Integrating Behavioral And Cognitive Theories

Introduction

Cognitive-behavioral approaches come from two distinct fields, behavioral theory, and cognitive theory. Behaviorism centers on external behaviors and disregards mental processes that are internal (Thigpen et al., 2015). By contrast, the cognitive approach focuses on thought processes that are internal (Thigpen et al., 2015). Therapies began to develop a strategy that blended the elements of cognitive therapy with behavioral therapy. Over time, the two approaches merged into cognitive behavioral approaches even though they initially appeared to develop in parallel paths. Cognitive-behavioral approaches are pragmatic and action-oriented and have become widely used psychotherapy. Cognitive-behavioral approaches were initially designed for anxiety and depression disorders, but have been modified for other conditions including eating disorders, substance abuse, and personality disorders (Wright, 2014). Cognitive-behavioral approaches are talking therapy that is evidence-based and concentrates on how the behaviors, thoughts, and emotions of an individual are connected. Cognitive-behavioral approaches enable individuals to become aware of behaviors and thoughts with an emphasis on exploring how their actions and thinking affect their emotions (González-Prendes & Brisebois, 2012). The focus on the ‘here and now' allows an individual to develop skills to enable them to identify and address behaviors and thinking patterns that are unhelpful (Thigpen et al., 2015). Cognitive-behavioral approaches allow for the exploration of an individual’s past experiences to understand how predisposing factors may have underlined the prevailing links between thoughts, experiences, behaviors, and emotions, and how it raises the individual’s susceptibility to developing mental health issues. According to Turner (2010), cognitive behavioral therapy is a form of psychotherapy that centers on the role of cognition in the expression of behaviors and emotions. Cognitive-behavioral treatment assumes that

maladaptive behaviors and feelings develop from cognitive processes that progress from interactions with experiences in the environment and others. The objective of therapy is to pinpoint the maladaptive cognitive process and to learn new ways of thinking about and perceiving events. The new ways of viewing and thinking about events result in more positive emotional and behavioral responses (Turner, 2010).

According to Fenn & Byrne (2013), cognitive behavioral approaches hypothesize that their perceptions of events influence an individual's behaviors and responses and that it is not the situation that determines what an individual feel but how they construe a situation. This implies that how an individual feels is determined by how they interpret a situation rather than the situation. Fenn & Byrne (2013) argue that although it is possible to describe the primary elements of cognitive approaches, the actual application can vary in practice. Also, cognitive behavioral approaches ultimately aim at teaching people to be their own therapist by assisting them to understand their current ways of behaving and thinking, and by providing them with the tools to alter their maladaptive behavioral and cognitive patterns (Turner, 2010). In this respect, the main elements of cognitive approaches can be grouped into the components that foster a collaborative empiricism environment and those that bolster the problem-oriented, structured focus of cognitive behavioral strategies. Collaborative empiricism is based on the inception of a collaborative therapeutic relationship where the individual and the therapist team up to identify maladaptive behavior and cognitions, test their validity, and revise if needed (Fenn & Byrne, 2013). The primary objective of the collaborative process is to assist patients to effectively define issues and gain skills in the management of the problems. Moreover, cognitive behavioral approaches also rely on the

non-specified principles of the relationship between the therapist and the patient such as empathy, understanding, rapport, and genuineness (Fenn & Byrne, 2013). It is important to note that to aid collaboration, the therapist should explain the rationale of the cognitive-behavioral approach and illustrate the description using examples from the experiences of the patient. Another principle of cognitive behavioral approaches is that they are problem-oriented as mentioned earlier with a focus on the present. Contrary to other talking therapies, cognitive behavioral approaches center on the ‘here and now' problems. Instead of focusing on past symptoms and past causes of distress, cognitive behavioral approaches look for ways to improve the current mental status of an individual. Besides, cognitive behavioral approaches involve specific, measurable, achievable, realistic, and time-limited goal setting that is mutually agreed. The individual gets assistance in prioritizing goals by breaking down their problem and developing a hierarchy of small goals to achieve. Therefore, cognitive behavioral approaches were selected because it is a structured and time-limited treatment (Fenn & Byrne, 2013). Given that cognitive behavioral approaches are structured, they enhance the efficiency of treatment, emphasize therapeutic efforts on problems and potential solutions that are specific (Fenn & Byrne, 2013). Further, cognitive behavioral approaches were chosen because the sessions begin with the setting of an agenda where the individual is assisted in selecting the items that can lead to productive therapeutic work in a specific session. Homework assignments are also used in cognitive behavioral approaches hence extending the efforts of an individual beyond the confines of the therapy session and underpinning learning of the concepts of cognitive behavioral approaches (Fenn & Byrne, 2013).

