What is Cognitive Behavioral Therapy (CBT)?
[Image Description: "It is okay to ask for help" in enlarged left-aligned bold black text overlapping a green background with several light blue teardrops. The image also has my First Former Buddy Club President logo in the top right corner.]
Cognitive Behavioral Therapy (CBT) also known as mental health counseling is an evidenced-based therapy used to help people with their social-emotional needs. This type of therapy is classified under psychotherapy services. There is strong controversy about the sensitive of this terminology among mental health advocates since "psycho" is offensive to many individuals. Many people think that the terminology should be referred to as "(mental health) counseling", "talk therapy", or "psychological therapy services." It is common for people who struggle with social-emotional skills as part of their disabilities to receive CBT services; however, people of all abilities can attend and benefit from CBT services too. People with mental health conditions such as but not limited to Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder, Generalized Anxiety Disorder (GAD), or Post-Traumatic Stress Disorder (PTSD) or who are struggling with trauma or challenging behaviors are common populations in the mental health community that receive CBT services. There is also a high population of individuals in the LGBTQ+ community who receive CBT services. This is because LGBTQ+ youth tend to be "at high risk for compromised mental health" due to lack of "societal acceptance" (Russell & Fish 2016).
Therapists and clients work together on how the client can manage their emotions in the aftermath of trauma and grief/loss and when it comes to anxiety, depression, self-esteem issues, stress/anger management, crisis management, challenging behaviors, difficulties with adjustment or transitions, relational conflicts, and drug and alcohol addiction. CBTs can also provide life coaching and marriage and family counseling to clients and help to teenagers and young adults during transitional periods of development. Feelings are acknowledged and how to differentiate between thoughts, feelings, and behaviors are addressed as well. To elaborate more, it is common for people of all abilities to struggle with the concept of "All or Nothing Thinking" (also known as "Black and White Thinking"). When people struggle with All or Nothing Thinking, they struggle with differentiating certain things, especially "can" versus "can't." For example, if they struggle with making friends or mathematics, they may think that they "can't make friends", "can't do math", or "will never be good enough." As a result, therapists can help these clients to develop a growth mindset and improve their self-regulation skills.
Related Links:
One of the main purposes of CBT is to challenge those negative automatic thoughts that everyone experiences. The training that comes with socratic questioning is to re-train the brain, which eventually shifts the behavior. A further example may be that a client has major anxiety about social settings. As a result, they may be nervous to walk into their school cafeteria with all of their peers. The therapist may ask their client, "What is the worst that could happen?". The client may reply, "Oh, I don't know. I drop my tray and spill everything all over myself. Then, everyone will laugh at me and hate me." Then, the therapist can re-train their client's brain by asking them, "What is the likelihood that that is actually going to happen? How many times have you dropped your tray so far this year?". When the client replies, "None", the therapist may help them to determine the chances of this happening. So, CBTs help their clients to re-train their thought process. Those underlying thoughts that everyone has are what cause their behaviors.
Qualifications and Credentials:
CBTs tend to be very knowledgeable, highly educated people and there are a wide range of qualifications that CBTs need in order to work their jobs. Many CBTs have Licensed Professional Counselors (LPC) and/or Licensed Marriage and Family Therapist (LMFT) certifications and their Bachelor's Degree in Psychology. It is common for many CBTs to double as Licensed Clinical Social Workers (LCSW) and have their Master's Degree in Social Work and Bachelor's/Master's Degrees in Education. Some CBTs are also licensed to provide psychological evaluations and can be qualified to work as school counselors and Emotional/Behavior Support teachers.
How CBTs Can Provide Support:
True CBTs are passionate about supporting the mental health community as a whole. CBT services can be provided to clients as young as two years old and up. The job responsibilities of CBTs include setting up treatment plans for their clients to address their social-emotional needs and teaching self-regulation and self-advocacy skills to clients. The CBT must get to know their clients and what their social-emotional needs are in order to address them. In order to gain an understanding of their social-emotional needs, the CBT should speak to the client, their parents/guardians, and the team around them because there can be other team members as well. When CBT services are provided to adult clients, the adult client may want a family member(s) or other trusted loved one present in their therapy sessions for additional support as long as their individual legal permission is provided.
CBTs also provide psychoeducation to the clients and the other team members to educate them about mental health and what is causing the client to struggle with certain social-emotional skills. For example, if a child with autism is struggling with challenging behaviors, this may be due to their struggles with communication skills. Psychoeducation can be a game changer in improving the developmental skills of people of all abilities and problem-solving their struggles.
