Cognitive Behavior Therapy Applied to the Case of Stan he tells himself and how he feels and acts.
d acts. This is some
From a cognitive behavioral perspective, I want
Stan to critically evaluate and modify his self-defeating
beliefs, which will likely result in Stan acquiring more
effective behavior. As his therapist, I am both goal
oriented and problem focused. From the initial session, I
ask Stan to identify his problems and formulate specific
goals and help him reconceptualize his problems in a
way that will increase his chances of finding solutions.
I follow a clear structure for every session. The
basic procedural sequence includes (1) preparing him by
providing a cognitive rationale for treatment and
demystifying treatment; (2) encouraging him to monitor
the thoughts that accompany his distress; (3)
implementing behavioral and cognitive techniques; (4)
assisting him in identifying and examining some basic
beliefs and ideas; (5) teaching him ways to examine his
beliefs and assumptions by testing them in reality; and
(6) teaching him basic coping skills that will enable him
to avoid relapsing into old patterns.
As a part of the structure of the therapy
sessions, I ask Stan for a brief review of the week, elicit
feedback from the previous session, review homework
assignments, collaboratively create an agenda for the
session, discuss topics on the agenda, and set new
homework for the week. I encourage Stan to perform
personal experiments and practice coping skills in daily
life.
Stan tells me that he would like to work on his
fear of women and would hope to feel far less
intimidated by them. He reports that he feels threatened
by most women, but especially by women he perceives
as powerful. In working with Stan’s fears, I proceed with
four steps: educating him about his self-talk; having him
monitor and evaluate his faulty beliefs; using cognitive
and behavioral interventions; and collaboratively
designing homework with Stan that will give him
opportunities to practice new behaviors in daily life.
First, I educate him about the importance of
examining his automatic thoughts, his self-talk, and the
many “shoulds,” “oughts,” and “musts”he has accepted
without questioning. Working with Stan as a
collaborative partner in his therapy, I guide him in
discovering some basic cognitions that influence what
of his self-talk:
● “I always have to be strong, tough, and
perfect.”
● “I’m not a man if I show any signs of
weakness.”
● “If everyone didn’t love me and approve of me,
things would be catastrophic.”
● “If a woman rejected me, I really would be
reduced to a ‘nothing.’”
● “If I fail, I am then a failure as a person.”
● “I’m apologetic for my existence because I don’t
feel equal to others.”
Second, I assist Stan in monitoring and
evaluating the ways in which he keeps telling himself
these self-defeating sentences. I assist him in clarifying
specific problems and learning how to critically evaluate
some of his faulty thinking:
You’re not your father. I wonder why you continue
telling yourself that you’re just like him? Do you think you need
to continue accepting without question your parents’ value
judgments about your worth? Where is the evidence that they
were right in their assessment of you? You say you’re such a
failure and that you feel inferior. Do your present activities
support this? If you were not so hard on yourself, how might
your life be different?
Third, once Stan more fully understands the
nature of his cognitive distortions and his self-defeating
beliefs, I draw on a variety of cognitive and behavioral
techniques to help Stan make the changes he most
desires. Through various cognitive techniques, he learns
to identify, evaluate, and respond to his dysfunctional
beliefs. I rely heavily on cognitive techniques such as
Socratic questioning, guided discovery, and cognitive
restructuring to assist Stan in examining the evidence
that seems to support or contradict his core beliefs. I
work with Stan so he will view his basic beliefs and
automatic thinking as hypotheses to be tested. In a way,
he will become a personal scientist by checking out the
validity of many of the conclusions and basic
assumptions that contribute to his personal difficulties.
By the use of guided discovery, Stan learns to evaluate
the validity and functionality of his beliefs and
conclusions. Stan can also profit from cognitive
restructuring, which would entail his observing his own
behavior in various situations. For example, during the
week he can take a particular situation that is
problematic for him, paying particular attention to his
automatic thoughts and internal dialogue. What is he
telling himself as he approaches a difficult situation?
