This essay will assess the use of cognitive counselling approach to help the client through the process of change and cope with depression.
Joan is 28 years old woman, suffering from depression; the Gp referred her to the counsellor who will help her to overcome it. Due to the nature of the problem, Cognitive behavioural therapy can be used to treat Joan’s depression condition. This therapy is an effective approach that is used for helping people to change their behaviour, thoughts and feelings.
NICE 2009 illustrated that depression is a common mental health problem and it affects nearly 1 in 6 in the United Kingdom. The main signs of depression are losing interest in the normal activities as well as isolating from other people. A person suffering from depression might experience sadness feeling, crying, irritable or feeling exhausted, feeling low, blaming and feeling unworthy to live, changes in appetite and having sleepless night and the person might experience poor memory and concentration. For these reasons, the person can become critical and holding negative thoughts about himself or herself. These feelings can lead to suicide or harm.
Cognitive therapy is simply a kind of psychotherapy that was created by Aaron T. Beck and Albert Ellis. This therapy is believed to alter unrealistic views and the way of thinking psychologists’ use cognitive therapy approach to view psychological problems for instance, depression develops from different areas of life experience. Beck discovered that cognitive therapy was an efficient intervention for treating depression. Cognitive therapy assists clients to feel better, to be aware of their feelings and to battle with their negative thoughts and perceptions (Beck, 1995; Beck, 2005).
Behavioural therapy was originated from classical learning theories which come from the work of Ivan Pavlov -respondent conditioning, John B. Watson and B. F. Skinner—operant conditioning. Behavioural therapy helps the person to tackle the problems by behaving positively. For instance the person who has fear of a dog, the therapist usually helps the person by spending more time on the situation in order to make the person feels comfortable in this particular situation (Masters. et. al, 1987).
Therefore cognitive behavioural therapy adds both the two techniques and normally it is performed in a structured environment with the main objective of overcoming the specific problem. A person requires doing tasks within sessions, for example using a diary to record events and finally the person learns to become his or her own therapist (Freman.et.al).
In Joan’s case as a depressive person, the diary can be used to monitor the mood and activities as this would be useful and helpful for both the counsellor and Joan to obtain more objective view of the problem and assess possible causes and changes of symptoms during the day or week (Foreman et.al. 2009).
Cognitive behavioural therapy is cheap and also a short term treatment with long lasting outcomes. It is a proficient treatment for many psychiatric conditions. The National Institute for Health and Clinical Excellence (NICE) suggested that Cognitive behavioural therapy has a reputation in treating diverse problems such as relationship problems, emotional problems, stress, schizophrenia, fear, phobia and eating disorders, anxiety, depression. Several controlled trials have shown its positive outcome (www.nice.org.uk/CG91publicinfo).
According to the therapeutic research, the duration of cognitive therapy is offered for 10-20 sessions. But The National Institute of mental health study on depression indicated that 16-20 sessions of cognitive behavioural therapy are not enough for most patients to overcome depression .
A study in British Medical Journal in 2002, reported that people with severe depression received treatment from their general practitioners which included behavioural and educational self help materials.
In November 2007,the government decided to spend ?170 million as a strategy to better psychotherapy service program and to make it more viable especially for patients with depression and anxiety. Most of them cannot afford to pay private therapists and also they have to be on the waiting lists (http://www.rcpsych.ac.uk/default.aspx).
Counsellor needs to work within the British Association Code of Practice which are values, principles and personal moral qualities (http://www.bacp.co.uk/ethical_framework/. Actually these are similar to Rogerian three core conditions, empathy, non-judgement, warmth and genuiness (Sanders, 2002).
