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Running Head: AN ANALYSIS OF COGNITIVE THERAPY

An Analysis of Cognitive Therapy


Shanell J. Meredith
Seattle University

AN ANALYSIS OF COGNITIVE THERAPY

Abstract
This paper explores the theory and practice of cognitive therapy. Origins of health and
dysfunction, treatment goals, strategies and the process of change, the therapeutic relationship,
client and counselor roles, as well as strengths and weaknesses of the theory (in regards to
multiculturalism and social justice) are all addressed individually. Cognitive therapy emphasizes
the role of cognitions to explain both health and dysfunction. It seeks to ameliorate problems by
client awareness and modification of faulty perceptions through the use and a good therapeutic
alliance. A variety of techniques and strategies are employed and quick progress is gained by the
client in the highly efficient therapy structure.

AN ANALYSIS OF COGNITIVE THERAPY

An Analysis of Cognitive Therapy


Cognitive therapy today is one of the most empirically validated theoretical approaches,
and it has proven itself to be effective in treating a broad range of disorders (Seligman &
Reichenberg, 2010). The idea that a persons view of things can be responsible for psychological
disturbances is traced back to Ancient Greek and Roman philosophers (Seligman & Reichenberg,
2010). In the 1960s Aaron Beck picked up where the ancient philosophers left off, by
developing and empirically testing his more detailed theory that suggests distorted thinking is
common to all psychological disturbances, and that modification of those maladaptive thoughts
is the key to regaining psychological health (Seligman & Reichenberg, 2010).
I picked cognitive theory because it most closely matched my assumptions of health and
dysfunction. I was attracted to the idea of taking a closer look at the theory in which I had so
quickly connected. I was especially drawn to this approach because the notion that a client learns
to evaluate and change their own cognitions in the process of therapy, is so empowering and
valuable, it seemed too good to be true (Seligman & Reichenberg, 2010).
Health and Dysfunction
Health. Cognitive theorists view a healthy, functioning person as someone that exercises
mastery over their assumptions, beliefs and appraisals (Schuyler, 2003). Cognitive awareness,
the ability to evaluate accuracy of thoughts and replace those cognitions which are found to be
faulty are some of the token characteristics of a healthy functioning person (Friedberg, 2002,
Seligman & Reichenberg, 2010). Even a person classified as being emotionally sound will
occasionally make mistakes with their processing and filtering of information, but what
distinguishes health from dysfunction is the capability to identify and modify immediate and

AN ANALYSIS OF COGNITIVE THERAPY

underlying thoughts and beliefs as well as the emotions and behaviors in relation to their
thoughts (Seligman & Reichenberg, 2010).
Dysfunction. In cognitive therapy, dysfunction is believed to be caused by distorted
cognitions on multiple levels, starting with our constant stream of automatic thoughts and
reaching as far as a persons inaccurate schema: the deeply ingrained way we perceive, filter and
organize our world (Seligman & Reichenberg, 2010; Safran, 1998). Experts in the field do not
share common terms or designations for the different levels of cognitions, however they do share
the basic premise that distorted cognitions can emanate from many areas of an individuals life,
including biology, social learning, and personal experience (Friedberg, 2002; Safran, 1998;
Seligman & Reichenberg, 2010). Dysfunctional thoughts in themselves do not deem a person
psychologically disturbed, rather, an inability to recognize and correct faulty thought patterns
causing emotional or physical harm is a defining characteristic of a person in need of therapy
(MicMullin, 2000; Seligman & Reichenberg, 2010).
Multicultural Considerations. Addressing the considerations of children, adolescents
and elderly are a standard area of research in cognitive therapy, while multicultural issues seem
to receive quite a bit less consideration (MicMullin, 2000). Half of the resources used in writing
this paper failed to address cultural issues of any kind. MicMullin (2000) stated that culture often
determines cognitions, so gaining an in-depth understanding of a clients culture is essential to
counsel effectively. When a client and counselor come from dissimilar cultures, it is especially
important for the counselor to be able to identify his or her preconceived notions of health and
dysfunction from a cultural standpoint (MicMullin, 2000; Seligman & Reichenberg, 2010).
Mislabeling a common cultural belief as dysfunctional could be emotionally damaging and
counterproductive to the ultimate goals of therapy (MicMullin, 2000). Since beliefs are formed

