Understanding Cognitive Therapy: The Basics

Understanding Cognitive Therapy: The Basics

Have you ever wondered how your feelings are generated? Do you understand what it is that triggers your emotions?

The fact is, there are many different answers to these questions in the field of psychology.  Let’s take a look at just one of those approaches from the world of cognitive therapy. Cognitive-behavioral therapy (CBT) teaches that all moods are generated by our thoughts and reinforced by our behaviors.

Most thoughts that occur in the heat of an emotional moment are automatic. Often, these thoughts occur spontaneously, without conscious intent; hence the term “automatic.” Thoughts that are skewed negatively can lead to amplified emotional pain (ex. Sadness, anger, anxiety, or hopelessness), which is often what prompts people to come to counseling to begin with.

A cognitive approach to counseling helps people with uncovering and re-framing negative thoughts with the assumption that changing these thoughts changes the intensity of the feelings.

What happens in cognitive therapy?

  • A counselor that uses cognitive therapy or CBT might start by asking you to describe the context in which particularly strong feelings are being triggered. What is happening? Where are you? Who are you with? What happened first?
  • The counselor might prompt you to name the different emotions happening in that specific situation. Sometimes there is more than one emotion happening at the same time. You might even rate the intensity of the feelings (Example: Shame 90%; Anxiety 55%).
  • A cognitive counselor will be especially interested in helping you identify the automatic thoughts that happened before, during, or after the situation you’re discussing. To help with this, they might ask questions like: What was running through your mind when you started feeling ashamed/anxious/sad/guilty? Sometimes there are several automatic thoughts related to a particular situation. Maybe you’ve experienced a flood of negative thoughts one after another. Sometimes thoughts can swirl around so quickly that they feel like a hurricane of negativity. When that happens, the therapist can help you address them one at a time. You might start with the thought that evokes the most painful or intense emotions.
  • You might be asked to identify and confront any distortions in your thought process. For example, noticing thoughts that are all-or-nothing, overly catastrophic, attempt to tell the future, attempt to read someone’s mind, or overly personalize things.
  • You might be asked to examine evidence that your automatic thought is not 100% true. The workbook, “Mind Over Mood,” has a wonderful Thought Record worksheet that can help with challenging those emotionally heated thoughts.
  • After examining the thought (and the evidence for/against the thought), you might be asked to try out a new thought. The new thought might not be all rainbows, unicorns, and false positivity. Instead, the new thought might be experienced as neutral, balanced, fair, and more reflective of a truth apart from emotional reasoning.
  • After trying out the new line of thinking, a cognitive counselor might check in to see how the intensity of the emotions changed as a result of changing thinking.
  • Perhaps, then, you might begin to explore how you would behave differently if the new thought were to take root.

Cognitive theory teaches that long-term thought change requires a re-examination of core beliefs.

After evaluating automatic thoughts over a period of time, many people find patterns in their thinking that reflect deeper beliefs that are at the center of their distress. Once exposed, you can dispute those beliefs and act against them.  This is when “schema” change takes place. According to Dobson & Shaw (1995), cognitive schemas reside in the long-term memory, serving as a “vulnerability factor” for their negative thinking. In order for enduring change to take place, individuals must create new lenses from which to see themselves, others, and their environment.

Cognitive counseling helps people develop an awareness of the unhelpful thoughts that are contributing to intense feelings. People really can learn to replace destructive thoughts with more functional thinking. In cognitive therapy, there is hope for a new perspective on life.

Interested in learning more? Check out the resources listed below or read additional articles on our Cognitive Behavioral Therapy page.

References

Burns, D. (1980). Feeling Good. New York: Signet.

Dobson, K. & Shaw, B. (1995). Cognitive therapies in practice. Comprehensive Textbook of Psychotherapy: Theory and Practice. New York: Oxford University Press.

Dozios, D., et al (2009). Changes in self-schema structure in cognitive therapy for major depressive disorder: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77 (6).

Froggatt, W. (2005). A brief introduction to rational emotive behaviour therapy. Handout.

Greenberger, D. & Padesky, C. (1995). Mind Over Mood: Change How You Feel by Changing the Way You Think. New York: Guilford Press.

Jones, S. & Butman, R. Modern Psychotherapies: A Comprehensive Christian Appraisal. Illinois: InterVarsity Press.

Wenzel, A, et al (2009). Cognitive Therapy for Suicidal Patients. Chapter: Cognitive therapy: General principles. Washington, DC: American Psychological Association.

Answers to 3 Questions about Boundaries in Counseling

Answers to 3 Questions about Boundaries in Counseling

1. How does confidentiality work in therapy?

Seeing a counselor is sort of like being in the witness protection program. Even the fact that the counselor knows you is kept private and confidential. That means that when they run into you out in public, the counselor does not flag you down and say– “Hey! It’s me, your therapist! Remember me from counseling?” (How awkward would that be!?)

Instead, therapists wait for you to initiate “hellos” and are usually glad to say “hi” right back. Counselors don’t ever want to put you in that uncomfortable position where you have to explain how you know them to the people you are with.

As you may have heard, there are some exceptions to confidentiality, especially when safety is at risk.

