Cbt for Psychotherapists: Theory and Practice

By Avigdor Bonchek

Avigdor Bonchek, a clinical psychologist, explores how cognitive behavioral therapy and treatment programs that derive from the theory can help solve a variety of psychological problems in CBT for Psychotherapists.
Drawing on professional literature and his decades of professional experience, he encourages readers and practitioners to think critically when deciding how to use CBT.
In straightforward language, he explains what CBT isand isntand how it differs from other approaches. He also highlights some of the strengths of CBT, including:
It takes a here-and-now approach: Knowledge of the patients past is not essential to helping the patient solve his problem.
It offers an individualized treatment plan for each patient: There is no one size fits all to solve problems.
It outlines clear behavioural goals for patients: CBT helps people overcome their problems.
Therapists take an active role: They direct the therapy, assign homework, and coach their patients
Lastly, CBT therapists usually see their patients as having a problem rather than seeing them as problem patients.
Filled with examples, anecdotes, and insights on varied approaches, this book is a balanced guide to CBT for new and experienced therapists alike.

• Language: English
• Publisher: Partridge Publishing Singapore
• Release date: Feb 20, 2017
• ISBN: 9781482882834

Book preview

Copyright © 2017 by Avigdor Bonchek, PhD.

ISBN:      Hardcover              978-1-4828-8281-0

                Softcover                978-1-4828-8282-7

                eBook                     978-1-4828-8283-4

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Contents

Preface

Chapter 1 What Is CBT?

How CBT Differs

The Therapist as Researcher

Thinking Outside the Box

Chapter 2 Basic Nonspecific Factors in Psychotherapy

Chapter 3 Operant and Classical Conditioning

Chapter 4 From Theory to Practice: Therapeutic Applications

Phobias

Treating OCD

Treating Panic Attacks

Agoraphobia

Social Phobia

Post-Traumatic Stress Disorder

Depression

Assertive Training

Trichotillomania

Insomnia

Anger Management

Chapter 5 How to Diagnose a Problem and Make a Treatment Plan

Fear of Flying

Migraine

Bulimia

Chapter 6 Introduction to Treating Children’s Problems

Reinforcing Behaviour that Does Not Exist

Putting an Infant to Bed

Encopresis

Toilet Training in Less than a Day

A Final Word

Preface

The goal of this book is to give students and practicing psychologists a basic understanding of the theory behind cognitive behavioural therapy (CBT) and a view of treatment programs that derive from the theory to deal with a variety of psychological problems. It also encourages readers and practitioners of CBT to think critically, to think outside the box. All that is claimed to be CBT isn’t necessarily the best of CBT. The book is based on the professional literature on this subject, but I do occasionally offer ideas based on my own experience.

Chapter 1

What Is CBT?

CBT stands for cognitive behavioural therapy. In the realm of psychotherapy, there are hundreds of different therapeutic approaches. But there are two main approaches: dynamic and behavioural. The dynamic approaches are based on Freud’s psychoanalytic theory; the behavioural approaches (including CBT) are based on learning theory.

How CBT Differs

I will cite a case that came to me recently in order to exemplify the difference between the CBT-oriented and dynamic-oriented therapies.

A middle-aged woman, married with seven children, came down with a crippling disease. She was confined to a wheelchair and could not take care of her household duties. She hired a woman to cook and clean for her. Five of her children were married and out of the house. Just a seventeen-year-old girl and a twelve-year-old boy remained at home.

The problem was that the daughter refused to have anything to do with the helper. She wouldn’t eat the food she prepared or let her clean her room. The girl refused to touch anything this woman touched. If she opened the refrigerator, the girl would only open the door holding a towel. This caused much anger and discomfort for the mother and the family.

The girl agreed to go to therapy and was seen by a dynamic-oriented therapist. The mother understood from the therapist the goal of therapy. The therapist explained that she understood the girl’s behaviour as indirect anger towards the mother. Because the mother no longer functioned like a mother, the girl saw this as a rejection of her as her daughter. By ignoring and banning the helper, the girl was getting back at her mother through the mother’s substitute.

The therapist then instructed the mother to go out of her way to show her love and caring for her daughter. She should not be angry with her – just the opposite. She should understand what is happening emotionally to the daughter and try to overcome it by warmth and love, without criticism.

After several months of therapy, there was little change in the girl’s behaviour; the therapist thought maybe medication should be used.

The mother then turned to me and a CBT approach.

I explained how I saw it. I said, The girl may be angry, but that does not justify her behaviour. I suggested the following steps:

1) The girl should not derive any benefit from her behaviour. For example, she had made a deal with her brother for him to help her clean up her room, and she would repay him with another favour. I said this should be stopped. If the helper couldn’t clean her room, then the girl must do it herself. No one should make food for her if she refused to eat the helper’s food.

2) There should be no accommodation to the girl’s whims.

3) No anger should be directed towards her. Everything should be explained calmly. It is just too inconvenient for the family to do as the girl would like.

With these rules implemented, there was some change in the girl’s behaviour. For example, at a family meal, the father gave everyone dessert in regular dessert dishes. He honestly forgot that his daughter only used disposable dishes. Nevertheless, she accepted this with no complaint.

Let us analyse the differences in the two approaches. They really called for diametrically different approaches towards the daughter.

The dynamic approach, much more than CBT, sought a change in the girl’s attitude by talking therapy. CBT, on the other hand, placed more emphasis on the people in the girl’s environment. If the parents would make rules and act differently towards the girl, this was would lead to a change in the girl’s attitude.

In short, we could say dynamic therapy looks for change from the inside (in a person’s attitude and understanding) to affect the outside (change in behaviour). CBT seeks a change from the outside (change in behaviour) to affect the inside (change in attitude).

Another difference is that the dynamic approach was based on the therapist’s understanding, which was, in fact, an assumption. Nothing overt in the girl’s behaviour said she took out her anger against the helper as a way of expressing her anger towards her mother. It was a subjective opinion of the therapist.

The CBT approach made no assumptions. It accepted the facts as they were: the girl would not use anything the helper touched.

This is significant because when we focus on matters in a subjective realm, they cannot be measured or seen. CBT advocates see this as a serious handicap. Scientific advance is based on empirical evidence that can be seen by all and agreed upon by all. Subjectivity is antithetical to objective evidence, and objective evidence is essential for improving one’s methods. This helps us stop using what does not work (which has little or no empirical evidence) and begin using what does work (which does have empirical evidence).

I will mention here some of the characteristics of CBT that differentiate it from the dynamic therapies:

1) Here-and-now approach. Knowledge of the patient’s past is not essential to helping the patient solve his problem. We are interested in the present environment, the here and now of his life. Undue attention to the past wastes time without contributing to solutions. The question may be asked, How can we solve a problem without knowing its cause (in the past)?

Our answer is that there are two types of causes to problems: the initial cause and the maintaining cause. The initial cause is the precipitating