How is he setting himself up for failure with his self-talk?
As he learns to attend to his maladaptive behaviors, he
begins to see that what he tells himself has as much
impact as others’ statements about him. He also sees
the connections between his thinking and his behavioral
problems. With this awareness he is in an ideal place to
begin to learn a new, more functional internal dialogue.
Fourth, I work collaboratively with him in
creating specific homework assignments to help him
deal with his fears. It is expected that Stan will learn new
coping skills, which he can practice first in the sessions
and then in daily life situations. It is not enough for him
to merely say new things to himself; Stan needs to apply
his new cognitive and behavioral coping skills in various
daily situations. At one point, for instance, I ask Stan to
explore his fears of powerful women and his reasons for
continuing to tell himself: “They expect me to be strong
and perfect. If I’m not careful, they’ll dominate me.” His
homework includes approaching a woman for a date. If
he succeeds in getting the date, he can think about his
catastrophic expectations of what might happen. What
would be so terrible if she did not like him or if she
refused the date? Stan tells himself over and over that
he must be approved of by women and that if any
woman rebuffs him the consequences are more than he
can bear. With practice, he learns to label distortions
and is able to automatically identify his dysfunctional
thoughts and monitor his cognitive patterns. Through a
variety of cognitive and behavioral strategies, he is able
to acquire new information, change his basic beliefs,
and implement new and more effective behavior.
Follow-Up: You Continue as Stan’s Cognitive
Behavior Therapist
Use these questions to help you think about how to
counsel Stan using a cognitive behavior approach:
● My therapeutic style is characterized as an
integrative form of cognitive behavioral therapy.
I borrow concepts and techniques from the
approaches of Ellis, Beck, and Meichenbaum.
In your work with Stan, what specific concepts
would you borrow from these approaches?
What cognitive behavioral techniques would
you use? What possible advantages do you
see, if any, in applying an integrative cognitive
behavioral approach in your work with Stan?
● What are some things you would most want to
teach Stan about how cognitive behavior
therapy works? How would you explain to him
the therapeutic alliance and the collaborative
therapeutic relationship?
● What are some of Stan’s most prominent faulty
beliefs that get in the way of his living fully?
What cognitive and behavioral techniques
might you use in helping him examine his core
beliefs?
● Stan lives by many “shoulds” and “oughts.” His
automatic thoughts seem to impede him from
getting what he wants. What techniques would
you use to encourage guided discovery on his
part?
● What are some homework assignments that
would be useful for Stan to carry out? How
would you collaboratively design homework
with Stan? How would you encourage him to
develop action plans to test the validity of his
thinking and his conclusions?
COGNITIVE BEHAVIOR THERAPY
Aaron Beck’s Cognitive Therapy
● Tailored for specific diagnoses such as anxiety,
panic, eating disorders, and phobias.
● Treatments are standardized and based on
empirical research
● Homework allows lessons learned in group to
generalize to the client’s daily environment.
Theoretical Assumptions of Cognitive Therapy
1. People’s internal communication (or thought
processes) is accessible to introspection.
2. Clients’ beliefs have highly personal meanings.
3. These meanings can be discovered by the
client rather than being taught or interpreted by
the therapist
Basic Principles of Cognitive Theory
Automatic thoughts - personalized notions that are
triggered by particular stimuli that lead to emotional
responses.
● Individuals tend to maintain their core beliefs
about themselves, their world, and their future.
● A primary focus of cognitive therapy is to assist
clients in examining and restructuring their core
beliefs (or core schema). Schemas have an
important impact on how one operates
cognitively.
Schemas - a person’s core beliefs and basic
assumptions.
- Can either be functional or dysfunctional and
more than one schema can compete with
another.
Cognitive Vulnerability - when a person’s beliefs and
assumptions predispose him or her to psychological
distress.
Nature of Maladjustment
Maladjustment stems from irrational beliefs and
distorted cognitions.
