‘A theory based evaluation of Cognitive Behavioural Therapy’
The purpose of this essay is to provide a theory based evaluation of Cognitive Behavioural Therapy (CBT). The first part of this essay will concentrate on defining CBT including a brief description of its derived history and the therapies that have contributed to its development. I will then move on to review the tools used in the four step process of CBT (assessment, formulation, intervention and evaluation). I will also incorporate how my learning of theoretical concepts relates to my work based practice.
Cognitive Behavioural Therapy is a psychotherapeutic approach that aims to solve problems concerning with dysfunctional emotions, behaviours and thinking (cognitions) through a goal-orientated, systematic procedure. According to Craddy, CBT helps clients to change their behaviour and their thinking patterns. He states that clients can learn to ‘tolerate unpleasant feelings and discover that they are likely to diminish with time…they can be persuaded that avoiding experiences of any level of anxiety in the short term is not necessarily advantageous to their mental health’ (Craddy, 2006 p.28). CBT is a brief and time limited therapy which is highly effective for a number of disorders including phobias, anxiety, depression, eating disorders, drug or alcohol problems and sleeping disorders.
From the 1970’s CBT became politically appealing in the United Kingdom. At that time there was a large number of the population being in receipt of sickness benefits and on medication causing a financial burden on the economy. The Government’s aim was therefore to address these issues by using CBT. This therapy suited the political agenda as CBT was cost effective, measurable and was a short term intervention particularly when compared to other therapies. However, it is important to recognise that CBT does not meet the needs of all individuals and will therefore not always be effective. Other types of therapy should not be dismissed. In addition to this, CBT has been criticised as being a ‘simple minded “cookbook” approach to therapy: if the client has this problem, then use that technique’ (Westbrook et al, 2011,p1). Very often, CBT clients will return to a CBT therapist a number of years later after it was first received. This can therefore raise the question, how effective was this therapy the first time it was accessed?
CBT was developed through the merging of two therapies, Behaviour Therapy and Cognitive Therapy. I will not go on to discuss Behaviour therapy in more detail.
Behaviour Therapy developed in the early 20th Century with its three distinct points of origins in South Africa (Wolpe), United States (Skinner) and the United Kingdom (Rachman & Eysenck). Behaviour Therapy is based on learning theory which aims to treat the client through techniques designed to reinforce desired and eliminate undesired behaviours (McGuire, 2000). Classical and Operant Conditioning are seen as the primary theories of learning. Classical conditioning (Pavlov) is described as learning that is achieved through association, for example a fear of the dentist maybe associated with the feeling of discomfort and pain. Operant conditioning (Skinner) is described as a process of learning responses through positive and negative reinforcements. Skinner describes positive reinforcement as rewards which are given every time a correct response is given to a stimulus e.g. affection may be given as a ‘reward’ to a child. That child will repeat that behaviour to endeavour to gain that affection again. Negative reinforcement is described as the removal of the unpleasant stimulus once the correct response has been elicited. In other words, negative reinforcement is if something such as pain that is relieved through painkillers is removed from us, we would reach for the painkillers again if the pain returned. According to Skinner, both positive and negative...
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