Cognitive-behavioral approaches also have three critical advantages. First, cognitive behavioral strategies have been shown to have a long-term outcome (Fenn & Byrne, 2013). David et al., (2018) found that patients who were depressed and had been previously treated with anti-depressant medication had a higher probability of relapse through one year follow up than patients who had been treated using cognitive behavioral approaches. Patients who had prior cognitive behavioral approaches had a lasting effect regarding relapse prevention and recurrence during the period of follow-up that was at least as an assailable as continuing patients on anti-depressant medication (David et al., 2018). Second, cognitive behavioral approaches are evidence-based and extensive research support the effectiveness of this approach for many psychosocial problems (Fenn & Byrne, 2013). Today, evidence-based practice is crucial to the social work profession (Fenn & Byrne, 2013). As a result, cognitive behavioral approaches have become one of the frequently used therapeutic intervention.

According to González-Prendes & Brisebois (2012), cognitive behavioral approaches are one of the most widely published and researched models of therapy with over 300 published outcome studies that prove its efficacy. The empirical validation of cognitive behavioral approaches has made this theory popular among practitioners who seek the advantages of treatments that are evidence-based. Lastly, cognitive behavioral approaches are cost-effective. For instance, in a randomized trial of cognitive strategies and anti-depressant medication, although cognitive behavioral approaches are costly to provide initially, the accumulative cost of continued medications are more expensive (David et al., 2018). Further, cognitive behavioral approach treatments that are mindfulness-based are particularly cost-effective since they are delivered in a group format.

Since cognitive-behavioral approaches are popular among many practitioners that seek empirically supported theories, the theory has amassed its fair share of criticism that illuminates its disadvantages. One of the downsides is that the cognitive behavioral approaches are too mechanistic and fail to tackle the concerns of the ‘whole' patient (Gaudiano, 2013). The specific elements of the cognitive behavioral approaches often fail to outperform the abridged versions of the treatment that only contain the behavioral strategies that are more basic (Gaudiano, 2013). Cognitive-behavioral approaches also lack a strong link to neuroscience and cognitive psychology (Gaudiano, 2013). Cognitive-behavioral approaches developed from clinical observations obtained from therapy sessions instead of the laboratory. Therefore, the theoretical basis of cognitive behavioral approaches is not linked to the science of human cognition (Gaudiano, 2013). As a result, there is a need to modify the critical aspects of cognitive behavioral approaches to conform to the experimental knowledge of cognitive science. Finally, the generally considered mechanisms of cognitive behavioral approaches have failed to conform to the predictions that the model sets forth (Gaudiano, 2013). Assessment, Planning, and Intervention Using Cognitive-Behavioral Approaches Assessment in cognitive behavioral approaches aims at deriving a shared and detailed formulation of Kelvin’s presenting problems, and to develop a personalized treatment plan together. Assessment helps in diagnosing disorders, discuss the goals of the treatment with the patient, plan the treatment, and facilitate positive changes in the individual. Using effective communication skills, the social worker collects quality information to understand Kelvin’s problems. This will also ensure that Kelvin collaborates with the social worker and make the consultation effective. Assessment requires data gathering, and to facilitate the process of data gathering, and the social worker considers the settings in which the interview is conducted and

communication barriers. Kelvin will be interviewed in a silent and private with both the social worker and kelvin seated in chairs of equal height without a desk separating them. The social worker will then listen carefully and guide Kelvin through his storytelling to allow effective assessment. The five P's will be used to formulate Kelvin's case with the cognitive behavioral approach. The five Ps are presenting issues, predisposing factors, precipitating factors, perpetuating factors, and protective factors. Kelvin's presenting problems include challenging behavior both at home and school, lacks confidence, slightly overweight, and socially isolated. One of the main predisposing factors in Kelvin's case is that his father separated from her mother Denise, and has only been in touch on an occasional basis. Kelvin's father also refuses to become involved in matters that concern Kelvin. This implies that the models Kelvin received from his father were absent. On the other hand, precipitating factors in Kelvin's case include the fact that he is tall and slightly overweight making other children to tease him. Also, Kelvin may also be feeling responsible for his parents' separation. The main perpetuating factor, in this case, is that Kelvin is socially isolated which makes it difficult to talk about his feelings and reach out to someone. This makes him vulnerable to act violently. In Kelvin’s case, intervention is made by working with the cycle of negative thinking by testing negative beliefs and thoughts. This involves confronting his negative beliefs and thoughts, the way he thinks about things, and examining them against other points of view and reality. Problem-solving and development of compassion and practicing what is learned in sessions is also critical in this case. Interventions will include setting goals that are realistic and learning how to solve the issues. Learn how to manage anxiety

and stress, identify situations that should be avoided and approaching feared situations gradually. Further, it is vital to identify and engage in activities that Kelvin enjoys, identify negative thoughts and challenge them, and ensure that Kelvin keeps track of his feelings, behaviors, and thoughts so that he can become aware of the symptoms and make it easy to change behaviors and thoughts.