Cognitive Distortions - systematic errors in reasoning
that lead to faulty assumptions and misconceptions.
● Arbitrary inferences - making conclusions
without supporting and relevant evidence.
- “Catastrophizing” or thinking of the absolute
worst scenario and outcomes for most
situations.
● Selective abstraction - forming conclusions
based on an isolated detail of an event.
- In this process other information is ignored, and
the significance of the total context is missed.
● Overgeneralization - process of holding
extreme beliefs on the basis of a single incident
and applying them inappropriately to dissimilar
events or settings.
● Magnification and minimization - perceiving a
case or situation in a greater or lesser light than
it truly deserves.
● Personalization - tendency for individuals to
relate external events to themselves, even
when there is no basis for making this
connection.
● Labeling and mislabeling - involve portraying
one’s identity on the basis of imperfections and
mistakes made in the past and allowing them to
define one’s true identity.
● Dichotomous thinking - involves categorizing
experiences in either-or extremes. With such
polarized thinking, events are labeled in black
or white terms.
Pattern that triggers depression:
1. Clients hold negative views of themselves.
(labeling and mislabeling??)
➢ “I am a lousy person.”
2. Selective abstraction
➢ Client interprets life events through a
negative filter.
➢ “The world is a negative place where
bad things are bound to happen to
me.”
3. Client holds a gloomy vision of the future
(arbitrary inferences?)
➢ “The world is bleak and it isn’t going to
improve.”
The Generic Cognitive Model
- stipulates that perceptions of situations, rather
than the situation itself, directly influence
emotion, physiology, and behavior (Beck, 1963,
Beck, 1964).

The Generic Cognitive Model
- Provides a comprehensive framework for
understanding psychological distress.
- Psychological distress can be thought of as an
exaggeration of normal adaptive human
functioning.
- Faulty information processing is a prime cause
of exaggerations in adaptive emotional and
behavioral reactions.
Basic Principles of Cognitive Theory (10th ed.)
● Psychological problems are an exaggeration of
adaptive responses resulting from
commonplace cognitive distortions.
● It is an insight-focused therapy with an
emphasis on changing negative thoughts and
maladaptive beliefs.
● Client’s distorted beliefs are the result of
cognitive errors.
● Through Socratic dialogue or reflective
questioning, clients test the validity of their
cognitions (collaborative empiricism).
● Change results from reevaluating faulty beliefs
based on contradictory evidence that clients
have gathered.
● Clients’ distorted beliefs are the result of
cognitive errors rather than being driven solely
by irrational beliefs.
Differences between CT and REBT
The main differences between CT and REBT lie in their
therapeutic methods and style.
● REBT is often highly directive, persuasive, and
confrontational, whereas CT uses a Socratic
dialogue by posing open-ended questions to
clients to help them arrive at their own
conclusions.
● REBT places more emphasis on the teaching
role of the therapist, while CT places more
emphasis on helping clients identify their
misconceptions for themselves. The cognitive
therapist attempts to collaborate with clients in
testing the validity of their cognitions through a
process called collaborative empiricism.
● Through a process of rational disputation, Ellis
works to persuade clients that certain of their
beliefs are irrational and nonfunctional, while
Beck views his clients' beliefs as being more
inaccurate than irrational and asks his clients to
conduct behavioral experiments to test the
accuracy of their beliefs.
● Cognitive therapists view dysfunctional beliefs
as being problematic when they are irrational,
or when they are too absolute, broad, and
extreme. Beck suggests alternative rules for
clients to consider, without indoctrinating them.
Although cognitive therapy often begins by
recognizing the client's frame of reference, the
therapist continues to ask for evidence for a
belief system.
The Client-Therapist Relationship
● Cognitive therapy places emphasis on the
therapeutic relationship, and effective
therapists must combine empathy and
sensitivity with technical competence.
● A working alliance is a necessary first step in
cognitive therapy, especially in counseling
difficult-to-reach clients.