AN ANALYSIS OF COGNITIVE THERAPY

not only from ones personal experiences but also from the broader belief system held by a
culture, a competent clinician is responsible for learning the expected and acceptable values,
perceptions and beliefs that a client has been culturally exposed to (MicMullin, 2000; Seligman
& Reichenberg, 2010). Once the clinician has defined the cultural norms, it enables the clinician
to discern true maladaptive cognitions from beliefs that are core to a clients culture (MicMullin,
2000). Cultural competence, and an understanding of the systems influencing a clients principal
beliefs, is especially important in cognitive therapy; without it, counselors are not in a position to
make any assumptions as to what needs to be changed (MicMullin, 2000).
Process of Change
Change is accomplished through multiple methods: It is short-termed, focused in the
present and very structured (Friedberg & McClure, 2002; Schuyler, 2003; Seligman &
Reichenberg, 2010). The treatment process often begins with intake questionnaires and
inventories, which are used alongside the Diagnostic and Statistical Manual of Mental Disorders
(DSM) to determine whether a set of symptoms meet the criteria for a diagnosis of a disorder
(Schuyler, 2003; Seligman & Reichenberg, 2010). Cognitive theory suggests that each mental
disorder is characterized by relatively predictable types of underlying cognitions meaning a
diagnosis can be seen as the first step in change by identifying cognitive distortions (Seligman &
Reichenberg, 2010, p. 274). The second step involves evaluating current thoughts and belief
systems and then recognizing how they relate to problematic feelings and emotions (Friedberg &
McClure, 2002; Schuyl, 2003). Next the client and clinician examine and weigh evidence for
and against fundamental beliefs. Clinicians use a broad range of strategies and interventions to
modify thoughts and teach the client how to independently recognize and correct future cognitive
errors (Seligman& Reichenberg, 2010).

AN ANALYSIS OF COGNITIVE THERAPY

Counseling Goals The ultimate goals of cognitive therapy are to alleviate symptoms and
simultaneously teach the client the skills required to recognize and restructure ones inaccurate
cognitions (Seligman & Reichenberg, 2010; Schuyl, 2003). The goal for each session is for the
client and clinician to work jointly to set specific, measurable goals and to identify and change
problematic thoughts (Seligman & Reichenberg, 2010). The gained aptitude of independently
and successfully handling cognitive errors is empowering to clients (Schuyl, 2003). Thus, the
goal of therapy is to enable clients to cope with life challenges and lead happier, healthier and
more rewarding lives (Seligman & Reichenberg, 2010).
Therapeutic Alliance
In the early 1960s, when cognitive therapy was still in its infancy, one of its greatest
criticisms was the perceived emotionlessness and coldness of the clinicians (Seligman &
Reichenberg, 2010 & Wills & Sanders, 1997). Yet, it seems this perception was based on a
comparison between cognitive therapy and person-centered counseling, in which feelings were
the primary focus (Seligman& Reichenberg, 2010 & Wills & Sanders, 1997). Although many of
the writings on cognitive therapy do not attempt to explicitly describe the qualities involved in a
desirable therapeutic alliance, Aaron Beck, the grandfather of cognitive therapy, stated that
Effective cognitive therapy requires a good therapeutic alliance (Seligman& Reichenberg, 2010,
p. 278). Today cognitive therapy openly embraces the traditional core conditions of the
therapeutic alliance (Seligman & Reichenberg, 2010 & Wills & Sanders, 1997). Clinicians
collaborate with clients on the recognition and identification of problems, establishing
meaningful goals and initiating change through the use of empathy, warmth, interest,
congruence, and unconditional positive regard (Seligman & Reichenberg, 2010).
Counselor and Client Roles