Person-Centered Approaches

Person-centered approaches are based on the positive notion that an individual who is in touch entirely with their inner self will always be pros-social in their behaviors and attitudes (Madoc-Jones, 2008). A social worker’s goals using this approach are to establish a genuine and warm with a client so that the client can be free to explore, develop, discuss, and realize their inner self (Madoc-Jones, 2008). When using this approach, a social worker attempts to tune into the individual and then reflect back to the individual and what they are saying. This enables the individual to develop and sharpen their understanding and appreciation of who they are. A social worker achieves this by exercising empathy and unconditional positive regard. Unconditional positive regard is critical because it allows one to be free and fully explore their perceptions. Empathy is also vital because it will enable the social worker to tune into the client allowing the social worker to reflect the perceptions of the client. Like cognitive behavioral approaches, empathy in a person-centered approach enables the social worker to collaborate and work together as a team to explore feelings and perceptions in depth (Madoc-Jones, 2008). A social worker using the person-centered approaches typically locates the sources of the problems within the person rather than the society, and seek change at a personal level. According to McLeod (2015) the person-centered approach functions according to three basic principles that reflect the therapist’s attitude towards the client. First, the social worker is

congruent to the client. Second, the social worker provides the client with positive regard that is unconditional. Third, the social worker shows empathetic understanding to the individual. The person-centered approach is selected to tackle Kelvin’s case because of its advantages. It is an ambitious and holistic approach that seeks to deal with matters that are existential. Also, the goals are small and developing an empathic relationship and understanding an individual’s perspective are regarded as positive ends (Madoc-Jones, 2008). However, person-centered approaches have two main disadvantages. One of the downsides is that like the solution-based models, and person-centered approaches are soft on offenders. Another problem with this approach is that it defies easy measurement and quantification. Assessment, Planning, and Intervention Using Person-Centered Approaches The person-centered approach offers a different and radical view of assessment and how it should be carried out (McLeod, 2015). Some of the essential elements that are used in Kelvin’s case include the function of respect, empathy, concreteness, genuineness, and warmth. The purpose of the assessment is also clearly stated so that Kelvin can speak openly and understand himself. Additionally, in the interpretation of the test, the focus remains with Kelvin. Kelvin will equally have input in selecting the tests. In ensuring that person-centered approach is effective, clear boundaries are set, let Kelvin explain what the problem is, and listen carefully to what he is saying and explain to him what he is saying is social worker’s own words. Also, it is critical to avoid being judgmental if the person-centered approach is to be effective. Kelvin may feel that because he is slightly fat and tall for his age, he may think that he falls short of the ideal. Therefore, reassurance is essential. Additionally, it is critical to help Kelvin explore the options that are available to him but not make decisions for him. Finally, a social worker should concentrate on what the client is saying, be genuine, accept emotions that are negative, and how

a social worker speaks is essential. Using the correct tone of voice is advisable and short pauses to give time for reflection. The person-centered approaches allow a social worker to understand that they may not be the best person to provide help.

Anti-Oppressive and Anti-Discriminatory Practice

Approaches that are anti-oppressive are concerned with social justice implementation and aims at challenging the use of power, and the structure of the society where they are being used to maintain certain groups in disadvantaged positions (Collins & Wilkie, 2010). To ensure that anti-oppressive practices are incorporated in using these theories, it will be essential to know the legal framework that underpins equalities and practice and continue to develop the capabilities that are expected of a social worker. Also, it is important to be aware of the personal values as a social worker and these values affect practice. In Kelvin's case, the source of oppression is structural as it arises from the way processes and systems operate. Additionally, children's social care services users are usually from groups that are considered to be socially disadvantaged. The anti-discriminatory practice aims at counteracting the adverse effects of discrimination on clients to fight all forms of discrimination. Kelvin could be facing discrimination at school because of being slightly fat and tall for his age.

Bibliography

• Collins, S. & Wilkie, L., 2010. Anti-Oppressive Practice and Social Work Students' Portfolios in Scotland. International Journal of Psychology, XXIX(7), pp. 760-777.
• David, D., Cristea, I. & Hofmann, S. G., 2018. Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy. Frontiers in Psychiatry, IX(4), pp. 45-65. Fenn, K. & Byrne, M., 2013. The key principles of cognitive behavioural Therapy. SAGE Journals, VI(9), pp. 559-585.
• Gaudiano, B. A., 2013. Cognitive-Behavioral Therapies: Achievements and Challenges. Evidence-Based Mental Health, XI(1), pp. 5-7. González-Prendes, A. A. & Brisebois, K., 2012. Cognitive-Behavioral Therapy and Social Work Values: A Critical Analysis. Journal of Social Work Values and Ethics, IX(2), pp. 21-33.
• Madoc-Jones, I., 2008. Models of Intervention. Social Inclusion Research, VII(9), pp. 128-153. McLeod, S., 2015. Person Centered Therapy. Simply Psychology, II(3), pp. 1-7. Thigpen, M. L. et al., 2015. Cognitive Behavioral Treatment. International Journal of Psychology, V(7), pp. 78-96.
• Turner, R., 2010. Cognitive Behavioral Therapy (CBT). Encyclopedia of Cross-Cultural School Psychology, IV(6), pp. 226-229. Wright, J. H., 2014. Cognitive Behavior: Basic Principles and Recent Advances. Focus, IV(2), pp. 102-113.

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