Saturday, April 21, 2012
A Cognitive Behavioral Approach
A Cognitive Behavioral Approach for Aaron
The cognitive-behavioral approach has strengths and limitations specific to the needs of the client. According to Corey (2009), REBT and cognitive behavioral therapy assume clients can change irrational thinking, and that they have an overall prevailing goal toward well-being and communication with fellows and loved ones, as well as a desire for growth and self-actualization.
Strengths of this Approach
Using the cognitive behavioral approach for Aaron has several benefits, the first of which is for the immediate relief of some of his symptoms. As Matthew Geyer (Laureate Education, Inc., 2006) remarked, rather than using the depth of investigation more common in psychoanalysis, cognitive behavioral therapy contends with the more external symptoms with less of an exploration into his past and the depths of his psyche. It seems essential to help Aaron integrate his thoughts about his health and performance with his capacity to care for himself in a way that is conducive to his health, rather than a detriment.
Corey (2009) claims REBT focuses on the client's ability to integrate the capacity to think, feel, and behave. Cognitive behavioral therapy has been effective in a wide range of applications that include skills training. Perhaps incorporating this aspect of cognitive behavioral therapy would appeal to Aaron's desire to focus on his athletic abilities and simultaneously relieve the obsessions associated with his training regimen and his other compulsive behaviors. Research suggests cognitive behavioral therapy is usually therapeutically effective for obsessive compulsive disorder as well as for eating disorders (Butler, Chapman, Forman & Beck, 2006).
Some research has found a cultural context for obsessive behavior (Okasha et al, 1994). For this reason, I would want to involve his parents to some extent, at least to determine their values and how, and for what Aaron has been rewarded throughout his life. As stated by Geyer (Laureate Education, Inc., 2006), having Aaron's parents as allies during this process may be critical.
It will be important to take into account Aaron's developmental stage. Teens can have issues about self identification. I would want to be sensitive to Aaron's idea that his performance as an athlete may be a significant part of how he sees himself. I would want to strengthen his sense of self-esteem and self-efficacy, helping him perceive himself as multi-dimensional, not just as an athlete, but as a young man with considerable options for a positive future.
Additionally, I like the idea of helping Aaron develop a new set of coping skills (Corey, 2009). Although he may not initially concede to the idea of his use of compulsive behavior to cope with his underlying insecurity or other inadequacy or inefficiency issues, but as he begins to reorient himself to rational thought, he will most likely need new coping skills to replace his maladapted ones. One last thought about using a cognitive behavioral approach with Aaron is the flexibility of the approach. Enlisting the help of Aaron's parents should be helpful in creating a bargain or a contractual agreement with Aaron; as Aaron continues to create healthy and rational habits, he will be allowed to continue his involvement with athletics. If he does not, he will be forced to forfeit his involvement in sporting events and training.
Limitations of the Approach
Although cognitive behavioral therapy may be effective in ameliorating some of Aaron's symptoms, it is not devised to delve deeply into why Aaron uses the compulsive behavior (Laureate Education, Inc., 2006). Additionally, if Aaron does not see a benefit to a particular change or a goal of therapy, he may not have the motivation to make the necessary changes. One idea would be to approach it from a health perspective. If he understands that osteopenia will eventually eliminate him from athletics in general, that may affect his motivation.
Corey (2009) describes the importance of understanding the client's world prior to trying to change it. If Aaron has reservations about change as defined by the therapist, he will not maintain the motivation necessary for significant change (Corey, 2009; Laureate Education, Inc., 2006). It will be important for Aaron to understand the difference between his perceptions and those of the therapist, and that the new perceptions will serve him better than his current approach to his health and well-being. Furthermore, Corey (2009) states the cognitive-behavioral approach minimizes emotions and does not explore underlying issues. It does not focus on the past or the client's history which may contribute to a significant degree, the reasons for the client's behavior. It will be important to keep these limitations in mind when working with Aaron.
Butler, A., Chapman, J., Forman, E., & Beck, A. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31. doi: 10.1016/j.cpr.2005.07.003
Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Thompson Brooks/Cole.
Laureate Education, Inc. (Producer). (2006). Case study: a CBT/behavioral therapy perspective In Counseling and Psychotherapy theories [Streaming Video]. Baltimore: Author.
Okasha A, Saad A, Khalil A. H., El Dawla A.S., Yehia N. (1994). Phenomenology of obsessive-compulsive disorder: a transcultural study. Comprehensive Psychiatry 35, 191–197.