Psychotherapy is one of the leading forms of psychological studies in America. It is used as a crucial part of finding out how counseling can help individuals overcome many emotional problems they face in their everyday lives. Even though many of the theories do overlap one another, they all are very useful in helping to develop a normal life for individuals who are looking to achieve a positive goal from therapy. Therapy can also help with clearing up any biases and schemas in a person’s life and thought process. The two theories I have chosen to compare is cognitive behavioral therapy and person center therapy. These two styles of therapies have the same goal in mind, and that is to change the lives of their clients and build a relationship of honesty, genuineness, and unconditional positive regard to their problems in their lives.
Both cognitive behavioral theory (CBT) and person-centered approach (PCA) were developed in the mid 20 th century to address the complex emotional problems faced by clients. According to Josefowitz & Myran (2005), a positive therapeutic alliance across all modalities in psychotherapy improves patient outcome. PCA was developed by Carl Rogers in the 1940s; its focus is on the importance of the therapeutic relationship with the client to inspire change. Carl Rogers was a radical; he developed PCA as a nondirective form of treatment (Anderson, 2001). PCA moved away from the notion that a therapist is the expert, and instead focused on the need to build a positive client-therapist relationship. A positive relationship can only be formed if the therapist possesses positive characteristics to nurture the relationship. This helps the client to see the actual genuineness in the counselor therapy sessions. The counselor must show and be willing to be fully transparent and honest so that the client cannot only develop an open dialogue with the therapist. The therapist must adopt an empathic and non-judgmental approach towards the client throughout the therapy session (Marriott & Kellett, 2009). Eventually, the state of the client-therapist relationship will determine the outcome of the treatment. Once a positive relationship has been established, client self-actualization will take place throughout the therapy process. Self-actualization is the main concept of the therapy process.
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PCA is characterized by unique interventions and processes, but some of them are borrowed from CBT. Rogers developed a framework to help counselors develop an effective therapeutic alliance with patients by identifying the three necessary conditions for therapy (Josefowitz & Myran, 2005). The conditions include acceptance of the client, empathy, and therapeutic genuineness. Rogerian approach to PCA has been developed over the years into a complex and wide therapeutic orientation. There are now tow approaches to PCA: experientialists and non-directive, client-centered group (NDCC). Experientialists maintain Rogers’ focus on the centrality of the therapeutic relationship, but experiment on other aspects. NDCC focuses on non-directive empathic therapy. In PCA, therapists believe that clients have the ability to deal with their situations and the role of the therapist is to provide full knowledge to the client in a genuine, empathic, non-judgmental, and non-directive approach. The therapist explores the client’s story fully to help clients be aware of their thought processes.
On the other hand, CBT was developed primarily to treat depression, but it has been applied to a wide range of emotional problems. The father of CBT, Aaron Beck, developed CBT by borrowing on Freudian perspective pertaining depression. Beck found out that he could not replicate Freud’s outcome, and eventually decided to work on his own empirical theory, thus the formation of cognitive behavioral therapy. CBT is based on the notion that thoughts, feelings and actions interact, such that negative thoughts and actions lead to maladaptive behaviors (Basco et al., 2000). When CBT is applied correctly, the therapist will help the client alter thoughts and even reveal the possible reasons behinds the client’s misinterpretation of thoughts and feelings. CBT is a structured, it moves through phases and the therapist directs the course of the treatment (Josefowitz & Myran, 2005). When CBT is not conducted properly, the clients are more likely to feel judged rather than understood. Therapists are encouraged to add empathy to CBT sessions to help build a positive therapeutic alliance with clients.
CBT has a way of uncovering and altering the client’s distorted perception of self. CBT therapists ask clients a series of questions to unearth the underlying motive for their problems (Lin, 2002). Once the root of the problem has been identified, it will be easier to alter the client’s thought process. The model has a thought tracking plan to help the patient to control his/her thoughts outside therapy. Once the client understands and alters the cognitive patterns, the brain is re-oriented on how to think differently. The behavioral response is also altered at the same time to help clients react better to their thoughts.
The two approaches have similarities in their basic premises. According to Tursi & Cochran (2007), the basic premise of CBT is the relationship between thoughts that lead to emotions. CBT is applied to change the detrimental thoughts through cognitive restructuring aimed at changing one’s perception. Cognitive restructuring is also applied in PCA. Rogers commented that, “When the perception changes, the reaction of the individual changes” (Tursi & Cochran, 2007 p. 388). In CBT, there are schemas, which are beliefs that play an important role in the perpetuation of a problem. The CBT concept of schemas is almost similar to the concept of the perceptual map in PCA. Alternatively, CBT’s concept of irrational belief is similar to the concept of illogical thinking in PCA (Tursi & Cochran, 2007). Rogers commented that there are many irrational aspects of our thinking, in other words, paraphrasing the goal of CBT process, which is to help clients move away from the negative and untrue thoughts that affect their emotions and actions. Evidently, key aspects of CBT and PCA approaches overlap because the two approaches have common goals.
