The Cognitive Behavioral Therapy

Can a humanistic model of counselling be integrated with a cognitive (or cognitive – behavioural) one? Discuss with reference to Rogers and either Beck or Egan. In the first part of this essay I will summarise the main features of humanistic counselling and the cognitive approach. Rogers used a humanistic person centred approach to therapy and I will look at his view of people, their potential, what goes wrong and what can help them to change. Egan was a cognitive therapist and I will address the above points in relation to his “Skilled Helper” model.

Similarities and key differences in theory, practise and value base between the two approaches will then be discussed. In the second part of the essay, I will use my own previous experience as a client to show how an experienced counsellor can integrate aspects of these two models effectively. I will then look at potential difficulties in making the humanistic and cognitive approach to therapy fit together successfully.

I will give a critical analysis of these models, with particular reference to my own therapy and general diversity of needs within the client group.

The concluding paragraph will contain an abridgement of the main points covered within the essay. Humanistic therapy emphasises the therapeutic relationship advocated by Rogers with the three core conditions of empathy, congruence and unconditional positive regard. Without these conditions present Rogers asserts that the counselling will be ineffective. Humanistic therapy is non- directive and optimistic. Rogers, (2008 p. 137) supports this viewpoint “The person – centred approach, depends on the actualising tendency present in every living organism, the tendency to grow, to develop, to realise its full potential”.

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A humanistic therapist s uses active listening skills including clarifying, paraphrasing, reflecting and summarising. The therapist being non-judgemental is essential to the success of person centred therapy. The only ‘tool’ required in the counselling Page two room is ‘the self’; the relationship in and of itself, with the ‘safe space’ for the client to freely express emotions accomplishing the healing. Egan’s cognitive approach is a directive, systematic, cumulative, problem solving three stage model of helping.

Stage one considers the client’s present scenario; the counsellor encourages the client to tell their story; using core conditions, active listening skills plus a few challenging questions enabling the counsellor to understand the client’s present frame of reference. Stage two considers the preferred scenario; using directive questions prefixed with words like ‘how’ and ‘in what way,’ the client is moved towards a more objective understanding, an alternative way of viewing their world. The client is encouraged to develop Goals and objectives based on opportunities for future action.

Stage three A strategic action plan workable within the clients lifestyle moving them towards desired outcomes is formulated, with plans for future evaluation. Egan (1990 p. 29) identifies one of the main roles of the counsellor in this process “Counsellors can help their clients empower themselves by helping them identify and develop unused or underused opportunities and potential”. Egan’s model provides principles as guidelines, the correct formula; taking action to valued outcomes is individually tailored to each client, including homework for the client on agreed goals.

Rogers views the person as having an inner core to his personality which he terms the organism. The instinctual, somatic, sensory unselfconscious aspect of a human being, as opposed to the reflective, measured and self-conscious part that he describes as the self. Rogers considers, as stated by Embleton, L. ( 2004 p. 32 ) “ that the organism is trustworthy and does not need to be controlled or directed from the outside”. He considers people to be social, self-regulatory and responsible for their own actions, with a natural tendency towards growth and self-actualisation.

Each person is valued as a unique individual. Within Humanistic therapy the potential is there for the re integration of self and organism, thus Page three enabling self-actualisation to take place. A phrase used by Kierkegaard the first modern existentialist – to be that self which one truly is – I feel expresses the idea of self-actualisation very well, indicating the potential for growth and change believed by Rogers to be inherent within all of us.

Rogers puts forward the view that the client held in the therapeutic relationship, when given the freedom to fully experience his feelings realises his potential to experience being (increased self- awareness) and becoming (self-actualisation). What goes wrong, thus bringing a client into therapy? Rogers considers the problem to be lack of balance in a person’s life, conflict between what has been internalised as belief, conditions of worth and values, and what the person is presently experiencing.

Dissolution of protective defence mechanisms that had previously enabled the client to function in their daily life, leads as they experience a life changing event to dysfunction with mental, emotional and sometimes physical disintegration. To reverse this process and bring about reintegration and balance through humanistic therapy, the relationship needs to be firmly established and the core conditions of the therapeutic relationship modelled by the therapist. Within this relationship conditions of worth are minimised.

The positive regard offered by the counsellor facilitates an increase in the client’s positive self-regard leading to reintegration and ultimately self-actualisation. Egan views people as being subject to operant conditioning. In essence “in any situation or in response to any stimulus, the person has available a repertoire of possible responses and emits the behaviour that is reinforced or rewarded” (Mc Leod p. 126). Egan considers that the client’s repertoire of available responses and processing of information mostly learned during childhood will be uniquely theirs, and may not presently be serving their best interests.

The cognitive therapist will Page four look for unused or unrecognised life enhancing potential within the client. Egan views peoples actions as a direct result of their feelings and the thinking (cognition) preceding them. People have the potential to unlearn behaviour that does not serve their vital interests and replace it with learned appropriate behaviour. The therapist using ‘The Skilled Helper’ model is able to facilitate the client’s understanding of what is going on for them right now, what they would like to be happening and to assist them in developing strategies, achievable goals and an action plan to get them there.

Both cognitive and humanistic therapists are in agreement that the counsellor needs first to establish the core conditions of empathy, congruence and unconditional positive regard with their client. During the first stage of the cognitive approach when the client is telling their story as in person centred therapy active listening skills are used. The cognitive therapist will also add challenging the client’s perception of their present situation, which is directly in opposition to the total acceptance of the clients frame of reference proffered by the humanistic therapist.

