Key Features Of Behavioural Approach

In the first century AD, the Stoic philosopher Epictetus observed that people are not disturbed by the events that happen, more so by the view that they take of them (Woolfe and Dryden, 1996). The view a person takes of an event depends on their chosen orientation, and their orientation is influenced by their beliefs about their self in relation to the world (Woolfe and Dryden, 1996). This is the theoretical origin of contemporary Cognitive Behavioural Therapy, one of the major orientations of psychotherapy deriving from cognitive and behavioural psychological models of human behaviour (Grazebrook and Garland, 2005).

The earlier of the two approaches was behaviourism, created by JB Watson in 1919 when academic psychology was in its infancy. Watson believed psychology need only concern itself with overtly observable phenomena, not invisible thoughts and images (McLeod, 2003). One of the primary theories pioneered by behaviourists such as Skinner, Watson, Pavlov, Tolman and Thorndike was that all behaviour and beliefs must be learned, and controlled laboratory experiments proceeded to discover how they were learned (McLeod, 2003).

Pavlov’s (1927) Classical Conditioning model and Skinner’s (1938) Operant model of learning (Gross, 2005) were the first attempts made to turn behaviourism into therapy and provided the rationale for the Systematic Desensitisation Technique (McLeod, 2003) devised by Wolpe in 1958 (Gross, 2005). However, Tolman (1948) ran a series of experiments with laboratory rats and a maze, which led him to believe they had created a ‘mental map’ of the maze introducing the study of internal mental events (or cognitions) to behaviourism (Gross, 2005).

This new interest in cognition eventually led to ‘the cognitive revolution’ and the limitations of the stimulus response analysis of human behaviour had in effect been reversed as the fixation of the introspectionists with inner, mental events or cognitions returned to govern psychology once again.

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This time however, allied to more sophisticated research methods than naive introspection (McLeod, 2003). During the 1960s and 1970s, two pioneering psychologists of psychoanalytic background, Ellis and Beck (respectively) became increasingly aware of the importance in the way the clients though about themselves.

Ellis had evolved a more active style of therapy than the associated Cognitive therapy, which over time was renamed several times, but most recently known as Rational Emotive Behaviour Therapy (REBT). High levels of challenge and confrontation during therapy enabled the client to scrutinise their ‘irrational beliefs’ or ‘crooked thinking’, which Ellis believed stemmed from seeing life in terms of ‘must’s or ‘should’s which he claimed were invariably exaggerated or overstated and the cause of most emotional problems (McLeod, 2003).

Ellis’s (1962) ABC model of human disturbance has made a great impact on the progress and current popularity of cognitive-behaviour therapy (De Bernardi and Wirga, date not known). The A stands for the Actualising event. C stands for the emotional or behavioural consequence and between A and C comes B, the beliefs about the event. Events and the emotional consequences are determined by the belief about the event rather than the actual event (McLeod, 2003).

Beck (1976) in his story of his conversion to cognitive therapy explained how after years of working in the psychoanalytic tradition, he was struck by the impact of the patient’s cognition on his feelings and behaviour. His theory postulates that incorrect habits of interpreting and processing date are learned during cognitive development. The basic concepts of cognitive therapy are fundamentals of contemporary CBT. The first of these concepts is that of schemas, cognitive structures of people’s fundamental beliefs and assumptions which can be adaptive of maladaptive (Nelson-Jones, 2006).

Second are Modes, networks of cognition that interpret and adapt to ongoing situations (Beck and Weishaar, 2005). Another is that of cognitive vulnerability, human’s cognitive frailty unique to each individual and based upon their schemas (Nelson-Jones, 2006). Dysfunctional beliefs embedded in to schemas contribute to another basic concept called cognitive distortion (Nelson-Jones, 2006). Beck’s Cognitive Distortion Model (1976) is the best known model of cognitive processing used by cognitive behavioural therapists.

Perceptions of events become highly selective, egocentric and rigid when they perceive a situation as threatening causing impairment to the function of normal cognitive processing (McLeod, 2003).Beck (1976) identified many different kinds of cognitive distortion including; arbitrary inference, selective abstraction, overgeneralisation, magnification, minimisation and personalisation (McLeod, 2003). Beck described self critical cognitions as automatic thoughts, one of the keys to successful therapy.

Automatic thoughts reflect schema content, deeper beliefs and assumptions which are less accessible to awareness (Nelson-Jones, 2006). Acquisition of schemas, automatic thoughts and cognitive distortions and the associated vulnerability to psychological distress, is the result of many factors such as; evolutionary, biological developmental and environmental. Many of these are common across individuals, however, each person has their own unique variations (Nelson-Jones, 2006).

The therapeutic goals of cognitive therapy are to re-energise the reality testing system (Nelson-Jones, 2006). Also, to teach the client adaptive meta-cognition, which is the ability to change oneself and environment in order achieve therapeutic change (McLeod, 2003). This concept is central to the work of Ellis and Beck and has been widely researched in developmental psychology. Another therapeutic goal in cognitive psychology is to enable the client to become their own therapist, by providing skills for problem solving for example.

Ellis (1962) and Beck (1976) led the way for many other clinicians and writers within the cognitive behavioural paradigm to further develop this (historically, most recent) approach to counselling with yearly contributions of new ideas and techniques being added (Dryden and Golden, 1986: Dryden and Trower, 1988; Dobson, 1988, Freeman et al, 1989). The term Cognitive Behavioural Therapy (CBT) is now used to refer to behaviour therapy, cognitive therapy and to any therapy based upon the pragmatic amalgamation of the ideology of both cognitive and behavioural theories (Grazebrook and Garland, 2005).