AN ANALYSIS OF COGNITIVE THERAPY

The limited time frame common to classic cognitive therapy requires both the counselor
and the client to be very structured and efficient for the duration of each session (Seligman &
Reichenberg, 2010; Schuyler, 2003). Prior to an initial meeting, the counselor is responsible for
reviewing the clients completed intake assessments and questionnaire and using the DSM to
make a diagnosis and treatment plan (Seligman & Reichenberg, 2010; Schuyler, 2003). After
collaboratively establishing an agenda for treatment, the counselor leads the client through the
series of procedures beginning with measuring the clients present mood and determining if there
have been any notable changes (Seligman & Reichenberg, 2010). Next, the clinician inquires as
to the clients reaction of the past weeks assignment (Schuyler, 2003). Much attention is paid to
client success in order to reinforce efforts which have led to positive progress (Seligman &
Reichenberg, 2010). The clinician is also responsible for eliciting and assessing thoughts related
to the identified issues, and assigning new homework with the aim of further changing the
negative thoughts and maladaptive beliefs (Seligman & Reichenberg, 2010). The clinician closes
the session by summarizing the pertinent points of their time together and invites the clients
feedback in relation to the session and the treatment process (Seligman & Reichenberg, 2010).
The termination of treatment entails the clinician tapering the frequency of sessions and
providing continued follow-up to prevent client relapse (Seligman & Reichenberg, 2010 & Wills
& Sanders, 1997). The role of a cognitive therapist is dynamic; it requires the clinician to be a
teacher, investigator, encourager, and an expert in crafting interventions and strategies for the
client (Seligman & Reichenberg, 2010).
The role of the client is also work-intensive: the client must be an engaged, motivated
learner that assesses and verbalizes ones own cognitions (Seligman & Reichenberg, 2010). In

AN ANALYSIS OF COGNITIVE THERAPY

addition, the client must be a proactive agent in treatment by completing the homework designed
to challenge cognitions and generate growth (Seligman & Reichenberg, 2010).
Techniques and Approaches
Cognitive theory assumes realistic evaluation and modification of thinking are the keys to
improving and maintaining emotional health (Seligman & Reichenberg, 2010). The path leading
to these therapeutic objectives is paved largely by the techniques chosen by the clinician. Just as
learning the alphabet precedes the ability to read, clients will not find success until they have
mastered the basic skills required to initiate change. It is up to the clinician to decide the
appropriate starting point for the client and build from there (Schuyler, 2003). For some, that
point is simply learning to accurately label cognitions; others begin by determining the validity
of ones cognitions. If the client has already recognized the cognitive error, the practitioner may
start with labeling the clients cognitive distortions (Schuyler, 2003). Seligman & Reichenberg
(2010) give examples of a few of the common distortions: All-or-nothing thinking (situations are
seen in terms of extremes, instead of on a continuum), Catastrophizing (the expectation of the
worst outcome without considering other possibilities), and Emotional reasoning (believing
something is true based on only the way it feels).
Another vital part of cognitive therapy is performing mood assessments (Seligman &
Reichenberg, 2010). Most people seek therapy due to emotional discomfort; therefore emotions
are readily available at the start of treatment and can be used like a compass pointing the
clinician towards the underlying distorted cognitions (Seligman & Reichenberg, 2010).
Furthermore, emotional assessments can work as a motivational tool for the client by
benchmarking and documenting progress (Seligman & Reichenberg, 2010).

AN ANALYSIS OF COGNITIVE THERAPY

There are an abundance of techniques associated with the formulation of new cognitions
(Schuyler, 2003; Seligman & Reichenberg, 2010). Each therapist draws on techniques he or she
believes will be the most effective and fitting for the clients unique and specified problem.
Thought stopping, cognitive rehearsal, activity scheduling, and diversions are just a few of the
strategies clinicians use with clients (Seligman & Reichenberg, 2010). These can be assigned as
homework or used together in a session (Schuyler, 2003). Unfortunately, what works for some,
may not be effective for others (Schuyler, 2003).
Critique
Multicultural Considerations
Strengths. The phenomenological approach used in cognitive therapy, and the respectful
stance taken by clinicians, enables people from a variety of backgrounds to benefit from this
method (Seligman & Reichenberg, 2010). Seligman & Reichenberg (2010) reported empirical
research that suggested people from multiple cultures and backgrounds, suffering from different
setbacks and psychological disorders, have found value and success from cognitive therapy. The
ease of combining this approach and personalizing this approach to appropriately target the needs
of a similar population is one of cognitive psychologys best features (Schuyler, 2003; Seligman
& Reichenberg, 2010). Clients from an Asian background (culturally valuing privacy), lowincome Latina women and low-income African American women dealing with depression, as
well as African American clients lacking hope, were among the minorities that benefited through
cognitive therapy (Seligman & Reichenberg, 2010).
The wide variety of strategies in cognitive therapy provides the clinician flexibility when
selecting techniques appropriate and respectful of the culture of each client (Seligman &
Reichenberg, 2010) The accepting nature of cognitive therapy, which is a characteristic of