Who has the answer to the client’s problem? The humanistic therapist places their trust in the client, and their innate ability to resolve their own issues and reach their full potential. The counsellor listens to the client clarifying even those issues which may be just below the client’s level of awareness. “Listening of this very special active kind is one of the most potent forces for change that I know” (Rogers2008p. 136). Cognitive therapy sees people as needing direction and guidance to resolve their problems.

This therapeutic approach has a rather pessimistic view of people seeing them as innately sinful, destructive, and lazy or a combination of all three; the client being unable to be trusted without assistance to ‘find their own way’. A structured disciplined approach is used in cognitive therapy the value of the therapy is considered to be dependent upon the achievement of set goals and actions by the client. The desired end result Page five is discussed and set with the client very early on in the therapy.

The counsellor has in mind at the outset how the therapy will progress, and what needs to be accomplished as the client is encouraged to move from stage one through to stage three. In humanistic therapy the client chooses what will be brought to each session not the counsellor. There is no structured problem solving or set goal, and the right time to end therapy is ideally decided by the client. The client’s autonomy is highly valued. Rogers speaks of a ‘directional flow’ moving the client towards growth, healing and the self-actualisation considered by Maslow to be the pinnacle of achievement that all human beings are striving for.

For either therapy to work Egan and Rogers both agree that there has to be a willingness by the client to engage in the therapy. They put forward slightly different reasons for resistance in some clients. Rogers (2008 p. 213) feels that “resistance to the therapist is entirely due to too much probing or too rapid interpretation on the part of the counsellor”. Egan(1990 p. 169) puts forward the idea that resistance refers to “ the reaction of clients who in some way feel coerced”. Both therapeutic approaches stress, that for therapy to be effective the inevitable power differential between client and counsellor needs to be minimised.

Also individuality including aspects of the client’s culture religion and gender should be valued and respected by the therapist. I can foresee potential difficulties for myself as a newly qualified therapist in using the two approaches together effectively as I may lack the expertise to know when to use each model and with which client. As I gain in experience and self-awareness I anticipate making effective use of both therapeutic models within my practise. My training uses an integrative approach and I plan to use a variety of different therapies in my future work.

I was fortunate to see cognitive and humanistic approaches well modelled by my Page six personal therapist over the eighteen months of our work together. When I entered personal therapy all of the structure in my life had vanished. My defence mechanisms spoken of by Rogers had been breached. I had little self-worth and low self-esteem blaming myself for remaining in a physically and emotionally abusive relationship for thirty four years. In April 2008 as I sat for the first time opposite a counsellor I was vulnerable, frightened and suicidal.

I am sure for several months I would have been incapable of rising to the challenge of a cognitive approach. I did not at that time have the mental and emotional capacity to set goals or the motivation to see them through. Using a rather gentler person centred approach the therapeutic conditions of empathy, congruence and unconditional positive regard were established as we worked through various issues and emotions. About half way through my therapy we came to a ‘sticking point’. I had developed an eating disorder and the humanistic model didn’t seem to be helping me.

My counsellor opted for a cognitive approach at this stage and asked me to keep a food diary. Together we set goals; the desired outcome was for me to eat healthy food three times a day. At this point I was ready for a challenge. In achieving these goals my self-esteem was boosted. Egan 1990 p. 37 states “Ideally, clients by their actions come to “own” the helping process instead of being the objects of it”. This is exactly what happened to me; as from then on I took a more active part in my own therapy.

The positive regard shown by my therapist at all times empowered me to ‘own my healing process’. For me the integration of the two different approaches gave the best therapeutic outcome. Had my therapist initially used only a cognitive approach I am sure I would have felt overwhelmed. My life had recently involved massive changes I did not feel capable at that time of working towards further change. It would have appeared too intrusive and directive. I would have been resistant to Page seven the therapy and stopped attending, possibly prejudicing future therapy.

Later cognitive therapy was used very effectively when I reached a ‘sticking point’. People are unique bringing their own values and beliefs to therapy. These may be shaped by culture, religion, gender, class or ethnic origin. Any or all of these will have an impact on the counselling relationship, and which therapeutic approach might be most effective in helping a particular client. Native Americans tend to resent being coerced and motivated into doing things, they prefer to work things out for themselves; a counsellor therefore may find a humanistic approach suits this client.

In contrast “A characteristic of certain ethnic minority groups is the desire for a structured relationship in which the counsellor is cast as an expert giving advice and solutions to problems, a therapist who is active, authoritative and directive” (Patterson C. H. ). This client may not be able to engage with person centred therapy but benefit from the more directive cognitive approach. Care must be taken however not to stereotype a particular client group In conclusion I have looked at both humanistic and cognitive therapies, their similarities and differences.

Having myself experienced both therapies effectiveness in the healing process, I can see how they could be used at different times with the same client. However, therapy needs to be uniquely tailored to the individual clients needs with particular reference to the diversity of culture, religion, ethnicity and values found within all humanity.

References

1. Egan, G. ed. (1990) The Skilled Helper. Loyola University of Chicago, Brooks/Cole. Publishing company Pacific Grove California.
2. Embleton, L. et al. (2004) The Person Centred Approach.A contemporary introduction.
3. U. K. Palgrave Macmillan. Mc Leod, J. ed. (2008) Behavioural methods in counselling. IN: Mc Leod, J.
4. An introduction to Counselling. Finland. W. S. Bookwell. Patterson, C. H. Multicultural Counselling: From diversity to Universality. Available at. [Accessed 10 December 2010].
5. Rogers, C. ed. (2008). The therapeutic relationship. IN Kirshenbaum, H. Land Henderson, V. The Carl Rogers Reader. Great Britain. Constable.
6. Rogers, C. ed. (2008). Theory and research. IN: Kirsenbaum,H. Land Henderson, V. The Carl Rogers Reader. Great Britain.