Problem:Cognitive therapy or Cognitive Behavior Therapy has taken on the reputation as being manualized, sterile, mechanical, inflexible, etc. This may be due in part to the methods that are utilized to train therapists in this modality, namely through manuals /protocols for academic research. While randomized controlled trials should certainly be given appropriate credit for validating the theory and therapy, there is room however for a broader, humanistic approach to treating individuals with CBT. Below I have defined the two approaches of learning and disseminating CBT in greater detail and finally composed a hypothesis regarding the relationship between the two contrasting models.
I.The Empirical Model
a.The various procedures and components in this model are stringently operationalized. No deviation from the protocol is permissible. Clinical trials of a particular therapy require a high level of precision in the delivery of the treatment because of the need for high reliability among participating therapists and a high level of reproducibility for validating studies.
b.The focus, therefore, is on the research design. The actual material is extracted from the individual (patient, consumer, or person) and molded into quantitative form. The language is technical and totally understandable by the scientist. However, the same level of understanding may not be gained by the individual being treated.
c.The result of this is that the format of the treatment manual tends to be relatively inflexible, describing the interventions in a prescribed fashion and the application of these techniques in a predetermined sequence.
d.The therapist takes on to a degree, the role of the experimenter and thus less attention is paid to the elaboration of therapists’ behaviors such as understanding empathy and warmth (which are actually therapeutic modalities in themselves).
e.Since the term cognitive behavioral therapy implies the use of cognitive behavioral interventions, the therapist and the therapeutic manual are less likely to pay attention to the individuals’ emotions.
f.The research designed therapeutic manual is often more popular and more easily mastered than the books which are on the one hand more complicated and on the other hand, considerably more flexible.
g.In practice, cognitive behavioral therapy is based on the cognitive conceptualization of the case from which the therapeutic interventions are derived and subsequently applied.
II.The Therapeutic Model
a.This model is focused on the individual (patient, consumer, etc.).
b.The therapist will typically use language of the individual which may be imprecise or even vague but does carry a meaning to the patient. The individual uses words like upset, stressed out, proud of self, etc. While these words are vague and imprecise, the therapist has the client’s idea of the meaning and so can communicate successfully with the individual.
General Hypothesis:The empirical model contaminates the therapeutic model.
Recommendations:I believe that individuals practicing CBT need to be evaluated not according to the prescribed format of the treatment manual but in terms of general principles that are found in various books on the subject. A much greater emphasis needs to be placed on the cognitive theory and formulation of the cases which depends on understandings derived from the volumes and less on achieving a high degree of reliability in the delivery of the therapy via a manualized protocol.
The following procedure should thus be followed:
1.Obtain relevant data from patient
2.Organize data according to the therapeutic model
3.Develop and Apply strategies according to the formulation and intrinsic characteristics of the individual
Suggested Books (abbreviated list):
Cognitive Therapy of Depression-Aaron T. Beck, M.D.
Cognitive Therapy of Anxiety Disorders: Science and Practice-David A. Clark & Aaron T. Beck, M.D.
Cognitive Behavior Therapy: Second Edition: Basics and Beyond-Judith S. Beck
CBT Made Simple-Seth Gillihan
Mind over Mood-Christine Padesky