lebih memberangsangkan (more exciting) daripada pendekatan

kognitif dan tingkah-laku? Bahkan lebih-lebih lagi, tidak benarkah
iaitu

berlawanan

dengan

berorientasikan-pemahaman

terapi
/

kognitif,

tanggapan

dan
adalah

terapi
lebih

menghasilkan motivasi untuk pembelajaran baharu?

Response:
Samada terapis kognitif atau terapis tingkah-laku, pergi kepada terapis
psikodinamik atau terapis berdasarkan eksperiensial, supaya berlaku
atau terjadi pelarasan yang stabil antara teknikal terapi yang hendak
dilalui oleh klien. Dan dengan ini klien tidak jemu terhadap perjalanan
sesi terapi tersebut. Memang benarlah terapi psikodinamik atau yang
orientasikan eksperiensial akan memberi rangsangan yang lebih
kepada klien untuk terus / ada bersama dalam sesi terapi dengan
tenang dan penuh harapan. Ianya juga meningkatkan motivasi kepada
klien dalam merealisasikan dirinya dan organisme dalam kehidupan
sebenar. Semua perubahan yang dialami dalam diri (self) klien, dan
juga sifat-ciri luaran seperti dalam tingkah-laku klien, sedikit demi
sedikit dirasainya melalui proses terappi yang dijalankan. Semakin
banyak pembelajaran bahawa berlaku dan diterima, dan di fahami oleh
klien, semakin besarlah harapan berlakunya pengurangan simptom
negetif yang dimiliki klien sekian lama. Aliran pengurangan simptom
negetif diri dan peribadi klien akan kelihatan lebih ketara bersama
terapis berorientasikan eksperiensial yang bijaksana. Dari luar, kita
akan dapat melihat aliran pengurangan simptom psikopatologi dan
psikologi ini pula, sebagai satu langkah / tahap kedua motivasi, bukan
sahaja kepada klien, tetapi juga kepada terapinya.
Memanglah
(pengalaman),

terapi

mudah

yang

diurus-selia

berorientasikan
semasa

sesi

eksperiensial
terapi,

kerana

pengalaman-pengalaman negatif ini telah sedia dihamburkan oleh

klien. Terapis memang sedia menerima klien dengan seadanya, sedia
8

mendengar eksperien dalam kehidupan kliennya, akan dapat membuat

asesmen yang sesuai kepada kllien dengan mudah sekali. Hubungan
(relationship) antara terapis dengan klien pula akan berlaku dengan
baik. Inilah keperluan asas yang secara terus dan tidak terus
memberi / menyediakan peluang yang besar untuk / perubahan
menyeluruh (total) dalam diri klien itu.

4. Despite the fact that cognitive therapists pride themselves on

their empirical foundation, relatively little data are available on
the application of cognitive therapy with various cultural groups.
Given the complete absence of empirical data on cognitive
methods with diverse clients, in order to stay consistent with
their orientation, cognitive therapists should either label their
treatment approaches as experimental with non-White clients
or refrain from using their treatment methods with non-White
clients. What are your thoughts on this issue? Because of their
criticism of humanistic-existential therapists, arent cognitive
therapists being hypocritical when they apply their techniques on
non-White clients?
Response:
Theres little doubt about the efficacy of cognitive therapy. Both
philosophically and empirically it has demonstrated itself to be a
logical and effective form of treatment. Cognitive theory and therapy
also provide us with an excellent general metaphor representing the
many paradoxes of counseling and psychotherapy theory.
As a theory and technique the cognitive approach is both new and old.
It is empirical and philosophical. Its roots come from the behavioral,
psychoanalytic, and constructivist philosophical traditions. In addition,
the study of cognitive approaches raises crucial questions about the
9

nature of the relationship between therapist and client. Should the

therapist

be

judgmental

expert

or

an

empirically

oriented

collaborator? How much faith should we place in the clients

mentalistic processes? Do we rely on objective scientific facts or
subjective client experiences?
In a relatively short time period, cognitive approaches have performed
exceptionally well under the experimental microscope, with precisely
defined symptoms and carefully measured outcomes. Within this set of
definitions, cognitive therapy can claim significant scientific support.
So have we arrived? Do cognitive-behavioral techniques provide the
ultimate answer to human suffering? Is cognitive therapy the way
forward for human growth and actualization? Wherever there is
certainty, there is always room for doubt, and Mahoney provides us
with some. He states:

