Cognitive Behavior Therapy:



Cognitive Behavior Therapy:

Why use it in schools?

Amber Spicer

Techniques of Individual Counseling

CLED 602

Cognitive behavioral therapy(CBT) is an “action-oriented model of therapy that stresses the role of thinking and belief systems as the root of personal problems (Corey, 2005).” It is an insight-focused therapy that emphasizes recognizing and changing the negative thoughts and maladaptive beliefs of a client. Assumptions of cognitive behavioral therapy were initially developed by Albert Ellis in Rational-Emotive Behavior Therapy(REBT) and, then, later altered by Aaron Beck with Cognitive Therapy(CT) and Donald Meichenbaum with Cognitive Behavioral Modification.(CBM). Although, rooted in many of the same assumptions and key concepts, Rational-Emotive Behavior Therapy, Cognitive Therapy and Cognitive Behavior Modification have specific differences. REBT is a directive, persuasive, and confrontational form of therapy in which the therapist fulfills the role of a teacher. REBT claims that clients have negative “irrational” thoughts when faced with an activating event. If clients confront these thoughts and change them, then wanted changes in behaviors/reactions will follow.

Beck’s CT recommends that the therapist pose open-ending questions to clients with the goal of getting clients to reflect on personal issues and arrive at their own conclusions. Cognitive therapists believe that clients are living by and responding to life events based on a set of self-developed life “rules” that are too absolute, broad, or extreme. CT asks clients to gain insight to their “automatic thoughts” and determine if these thoughts are “cognitive distortions.” If so, clients are to engage in dialogue with the therapist, carry out homework assignments, gathering and recording data on assumptions they make, and form alternative interpretations.

Finally, Meichenbaum’s CBM is unique because this theory focuses on changing the clients’ self-verbalizations. CBM proposes that “behavioral change occurs through a sequence of mediating processes involving the interaction of inner speech, cognitive structures and behaviors, and their resultant outcomes (Corey, 2005).” Meichenbaum helps clients become more aware of their self-verbalizations through the utilization of a three phase self-instructional training process. First, each client must complete self-observations of how they think, feel, behave, and impact others. Second, clients start new internal dialogue. Finally, clients learn and apply new coping skills.

There are many reasons as to why cognitive-behavioral therapy(CBT) could and should be used for various populations and contexts, especially a school counseling setting. Although there are many methods or techniques that utilize the beliefs and assumptions of cognitive-behavioral therapy, altogether CBT is a highly structured, relatively short-term, focused psychotherapy for a wide range of potential problems. Also, when considering the time constraints, potential variety of developmental problems, and amount of depth a school counselor typically reaches in a relationship with a student, CBT is a realistic approach to use because it is “action-oriented, practical, rational approach that helps the client gain independence and effectiveness in dealing with real-life issues (2002).”

To begin, cognitive-behavioral therapy is a counseling approach that lends itself to a very systematic therapeutic process making it an approach that is applicable to a population that needs clear, concise, purposeful counseling. Using a step-by-step process allows clients to set personal goals, see their progress throughout the counseling process, and, eventually, to independently solve problems they may face in the future. For the same reasons certain adult clients may prefer this approach, students of any age will also benefit from the organized format as well.

Students are comfortable with a learning environment in which someone teaches them skills. Therefore, using CBT in schools, first, allows counselors to play the role of a counselor, helping students gain insight to their own negative thoughts and draw their own conclusions on how to change their negative thinking and behaviors. However, through CBT school counselors also can play a more directive teacher role and “work collaboratively with the child and his or her parents to specify the problem, and develop an individualized treatment plan(2002).” As the student works through the structured, goal directed plan, a child’s self-esteem and competence grows as he/she learns and practices new skills and problem-solving strategies taught by the counselor(2002).

Secondly, cognitive-behavioral therapy is an approach that is applicable for a population of clients that do not have a lot of time to spend in counseling. CBT is an approach to counseling that tries to work efficiently in fourty-five minute sessions or less. Unlike other un structured forms of therapy, the client and therapist set agendas for sessions that discuss homework assignments, a review of accomplishments, and one or two current problems. The goal of each session to focus on the present issues and solve problems, not just complain about them.

When working as a school counselor, it is obvious that a student population is one in which most of their time and energy is focused on academics. Thus, a school counselor needs to use a counseling approach, like CBT, that is efficient and goal oriented. More specifically, school counselors use CBT because it is a practical approach that identifies a student’s problem, generates realistic solutions, accommodates homework, and teaches self-help strategies in a short period of time. All these stages could even be completed in one session, if necessary.

One example of the implementation of efficient CBT in school counseling is a program called the Cognitive Behavioral Intervention for Trauma in Schools (CBITS). CBITS is a “collaborative project with the Los Angeles School District that provides mental health screening and a standardized brief cognitive behavior therapy treatment in schools for students who have been exposed to violence (2003).” After administering a pilot study, CBITS discovered that many more students than expected reported significant community violence exposure and trauma-related Depression and/or Post-Traumatic Stress Disorder. Unfortunately, most, it not all, of these students were not able to afford any private counseling, therefore the public school setting seemed to be a best resort to helping these students. In order to reach as many students as possible, CBITS was developed to reach these students in need mainly because it is a brief approach to therapy. The program proved to be very successful.

In addition, cognitive-behavioral therapy is an approach that is applicable to any population that may have a large variety of psychological disorders. Although schools may differ in socioeconomic status, geographic region, or amount of cultural diversity, all children suffer from many of the same or related issues, and, thus, schools are an ideal environment in which to use CBT with students of all developmental stages. Cognitive-behavioral therapy provides comprehensive treatment to many childhood disorders, such as depression, anxieties and fears, obsessive-compulsive disorders, attention deficit/hyperactivity disorder, disruptive and noncompliant disorders, social skills training, and eating disorders. It is certainly beneficial for a school counselor to understand and to be equipped with an approach like CBT because he/she is then able to counsel many students with such diverse and extreme problems using just one approach.