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phenomenological approaches, provides a much better fit for clients whose value systems or
cultural beliefs differ from the common regional mindset (MicMullin, 2000; Seligman &
Reichenberg, 2010).
Limitations. Cognitive therapy, by definition, proportionately gives higher weight to
what is occurring in the present (Seligman & Reichenberg, 2010). This creates a potential hazard
for counselors who overlook a clients history and cultural aspects of a clients life, which means
the completion of therapy may only be resulting in a Band-Aid effect, where only the
presenting problem was ameliorated, but the underlying issue was not resolved (MicMullin,
2000; Seligman & Reichenberg, 2010).
As mentioned earlier, understanding the cultural values of a client is absolutely essential
for success (MicMullin, 2000; Seligman & Reichenberg, 2010). On top of this, it seems a clients
culture must be taken into account to avoid ostracizing the clients sense of self and to assure that
wellbeing is not harmed in the therapeutic process. This is limiting to cognitive therapy, because
clinicians should not ethically work with clients of unfamiliar cultures to avoid detriment under
this approach (MicMullin, 2000). Learning the inner workings, values, thoughts and family
systems of different cultures is laborious and although it is beneficial to the therapist and the
client, it is time consuming and can be restrictive to time constraints (MicMullin, 2000; Seligman
& Reichenberg, 2010).
Respecting the cultural beliefs and perceptions of a client is also a necessity (MicMullin,
2000; Seligman & Reichenberg, 2010). This brings up an interesting question: what happens
when a clinician believes the cultural beliefs are causing a client to put themself in physical or
emotional danger (a cultural perception of beauty prompting a client to partake in hazardous and
irreversible behaviors) (MicMullin, 2000)?

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Some inaccurate cognitions can be helpful and positive (being unrealistically hopeful of
recovery in a terminal disease), while conversely, some accurate rational thoughts have the
possibility of causing harm (being acutely aware of the risks outside your home to a paralyzing
extent) (MicMullin, 2000). Changing the inaccurate, but helpful cognitions, and doing nothing
about the accurate but harmful cognitions may prove to be detrimental in the long run
(MicMullin, 2000). It seems there needs to be an exception: should the ultimate goal be to really
have people think about life in a realistic light? Or should it be to live a life full of positivity and
hope?
Social Justice Considerations
Strengths. Innovative advances in cognitive therapy see value in assessing social
systems, interpersonal relationships and personality factors (Wills & Sanders, 1997). Wills &
Sanders (1997) wrote that newer advances in cognitive therapy have asserted that although the
primary focus of therapy is on internal thought processes, they are not disregarding the role of
external factors, in fact, they look closely at personal characteristics in combination with life
events (particularly ones social environment).
Limitations. This theory implicitly suggests external events and processes are not
significant factors contributing to mental health, and that dysfunction is simply caused by
cognitive processing errors (Wills & Sanders, 1997). This type of approach runs the risk of
blaming the clients maladaptive thoughts regarding external stressors (such as racism and
homophobia) that take place outside the clients control, and then modifying those thoughts in a
way which the client accepts the oppressive factors, rather than working to alleviate the unjust
source of angst (Wills & Sanders, 1997). Clinicians need to also evaluate the best course of
action for their client, whether it be working within a session, or lobbying for change.