I do not believe that the simple cueing, recitation, or reinforcement of

positive self-statements or the rationalistic reconstruction of explicit
beliefs are optimal or sufficient approaches for facilitating significant
and enduring personal development. (Mahoney, 1985, p. 14)

Even further, in his magnum opus, Human Change Processes

(Mahoney, 1991), he quotes Hayek (1979), suggesting there may even
be a superstitious quality to scientific validation:

An age of superstitions is a time when people imagine that they know

more than they do. In this sense the twentieth century was certainly an
outstanding age of superstition, and the cause of this is an
overestimation of what science has achievednot in the field of
10

comparatively simple phenomena, where it has, of course, been

extraordinarily successful, but in the field of complex phenomena,
where the application of the techniques which prove so helpful with
essentially simple phenomena has proved to be very misleading.
(Hayek, 1979, p. 176)

Hayeks comments suggest that it might be possible to ask larger,

more complex questions than does this technique make this symptom
go away? Cognitive and cognitive- behavioral approaches are very
effective and, in many ways, very satisfying. Failing to at least think
about using cognitive and behavioral techniques in certain situations
and with certain diagnoses might almost be considered malpractice,
due to their proven efficacy. But the question always remains: Shall we
continue our search for even more optimal approaches for facilitating
enduring personal development?

Review Questions

1. What are the main differences between Elliss REBT and

Becks cognitive therapy?

Albert Ellis views the therapist as a teacher and does

not think that a warm personal relationship with a client
is essential. In contrast, Beck stresses the quality of the
therapeutic relationship.

11

REBT

is

often

highly

directive,

persuasive

and

confrontive. Beck places more emphasis on the client

discovering misconceptions for themselves.

REBT

uses

different

methods

depending

on

the

personality of the client, in Becks cognitive therapy, the

method is based upon the particular disorder.

2. What are the five bedrock assumptions of Elliss REBT?

The five bedrock assumptions of Elliss REBT are as follows:
i.

People dogmatically adhere to irrational ideas and

personal philosophies.

ii.

These irrational ideas cause people great distress

and misery.

iii.

These ideas can be boiled down to a few basic

categories.

iv.

Therapist can find these irrational categories rather

easily in their clients reasoning.

v.

Therapists can successfully teach clients how to give

up their misery-causing irrational beliefs.

3. Meichenbaums approach is based on verbal meditational

processes. In practical terms, what does he mean by verbal
meditational processes?
Verbal meditational is private speech that facilitates learning
and problem solving. Speech produced via verbal mediation
12

cab be either subvocal or uttered aloud; in either case, the

speech is intended for the speaker, not an outside listener.
Further, although verbal mediation can be accessible to
conscious awareness, it is often automatic and implicit.
Verbal mediation strategies increase with the development of
fluent language. Although a verbal process, verbal mediation
also improves performance on visuospatial and motor tasks.
This process was identified early in the study of learning and
memory.
4. List and describe four of Becks cognitive distortions.

i.

Filtering

We take the negative details and magnify them while filtering

out all positive aspects of a situation. For instance, a person
may pick out a single, unpleasant detail and dwell on it
exclusively so that their vision of reality becomes darkened or
distorted.

ii.

Polarized

Thinking

(or

:Black

and

White

Thinking).
In polarized thinking, things are either black or white. We
have to be perfect or were a failure there is no middle
ground.

You place people or situations in either/or

categories, with no shades of gray or allowing for the

complexity

of

most

people

and

situations.

If

your

performance falls short of perfect, you see yourself as a total

failure.

13

iii.

Overgeneralization.

In this cognitive distortion, we come to a general conclusion

based on single incident or a single piece of evidence.