  • If you talk about children, elderly people, or disabled people that are being abused or neglected, your counselor is considered a mandatory reporter.
  • Your counselor would also break confidentiality if you disclosed plans to harm someone else. Counselors really don’t want anyone to be murdered! (That’s a good thing, right?!)
  • Counselors often see clients with thoughts of suicide. That really doesn’t freak us out. It’s more common than you’d think! When we DO break confidentiality is when that person is losing the ability to keep themselves safe. Because teens are a high risk population when they have thoughts of suicide, it’s common for therapists to seek coordination with family supports whenever risks of harm are involved.
  • Counselors are required to provide you with a copy of their privacy practices where you can read in more detail about how confidentiality works in this unique setting.

 

2. Why can’t I be Facebook friends with my counselor?

Counselors have to abide by professional standards and ethical guidelines. The 2014 ACA Code of Ethics introduced a requirement asking counselors to separate their professional and personal social media profiles. Those ethical guidelines do not permit counselors to communicate with clients via personal social media accounts. Counseling is unlike other relationships in your life, different from friendships and different from family connections. Part of what makes it effective is that separation and neutrality. Those boundaries help make therapy a safe place to express yourself without worrying about what your therapist is going to think, which can be triggered by social media comparisons. It’s for these reasons that your counselor cannot connect on Facebook or similar platforms.

 

3. What should I get my counselor for Christmas?

Okay, this was a trick question. Please don’t get your counselor anything for Christmas (or any other special occasion). Our ethical codes discourage counselors from receiving gifts from clients. We see some very generous people come through the door who love to show appreciation and gratitude by gift giving. When counselors decline your gift, know that it is not a personal rejection. It is instead another one of those professional boundaries drawn from the ACA Code of Ethics, which advises counselors to remain mindful of putting the therapeutic relationship first. More than anything, your counselor wants to avoid any situations that may cause a conflict of interest.

How to Get the Most Out of Counseling

How to Get the Most Out of Counseling

Most people start the counseling process with a readiness for change. Some may not know the specifics yet for how they’d like that change to look (maybe that’s why they’re in therapy), but in some way, they are not 100% satisfied with the status quo.

When you step through the doors of our counseling office, we know you are sacrificing your time, emotional energy, and finances to work toward your change goals. You are intentionally prioritizing your mental health and well-being. You are worth it! We want you to get the most out of your sacrifice.

In this article, I’ll outline a few tips that will help maximize your time in therapy, so you can get the most out of your journey in counseling.

 

BE YOURSELF. Counseling is a place where you don’t have to pretend. You don’t have to put on a happy face (unless you genuinely feel happy!). It’s okay to say “I don’t know” and it’s okay to say “This conversation is hard for me.” It’s okay to giggle, have your mind go blank, burst out in tears, or speak an unpopular opinion. The confidential nature of therapy is part of what makes it a safe space to be yourself. A good counselor will offer a non-judgmental, supportive setting.

 

DO THE HOMEWORK. Often, the most beneficial work of therapy happens outside of the therapy office, where you apply the concepts you are working on in the real world. You will get the most out of therapy if you are giving the homework a try. Hopefully, you will find most of the homework to be helpful; however, sometimes it might only partially help and other times it might not help at all. The results of your effort matter. Your counselor will ask about what happened–what worked and what did not work. This will help you and your counselor to troubleshoot coping skills, tailoring them more specifically to where you are getting stuck.

 

GIVE HONEST FEEDBACK. Counselors are not psychics; they cannot always know you are struggling, confused, holding back, or stumped unless you say it out loud. Sometimes counselors will tread on ground that you might not be prepared to discuss yet. Your honest feedback is welcome and will help you progress at a pace that fits your readiness.

 

ATTENDANCE COUNTS. Clients tend to make the most progress when they are meeting with their counselor on a weekly or every-other-week basis to start. Once-a-month therapy is typically reserved for clients who have achieved most of their goals and are only fine-tuning subtle points. Missed appointments = Missed momentum.

 

REVIEW BIG-PICTURE GOALS. As therapy progresses, it can be extremely helpful to pause periodically, zoom out, and take a look at the bigger picture. Where have you come? And where are you headed? Often, clients are so caught up in this week’s problem and this week’s to-do list that they lose track of the progress they’ve made over time. Your counselor is like a time capsule that can remind you of where you were when you first started, the steps you took to get where you are, and the strengths they’ve observed. Revisiting treatment goals can also help you identify specific areas where you have ongoing work to do. It is important for you and your counselor to be on the same page about how to prioritize your work.

 

Check out our FAQ page to review other commonly asked questions about the counseling process. You don’t need to have it all figured out before you schedule that first appointment. It’s natural to have lingering questions and even fears about starting counseling. Your readiness for change is what matters most! We’ll be here to help.

Embody Boldness: Overcome Your Fear of Failure

Embody Boldness: Overcome Your Fear of Failure

The fear of failure can be paralyzing. In fact, a fear of failure can derail a life’s passion, sap out motivation, and sometimes stomp the brakes on all forward momentum. It’s what convinces you NOT to apply for that promotion, NOT to ask that girl out, and invites you to settle for a compromised, lesser version of your dreams. (more…)