Cognitive and cognitive behavioural psychotherapies are assumptions which hold that how a person perceives and processes his experiences in life determines how he feels and behaves. The author will firstly present the history, development and principles of cognitive therapy and the contributions of influential figures such as Alfred Adler, George Kelly, Aaron Beck and Albert Ellis will be assessed. The potential of this active and time limited therapy to enable the client to become his own therapist will be explored. Generalised anxiety with or without panic disorder, mono-symptomatic phobias and agoraphobia will be defined, examined and their effects analysed.
The effectiveness of hypnotherapy in bringing to awareness the client’s negative automatic thoughts and visual images will be explained as will the subsequent restructuring and replacement with realistic ones. The author will provide a relevant case history to show the efficacy. A discussion will then follow leading to an evaluative comparison of Cognitive, Psychodynamic and Behavioural therapies, and their appropriate uses to differing clients.
The conclusion of the author is that cognitive behavioural therapy/psychotherapy is in itself a very powerful medium for helping the client to overcome his difficulties and if correctly and appropriately applied can enable the client to become his own therapist thus taking the solution with him wherever he goes.
Chapter 1 – An historical perspective
In the first and second centuries A.D. the slave Epictetus is quoted as saying “men are disturbed not by things, but by the views they take of them.” In the eighteenth century the philosopher Emmanuel Kant said that we are never able to perceive reality directly but only to see things filtered through mental categories. In the nineteenth century Alfred Adler, like Sigmund Freud, believed that a child’s formative years were extremely important in moulding the personality. Freud pursued the theory of unconscious libidinal drives while Adler asked the question [1] “What does the world seem like to a small child.” He felt that human beings began life with natural inferiority as adults were bigger than the child, and as a consequence of this perception the child would compensate. Adler asked parents to encourage the child to build confidence and self-esteem. Adler was a social psychologist who believed in social interest and that a person’s mental life is determined by his goal. Teleology. If the child’s attempts for recognition were met with persistent criticism or lack of love the perception of being inadequate would make the child behave in a manner which was incongruent and therefore detrimental to the psyche.
Private logic, the person’s inner belief system is based on biased-apperception rather than common sense, it is unique to the individual and it is the glue which bonds inferiority and behaviour to fantasy goals. Security without security. Utopia on tap. Realistically destructive. [2] “The meaning that is attached to events determines behaviour.” and thus Adlerian therapy involves re-educating the client towards a more satisfactory lifestyle, by changing his attitudes, his goals, his values and his behaviour.
Murray and Jacobson rightly described Adler as the forerunner of many modern cognitive therapists such as Albert Ellis, Julian Rotter, George Kelly, Eric Berne and Aaron Beck.
George Kelly.
In the 1950’s when behaviourism was the dominant psychology George Kelly recalls how he sat through many lectures watching Stimulus Õ Response being written on the blackboard and waited for the teacher to explain the meaning of the arrow. Influenced by Emmanuel Kant Kelly regarded man as a scientist who constructed his own interpretation of the world. Personal constructs are seen as bi-polar. [3] “We approach the Worlds not as it is but as it appears to be; we gaze at it through our construing goggles.” Kelly viewed all behaviour as if it were an experiment and then determined to validate the hypothesis. If the behaviour matches up to the pre-verbal (sub conscious) view of self then the behaviour is effective functioning, but problems will arise if the pre-verbal view of self is incongruent. At a superficial level an inability to achieve a favourable outcome is ignored [4] “problems persist until the person is able to find acceptable alternative ways of dealing with the world.”
Aaron Beck
Originally a psychoanalyst Beck became increasingly frustrated with its lack of efficacy. His observations in the early 1960’s with depressed patients showed a negative bias in their thought processes, rather than the Freudian concept of anger being turned inwards – reversal. Beck labelled this a cognitive triad where the client has a negative view of self, the world and the future. Beck believed that the way a client structured incoming information – schemata – led to the clients emotional disorders. Beck’s therapeutic approach was to track down and have the client test the validity of these negative automatic thoughts, and then to replace them with more effective ones. As Beck’s cognitive therapy has progressed, trials on its effectiveness have shown increasingly encouraging results [5] “The conclusion from these treatment trials is that cognitive therapy is at least as effective as anti-depressant medication in the treatment of unipolar non-psychotic major depression.”
Albert Ellis
Like Beck Ellis was originally a psychoanalyst but found it “inefficient.” He differed from Beck inasmuch Ellis would home in on the irrational beliefs and the emotions it brought to the client. Ellis also believed that humans have a strong tendency to think and act irrationally. He originally named his method Rational Therapy, however he later changed it to Rational Emotive Therapy as he felt there were misconceptions that Rational therapy was only concerned with thought. Ellis held that thought, emotion and behaviour were all closely linked. In 1994 he changed the name of his therapy again to Rational Emotive Behavioural Therapy. R.E.B.T. is a problem solving approach to emotional disorders. It has been described as psycho-educational, the client is encouraged to scrutinise and review his irrational beliefs such as the social phobics one of “I must come across well in front of significant others, and if not it’s awful, I’m a damnable person, I can’t stand it” (ego disturbance) and be taught that the self defeating “musterbatory” belief should be replaced with a preference thus moving anxiety to one of concern. [6] Ellis’s aim is to eventually penetrate the educational establishment with his framework of treatment. If he succeeds he may well become the new Alfred Adler.”
Robin Thorburn ADHP (NC) MNRHP FNSHP UKCP (H)
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Presented by Robin Thorburn at the British Psychological Society Conference 2017
Such was the 2025 Low Country Mental Health Care conference in Charleston S.C. and it was an honor and a joy for me to attend and present there.
Heartfelt thanks to brilliant David Diana and his team for creating this magnificent event, thank you Matt Dorman for your great questions and discussion in our session, and thank you to all the attendees of my sessions and to all others who l met there ✨
Thank you Robin for sharing those photos