Cognitive Behavioural Therapy: a good therapy with a bad name

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1 Cognitive Behavioural Therapy: a good therapy with a bad name Item type Authors Publisher Conference Presentation Health Service Executive (HSE); MacLiam, Fionnula Health Service Executive (HSE) Downloaded 15-Jun :30:17 Link to item Find this and similar works at -

2 Cognitive Behavioural Therapy: a good therapy with a bad name Fionnula MacLiam Advanced Nurse Practitioner/CBT Dublin South East/Wicklow Mental Health Services HSE Critical Perspectives in Mental Health Conference University College Cork, 11 &12 November 2015

3 Behaviour Therapy Based on Learning Theories (psychology) Evidence-based: effective Uses positive reinforcement to aid change Had a useful underpinning model (Lange s three part model) that was easily grasped Clients understood the therapy Motivation was the therapists problem, not the clients.

4 Stimulus or Consequence (internal or external) Response Action Non-action Organism: Reflexes Emotions Cognitions Behaviour

5 Functional Analysis This is the core of behaviour therapy: why has this person developed this problem at this time and what keeps it going? Predisposing factors Precipitating factors Maintaining factors Secondary gains And why isn t it worse than it is? Protective factors

6 Behaviour Therapy was successful: Phobias Obsessive Compulsive Disorder Insomnia Skills Training (social skills, assertiveness etc) Relaxation training Family, couples, child rearing.

7 However There was an upswing in the interest in, and involvement with, humanistic therapies. These placed the therapist/client relationship at the centre, and aimed to provide an atmosphere where the client felt able to develop herself to her full potential. Also, it didn t require a mental health qualification first. Courses burgeoned.

8 Early 1990s Counselling was becoming popular Behaviour therapy was seen as: Mechanistic Simplistic Only tackling the symptoms, not the roots of the problem Ignoring the wishes of the client Ignoring the therapeutic relationship Not looking at the whole person, only the problem Regarding the client as passive or conditioned Manipulative Punishing

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10 Are you afraid of Heights? Spiders? Dogs? Mice? Thunder? Food? Clowns? Lifts?

11 But then..

12 Then came Cognitive Therapy Aaron Beck & Albert Ellis

13 The overlap means BT & CT fit together well Behaviour Therapists: Behaviour is shaped through reinforcement Learning is sequential and hierarchical Easily measured Aim to improve the learning process. Previous knowledge determines what is taught. Cognitive Therapies: learning is an internal process Learning is a process of changing existing knowledge Socratic questioning enables learning

14 Genetics Personality Experiences Upbringing Environment Me: My beliefs, reactions, sensitivities How I behave in the world

15 Cognitive Therapy The rise in its importance reflects the rise in popularity of therapy generally. Culturally, the notion of 'getting on with it or offering it up has declined People seem to understand CT. It makes sense It is a solution-focused, short-term therapy The efficacy of CT can be empirically measured It garnered much positive media Palatable AND effective!

16 But

17 Everyone s a CBT therapist now!

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19 Well, it s no wonder The Human Cannonball Career Trajectory Theory

20 Therapists who are well trained Fewer Clients drop out of treatment Clients report greater improvement of symptoms Clients report better satisfaction with the therapy Carr, 2007, Clearly, therapist training is an important factor contributing to the outcome of therapy % of effects of therapy is due to therapist factors, with 15% of that due to therapist training. Stein and Lambert (1995); Alan Carr, 2007

21 Roth & Fonagy: What Works for Whom 1997

22 CBT Outcomes in Routine Care

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25 CBT is not a panacea! CBT won t help everyone CBT can t help everyone We re trying to find out what kind of CBT is useful for whom and for what problems. We know that no amount of CBT will help unless the client is engaged, willing to give it a good go, and has a good relationship with the therapist. Preferably well-trained, reflective, good supervision, has kept up with the field with regular CPD, and also has lots of experience.

26 References What Happened to Behaviorism, Henry L. Roediger, III Observer Vol.17, No.3 March, egorized/what-happened-to-behaviorism.html Fonagy, P., Target, M., Cottrell, D., et al (2002) What Works for Whom: A Critical Review of Treatments for Children and Adolescents. New York: Guilford. Alan Carr, 2007, The Effectiveness of Psychotherapy. A Review of Research, Irish Council for Psychotherapy Hunsley, Elliott, Thierrien, 2013, The Efficacy and Effectiveness of Psychological Treatments, Canadian Psychological Association

27 05/behaviorism-and-humanismcomparison.html American Psychological Association. (2012, August 9). Resolution on the recognition of psychotherapy effectiveness. American Psychological Association. 2/08/resolution-psychotherapy.aspx