Diploma in Psychotherapeutic Counselling Component 3.

Key Models Incorporated within the

Pluralistic Approach 3. The Cognitive Behavioural Approach- Reflection on Praxis

Course Code: LONDO3S 21 3-1

Student: Mihaela Grecu
Word count: 1526

Theoretical Essay: Reflection on Praxis – The Cognitive Behavioural Approach

1. From your chosen theoretical approach explain Tom’s difficulties

When explaining Tom’s difficulties from a cognitive behavioural perspective one would assume

that the main cause of Tom’s difficulties is the way he thinks about his situation, which in turn

influences his experience of the world. Although the triggering event, in Tom’s situation leaving

home to undertake studies, is an important factor in the development of his condition, in CBT we

look at Tom’s current thinking patterns and enduring patterns of interpretation as the ‘culprits’ for

his problematic behaviour and difficulties. Or in other words, Tom is not disturbed by the event itself

but rather by the way he interprets that event. According to Reeves (2018) people interact with their

environment through the process of thinking, interpretation and evaluation, areas which are directly

linked to their feelings and behaviour which in turn affects their physical well- being. One’s cognition

is consciously available; however, the way people evaluate and challenge their thoughts is not often

known to them and it can have a profound effect on their emotions.

From a CBT perspective Tom’s feeling depressed and desperate could be caused by his isolation

from peers and friends which may stem from thoughts of not being worthy of friendship; thoughts

that he may be judged by people whose’ expectations of him are unknown or a variety of self –

deprecating, fear inducing cognitions.

These cognitions could be referred to as underlying assumptions, belief rules Tom has assimilated

and made his own through exposure to cultural environment or experience but also from peers,

caregivers and other people he has come in contact with. Underlying assumptions in turn activate

core beliefs, which are also named as schema – deep-seated, early, fundamental beliefs people have

about themselves in their internal and external world.

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Diploma in Psychotherapeutic Counselling Component 3. Key Models Incorporated within the
Pluralistic Approach 3. The Cognitive Behavioural Approach- Reflection on Praxis

Course Code: LONDO3S 21 3-1

Student: Mihaela Grecu
Word count: 1526

Theoretical Essay: Reflection on Praxis – The Cognitive Behavioural Approach

If Tom’s early beliefs about himself or the world around him are negative: for example, ‘People

don’t like me’; ‘People think I’m stupid’’ ‘People will judge my appearance’; these in turn can be

activated in the present by challenging situations, in Tom’s case finding himself in a new

environment with no one he knows or trusts and a lot of school work that may sometimes challenge

his self- esteem. Once activated, these core beliefs can make Tom susceptible to negative

interpretation of events conducive of negative cognitive distortions and dysfunctional reactions

which lead to his experiencing negative emotional responses like feeling depressed, desperate and

lonely.

An important concept in CBT is the ABC model, where A is the Activating or Adverse event or

Adversity; B is beliefs; and C represents Consequences. For Tom, A could be leaving home or finding

himself alone in a new, unfamiliar environment; B are the beliefs mentioned above regarding other

people’s possible negative appraisals of himself or his worth; and C the emotional and behavioural

consequences, i.e. his isolation from peers and the accompanying feelings of aloneness, desperation

and depression. The aim for CBT in Tom’s case is to help him overcome the unhealthy negative

emotions and the associated self – defeating dysfunctional behaviours by underlying the connection

between B and C and take the focus off the A as causing his difficulties per se where he takes

responsibility for causing his own distress by maintaining the beliefs and cognitions which lead to his

experience. Ultimately the purpose is to help Tom respond with healthy negative emotions such as

mild apprehension or concern, and functional behaviour that helps rather than making problems

worse.

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Diploma in Psychotherapeutic Counselling Component 3. Key Models Incorporated within the
Pluralistic Approach 3. The Cognitive Behavioural Approach- Reflection on Praxis

Course Code: LONDO3S 21 3-1

Student: Mihaela Grecu
Word count: 1526

Theoretical Essay: Reflection on Praxis – The Cognitive Behavioural Approach

2. Focus on three key concepts from your chosen theoretical approach and show how they

might be employed in the counselling with Tom

The concept of Goals is a very important one in the CBT approach and it refers to the

objectives that underlie client and therapist’s working together. The goals are established in a

collaborative manner and expressed in such a way that is facilitative to their achievement.

According to Trower, Jones and Dryden (2016) the client is most likely to achieve his goals if

these are in his own power to achieve and the focus could be on the actual problematic

behaviour of any other specific issues the client wants to become better at managing.

Tom’s goals may be to change his experience of life at University, whereas he would make

friends or interact with his peers more which in consequence will alleviate his feelings of

aloneness and desperation. It is imperative that Tom’s thinking shifts from problems to goals,

that is to say his orientation changes from being problem- focus to being solution- focused, on

the basis that a healthier state is easier to achieve than reducing a negative or make it go away

entirely.