If

something bad happens only once, we expect it to happen

over and over again. A person may see a single, unpleasant
event as part of a never-ending pattern of defeat.

iv.

Jumping to Conclusions.

Without individuals saying so, we know what they are feeling

and why they act the way they do. In particular, we are able
to determine how people are feeling toward us. For example,
a person may conclude that someone is reacting negatively
toward them but doesnt actually bother to find out if they are
correct.

Another example is a person may anticipate that

things will turn out badly, and will feel convinced that their
prediction is already an established fact.

5. Provide examples of what sorts of self-talk Meichenbaum might

teach anxious
or angry clients

when

using

stress

inoculation

training

approaches.
Stress inoculation training procedures have been used in the
treatment of a wide variety of clinical problems (Meichenbaum,
1985, 1996; Novaco, 1979). These procedures involve three
separate but interrelated treatment phases.
1. Conceptualization. This phase includes the development of a
collaborative relationship, the use of Socratic questioning to
14

educate clients about the nature and impact of stress, and

conceptualization of stressful situations as problems-tobesolved (Meichenbaum, 1996, p. 4). When stress is viewed as
a challenge, the therapist can begin assisting the client in
formulating personal or individualized methods for preparing
for, confronting, and reflecting on stressful experiences.
2. Skills acquisition and rehearsal. During this phase specific
coping skills are taughtand practiced in the office setting and
eventually in vivo. The particular skills taught are related to
the individual problems. Examples include relaxation training,
self-instructional

training,

emotional

self-regulation,

and

communication skills training.

3. Application and follow-through. In this phase, clients apply
their newly acquired coping skills to increasingly challenging
stressors. Personal experiments are used to help inoculate
clients from the effects of later stressful situations. Relapse
prevention strategies, attribution procedures (in which clients
are taught to take credit for their accomplishments), and
booster sessions are built into this final phase of the stress
inoculation training model.

6.

List and describe the REBT ABCs (including D, E, and F).

1. A = The behaviors antecedents (everything that happens
just before the maladaptive behavior is observed)
2. B = The behavior (the clients problem specifically defined
in concrete behavioral terms; e.g., rather than being called
an anger problem, its referred to as yelling or swearing
six times a day and punching others twice daily)
15

3. C

The

behaviors

consequences

(everything

that

happens just after the maladaptive behavior occurs)

4. D =

the irrational belief. He might choose to directly

dispute Jems belief by asking, Is it true that your wife

must always be home right on time to prove her love for
you? or Isnt it true that sometimes your wife can be late
and that its really not all that awfulit doesnt mean she
doesnt love you, but instead its just an inconvenient
behavior that sometimes happens to the best of couples?
As we will discuss later, REBT is a flexible form of therapy
that allows therapists to use a wide range of techniques, all
in the service of disputing, annihilating, or destroying the
clients misery-causing irrational beliefs.
5. E = on Jem. Hopefully, this effect will be the development
of a set of alternative, more effective beliefs.
6. F = Finally, if the therapy is successful, Jem will experience
a new feeling.

7. Describe what Beck means by a self-schema.

This technique is a variation of response prevention
discussed by Beck and colleagues (Beck et al., 1979; Shaw
& Beck, 1977). It was employed in Jacksons case because
much more work was needed to help him change his selfschema. Specifically, Jackson was instructed to clearly
verbalize his should rule, to predict what would happen if
the should was not followed, to carry out an experiment to
test the prediction, and to revise his should rule according

16

to the outcome of the experiment (Beck et al., 1979, p.