Examples of Common Resources Used by CBTs:
- CBT-based curriculum used by CBTs, school counselors, and Emotional Support teachers
- Lawrence Shapiro (notable child psychologist and parenting expert)
- Trauma-informed care and education resources provided by Dr. Bruce Perry who is a notable trauma-informed psychiatrist - www.bdperry.com
- Trauma-informed care and education is highly emphasized by CBTs and these practices are not used in educational and mental health intervention settings enough. Social-Emotional Learning (SEL) as a whole is very important. It is important for mental health professionals to provide trauma-informed practices to all clients at all times without assuming whether their client has experienced trauma or not. All because a client and/or their family has not stated that they have experienced trauma does not mean that they definitely have not experienced trauma. They could be too afraid to open about it or even be struggling with trauma responses and not know that their struggles are as a result of trauma.
- Daniel Goleman (psychologist, science journalist, and author) - www.danielgoleman.info
How Creating Intervention Plans in CBT Works:
To create intervention plans, therapists use the Anecdotal, Behavior, Consequence (ABC) method and conduct observations of clients. Communication between the therapist and all of the team members occurs and they work as a team to create a plan for positive consequences as a result of improved behaviors and to prevent anecdotes.
Progress Monitoring Conducted by CBT:
CBTs create Behavior Intervention Plans (BIP), which are developed with individual goals. The goals are individually planned because every person has their different needs even if they have the same mental health condition or other similar needs because everyone experiences social-emotional struggles differently. There is a step-by-step process that is worked on to achieve these goals. Behavior charts for self-monitoring are typically used by clients who are young children. Clients may meet with their therapists at different frequencies depending on the intensity of their needs. For example, some clients may meet with their therapists one time per week. Then, eventually, their appointments may change to being scheduled every other week, and then, this may possibly change to one time per month as time goes on depending on how much that they have improved. Reflections about their success and what caused them to struggle to meet their goals will occur. CBTs also use data to determine the progress of the clients. Progress monitoring is conducted on a daily basis by CBTs since changes in the development of clients are constantly occurring.
Collaboration Between CBTs/School Counselors and General Education Teachers:
Typically, CBTs work in practices outside of school settings and school settings have school counselors and sometimes even Emotional/Behavior Support teachers, which have similar job responsibilities of CBTs. Emotional/Behavior Support classroom settings are for students with disabilities that cause them to struggle with their social-emotional skills so much that they need Tier 3 level support to address their social-emotional needs when it comes to succeeding in their education. Students who are placed in Emotional/Behavior Support classrooms may be placed in additional Special Educational placement settings depending on their eligibility. I have observed that Learning Support classrooms are a common additional educational placement that they may be placed in. In school settings, the school counselors will partake in frequent meetings with General Education (GE) teachers, Emotional/Behavior Support teachers, and additional support team members. School counselors, GE teachers, and Emotional/Behavior Support teachers share their observations of students with each other and discuss their findings and what methods that they have discovered successfully help their students.
Referrals for CBT/School Counseling:
Clients are typically referred for CBT or school counseling through the Individualized Education Program (IEP) process. In addition, since CBT is a related service that is usually provided outside of school settings, families and even the individual child may just decide on their own that the child could benefit from CBT for additional help outside of school. This is what usually occurs for almost all adult clients as well.
Challenges in the CBT Field:
There are numerous challenges that CBTs face. Social-emotional needs are not always being addressed for many reasons. Clients may be receptive to trying, but due to the severity of their struggles, it may be hard to determine what techniques work for certain individual clients. This is also because every individual person has different needs and certain things that work for some people may not work for other people and certain things that do not work for some people may work for other people. There are also many clients who are not receptive to constructive criticism and therapists often experience difficulty with being on the same page as clients and their families. There may be so-called "involved" families who lack cooperation as well. For example, the therapist may recommend to the family of a client on the autism spectrum that they could benefit from being given space when they are experiencing outbursts until they are calm to speak to each other again. However, the family may not follow through with utilizing this technique by impatiently demanding that their (adult) child speaks to them on their terms instead.
Behaviors can jeopardize the health and safety of everyone involved on the team and even individuals outside of the team. For example, when clients behave violently, they could intentionally or accidentally hurt themselves or other people or become traumatized by incidents. Unfortunately, it is common for therapists to receive lack of cooperation from families and for school counselors and teachers to receive lack of help from school administrators when it comes to meeting the needs of students who exhibit these extreme behaviors. Lack of contingencies as consequences for their behaviors can result in further negative incidents or even tragedies.
Advice for CBTs:
It is important for therapists to avoid assumptions about behaviors. As the saying goes, "Everyone is going through a rough battle that no one knows anything about. So always be kind." Mental health struggles are not always visible or opened up about. A person may be smiling or look fine while in reality, they may be very depressed or traumatized by something on the inside and internalizing their emotions. When people internalize their emotions, they are not telling people what is on their minds, and this may be due to fear of judgment, invalidation, or lack of help.