A way to achieve a healthier state is by identifying and evaluating the NATs, that is to say

Tom’s Negative Automatic Thoughts and supporting him to grow and develop new adaptive

thoughts instead. Together with the therapist, Tom can evaluate the truthfulness and accuracy

of the negative thoughts by analysing and looking at the actual evidence both for and against

these thoughts, all the while endeavouring to develop a more helpful and constructive thought

process that will consequently lead to a change in his emotions and behaviours. The way to go

about recording NATs is by encouraging Tom to keep a thought record where he can write down

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Diploma in Psychotherapeutic Counselling Component 3. Key Models Incorporated within the
Pluralistic Approach 3. The Cognitive Behavioural Approach- Reflection on Praxis

Course Code: LONDO3S 21 3-1

Student: Mihaela Grecu
Word count: 1526

Theoretical Essay: Reflection on Praxis – The Cognitive Behavioural Approach

the situations he identifies as provoking strong unwanted emotions in him and the thoughts that

might precede these feelings. In this way he can identify what is called in CBT as ‘thinking errors’:

‘All or nothing’ and ‘black and white’ thinking such as ‘Nobody wants to be my friend’; trying to

predict the future, often negatively: ‘They will reject me if I reach out to them’ ; Dismissing

strengths and dwelling on the negatives and weaknesses: ‘ Yes I have friends at home but

they’re only friends because they have to, no new people would like me’; Mind reading: ‘People

think I’m boring’ ; Emotional reasoning: ‘ I feel lonely so it must be that no one wants to spend

time with me’; Catastrophising: ‘ I will never make new friends again’. etc.

Together with the therapist Tom examines these NATs and questions the quality of the evidence

for the purpose of changing them for the healthy alternatives.

Another CBT concept that can help Tom is the process of decentring, whereas he would gain

the ability to sit back and notice his thoughts and feelings as temporary, objective elements in

his mind rather than actual facts. The therapist teaches Tom relaxation and breathing techniques

that facilitates decentring and can build a mindset of ‘just because I have a thought doesn’t

mean it is true’ which in turn can help Tom relieve his anxiety around meeting new people and

finding potential friends.

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Diploma in Psychotherapeutic Counselling Component 3. Key Models Incorporated within the
Pluralistic Approach 3. The Cognitive Behavioural Approach- Reflection on Praxis

Course Code: LONDO3S 21 3-1

Student: Mihaela Grecu
Word count: 1526

Theoretical Essay: Reflection on Praxis – The Cognitive Behavioural Approach

3. From what you have read in the scenario what do you think are the main professional

practice issues in working with Tom?

One of the first issues that springs to my attention is that the placement is in a small town

where I would be studying for my diploma and which seems to be the same as Tom’s. This

setting can give rise to many interpersonal problems such as chance encounters with Tom in the

local supermarket or swimming pool, finding that he is attending the same social events or

conferences, discovering that we have mutual acquaintances and friends which may disclose

information about both parties which could possibly affect the therapeutic relationship etc.

Most likely, like with most clients thinking that their distress is caused by a negative event,

Tom will be an AC thinker, that is to say he would believe that his problems (the C – emotional

and behavioural Consequences) are caused by and Adverse event, and may be completely

unaware of the mediating Beliefs. Introducing the ABC way of thinking to Tom and showing him

that he is not a helpless victim of events outside his control can be risky though. Although my

intention is to help him assume responsibility for his own beliefs and see how these are creating

his dysfunctional behaviour and distress this can easily backfire and lead to Tom thinking that he

is being blamed for causing his own unhappiness and add to his original distress by making him

feel anger, shame or guilt. This in turn can damage the therapeutic bond and possibly lead to

early termination of Tom’s therapy.

Issues around confidentiality may ensue as well due to the charity being solely staffed by

volunteers with no provision of supervision; this can mean that the details of the therapy

undertaken with Tom and also aspects related to the trust’s internal processes may be revealed

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Diploma in Psychotherapeutic Counselling Component 3. Key Models Incorporated within the
Pluralistic Approach 3. The Cognitive Behavioural Approach- Reflection on Praxis

Course Code: LONDO3S 21 3-1

Student: Mihaela Grecu
Word count: 1526

Theoretical Essay: Reflection on Praxis – The Cognitive Behavioural Approach

to a party outside the placement. Furthermore, not being provided with supervision internally

may lead to confusion as to whom to report safeguarding concerns and how to approach these

in a time efficient manner and in accordance to what is best for the client.

Bibliography

Cooper, M. & Dryden W. (2016). The Handbook of Pluralistic Counselling and Psychotherapy, London:

Sage

Reeves, A. (2018). An Introduction to Counselling and Psychotherapy, From Theory to Practice, 2nd

Edition, London: Sage

Trower, P. & Jones, J. & Dryden, W. (2016). Cognitive Behavioural Counselling in Action, London:

Sage

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