Cognitive behavioural therapy needs counsellors who have experience and knowledge on how to perform interview with the patients. As (Sanders, 2002) pointed out depressive people need help, support and encouragement. Cognitive behavioural therapy usually encourages a patient to talk freely about whatever comes in his/ her mind because sometimes the patient can turn up without being prepared or planned on what to talk about (Foreman, et. Al., 2009)
The counsellor should totally address the confidentiality issues with the client to make him or her feel secure in advance before the session starts (Sanders, 2002)
During the session, for example looking at Joan as a depressive person she will be required to learn and practice specific strategies in every session and she will have an assignment to do such as recording events in the diary and bringing the result to the next session. The aim of this is to improve her present condition. Although this needs a lot efforts for a person who is feeling depressed. Therefore, the counsellor plays a big part and becomes very important in engaging Joan in the therapy. This can be achieved when Joan realises that the counsellor understands her situation and empathise with her feelings and able to proffer solutions to her problem (Hough,2006)
Rogerian interviewing techniques are very helpful in creating good environment in therapeutic. The interviewing techniques involve paraphrasing, reflection of feelings, and summarising (Hough, 2006)
Paraphrasing include repeating what the patient spoke, the counsellor supposes to use his or her own words. This indicates that the counsellors has understood accurately and reassure the client that the counsellor has been concentrating and obtaining the key message. In this point if the counsellors misinterpret the client’s key points, then the client can rectify the counsellor’s fault (Sutton & Williams).
Reflection of feelings entails the statements; the counsellor usually expands the client’s factual feeling and elaborates in his or her own words. This way again indicates that the counsellor has been listening accurately and identifies client’s emotional state. Actually, in this section, the counsellor will be informing the client that they are emphasising together. Furthermore at this stage, the counsellor also shows his emotional reaction towards the story (Sutton & Williams).
Summarising is carried out throughout the session; it includes gathering and breaking down the final few moments of the discussion. As a result, this would help the client to see and understand the situation more effectively (Sutton & Williams, 2002)
Above all, the counsellor has to ensure that during this time in dealing with a depressive client, there should be some boundaries. Joan can feel helpless and aimless with the situation; this does not mean that the counsellor should step back. The counsellor must make sure that he is not too carried away with the client’s emotions as he needs to be strong before the client and find possible way of uplifting the client (Sutton & Williams, 2002).
In counselling session, active listening skills are regarded as the main vessel in communicating with the client. To break the communication barrier, the counsellor needs to consider listening effectively to his client’s verbal means of communication as well as understanding the non-verbal means of communication. Suppose, in Joan’s depressive condition, the counsellor must be able to identify and work on the clues such as negative statements that need contradiction and short phrases (Egan, 1998).
However asking questions sometimes can be problematic in counselling as it reflects on external rather than internal reference. The method of asking questions enables the counsellor to get facts for their own use instead of having a desire to understand client’s subjective experience of things (Sanders, 2006).
On the other hand, difficulties in therapeutic alliance might happen as some of the clients can find it difficult to express themselves and to explore their interpersonal problems particularly to those problems that are connected to personal belief, others and relationships. For example (i must never let anyone to see my true ‘self). Thus, In this situation the clients might not be willing to discuss their problems openly. This can cause the therapist’s behaviour to be misinterpreted because the therapist might activate his or her own negative belief and dysfunctional assumptions. As a result of this, dismiss the development of warm, equal collaborative alliance (Safran & Segal, 1990).
The behavioural approach helps to treat undesirable behaviour and sometimes, the problems can be deep rooted from inside. For example, in counselling session, a depressive client might re-act positively well to behavioural approach. The problem can still persist until the source of depression is recognised then lasting cure of the depression is unlikely (Hough, 2006).
Furthermore, to solve this problem, it appears that a depressive client will need to be committed and starts to show high level of stress in the beginning of the session while the behavioural is occurring. Thus, counsellor who works as a strict behavioural perspective might overlook client’s view. Because of the basic principle of approach which lies on people’s reaction in an automatic way to stimuli. This view does not take into account the influence of thinking or cognition in determining behavioural (Hough, 2006).
