Selected Essays And Book Reviews
COUN 612 - Theories and Techniques of Counseling I
Lessons 15. Cognitive-Behavior Modification: Meichenbaum {1,038 words}
1. Discuss the recent history of cognitive-behavior modification therapy. Behavior modification started between 1953 amd 1965. B. F. Skinner wrote a book about its principles entitled "Science and Human Behavior". He had also done a book in 1948 that was more informal. He thought that behavior had to be publicly observable. Between 1965 and 1975, the focus was on behavioral self-control. Holmes decide that overt thoughts worked like behavior modification, and Mike Mahoney popularized behavioral self-control. In 1973, Mahoney published a book about cognition and behavioral modification. As a behavioralist, he ripped behavior modification apart with respect to covert thoughts and overt actions, and this was the start of cognition and behavior modification. In 1968, Don Meichenbaum was a Canadian psychologist working on his dissertation about learning in schizophrenics. By comparing their behavior with that of his young daughter, he saw that their verbal talk to themselves was a regression back to an earlier stage of life. He trained hyperactive children to stay on task by verbalizing what they were doing. He encouraged them to do "turtle", which meant to slow down. Cameron was his assistant, and in 1977, they published a book on behavior modification integration. Meichenbaum said that cognitions preceded behavior and that that led to consequences.
2. Discuss personality as seen by the cognitive-behavior modification therapist. Personality is described by the process of situations that lead to cognitions that lead to behavior that lead to consequences. The cognitions can take the forms of self-instructions about how to behave, cognitive processes about a pattern of thinking, cognitive structures about beliefs, plans, and things in our head, and meta-cognitions which are thoughts about how to think. Behavior can be broken down into responses and coping responses. Responses are motor, verbal, or emotional. Coping responses are change the situation, change the cognitions, or change the behaviors.
3. Discuss the causes of problems. The causes of problems are troublesome situations, faulty cognitions (structures, processes, self-instructions), ineffective responses to cognitions, and ineffective coping responses (self-controlling responses – people who cannot control themselves).
4. Discuss the theory of therapy. To change, a person must become aware of the need to change (therapy should do this), become aware of what to change (therapy should also do this), employ coping responses (self-controlling behaviors) that will effectively promote change, and persevere until change is accomplished. Usually the client is aware of the need to change and has tried repeatedly to change, but the attempts have not been effective.
The therapist’s role is to help the client become aware of what to change, help the client identify and employ effective coping responses, and help the client persevere until change is accomplished. For Meichenbaum, his short theory of therapy is: (a) phase one (self-observation under the direction of the therapist), (b) phase two (substitution of alternative cognitions and behaviors for troublesome ones), and (c) phase three (creating stable cognitions about change (meta-cognitions) – the client must be convinced that the change will last.). His assumptions about therapy are that the clients will learn most effectively through guided self-discovery (note the continuum from self-discovery through guided self-discovery to teaching) and that the clients learn by a multitude of modalities, mostly active (verbal, observation, experiential, role play, and especially practice).
5. Discuss cognitive-behavior modification methods. The method is stress inoculation training (SIT).
a. In the educational phase (which is not teaching):
(1) the client and therapist develop a joint conceptualization of the problem from the client’s data (focus on thoughts and behaviors) and culminates in a rationale that is directly aimed at treatment,
(2) come up with some standard rationales:
(a) anxiety (Meichenbaum and Cameron) and anger (Novaco) which are emotions. Try to get the client to understand what emotion is. A person has to be aroused and appraise the situation in order to have emotion. Then try to lower arousal or appraise the situation differently,
(b) emotion = physiological arousal * appraisal of the situation (Schachter and Singer, 1962),
(c) pain involves 3 components – sensory-discriminitive (need to reduce the detection of pain), motivational-affective (taught to deal with the negative effects of pain), and cognitive-evaluative (taught how to think and evaluate pain differently),
(3) develop a method of evolving a joint conceptualization (the client describes, and the therapist repeatedly asks about thought-behavior links. The therapist asks about examples when the problem is NOT experienced. The therapist concludes: when you think "x", you have the problem. When you think "y", you do not. Therefore, change your thinking from "x" to "y".),
(4) develop a method of making the client aware of coping strategies (the therapist asks what the client does to cope with the problem and elicits as many coping strategies as possible. If few or ineffective strategies, the therapist suggests that more are needed. The therapist will usually suggest that the client needs cues for employing the appropriate strategy at the appropriate time), and
(5) creating stages of arousal (this means preparing to confront the problem situation, confronting the initial stages, confronting the full-blown problem, and reinforcing self for coping at every stage.).
b. In the rehearsal phase (training in coping skills), the therapist teaches the client how to use distraction, imagery, relaxation, self-instructing training (how to interrupt their thoughts to something that does not feel so bad), and systematic desensitization with coping imagery.
c. In the application phase (practice using coping skills), the client uses imaginal practice to practice handling the problem, role play to practice managing behaviors, exposure to mild stress within the session, and controlled exposure to stressful situations outside of counseling.
d. The final step is to process what has happened in therapy. Discuss the client’s acquisition of coping and self-control skills. Discuss the permanence of change. Discuss expectations about how the client will deal with future problems.
Tom of Bethany
"He that hath the Son hath life; and he that hath not the Son of God hath not life." (I John 5:12)
"And ye shall seek me, and find me, when ye shall search for me with all your heart." (Jeremiah 29:13)
Index to Selected Essays And Book Reviews
Lesson 16. Cognitive Theories: Raimy and Kelly
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