CBT and PCA have similarities regarding their therapeutic interventions. They both make use of the core concepts of empathy, positive regard and congruence (Marriott & Kellett, 2009). In both approaches, a congruent counselor uses the skills of reflection to make clients open up about their problems and other factors that play a role. Counselors use a host of awareness techniques to make the clients understand and deal better with their situations.
Additionally, the two approaches could work hand in hand when working with clients with depression, eating disorders, and stress related issues. Both approaches demonstrate that the maladaptive behavior among patients is attached to their thought process, which can be transformed positively to produce positive behavior. The two therapeutic approaches assess the issues facing clients differently, but there are areas where CBT and PCA converge (Tursi & Cochran, 2007). Both CBT and PCA have a lot in common since they have the same goals. One of the significant principles of PCA is unconditional positive regard for patients, and this is applicable in CBT. PCA warns counselors against making value judgments about clients, even when the judgment is positive instead, counselors must be guided by empathic listening. During the sessions, therapists focus on making the clients become self-aware. The therapist probes in an empathic manner that shows positive regard for the client and client’s issues. Empathic therapy is also practiced in CBT. Beck stressed on the importance of warmth, empathy, and genuineness in CBT therapy sessions. When empathy is practiced in CBT sessions, the client will not feel judged and the process will have a higher chance of success.
There are notable differences between the two models. The differences are seen in the underpinning assumptions, key techniques used and the therapeutic relationship. According to Anderson (2001) PCA is client-centered therapy process that is based on the assumption that clients are capable of changing their situations with the right knowledge at their disposal. Therefore, therapists make the clients to be self-aware in a way that makes them want to change their situations. On the other hand, the key assumption of CBT is that thoughts, feelings, and actions interact. CBT therapists teach clients to alter their thinking process.
Both CBT and PCA apply different techniques. When using PCA, the focus for the therapist is to get the client to be self-aware of what he/she is saying. Therapists use the reflection process to make clients self-aware. The therapist probes the client in a genuine and caring manner while showing positive regard for the client and client issues. PCA sessions lack a structural plan; instead, the therapist focuses on the relationship with the client to understand the problem better. On the other hand, in a CBT session, therapists use different techniques to assess the client needs. CBT therapists have the freedom to be more engaged in the therapy sessions, hence they guide the process by helping clients come up with goals and understand and alter their thought process. CBT therapists make use of reflective questioning to enable the client to understand and assess himself or herself throughout the process. Unlike person-centered therapy, CBT is a structured process with a plan. The therapist has a prior plan to guide the therapy process.
Still under the key techniques, both approaches use different processes to effect change. In CBT, a therapist equips clients with skills to rethink and change the unspoken motives behind their thought process to understand the cause of the distortion (Szentagotai, 2005). CBT uses a humanistic approach to behavior to help clients understand how distorted thoughts affect behavior, and once the clients change their thought process, the change is reflected in behavior. The positive change in behavior occurs in a period of 6 to 12 weeks with CBT. Alternatively, in PCA, the change might take a little longer to occur. Person-centered therapy is not structured and it lacks a plan of action to guide the process. Therapists using PCA rely on reflection and self-awareness instead of guiding the process. PCA is not collaborative like CBT, hence the behavior change might take longer because clients take longer time to identify their irrational thoughts and change them on their own.
The therapeutic relationship in PCA and CBT sessions has some notable differences. Under the two approaches, therapists have a different approach to the client-therapist relationship. In PCA, the therapist uses a non-directive technique to help clients achieve self-actualization. The therapists must be supportive and willing to accept clients for who they are. In PCA, the focus is a positive client-therapist relationship; therapists must connect with clients on a deeper level otherwise the clients will not open up. In PCA therapy, therapists must be available emotionally for their clients. They must accept clients for who they are; hence, they listen to clients without evaluating, judging, disapproving, or censoring certain aspects of the client’s feelings, actions and characteristics (Simms, 2011). Therapists using person-centered approach must practice active listening; they must pay attention and maintain eye contact. Therapists apply reflection to paraphrase and summarize client information in an effort to get the client to examine their own thoughts and feelings as they repeat them to the therapist. On the other hand, the client-therapist relationship in CBT is guided by the directive technique. The therapist helps the client process information and different aspects of their behaviors. CBT therapists use a wide range of skills, ranging from reflection to Socratic discussion to make clients open up. The therapist asks questions, makes interpretations, and directs the client’s attention and emotions during the session. The therapist is actively involved in the session, hence the notion that cognitive behavioral therapy is manipulative. The therapist then uses various intervention skills and exercises to change patient behavior.
