There are many types of therapeutic approaches that therapist use to help their clients work through their issues. A popular and effective one is cognitive behavioral therapy. To help you understand cognitive behavioral therapy I have interviewed Robert Reiser Ph.D who is a licensed psychologist in Marin, California.
Tell me a little bit about yourself.
“I am a licensed psychologist who specializes in cognitive or cognitive behavioral therapy. I have a private practice in Marin County California and I run a psychology-training clinic in Los Altos for a graduate school called Palo Alto University. I trained in cognitive therapy at the Beck Institute outside of Philadelphia and I am certified as a fellow of the Academy of Cognitive Therapy. I am particularly interested in working with people with more serious disorders including chronic depression, bipolar disorder, and psychotic disorders.”
What is cognitive behavioral therapy?
“Cognitive behavioral therapy is a type of psychotherapy developed by Aaron Beck that involves a very structured, problem-oriented and somewhat directive approach to helping people manage problematic feelings and behaviors. It is typically time-limited or at the least, time effective, in terms of being a focused problem oriented approach. It tends to take a very practical approach to problems and the intent is to work with clients in terms of their current problems in ways that will be helpful.”
“Cognitive behavioral therapy also takes a highly collaborative approach in terms of helping clients identify and resolve their emotional problems. Cognitive behavioral therapy or cognitive therapy takes the point of view that the way people think about things determines how they feel and how they behave. A central tenet of cognitive behavioral therapy is that people make unhelpful assumptions, hold important but not necessarily accurate or valid beliefs about themselves and others, and that these beliefs and expectancies, these schemes or ‘core beliefs’, or ways of viewing the world can cause problems in terms of how people respond to others. For example an individual who grew up in a physically abusive family might continue to view others as threatening and this might interfere with developing intimate relationships later in life. Viewing others as threatening was appropriate and protective in the childhood environment, but is a problematic ‘core belief’ that does not translate well into the adult world.”
“Problems can be broadly classified into problems related to emotional responses or reactions (usually involving distressing emotions- anxiety, fear, sadness, anger) and problems related to behavioral responses or behaviors (over-reacting, getting angry at others, withdrawing, isolating, etc.). Thoughts, feelings and behaviors are seen as having an important reciprocal relationship such that interventions that help people change their way of thinking can result in improvements in how they behave, and vice versa.”
Who can benefit from cognitive behavioral therapy?
“Cognitive behavioral therapy has been shown to demonstrate benefit for a wide range of problems across a variety of populations. Currently, there are over 325 experimentally controlled and well designed studies which have demonstrated that cognitive behavioral therapy is effective with a range of disorders including anxiety, PTSD-trauma, obsessive compulsive disorders, depression, bipolar disorder, schizophrenia and other psychotic disorders, eating disorders, substance use disorders, a wide variety of behavioral health problems, including obesity, insomnia, health anxiety (aka hypochondriacal disorder) and a wide range of other medical conditions. This is not a complete list.”
Are there certain types of issues that benefit more from cognitive behavioral therapy?
“Cognitive behavioral therapy has been shown to be effective with a wide range of problems, but the strongest empirical evidence involves anxiety and mood disorders. In addition, cognitive behavior therapy may be a good choice for people who want to take a concrete, practical approach to resolving their problems.”
What types of cognitive behavioral techniques are used on a client?
“Cognitive behavioral therapy tends to be a practical, problem oriented approach, which focuses on addressing current problems that the client is experiencing. Cognitive behavioral therapy uses a key technique called Socratic questioning or guided discovery that is a form of directed questioning designed to help the client think about their problems from a broader, more helpful perspective. This type of therapy by definition focuses on how people think about things, their beliefs about themselves and the world, and tries to identify unhelpful beliefs or assumptions. In addition, this type of therapy can focus on making small changes in behavior to help clients get out of a cycle of anxiety or depression. There is often a very practical concrete focus to the sessions in which the client is asked to focus on a problem that occurred over the past week in which they experienced distress or negative feelings or during which they had problems in terms of their behavior and responses.”
“A number of specific techniques are used. One technique often used involves using a ‘Thought Record’ in order to help the client look in detail at specific situations, the thoughts they were having, the emotional distress they were experiencing, and the outcomes of the situation. In using a Thought Record and carefully monitoring thoughts and feelings, there is a collaborative effort to understand how the clients thinking might be unhelpful in terms of their response to situations. Using guided discovery and Socratic questioning the therapist would help the client identify more helpful ways of thinking or ways of behaving.”
“Another technique that is often used is to help the client monitor their behaviors and specifically their activities to look at activities that are connected to feelings of enjoyment or mastery. For clients who are depressed, they have often begun to change their level of activity and engagement with others in a direction that maintains their depression. By using relatively simple techniques called behavioral activation, the therapist will encourage the client to become reengaged in behaviors that are likely to be more rewarding and pleasant. This has been shown to be a very powerful technique in terms of helping people who are depressed return to a former higher level of functioning.”
How much does it cost to get cognitive behavioral therapy?
“The cost of cognitive behavioral therapy in the Bay Area or San Francisco Bay area can range from $125-$225 for licensed practitioners, depending on the choice of therapist (Masters, nurse practitioner, psychologist, psychiatrist) and the skill level and expertise of the therapist. There are a few lower-cost training clinics including my training clinic called the Kurt and Barbara Gronowski clinic in Los Altos which offers a modest sliding scale fee for doctoral level students in training supervised by licensed psychologists. In general, I would advise using the Academy of Cognitive Therapy Website to search for accredited practitioners. While many therapists claim to practice cognitive behavioral therapy, I would look closely at their training and experience.”
What advice would you like to leave for someone who is thinking about getting cognitive behavioral therapy?
“All therapy is dependent upon establishing a strong and positive therapeutic relationship in which the client feels that there is an emotional bond with the therapist and the client feels that the therapist is going to be helpful. It is important that you feel comfortable with the person that you choose, even if that involves interviewing several therapists. Cognitive behavioral therapy can be a good choice for people who are looking at a problem oriented, time effective therapy that focuses on current problems and takes a relatively practical approach.”