255).
As in the example in Becks work, Jackson was given a
series of activities designed to test his should statement:
Every task I do must (should) be performed flawlessly or
there is just more proof that Im defective. He predicted
that he might receive a reprimand from his boss if he
ignored this should and turned in poor-quality work.
Consequently, he was asked to perform several work tasks
as quickly as he could, but still keeping his overall work
quality within the 7584 marginally acceptable range.
Jackson successfully completed this test of his should rule
and discovered that instead of receiving a reprimand from
his boss, he received a pat on the back for a job well done.
8. Apakah tiga langkah-langkah latihan Inikulasi tekanan (stress
inoculation training)?
Tiga langkah-langkah Latihan Inokulasi Tekanan ialah:
1. Konseptualisasi / pengkonsepsian (Conceptualization).
Fasa ini termasuklah:
perkembangan

hubungan

usaha-sama

(collaborative

relationship), penggunaan kaedah-menyoal Socratis untuk

mengajar klien tentang keadaan dan kesan tekanan, dan
konseptualisasi situasi tekanan-penuh (maksima) sebagai
masalah-yang-mesti

diselesaikan

(Meichenbaum,

1966,

p.4). bila tekanan dipandang sebagai satu cabaran, terapis

bolehlah mula membantu klien memformulakan suatu cara
sebagai

cadangan

untuk

melawan

dan

mengambil

tindakan keatas eksperien tekanan-penuh tersebut.

17

2. Kemahiran Perolehan dan Latihan (skill acquisition and

rehearsal).
Semasa fasa ini, kemahiran berupaya tertentu adalah
difikirkan dan dipraktiskan didalam pejabat / ofis dan
akhirnya didalam vivo (vivo). Kemahiran tertentu yang
difikirkan adalah berkaitan dengan masalah individu itu.
Contohnya

termasuklah

Latihan

Kerehatan,

latihan

instruksional-kendiri (self-instructional training), regulasikendiri (self-instructional training), regulasi-kendiri tentang

emosi, dan Latihan Kemahiran Komunikasi.

3. Aplikasi dan mengikuti-melaluinya (Aplicational followthrough).

Dalam

fasa

ini,

klien

mengaplikasi

mengguna-pakai

kemahiran yang telah diputuskan tadi untuk meningkatkan

cabaran terhadap apa-apa tekanan. Eksperimen personal
digunakan

untuk

membantu

klien

daripada

kesan

stresfulyang terakhir. Mengulangi strategi penghalang

dan

prosedur

yang

member

kesan,

dan

sesi

yang

menggalakkan hendaklah dibuat / direkakan dalam fasa

akhir ini.

9. Apakah informasi yang akan anda masukkan kedalam Rekod

Pemikiran (Thought Record)?
18

Informasi

yang

akan

dimasukkan

kedalam

senarai

Rekod

Pemikiran ialah:
1) Haribulan dan masa respon emosional itu berlaku.
2) Situasi dimana respon emosional itu wujud.
3) Tingkah-laku yang ada pada klien ketika itu.
4) Emosi yang bagaimana terhasil / wujudnya.
5) Bagaimana pemikiran klien semasa wujudnya emosi.
6) Respon yang berkaitan yang timbul ketika itu.

10.

Apakah kognitif bercerita (cognitive story-telling), dan

apakah tijuan menggunakannya kepada klien muda?

Jawapan:
Kognitif bercerita adalah satu teknik yang direka-bentuk, iaitu
terapi per-kognitif untuk mengilustrasikan prinsip Terapi Kognitif
untuk menyentuh minat semasa menggunakan prinsip kognitif
ini dalam kehidupan. Klien muda kebanyakannya adalah jemu
dengan terapi ini, juga disebabkan oleh tekanan, kurangnya
motivasi, halangan dari perbezaan dan keadaan otoriti. Oleh
yang demikian, untuk memulakan teknik ini, terapi hendaklah
memberitahu klien-klien muda ini, yang kita ada satu cerita yang
sangat

menarik,

dan

menghendaki

mereka

mendengarnya

dengan baik, dan memberi pendapat masing-masing, apakah

moral cerita ini. Lebih baik lagi, sebagai menyuntik minat yang
lebih hebat lagi daripada klien muda ini, kita menyediakan
hadiah yang sesuai kepada klien yang terbaik dengan persepsi
moral dalam cerita tadi. Sebagai teknik tambahan, hadiah utama
diberi kepada yang terbaik dan yang lain mendapat hadiah juga
19

(sagu hati)-i.e; rupa-bentuk hadiah yang biasa digemari oleh

kanak-kanak.

20