Despite the general acknowledgement that it is important for counseling and psychotherapy practice to be informed by research, it is clear that in recent years a widening gap has emerged between research and practice. This paper briefly reviews some of the factors responsible for the current crisis in therapy research and offers a number of reasons why a healthy relationship between research and practice is necessary.
It is suggested that, at present, there exists within psychology and social science a level of acceptance of pluralistic and innovative approaches to research, which may facilitate the emergence of a new genre of practitioner-oriented inquiry in the field of counseling and psychotherapy. Some of the ways in which Counseling and Psychotherapy Research intends to contribute to this movement are described, for example the promotion of new forms of writing, use of information technology, and the creation of knowledge communities.
While it might seem to be the case, evidence-based psychotherapy is not new. The term “evidence-based” can be defined two ways: an approach to therapy emphasizes the pursuit of evidence on which to base its theory and techniques, as well as encourages its patients or clients to consider evidence before taking action; or an approach to therapy is supported by research findings, and those findings provide evidence that it is effective. Each approach to psychotherapy is based on the assumption that it is correct in terms of its explanation of human behavior.
Therefore, practitioners of each approach believe that they have “evidence” that their approach is correct, or they would not waste their time practicing that approach. However, cognitive-behavioral therapists seek to acquire evidence to determine the accuracy of their theories and effectiveness of their techniques. For example, cognitive-behavioral therapists believe that their explanation of human behavior (that “learned” behaviors and emotions are caused by one’s thoughts) is correct.
Rather than assuming that their theory is correct, they base this assumption on psychosomatic research that in fact proves that the assumption is indeed correct. Cognitive-behavioral therapists take into the therapy session this interest in gathering evidence and assessing it. Cognitive-behavioral therapists ask questions to obtain a clear, accurate picture of the client’s experience. Cognitive-behavioral therapists also look for evidence in relation to their clients’ thoughts, and encourage clients to base thinking on the FACTS (the evidence).
Therefore, cognitive-behavioral therapy has always been “evidence-based” and will continue to be so whether or not there is an emphasis by managed-care or governmental agencies to be so. Many approaches to psychotherapy do not lend themselves well to being researched and proven effective because they either utilize techniques that are vague and difficult to repeat with consistency, or the approach attracts practitioners that are not very interested in testing the effectiveness of it.
Cognitive-behavioral therapy is the most researched psychotherapeutic approach because each cognitive-behavioral approach has specific techniques that can be tested for effectiveness; Cognitive-behavioral therapy encourages the development of specific goals that are measurable, and, therefore, can be researched; cognitive-behavioral therapists (to varying degrees) are interested in the research and research process; cognitive-behavioral therapists are not interested in techniques that “feel right” or “seem correct”, but techniques that are effective (Pucci, 2005). Cognitive-Behavioral Therapy
Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and “negative” emotions. (Maladaptive behavior is behavior that is counter-productive or interferes with everyday living. ) The treatment focuses on changing an individual’s thoughts (cognitive patterns) in order to change his or her behavior and emotional state. Theoretically, cognitive-behavioral therapy can be employed in any situation in which there is a pattern of unwanted behavior accompanied by distress and impairment.
It is a recommended treatment option for a number of mental disorders, including affective (mood) disorders, personality disorders, social phobia, obsessive-compulsive disorder (OCD), eating disorders, substance abuse, anxiety or panic disorder, agoraphobia, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD). It is also frequently used as a tool to deal with chronic pain for patients with illnesses such as rheumatoid arthritis, back problems, and cancer. Patients with sleep disorders may also find cognitive-behavioral therapy a useful treatment for insomnia.
Cognitive-behavioral therapy combines the individual goals of cognitive therapy and behavioral therapy. Pioneered by psychologists Aaron Beck and Albert Ellis in the 1960s, cognitive therapy assumes that maladaptive behaviors and disturbed mood or emotions are the result of inappropriate or irrational thinking patterns, called automatic thoughts. Instead of reacting to the reality of a situation, an individual reacts to his or her own distorted viewpoint of the situation. For example, a person may conclude that he is “worthless” simply because he failed an exam or did not get a date.
Cognitive therapists attempt to make their patients aware of these distorted thinking patterns, or cognitive distortions, and change them (a process termed cognitive restructuring). Behavioral therapy, or behavior modification, trains individuals to replace undesirable behaviors with healthier behavioral patterns. Unlike psychodynamic therapies, it does not focus on uncovering or understanding the unconscious motivations that may be behind the maladaptive behavior. In other words, strictly behavioral therapists do not try to find out why their patients behave the way they do, they just teach them to change the behavior.
Cognitive-behavioral therapy integrates the cognitive restructuring approach of cognitive therapy with the behavioral modification techniques of behavioral therapy. The therapist works with the patient to identify both the thoughts and the behaviors that are causing distress, and to change those thoughts in order to readjust the behavior. In some cases, the patient may have certain fundamental core beliefs, called schemas, which are flawed and require modification. For example, a patient suffering from depression may be avoiding social contact with others, and suffering considerable emotional distress because of his isolation.
When questioned why, the patient reveals to his therapist that he is afraid of rejection, of what others may do or say to him. Upon further exploration with his therapist, they discover that his real fear is not rejection, but the belief that he is hopelessly uninteresting and unlovable. His therapist then tests the reality of that assertion by having the patient name friends and family who love him and enjoy his company. By showing the patient that others value him, the therapist both exposes the irrationality of the patient’s belief and provides him with a new model of thought to change his old behavior pattern.
In this case, the person learns to think, “I am an interesting and lovable person; therefore I should not have difficulty making new friends in social situations. ” If enough “irrational cognitions” are changed, this patient may experience considerable relief from his depression (Ellis, 2008) A Cautionary Statement About Psychotherapy Outcome Research Most psychotherapy outcome research is focused on short-term reduction of symptoms, and this is the reason why many “studies” find that cognitive-behavioral therapy is as effective as antidepressants in the treatment of depression.
This has been a pretty consistent finding. However, cognitive-behavioral therapy is focused on “getting better” rather than “feeling better”. So while we are encouraged that clients improve their symptoms with cognitive-behavioral therapy, we are more interested in helping them with the underlying thoughts and core beliefs that caused their emotional distress, helping them rid themselves of problematic, inaccurate thoughts, and replacing them with thoughts that are healthy and accurate. This emphasis on “getting better” helps clients to do well long-term.
Today, many treatment centers and facilities are very interested in having their staff trained in cognitive-behavioral therapy (Pucci, 2005). Christian Faith in Clinical Practice Use of Religious and Spiritual Resources in Therapy (e. g. , prayer, inner healing prayer, use of Scripture in therapy, referral to religious groups, etc. ); Dealing with Spiritual Issues in Therapy; Fostering Intrapersonal Integration and the Development of Spirituality in the Therapist and Client (Use of Spiritual Disciplines and Role of Authentic Disciplines or Circumstantial Spiritual Disciplines); Mindfulness-based Cognitive Therapy (MBCT) that combines mindfulness training with CBT for the treatment of depression and its recurrence; Dialectical Behavior Therapy (DBT) with four major components: regulating affect, tolerating distress, improving interpersonal relationships, and training in mindfulness; Acceptance and Commitment Therapy (ACT) with six major components: acceptance, cognitive diffusion, being present, self as context with a transcendent sense of self, values, and committed action; Ethical Guidelines.