Therapists should also be open-minded about the fact that negative behaviors are not just laziness, being oppositional, defiance, or caused by disabilities and to avoid jumping to conclusions about the functions of behaviors, which are the causes of behaviors. When individuals exhibit certain negative behaviors, it is a sign that they could be upset about something and/or an atypical way of communicating a need. While these things can be true about behaviors in some cases, it is important for teachers to conduct investigations to determine the deeper reason as to why the behavior is occurring, such as why they are not cooperating with authority figures or avoiding completing their schoolwork. Instead of saying that a person is "lazy" as a result of procrastination, it is highly recommended by therapists to say that the individual is "motivated to do something else." Instead of saying that an individual is "clingy," it is highly recommended by therapists to say "attention-seeking" or "connection-seeking." As a result of these behaviors, it is important for all team members to find a way to serve the function or purpose of the behavior and this can help to improve the overall environment.
It is also important to avoid armchair diagnosing people when it comes to their behaviors. In addition, in the event that people do jump to conclusions, it is important to take into consideration that not everyone who jumps to conclusions does it because they are biased or have malicious intentions; sometimes it is because they care and are trying to help people. However, it is still important to avoid making assumptions. Instead of making assumptions, I make theories because I may not be qualified to identify what is definitely occurring, but I think of the possibility that maybe the person is experiencing a difficult home life, has a diagnosis that affects their mental health and they may need further testing and extra support, or the person could be exhibiting certain atypical behaviors because they could be upset about something.
To reiterate, behaviors communicate social-emotional struggles. For example, clients or students may be having a bad day or experiencing a rough period in their lifetime, upset about something, or going through something at home. While these things do not excuse these behaviors, they may explain the behaviors and it is important to know the reasons for all behaviors for health and safety purposes in order to determine if a client needs any type of extra support. No one ever knows the full story about what anyone is going through even when certain details are disclosed to them.
How the COVID-19 Pandemic Impacted CBT:
During the COVID-19 pandemic, it was difficult for therapists to provide services to clients who are young children. This is because young children tend to be visual, hands-on learners and it can be hard to find ways to provide visual, hands-on learning experiences on Zoom and other video chatting platforms. The availability of these visual, hands-on learning experiences was also very limited because therapists can only do so much. In addition, there was lack of spaces in homes for some clients to speak confidentially during appointments.
Positive Experiences That Come Out of Working in CBT:
While there are challenges that come with working in every career field, there are also many positive parts. Many therapists enjoy working as a team with all of the team members because positive relationships can be built between the therapist, clients, and families. There are also people who are receptive to feedback and constructive criticism. In addition, many therapists find it rewarding to watch clients experience self-growth as they improve their social-emotional skills.
From my perspective, I think that CBT is something that everyone should be knowledgeable about just because this intervention is good to know about. This is especially true for all teachers, interventionists, families, and people in diverse communities. There are certain aspects of CBT that teachers, interventionists, families, and people of all differences can include in their day-to-day lives.
You might also like and gain a better understanding of interventions for the mental health community by reading:
If you are affected by mental health struggles, remember that you are not alone and there is hope. If you or someone you know needs support right now, call the National Suicide Prevention Lifeline at 988 or text "HOME" to the Crisis Text Line at 741741 or text "CONNECT" to the Crisis Text Line at 686868 if you live in Canada.
You can also visit The Mighty's suicide prevention resources page by clicking on this link: https://themighty.com/suicide-prevention-resources/
Did you enjoy and find this post helpful? If you want to see more content like this and my other content about teaching and advocating for the disability community, please follow me on Instagram and like my Facebook page if you have not already by clicking on the hyperlinks below:
Instagram: @firstformerbuddyclubpresident
Facebook: First Former Buddy Club President
Give feedback! Questions? Compliments? Suggestions? Let me know in the comments section below and/or email me at ehoffbuddyclub@gmail.com !
If you repost to your own page or story, please tag me in the caption and the post and keep my logo visible. Thank you💕
Citations
1. Goleman, D. (2021). https://www.danielgoleman.info
2. Kennedy & Shapiro. (2011). Lawrence Shapiro. https://en.wikipedia.org/wiki/Lawrence_Shapiro
3. Russell ST, Fish JN. Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth. Annu Rev Clin Psychol. 2016;12:465-87. doi: 10.1146/annurev-clinpsy-021815-093153. Epub 2016 Jan 14. PMID: 26772206; PMCID: PMC4887282. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887282/
4. Perry, B. D. (2023). https://www.bdperry.com
Comments
Post a Comment