In comparison, cognitive behavioural approach to psychodynamic approach, these two approaches have dissimilar features; firstly cognitive behavioural therapy gives client a reason for the approach and techniques used. A cognitive behavioural therapy is an educative, as well as inspires clients to actively involve in the therapeutic process. Unlike psychodynamic therapy, Cognitive behavioural therapy normally pays attention on a person’s functions at present time by searching the connection between feelings, belief, thoughts, attitudes, goals and behaviour. Rather than trying to evaluate unconscious psychic facts and events. Cognitive behavioural therapy assumes that person’s emotional reaction is caused by his thoughts and belief about a particular event or situation (Hough, 2006).
In Joan’s depressive condition, using psychodynamic approach, the counsellor will look at various factors that are influencing or causing depression. For instance, early childhood experiences and how these are related to an early attachment with her parents. Moreover, the counsellor will also link to Joan’s present relationships and the things she is doing without being aware of them as to protect herself from depressive thoughts and feelings as a result of experiencing a traumatic event (Gabbard & Western, 2003).
Counselling at work place module, links with life span development module and sociology of health module. In life span development, Erick Erickson theory of eight stages of psychosocial development which stress the important of helpful and supportive environment in human life to meet psychological needs. Freud, psychodynamic theory looks at the important of relationship with other people and also considering their early childhood experience or present experience. Psychodynamic theory gives us an idea to think about other people’s feelings especially in a difficult time as it is normal for a human being to feel anxious (Bee & Boyd, 2006).
Counselling in the work place module, links to sociology of health and healthcare, in terms of social behaviour and how to deal with people in professional manner. Biological model and social model of health and illness are explored and we looked at the mental health problem which can be treated not only with medicine but also with talking therapies such as psychodynamic therapy and cognitive therapy (Taylor & Field, 2007).
Cognitive behavioural therapy can be adequate for people who suffer from major depression. This is especially true for people who experience severe resources problems such as living in dangerous environment, food and shelter. Hence, it is obviously that these people’ depression is not in their head or neurotransmitter. Because of the hardship life they are experiencing, to dedicate time and make an effort to deal with depression can be inconvenience for them (Williams, 2006).
In conclusion
There are several evidences which have shown cognitive behavioural treatment approach in various studies. Although it should be remembered that cognitive behavioural therapy has shown a lot of achievement in treating different health problems with various studies have supporting its desirable outcomes.
Cognitive behavioural therapy has its weaknesses and strengths since it requires treating the clients’ main problems. For example, a client who suffers from depression, anxiety and phobia needs a therapist who identifies both the rewards and criticisms available for the cognitive behavioural therapy. So, the client should be wise and careful to choose experienced and knowledgeable therapist who can bring about some changes in the client’s psychological problems.
In the past, when behavioural therapy was newly established, it was a non-humanistic approach to treatment. Behavioural therapy was unable to produce warmth and emotions to the client. But it is crucial to be aware that these behavioural plans have emerged from far away until now. In the past, behavioural therapy process included repetitious training sessions involving pairing a stimulus with a reinforcer. Since the cognitive treatment strategies added with cognitive behavioural strategies, cognitive behavioural therapy has considered and reflected on the person.