● Cognitive therapists are continuously active
and deliberately interactive with clients, helping
clients frame their conclusions in the form of
testable hypotheses.
● Therapists must also have a cognitive
conceptualization of cases, be creative and
active, engage clients through a process of
Socratic questioning, and be knowledgeable
and skilled in the use of cognitive and
behavioral strategies.
 ● He or she functions as a catalyst and a guide
who helps clients understand how their beliefs
and attitudes influence the way they feel and
act.
● Cognitive therapists emphasize the client’s role
in self-discovery and aim to teach clients how
to be their own therapist.
● Homework is often used as a part of cognitive
therapy to facilitate more rapid gains, and is
tailored to the client’s specific problem and
arises out of the collaborative therapeutic
relationship.
● Homework facilitates more rapid and enduring
gains.
Applications of Cognitive Therapy
● Cognitive therapy is a widely researched and
effective approach to treating many psychiatric
disorders, psychological problems, and medical
conditions with psychological components.
● It has been successfully used to treat phobias,
psychosomatic disorders, eating disorders,
anger, panic disorders, generalized anxiety
disorders, posttraumatic stress disorder,
suicidal behavior, borderline personality
disorders, narcissistic personality disorders,
schizophrenic disorders, personality disorders,
substance abuse, chronic pain, medical illness,
crisis intervention, couples and families
therapy, child abusers, divorce counseling,
skills training, and stress management.
● Cognitive therapy programs have been
designed for all ages and for a variety of client
populations.
Applying cognitive techniques
● Cognitive and behavioral techniques are used
by cognitive therapists to help clients identify
and examine their beliefs, explore their origins,
and modify them if necessary.
● Behavioral techniques used by cognitive
therapists include activity scheduling,
behavioral experiments, skills training, role
playing, behavioral rehearsal, and exposure
therapy.
● Cognitive therapists are mainly interested in
applying procedures that will assist individuals
in making alternative interpretations of events
in their daily lives.
● Automatic thoughts and faulty inferences are
examined in cognitive therapy to become
aware of distortions in thinking patterns.
● Magnification or minimization of thinking, which
involves either exaggerating or minimizing the
meaning of an event, is addressed in cognitive
therapy.
● Clients in cognitive therapy learn how to avoid
disregarding important aspects of a situation,
engage in overly simplified and rigid thinking,
and generalize from a single incident of failure.
Treatment of Depression
● Depression results from negative thinking and
biased interpretation of events
● The cognitive triad triggers depression:
negative view of self, negative interpretation of
personal world, and gloomy vision of the future
● Depression-prone people set rigid, perfectionist
goals and anticipate failure even after success.
● Cognitive therapy focuses on specific problem
areas and reasons for symptoms. The Beck
Depression Inventory (BDI) assesses the
depth of depression.
● Depressed people often criticize themselves
excessively. Therapeutic strategies for
self-criticism include identifying and providing
reasons for excessively self-critical thinking.
● Depressed people often experience painful
emotions and may say they cannot stand the
pain. Therapeutic strategies for painful
emotions include asking clients to speak more
conversationally about events in the past week
in which their mood lifted.
● Depressed people exaggerate external
demands, problems, and pressures.
Therapeutic strategies for exaggerated external
demands include listing responsibilities, setting
priorities, and breaking down external problems
into manageable units
 ● Cognitive therapy helps clients regain
perspective on defining and accomplishing
tasks and combat self-doubts.
Application to Family Therapy
● The cognitive behavioral approach in family
therapy focuses on family interaction patterns.
● Family relationships, cognitions, emotions, and
behavior are viewed as mutually influencing
each other.
● Cognitive therapy places heavy emphasis on
schema, or core beliefs.
● Restructuring distorted beliefs has a pivotal
impact on changing dysfunctional behaviors.
● Cognitive behavior therapists examine
individual family members' cognitions and
"family schemata."
● Family schemata are jointly held beliefs about
the family shaped by experiences and
perceptions from the family of origin.
