Therapeutic Relationship in Cognitive Behavioral Therapy
Therapeutic Relationship in Cognitive Behavioral Therapy
One of the strategies employed in addressing a number of psychological problems and illnesses is the use of different kinds of psychotherapy. Aside from pharmacology, many psychiatrists and psychologists practice different techniques in psychotherapy in order to lessen drug-dependence of clients suffering from mental disorders. One of the psychological therapies used is Cognitive Behavioral Therapy, which helps enhance the therapeutic relationship that exists between the psychologist or psychiatrist and the client. However, Beck argues that the therapeutic relationship that exists between the client and the doctor in Cognitive Behavioral Therapy may not be sufficient to achieve a health or wholesome outcomes. With this statement, this essay discusses the concepts underlying Cognitive Behavior Therapy, with the emphasis on therapeutic relationship. Such concepts would be the basis for justifying Beck’s statement.
Cognitive Behavior Therapy
(1995) defines Cognitive Behavior Therapy as a branch of applied psychology that seeks to change problematic behavior through a number of methods. Methods include modifying the environmental contingencies that surround the problem, weakening previous conditioned associations that have resulted in maladaptive emotional reactions, offering clients more effective models of problem-solving and interpersonal behavior, seeking to change ways in which stimuli are recognized and interpreted in the first place, and offering an objectively superior basis for the therapeutic, counseling or casework roles of the psychologist or psychiatrist ( 1995). Such methods or approaches are not restricted to any one theoretical technique, but involves diverse yet interrelated strategies for providing new learning experiences that engage procedures and analysis. In addition, cognitive behavior therapy is guided by a number of principles, which serve to guide the therapist in the treatment of the client. Primarily, cognitive mediational processes are involved in human learning, such that the human organism responds mainly to cognitive representations of its environment rather than to the environment per se. Second, thoughts, feelings, and behavior are causally interrelated, thus, alterations to one aspect of the system will have effects on the other features. Third, cognitive activities are important in understanding psychopathology and producing therapeutic change. Fourth, cognitive processes can be cast into testable formulations that are integrated with behavioral paradigms, thus, desirable to combine with behavioral procedures, such as modeling, role-plays, and contingency management. Lastly, the task of the cognitive-behavior therapist is to act as a diagnostician, educator, and consultant, who assesses maladaptive cognitive processes, and works with the client to design learning experiences that may remediate these dysfunctional cognitions and behavioral patterns (1993). In this regard, it can be perceived that the process of cognitive behavior therapy involves addressing the feelings, behaviors and thoughts of the client during the therapy process in order to change or alter the maladaptive behavior of the client. In the process, the relationship between the client and the therapist is being emphasized.
Therapeutic Relationship in Cognitive Behavior Therapy
The review of in 1990 of cognitive behavioral treatment emphasizes that cognitive behavior therapy is based on the collaboration of the therapist and the client, thus, both of the parties work together to establish their goals, assignments, and means for success ( 1999). In this regard, the therapeutic relationship between the client and the therapist is being established. It has been reported that therapeutic relationship is at the absolute heart of psychotherapy, and is the vehicle whereby therapeutic change occurs ( 1991). It is regarded as the journey of both parties, which involves the participation, passion, cooperation, trust, and concern from both. In addition, a good therapeutic relationship is crucial to the success of cognitive behavior therapy for the therapist to carefully nurture the therapy alliance and pay attention to any ruptures within the relationship (2002). Because the success of the therapy lies on the relationship that exists between the therapist and the client, a careful and relevant approach must be employed by the therapist in order to ensure the effective treatment of the client.
Therapeutic relationships can be achieved through different means. Primarily, the therapist can use the process of collaboration, which involves establishing an equal partnership with the client through bringing skills, knowledge, emotion, and techniques that would help the client in the process. Another way is through formulation, which is a unique map of presenting problems or situations to the client that would integrate information from assessments of the therapist. Third, the therapist can use a Socratic dialogue or guided discovery, which involves gently probing or questioning for people’s meanings to stimulate alternative ideas. It explores and reflects on styles of reasoning and thinking differently. Lastly, the therapist can assign homework to the client, to allow him or her to try things out in between therapy sessions, thus, putting into practice what the client has learned in the therapy sessions (2005). With such methods, the therapeutic relationship between the client and the therapist can be established and determined. However, the problem that can be encountered in this sense is the fact that the client may have apprehensions towards the therapist, thus, limiting his or her disclosure of information. In this regard, the statement of Beck, emphasizing that such therapeutic relationships may not be enough to obtain desired outcomes come into picture.
Justifications of the Statement
The therapeutic relationship established through such means may not be effective due to a number of reasons. Primarily, the therapeutic relationship would not be effective in achieving healthy outcomes without the trust of the client to the therapist. It has been reported that the cognitive behavior therapist works with schemas, which are the collections of people’s beliefs, experiences and rules of behavior about themselves, others and the world ( 1999). If the client has schematic beliefs of mistrusting other people, then the therapist would have a hard time encouraging the client to disclose information. In this regard, the genuineness of the therapist must be observed, which has to do with confidence, appearing relaxed and at with one’s self, thus, presenting the therapy in a way that it would not sound artificial to put up a barrier between the therapist and the client (1995). Another hindrance to the practice is the lack of sensitivity on the part of the therapist. If the therapist is not sensitive enough for the needs of the client, then the client would not be able to obtain the best treatment that would help him or her to improve and develop as an individual. In this regard, non-possessive warmth must be expressed by the therapist, which consists of getting across to clients feelings of respect, liking, caring, acceptance, and concern, and managing these in a non-threatening way (1995). It is not enough that probing and collaboration with the client must be done, but the client must be able to feel the care and concern of the therapist.
Therapeutic relationship is also not enough if there is incompatibility between the client and the therapist. Incompatibility can be observed through the incompatibility of the approaches of the therapist, and incompatibility on the response of the client that hinders adequate and effective assessment. In this regard, it can be perceived that the relationship of the client and the therapist must be based on compatible approaches and strategies that would not only benefit the client, but provide learning and experience on the part of the therapist as well. Having a client-therapist relationship is not a mechanical and predictable relationship that provides help to the client because of sympathy. In this regard, empathy must be extended by the therapist, which involves letting the client know that the therapist has a grasp on his or her problems, showing the client that the therapist sees things on the client’s perspective, and letting the client feel and see that the mood and feelings of the therapist are in tune with him or her ( 1995). As such, the trust and confidence of the client can be obtained. In addition, the time allotted by the therapist also counts in cognitive behavior therapy. Therapeutic relationships must not only focused in providing cognitive activities and workshops to the client, but making the client feel that his or her problems matter to the therapist through providing ample time for listening to the client. However, psychotherapies, such as cognitive behavior therapy takes a lot of time and effort on both the client and the therapist, is a time-consuming process, and its full analysis may take several years (1988). In this regard, each therapy session between the client and the therapist must be grasped and taken advantage in order to yield the best possible result. However, the problem that can be encountered due to the slow and time-consuming process is that the client or the therapist may get tired, given the slow development of the client. In this case, psychotherapeutic activities must be done simultaneously to ensure the speedy improvement and treatment of the client. From this, it can be perceived that the therapeutic relationship between the client and the therapist that was established through probing, collaborating, and assigning homework must not be based only on by-the-book approaches. Such activities must be done with the empathy, genuineness, and sensitivity of the therapist to the needs of the client.
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