REFERENCES Beck, A.T. (2005). The current state of cognitive therapy. Archives of General Psychiatry, 62, 953-959. Beck, J.S. (1995). Cognitive Therapy—Basics and Beyond. New York: Guilford Press. Bee, H., & Boyd, D.,( 2006). Lifespan Development. 4th ed Pearson education.Printed in the United States of America. Clark, D. A. & Steer, R. A. (1996). Empirical status of the cognitive model of anxiety and depression. In Frontiers of Cognitive Ttherapy (ed. P. M. Salkovskis), (ed. P. M. Salkovskis), pp. 75-96. New. Collaborative Research Program. Archives of General Psychiatry, 49, 782-787 Egan, G., (1998). The Skilled Helper, 6th edition. Pacific Grove, California: Brooks/Cole Publishing Company, . follow-up. Findings from the National Institute of Mental Health Treatment of Depression Foreman, I.,E., Elliot,H., C., Smith, L., L. .(2009). Anxiety & Depression Workbook For Dummies.John wiley&S ons publishing. Gabbard, G,O,, Westen, D, (2003). Rethinking therapeutic action. International Journal of Psychoanalysis,84, 823-41. Hough M., (2006).Counselling Skills and Theory, 2nd ed.,Brooks/Cole Publishing Company in California. http://www.bacp.co.uk/information/education/ http://www.rcpsych.ac.uk/default.aspx accessed on 10/03/2011 Masters, J,C., Burish, T,G., HoHon, S,D., & Rimm, D,G.(1987). Behavior Therapy. Techniques of Congress Cataloging Russell, D.E. & Norvig, P., (2009). Artificial Intelligence: a modern approach, 3rd ed., Prentice-Hall Safran, J. & Segal, Z. V. (1990) Interpersonal Process in Cognitive Sanders, P.,2002. First Steps in Counselling. A students’ companion for basic introductory courses. Third (edition). Shea, T., Elkin, I , Imber, S.D., Sotsky, S.M., Watkins, J.T., CoUins, J.F., Pilkonis, P.A., Backham, E., Glass, D.R., Dolan, R.T., & Parloff, M.B. (1992). Course of depressive symptoms over follow-up. Findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Archives of General Psychiatry, 49, 782-787 Sutton, J.,& Stewart, W., (2002). Learning to Counsel:Develop the skills you need to counsel others.2rd ed., How to Books Ltd in United Kingdom., Taylor, S., & Field,D.(2007).Sociology of health and health care, 4th ed. BIBLIOGRAPHY Beck, A.T. (2005). The current state of cognitive therapy. Archives of General Psychiatry, 62, 953-959. Beck, J.S. (1995). Cognitive Therapy—Basics and Beyond. New York: Guilford Press. Bee, H., & Boyd, D.,( 2006). Lifespan Development. 4th ed Pearson education. Printed in the United States of America. Clark, D. A. & Steer, R. A. (1996). Empirical status of the cognitive model of anxiety and depression. In Frontiers of Cognitive Therapy (ed. P. M. Salkovskis), (ed. P. M. Salkovskis), pp. 75-96. New. Collaborative Research Program. Archives of General Psychiatry, 49, 782-787 Egan, G., (1998). The Skilled Helper, 6th edition. Pacific Grove, California: Brooks/Cole Publishing Company, . follow-up. Findings from the National Institute of Mental Health Treatment of Depression Foreman, I.,E., Elliot,H., C., Smith, L., L. .(2009). Anxiety & Depression Workbook For Dummies.John wiley &Sons publishing. Gabbard, G,O,, Westen, D, (2003). Rethinking therapeutic action. International Journal of Psychoanalysis,84, 823-41. Hough M., (2006).Counselling Skills and Theory, 2nd ed.,Brooks/Cole Publishing Company in California. http://www.bacp.co.uk/information/education/ http://www.rcpsych.ac.uk/default.aspx accessed on 10/03/2011 Masters, J,C., Burish, T,G., HoHon, S,D., & Rimm, D,G.(1987). Behavior Therapy. Techniques of Congress Cataloging Russell, D.E. & Norvig, P., (2009). Artificial Intelligence: a modern approach, 3rd ed., Prentice-Hall Safran, J. & Segal, Z. V. (1990) Interpersonal Process in Cognitive Sanders, P.,2002. First Steps in Counselling. A students’ companion for basic introductory courses. Third (edition). Shea, T., Elkin, I , Imber, S.D., Sotsky, S.M., Watkins, J.T., CoUins, J.F., Pilkonis, P.A., Backham, E., Glass, D.R., Dolan, R.T., & Parloff, M.B. (1992). Course of depressive symptoms over follow-up. Findings from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Archives of General Psychiatry, 49, 782-787 Sutton, J.,& Stewart, W., (2002). Learning to Counsel. Develop the skills you need to counsel others.2rd ed., How to Books Ltd in United Kingdom., Taylor, S., & Field, D.(2007).Sociology of health and health care, 4th ed.LibraryTherapy. Northvale, NJ: Jason Aronson.
Williams, C,. (2006). Overcoming depression and Low mood. A Five areas approach. 2nd ed. Hodder Arnord. Oxford University Press. New York.