● Family schemata have a major impact on how
individuals think, feel, and behave in the family
system.
The length and course of CT varies greatly and is
determined by the therapy protocols used for specific
diagnoses. Examples:
● CT for depression: lasts 16 to 20 sessions
and begins with behavioral activation
● CT for panic disorder: lasts 6 to 12 sessions
and targets catastrophic beliefs about internal
physical and mental sensations
Donald Meichenbaum’s Cognitive Behavior
Modification
● Meichenbaum’s cognitive behavior modification
(CBM) aims to change a client’s
self-verbalizations.
● CBM combines elements of behavior therapy
and cognitive therapy.
● Self-statements affect a person’s behavior in
much the same way as statements made by
another person.
● Clients must notice how they think, feel, and
behave and their impact on others for change
to occur.
● Meichenbaum’s approach suggests that it may
be easier and more effective to behave our way
into a new way of thinking.
● The therapeutic process consists of teaching
clients to make self-statements and modify their
instructions to cope more effectively.
● Cognitive restructuring plays a central role in
Meichenbaum’s self-instructional training.
● Therapist and client practice the
self-instructions and desirable behaviors in
role-play situations that simulate problem
situations in the client’s daily life.
● The emphasis is on acquiring practical coping
skills for problematic situations.
Focus:
● Client’s self-statements or self-talk
Premise:
● As a prerequisite to behavior change, clients
must notice how they think, feel, and behave,
and what impact they have on others.
Basic assumption:
● Distressing emotions are typically the result of
maladaptive thoughts.
Self-instructional therapy focus:
● Trains clients to modify the instructions they
give to themselves so that they can cope more
effectively.
● Emphasis is on acquiring practical coping skills.
Cognitive structure:
● The organizing aspect of thinking, which seems
to monitor and direct the choice of thoughts.
● The “executive processor”
How Behavior Changes
“behavior change occurs through a sequence of
mediating processes involving the interaction of inner
speech, cognitive structures, and behaviors and their
resultant outcomes” - Meichenbaum (1977)
According to him, focusing on only one aspect will
probably prove insufficient.
3 phases of behavior change:
1. Self-observation
Clients learn to observe their own behavior and
internal dialogue, and increase their sensitivity
to their thoughts, feelings, actions,
 physiological reactions, and ways of reacting to
others. They must realize that they are
contributing to their own problems through their
self-talk, and acquire new cognitive structures
through collaboration with the therapist.
2. Starting a new internal dialogue
Clients learn to notice their maladaptive
behaviors and initiate a new behavioral chain
that is incompatible with their old ways. They
change their internal dialogue as a guide to
new behavior, and understand the
interdependence of cognitions, emotions,
behaviors, and consequences.
3. Learning new skills
Clients interrupt the negative spiral of thinking,
feeling, and behaving, and learn more adaptive
coping skills. These skills are practiced in
real-life situations, and clients continue to focus
on self-talk and observe and assess the
outcomes of their behavior. They learn that
what they say to themselves greatly influences
the stability of their newly acquired behavior
and its consequences.
Stress Inoculation Training
● Stress Inoculation Training (SIT) is a coping
skills program that teaches stress management
techniques through cognitive techniques.
● SIT is designed to gradually increase the
tolerance of individuals towards stronger stress
stimuli.
● The program includes information giving,
inquiry, cognitive restructuring, problem solving,
relaxation training, behavioral rehearsals,
self-monitoring, self-instruction,
self-reinforcement, and modifying
environmental situations.
● SIT involves collaborative goal setting, hope,
direct-action skills, and acceptance-based
coping skills, which are designed to be applied
to both present problems and future difficulties.
● Clients are assisted in generalizing what they
learn in the training to daily living, and relapse
prevention strategies are taught.
● SIT is a complex, multifaceted cognitive
behavioral intervention that is both a preventive
and a treatment approach.