The nature of CBT explains why it is a short-term treatment method in comparison to PCA. Therapists engage in active dialogue with the clients to encourage change, therapists give homework and often ask the clients to keep diaries of the progress. CBT sessions are well planned, each session with an objective of achieving the main goal systematic (Szentagotai, 2005). The therapist tracks progress and use various motivating factors to encourage change in clients. On the other hand, the non-directive and non-structured nature of PCA makes it hard to put a time frame in the treatment process. PCA therapy takes longer as clients take time to be self-aware and change their thinking process on their own.
Each approach has its own strengths and shortcomings (Wedding & Corsini, 2014). A notable strength of the person-centered therapy is that it gives clients the freedom to express themselves. The therapist in a person-centered approach plays an active listening role only. The therapist develops a positive relationship with the client to encourage the client to open up about his/her needs in a nonjudgmental environment. PCA puts the responsibility of change in the hands of the client, such that the client is responsible for growth and change in behavior. PCA gives the clients the necessary tools to address personal problems without relying on the therapist. Once a client is self-aware, the client will be able to address the dysfunctional thoughts (Anderson, 2001).
Another significant strength of person-centered approach is that clients are accepted for who they are without judgment or pressure to change (Proctor, Tweed & Morris, 2016). The therapist is only supposed to show empathy and give clients a chance to express their true feelings in an effort to make them better. PCA therapy also gives clients a chance to reflect on their past behaviors, and identify areas that they need to work on.
On the negative side, the client is not challenged in a PCA therapy. According to Simms (2011), the therapist is an active listener in person-centered therapy, such that the therapist cannot question or suggest a better way to address the problem. The therapist does not offer his/her input, and it can be difficult for the client to achieve real progress. There is no intervention in PCA apart from the active reflection to encourage clients to talk about their problems. Person centered therapists cannot offer more help, even when the chances of a client attaining self-actualization are very slim.
Simms (2011) notes that PCA developed as early as the 1940s, yet it still lacks a theoretical background and a proper structure to guide it. There are many gray areas in person-centered therapy; individual therapists use their skills and knowledge to fill in the gaps as long as they observe the ethical principles of the profession. Without a proper structure, it is hard to evaluate the usefulness of the approach.
Alternatively, CBT is one of the leading forms of therapy today. It has shown the potential of addressing client issues because of the many positive techniques applied in CBT sessions. Studies on the effectiveness of CBT show that CBT has led to symptom reduction in patients with depression in comparison to other approaches (Beech, 2000). The most significant strength of CBT is that it is a directive approach. Therapists are encouraged to engage and guide clients to change their cognitive distortions. Cognitive behavioral therapists form a collaborative relationship with clients, whereby clients have to put in work and listen to their therapists if they want positive outcomes. The therapists must address the client with positive regard in an effort to change the schemas and biases responsible for client issues.
The collaboration between client and therapist is a significant strength of CBT. An equal partnership between client and therapist is sought in the interpretation of cognition (Beech, 2000). While the therapist guides the session, patients are still given the freedom to share their issues and even question their therapist when they are not agreeing with them.
On the flip side, the client’s wellbeing depends on the ability of the therapist to change cognitive distortion in the minds of their clients. The therapist must achieve that within the short period of therapy; otherwise, the client will be stuck with distortion. The structure and short-term nature of CBT requires a skilled therapist who will provide clear and effective directives needed by the client. The therapist must also ensure that the client follows through on the process, otherwise the client might not experience change by the end of the CBT intervention.
Beech (2000) explores the weaknesses of CBT in treating depression. Beech (2000) argues that the therapist’s subjective bias can affect the outcome of the intervention. First impressions and the way clients process information in the beginning affects the therapist perception on the rational cognitions and the ones that need restructuring. Beech (2000) also critiques CBT’s inability to explain physical symptoms that accompany depression, physical symptoms like sleep deprivation, aches, and lack of appetite.
In conclusion, CBT and PCA seem like two very different approaches to counseling due to the many differences in their underpinning assumptions, key techniques, and client-therapist relationship. However, a closer look at the two approaches shows that they share the same foundation. Both models believe that clients are capable of changing their distorted thought process. Both CBT and PCA also allow clients to participate in the process, though the level of client participation varies. Each model has its unique strength and weaknesses, therefore a therapist must be armed with both concepts to apply to the unique client situations.
References
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