Two of many areas of concern for children in schools are depression and antisocial behaviors. Rienecke and Simons discuss certain circumstances that make children vulnerable to depression may be puberty, changes in a family and social network, changes in educational environment, and other stresses and life events, such as divorce, death, etc. (Reinecke and Simons, 2005) In an attempt to counsel children experiencing depression, TADS, a counseling program based on a “CBT model has important practical implications” and has proven to be very successful with most children.(Reinecke and Simons, 2005)

Cognitive-Behavioral therapy has also proven to be successful in a study of counseling children who have been referred for antisocial behavior. Children, ages seven-thirteen, referred to counseling with severe antisocial behavior were assigned to one of three treatments, one of which being CBT/problem-solving skills training. Those children that received CBT/problem-solving skills training “showed significantly greater reductions in antisocial behavior and overall behavior problems, and greater increases in pro-social behavior(Kazdin, 1989).”

As you can see, cognitive-behavioral therapy is a practical approach to utilize when counseling a population that requires a structured form of therapy, a brief, efficient and goal-oriented form of therapy, and a therapy that can be applied to a variety of psychological problems, specifically depression and antisocial behavior. It is for these three reasons that CBT is a beneficial approach to practice as a counselor, especially school counselors that need to provide efficient, quality counseling services to meet the diverse needs of many different students.

Cognitive-behavioral therapy, like all theories in counseling, has limitations for multicultural counseling. Due to the fact that CBT requires clients to explore in depth their core values and beliefs, it is only ethical for the therapist/counselor “to have some understanding of the cultural background of a client and to be sensitive to their struggles(Corey, 2005).” Also, diverse cultures may be hesitant or offended to CBT because it is an approach that asks the client to confront their basic cultural values. One final potential limitation of CBT is that culturally diverse clients may become dependent on the counselor to tell them appropriate ways to solve problem and to make decisions for them.

Reference

Corey, Gerald (2005). Theory and Practice of Counseling and Psychotherapy.

Belmont, CA: Brooks/Cole-Thompson Learning.

Kazdin, A.E., Bass, D., Siegel, T., & Thomas, C. (1989). Cognitive-Behavioral

therapy and relationship therapy in the treatment of children referred for

antisocial behavior. Journal of Consulting Clinical Psychology, 57, 522-35.

Reinecke, AuthorMark A., & Simons, Anne (2005). Vulnerability to depression among

adolescents: Implications for cognitive-behavioral treatment. Cognitive and

Behavioral Practice. 12, 166-176.

(2003). Child and Adolescent Treatment. Retrieved September 23, 2006, from The

American Institute for Cognitive Therapy Web site:



(2002). UCLA Health Services Research Center. Retrieved September 24, 2006, from

Cognitive behavioral intervention for Trauma in Schools Web site:



Cognitive-Behavioral Therapy Technique

Technique Name: Magic Box Thoughts

Theory on which it is based: Cognitive-Behavioral Therapy Technique

Purpose-Goal and Objectives:

• The student will recognize his/her negative self-talk that is causing current problems in the classroom.

• The student will generate his/her own positive self-talk to confront his/her negative thoughts.

• The student will be able to conscientiously think about his/her negative thoughts and try to transform them into positive thoughts and thus positive behavioral reactions in the classroom.

Counseling Stage Appropriate: middle/working stage

Age Group: Third/Fourth Graders

Population: depressed students/ students with low self-esteem

Length of time needed: 20-30 minutes

Materials needed: Magic Box thoughts Sheet, notecards, magic box(tape, scissors, markers), pencil

Steps to doing the technique:

Previous session/homework- Write on notecards negative self-talk that you experience in school and at home.

Seesion Plans:

1. Share and review completed notecards.

2. Review the theory that we do and feel things simply because we think such negative thoughts about ourselves. Provide examples.

3. Complete Magic Box worksheet.

4. Write all generated positive self-talk sayings on notecards and place in the positive side of the Magic Box.

5. Demonstrate Magic Box. Place the negative notecard in one side. Discuss that the Magic Box transforms the negative thoughts to positive thoughts. Explain that your brain can do the same thing.

6. Next, explain that when you feel as though you are talking negative talk write it down on a notecard and place it in the Magic Box. After placing the negative self-talk in one side, then pick out a positive self-talk notecard from the other side.

7. Explain that you, as a student, can make these transitions to your thoughts just like the Magic Box. However, whenever you are faced with a negative thought and you just need some help to get you thinking more positively about yourself you can put in a negative self-talk card and talk out a positive self-talk card.

8. Make sure the student understands that occasionally you may need to replace the positive self-talk cards occasionally. However, after awhile you should be more aware of your self-talk and should have enough practice with positive self-talk that the Magic Box may not even be necessary anymore.

9. Give the Magic Box full of positive talk cards to the students to take home and practice for homework.

10. Review next time how it is working.

Name:______________________________ Date:_____________________________

Directions: Fill in three negative self-talk statements that you have experienced in the past week. After doing so, fill in three positive self-talk statements for each negative self-talk statement. Then copy all your positive self-talk onto notecards and place the notecards in the positive side of the Magic Box.

|Negative Self-Talk |Positive Self-Talk |

|1. |a) |

| | |

| |b) |

| | |

| |c) |

| | |

|2. |a) |

| | |

| |b) |

| | |

| |c) |

| | |

|3. |a) |

| | |

| |b) |

| | |

| |c) |

| | |

|4. |a) |

| | |

| |b) |

| | |

| |c) |

| | |

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