● Clients learn to modify their cognitive "set" or
core beliefs to acquire more effective strategies
in dealing with stressful situations.
● SIT involves exposing clients to
anxiety-provoking situations through
role-playing and imagery, and evaluating their
anxiety level.
The three-stage model for SIT include the following:
1. The conceptual-educational phase
- The therapist helps clients understand the
nature of stress and reconceptualize it in
social-interactive terms.
- The therapist works with the client to gain a
better understanding of the problem and
provides a conceptual framework in simple
terms to educate them on ways to respond to
stressful situations.
- Clients learn about the role of cognitions and
emotions in creating and maintaining stress
through didactic presentations and guided
self-discovery.
- The therapist elicits stories that clients tell
themselves to understand their subjective world
and teaches clients to become aware of their
own role in creating their stress.
- Self-monitoring is used throughout the phases,
with clients keeping an open-ended diary to
monitor their thoughts, feelings, and behaviors.
- Therapists use flexible techniques and are
sensitive to individual, cultural, and situational
circumstances.
2. Skills acquisition and skills consolidation phase
- clients are given a variety of coping skills to
apply to stressful situations. This includes
cognitive coping, where clients are taught that
their adaptive and maladaptive behaviors are
linked to their inner dialogue.
- Direct actions are taken during this phase,
such as gathering information about fears,
identifying specific stressors, and learning
methods of relaxation.
- Cognitive coping is taught, which links adaptive
and maladaptive behaviors to inner dialogue.
- Clients learn a new set of self-statements to
rehearse and apply in stressful situations.
➢ “How can I prepare for a stressor?”
(“What do I have to do? Can I develop
a plan to deal with the stress?”)
➢ “How can I confront and deal with
what is stressing me?” (“What are
some ways I can handle a stressor?
How can I meet this challenge?”)
➢ “How can I cope with feeling
overwhelmed?” (“What can I do right
now? How can I keep my fears in
check?”)
➢ “How can I make reinforcing
self-statements?” (“How can I give
myself credit?”)
- Behavioral interventions such as relaxation
training, social skills training, and
time-management instruction are used.
- The goal is to help clients make lifestyle
changes by reevaluating priorities, developing
support systems, and taking direct action to
alter stressful situations.
3. Application and follow-through phase
- The focus is on transferring and maintaining the
changes made in therapy to everyday life.
- Clients practice their new skills, participate in
activities such as imagery and behavior
rehearsal, and complete behavioral
assignments. These assignments become
increasingly demanding, and their outcomes
are checked at subsequent meetings.
- If clients do not follow through with
assignments, the therapist and client
collaboratively consider the reasons for the
failure.
- The final stage of SIT focuses on relapse
prevention, teaching clients to view lapses as
learning opportunities, and practice applying
coping skills in high-risk situations.
- Follow-up and booster sessions are conducted
at 3-, 6-, and 12-month intervals.
- SIT can be considered as part of an ongoing
stress management program
- SIT has potential applications for a wide range
of problems and clients for both remediation
and prevention
- SIT can be tailored to specific target
populations and has been successful in treating
a wide range of problems, including anger
control, anxiety, depression, addiction, PTSD,
and health problems. The flexibility of the SIT
format contributes to its robust effectiveness.
The Constructivist Approach to Cognitive Behavior
Therapy
● Meichenbaum's Constructivist Narrative
Approach (CNP) to Cognitive Behavior Therapy
(CBT) focuses on the stories people tell about
themselves and others regarding significant
events in their lives.
● Therapists elicit stories from their clients to
explore in therapy.
● This approach assumes that there are multiple
realities, and one of the therapeutic tasks is to
help clients appreciate how they construct their
realities and how they author their own stories.
● Meichenbaum's approach is less structured
and more discovery-oriented than standard
CBT, with more emphasis on past
development, deeper core beliefs, and
exploring the behavioral impact and emotional
toll of clinging to certain root metaphors.