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Not all cognitions that cause discomfort are dysfunctional; in fact many such thoughts
serve an important purpose (Safran, 1998). Being unhappy does not mean you are necessarily
unhealthy, so a central aspect of cognitive therapy is the analysis of ones cognitions to determine
whether they need to be modified (Safran, 1998). Though cognitive therapy is supposed to
discern between functional thoughts and those thoughts in need of modification, clinicians need
to be cautious of simply attending to cognitions, rather than the forces at the root of the
presenting problem (oppression, abuse, systemic issues) when they are electing a course for
treatment (Seligman & Reichenberg, 2010). Clinicians have the possibility of misjudging or
overlooking the more significant problem at hand, due to the attention cognitive therapy pays to
modifying cognitions when determining a course of action. Changing a clients cognitions to
accommodate problems requiring attention on a larger scale, may temporarily alleviate shortterm discomfort, but sets the client up for failure and simultaneously ignores those distress
causing bigger problems that need to be changed (Seligman & Reichenberg, 2010).
General Critique
Strengths. Cognitive therapy provides benefits to both parties involved in therapy. This
form of therapy is an attractive option to clients based on its empirically supported effectiveness,
nonintrusive and straightforward nature, and relatively short-term time commitment (Seligman &
Reichenberg, 2010). Fortunately, it also appeals to clinicians due to the vast number of strategies
and techniques available to aid clients in ameliorating symptoms (Seligman & Reichenberg,
2010).
Limitations. Beginning cognitive therapists are often overwhelmed with the task of
choosing the best techniques to aid clients in recognizing and modifying thoughts and beliefs, it
distracts from the formation of a quality relationship with the client (Wills & Sanders, 1997). The

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sheer number of strategies and techniques available, in combination with the short-term
treatment and structure demanded in this approach, does not appear conducive to creating the
vital therapeutic relationship attributed to positive therapeutic outcomes (Wills & Sanders, 1997).
Cognitive therapy is such a skill and technique-heavy approach, it can be overwhelming and the
clinician has such a large amount of responsibility in treatment, staying present and genuine is
too much to ask of many counselors (Wills & Sanders, 1997). Paul Gilbert entreated cognitive
therapists to take more time out of their technique-oriented approaches and consider what it is
to be a human being (Wills & Sanders, 1997, p. 7). My interpretation of Gilberts petition is
that counselors need to establish meaningful therapeutic relationships based off of mutual
understanding and respect; it is often within this bond that counselors see clients as unique
individuals rather than a set of inaccurate cognitions needing modification.
Reflection
The process of writing this paper was surprising, informative and, in a way,
disappointing. The moment I finished the last paragraph of chapter 14 covering Aaron Beck and
cognitive therapy in our textbook, I was elated to have finally found the theory I would practice
under. I was thrilled to have found my personal fit, and was fairly certain I would not be swayed.
The process itself brought to light how little I had thought about cognitive therapy
functioning in a context outside my own. I still see great value in the theoretical approach and
recognize that the identification and modification of inaccurate cognitions can stand alone in
some circumstances, but that it has a tendency to disregard the factors that are so closely
intertwined to a clients health. The next theory I adopt will need to be one that takes the whole
person, including their context, into account in a more balanced manner.

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I was surprised at how easily I criticized the shortcomings in a therapy, even when I was
lacking a reasonable solution. As my paper was being assembled, I kept noticing the limitation
sections were naturally formed, and the strengths were more of a struggle. I found this strange,
seeing that I chose cognitive therapy based off of the strengths and commonalities my personal
theory shared with it.
The knowledge and insight I have gained through the analysis of cognitive therapy has
propelled me to seek out a personal theory that more closely fits my beliefs regarding the origins
of difficulty and the path to wellness. A less structured, more holistic approach that considers
social justice and multiculturalism concerns, are just a few of the characteristics I will
incorporate into my personal theory. I will, however, use cognitive therapy techniques in
conjunction with the theory with which I choose to professionally adhere myself. The experience
was beneficial and I conclude this paper with a gained sense of who I am as a counselor and the
direction I want to go.

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References
Friedberg, R. D., & McClure, J. M. (2002). Clinical practice of cognitive therapy with children
and adolescents: The nuts and bolts. New York: Guilford Press.
McMullin, R. E., & McMullin, R. E. (2000). The new handbook of cognitive therapy techniques.
New York: W.W. Norton.
Safran, J. D. (1998). Widening the scope of cognitive therapy: The therapeutic relationship,
emotion, and the process of change. Northvale, N.J: Jason Aronson.
Schuyler, D., & Schuyler, D. (2003). Cognitive therapy: A practical guide. New York: Norton.
Seligman, L., & Reichenberg, L.W. (2010). Theories of counseling and psychotherapy: Systems,
strategies and skills. (3rd ed.). Upper Saddle River, NJ: Person Education, Inc

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