There are many facets to contemporary CBT as a result of the previously mentioned mass of regular contributions of new ideas and theories. There are however some key features comprehensively laid out by Grazebook and Garland (2005) as follows. CBT is based on scientific principles which research has proven effective for a wide variety of psychological disorders. A therapeutic alliance is formed between the client and counsellor to gain a shared view of problems in relation to the client’s thoughts, feelings and behaviour, usually in relation to the here and now.

This usually leads to the agreement of personalised and time limited therapy goals and strategies which the counsellor will continually monitor and evaluate with the client. The outcome of therapy is to focus on specific psychological and practical skills, through reflection and exploration of the meaning attributed to events and situations, and the re-evaluation of those meanings. The treatments are intrinsically empowering, aimed at enabling the client to tackle their problems by employing their own resources.

Acquiring and using such skills is seen as the main target, the active component being promotion of change, in particular using ‘homework’ to put what has been learned into practice between sessions. The client will hopefully accredit the improvement in their problems to their own efforts, with their alliance with the counsellor (Grazebook and Garland, 2005). One of the main differences between CBT and person centred therapy (PCT) is the therapeutic relationship between counsellor and client, which in cognitive behavioural therapy is characterised more as a psycho-educational rather than a medical one (McLeod, 2003).

Less attention is paid to the quality of the relationship than to the technical aspects of the therapy although it is not believed to be unimportant. In CBT its is taken for granted that the relationship is necessary, Beck et al (1979) did stress the importance of warmth, accurate empathy and genuineness, but it is not believed to be sufficient to provide therapeutic change (Woolfe and Dryden, 1996) as professed by Rogers (1957) in his proposal of the six necessary and sufficient conditions for therapeutic change.

In CBT there is a Therapist Client Rating Scale (Bennun et al, 1986) where the client can rate the therapist on three factors, positive regard/interest, activity/guidance, and competency/interest. The positive regard is one of Carl Rogers’ conditions, however, Rogers believed that the client’s self-concept was affected by a lack of unconditional acceptance in life.

The crucial aspect of UPR in person centred therapy is that the client more explore and express freely, without feeling they must do anything in particular to meet any specific standards of behaviour to ‘earn’ positive regard from the therapist (Mulhauser, 2007), however, CBT is less concerned with insight and relinquishes the endless search for past hurts and teaches the client how to prevent negative thoughts from creeping into their minds (Langerth, 2007) through set tasks, agendas, and homework assignments (Nelson-Jones, 2006),

Another difference between the two approaches is the lesser appreciation of the impact that the counsellor’s ‘self’ has on therapy, and cognitive behavioural therapists are not expected to undergo personal therapy, even though the approach allows confrontation and challenging of the client (McLeod. 2006).

The basic tenet of the CBT approach is to change the client’s thinking which results in a change of behaviour and feelings, when this is directed by the therapist rather than self-directed (as in PCT) there are recurring themes in CBT of management, control and monitoring, particularly from the behavioural origins emphasising operant and classic conditioning (McLeod. 2006). An important task for early behaviourists was to discover how behaviour is learned. McLeod (2005) suggests that this might be due to the coinciding growth of the American advertising industry and the consequent need to control and manipulate consumer behaviour.

Interestingly, Watson himself left his academic life to become an advertising executive (McLeod, 2003). In contrast, person centred therapy notes from the outset that the client is their own best authority the focus of PCT is always on the client’s own feelings and thoughts, as opposed to judgement by the counsellor through diagnosis or categorisation (Mulhauser, 2007) such as Person’s (1993) conceptualisation involves the counsellor devising a mini-theory of the client’s problems (McLeod,2003).

PCT typically does not give advice or interpretations as Rogers believed that people are trustworthy with a great potential for self awareness and self-directed growth (Cooper, 2007). Ellis (1973) actually claimed that there were virtually no legitimate reasons for a client to be upset, emotionally disturbed or hysterical, regardless of any psychological or verbal stimuli impinged on them.

The implications for the therapeutic relationship when the counsellor believes the client is irrational might be considered concerning, by person centred counsellors or theorists who encourage clients to encounter themselves and become more intimate with their own thoughts, feelings and meanings (Mulhauser, 2007). Person centred counsellors aim to help the client develop a framework for understanding life, rather than aiming to ‘fix people’ like Ellis implies (McLeod, 2006).

The efficacy of CBT is a further contrasting aspect, as the approach prides itself on how its effectiveness is amply confirmed in research literature (McLeod, 2006). The philosophy of the ‘Scientist-Practitioner’ model (Barlow et al, 1984) stresses therapists should integrate ideas of science with their practice, which through a wide array of techniques will provide counsellors with a rewarding sense of competence and potency (McLeod, 2003).

CBT maintains a healthy respect for the value of research as means of improving practice, enabling practitioners to be critical and questioning, learning constructively from their colleagues (Woolfe and Dryden, 1996). Person centred therapy however has a developed a reputation for being research aversive and counsellors steer from using evaluation tools on their clients or categorising them by predefined diagnostic measures.

The NICE guidelines for mental health and behavioural conditions also indicate little evidence of controlled research on person centred therapy (Cooper, 2007). Cognitive behavioural therapy is brief and time limited, structured and directive in form, whereas person centred therapy is long term, non-directive and the client is the ‘expert’. CBT is problem/solution orientation and based on an educational model where homework is the central feature. PCT could be considered simply problem focused, based on feelings and emotions rather than thoughts and behaviour.

A sound therapeutic method is necessary but not entirely sufficient in CBT, in contrast to Rogers’ claim of the relationship and unconditional positive regard being sufficient to provide therapeutic change. The Socratic method of questioning is a key feature of both CBT and PCT, using guided questioning to promote a change in self perception in order to achieve what is after all the main aim of both approaches – to make the client’s life happier and more satisfying.