● Therapists help clients learn how they construct
reality, examine the implications and
conclusions they draw from their stories, and
encourage them to tell the "rest of the story" to
develop resilient-engendering behaviors.
● Meichenbaum works collaboratively with clients
to develop coping skills necessary to achieve
treatment goals using a Socratic
discovery-oriented approach and the art of
questioning.
● Meichenbaum uses specific questions to
evaluate therapy outcomes, including whether
clients are able to tell a new story about
themselves and the world, use more positive
 metaphors to describe themselves, predict
high-risk situations and employ coping skills,
and take credit for the changes they have been
able to bring about.
● Successful therapy helps clients develop their
own voices, take pride in their
accomplishments, and take ownership of the
changes they are bringing about.
Cognitive Behavior Therapy from a Multicultural
Perspective
Strengths from a Diversity Perspective
● CBT uses the individual’s belief system, or
worldview as part of the method of
self-exploration.
● Emphasis on cognition, action, and relationship
issues appeals to clients from diverse
backgrounds.
● The collaborative approach of CBT offers
clients the structure they may want, yet the
therapist still makes every effort to enlist clients'
active cooperation and participation.
● CBT is inherently suited to treating diverse
clients due to individualized treatment, focusing
on the external environment, active nature,
emphasis on learning, reliance on empirical
evidence, concern with present behavior, and
brevity.
● CBT and multicultural therapy share common
assumptions that make integration possible,
including tailoring interventions to the unique
needs and strengths of the individual,
empowering clients by teaching specific skills,
activating inner resources and strengths of
clients to bring about change, and helping
clients make changes that minimize stressors,
increase personal strengths and supports, and
establish skills for dealing more effectively with
their physical and social (cultural)
environments.
Shortcomings from a Diversity Perspective
● Therapists must have an understanding of the
cultural background of clients and be sensitive
to their struggles.
● Caution should be used in confronting clients
about their beliefs and behaviors until their
cultural context is clearly understood.
● REBT’s negative view of dependency clashes
with the view of interdependence as necessary
to good mental health.
● Therapist's style should be modified depending
on the client's culture, and collaboration should
be emphasized over confrontation.
● Use of jargon and disrespectful language when
describing clients' cognitions should be
avoided, especially when interacting with
marginalized individuals.
●
The “rapid-fire active approach,’ used by some
clinicians, may alienate those who value being
reflective.
● Terms such as irrational or maladaptive may
seem disrespectful and insensitive to clients
who have felt marginalized in society.
● The emphasis on assertiveness,
independence, verbal ability, rationality,
cognition, and behavioral change may limit
CBT’s use in cultures that hold different values.
● Cognitive behavioral assessments may
overlook the role of past experiences rooted in
a client's cultural beliefs.
● Awareness of these limitations presents
opportunities for refining and adapting
psychotherapy to increase its effectiveness in
multicultural counseling.
● Inexperienced therapists may overemphasize
cognitive restructuring to the neglect of
environmental interventions.
Contributions of CBT
● Both Ellis’ REBT and Beck’s CT represent the
most systematic applications of CBT.
● The approaches are relatively brief and
structures treatments that are cost effective.
The cognitive behavioral theorists have
demystified the therapy process.
● The credibility of this model grows out of the
fact that many of its proportions have been
empirically tested.
 ● All cognitive behavioral approaches place
emphasis on practicing new skills both in
therapy and in daily life, and homework is a key
part of the learning process.
Limitations and Criticisms of Cognitive Behavioral
Approaches
● Extensive training is required to practice CBT.
● Therapists may misuse power by imposing their
ideas of what constitutes “rational” thinking on a
client.
● The strong confrontational style of Ellis’ REBT
may overwhelm some clients.
● Some clinicians think CBT interventions
overlook the value of exploring a client’s past
experiences.

Application of the generic cognitive model to various mental disorders. The model serves as a template to
conceptualize typical activating stimuli and associated beliefs and behaviors. For all disorders, the focus is
on the situation, beliefs, and behaviors