UNIT 6 COGNITIVE AND BEHAVIOURAL Cognitive and

Behavioural Approach

APPROACH*

Structure

6.1 Learning Objectives

6.2 Introduction
6.3 Behaviour Therapy
6.3.1 Emergence
6.3.2 Assumptions
6.3.3 Theoretical Frameworks
6.3.4 Role of Client and Counselor
6.3.5 Techniques
6.3.6 Evaluation

6.4 Behaviour Modification

6.5 Cognitive Therapy
6.5.1 Emergence
6.5.2 Assumptions
6.5.3 Theoretical Framework
6.5.4 Role of Client and Counselor
6.5.5 Techniques
6.5.6 Evaluation

6.6 Rational Emotive Behaviour Therapy

6.6.1 Emergence
6.6.2 Assumptions
6.6.3 Theoretical Framework
6.6.4 Role of Client and Counselor
6.6.5 Techniques
6.6.6 Evaluation

6.7 Let us Sum Up

6.8 Key Words
6.9 Answers to Self Assessment Questions
6.10 Unit End Questions
6.11 References
6.12 Suggested Readings

*
Dr. Shivantika Sharad, Associate Professor, Department of Applied Psychology,
Vivekananda College, University of Delhi, Delhi 125
Theoretical
Approaches to 6.1 LEARNING OBJECTIVES B
Counselling

After studying this Unit, you would be able to:

• Develop an understanding of cognitive and behavioural approaches to

counseling and therapy;
• Explain behavior therapy, cognitive therapy and rational emotive
behavior therapy in terms of their assumptions, theoretical frameworks,
client-counselor relationship and techniques; and
• Analyze the therapies in terms of their applications, advantages and
limitations.

6.2 INTRODUCTION
The field of therapy was largely dominated by the school of psychoanalysis
(discussed in unit 4 earlier) in the early 1900s. The second half of the 20th
century however, brought about a change in this. In the 1950s a new school
of thought arose and this would gain momentum in the next 20 years or so to
not only rival the popularity of psychoanalysis, but also be the preferred
choice among the two alternatives.

The many behaviour and cognitive approaches that developed during this
time differed from psychoanalysis in two key ways:

• They emphasized on client action as opposed to client passively waiting

for insight
• They believed the locus of trouble to lie in the present, as opposed to the
past and childhood

In this Unit you will learn about behaviour therapy, behaviour modification,
cognitive behaviour therapy, and rational emotive behaviour therapy in terms
of their assumptions, theoretical frameworks used, techniques, major
applications and limitations.

6.3 BEHAVIOUR THERAPY

6.3.1 Emergence
Behaviourism advanced when J.B. Watson (1913) stated that only observable
behaviours can be the empirical roots that will sustain the field of Psychology
in the future. The 1950s and 1960s saw psychologists across the globe
simultaneously beginning to develop therapeutic approaches that relied on
theories of learning. These approaches emerged in the United States, South
Africa and Great Britain. They focussed on changing the behaviour of
individuals experiencing psychological distress to help them cope better.
Phobias, bed-wetting and tension-related disorders were being tackled using
126 insights from Pavlov’s classical conditioning. In Africa, Wolpe and Lazarus
(1966) were developing the technique of systematic desensitization around Cognitive and
Behavioural Approach
the same time while the theoretical frameworks for operant conditioning were
being laid down by Thorndike (1905) and Skinner (1938). Using learning as
a basis for therapy soon gained momentum. Bandura’s social learning theory
(1962, 1977) provided this movement a much needed caveat, i.e. empirically
proving the sociological variables that impact learning.

Behavioural repertoire:The sum total of voluntary and involuntary overt

behaviours

Learning: A relatively permanent, observable change in behaviour that

results from experience and practice

Shaping: Modelling behaviour through demonstration and prompting

6.3.2 Assumptions of Behaviour Therapy

1) Behaviour is a result of the external environment, internal cognitions and
other mental processes such as attitudes and beliefs.
2) Using learning theories are a valid method to bring about significant and
lasting psychological change.
3) The client plays an active role in decreasing her/his psychological
distress by learning new ways of coping and self-management.
4) Effectiveness of therapy is measurable using empirical methods i.e.
impact of therapy on the client can be measured using standardised
psychological tools.
5) Success of therapy is marked by translation of therapeutic goals to real
life situations, not just reproducing them during sessions or having
knowledge and insight regarding them.
6) The therapeutic goals can only be reached if the client has self-efficacy,
i.e., has faith that change is possible, and that she is capable of bringing
about that change.
7) Psychological ailments are not disorders, but “problems in living” (Fall,
Holden & Marquis, 2017).
8) Therapeutic interventions and techniques aren’t universal and must be
tailored to the needs of each client and their presenting problems.

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Theoretical
Approaches to
6.3.3 Theoretical Frameworks B
Counselling
The field of behaviourism has moved from its initial conceptualization of a
human being as a “tabula rasa” to viewing humans as ‘beings’ who actively
engage with their external environment through an internal world comprising
attitudes, beliefs and values. We will be discussing all the main theoretical
frameworks in the following section.

Classical Conditioning

Developed by Ivan Pavlov in the 1890s, Classical conditioning pairs a natural

stimulus (for instance, a rattlesnake, which naturally elicits fear) with a
neutral stimulus (for instance hearing a rattling noise), to get a desired
response i.e. fear. Eventually this would lead the neutral stimulus to produce
the same response as the stimulus i.e. even hearing the rattling noise would
elicit fear.

Operant Conditioning

This is the model of learning that focuses on rewarding individuals for

displaying desirable behaviours and penalising them for displaying
undesirable ones. Here learning is achieved through reinforcements and
punishments. Reinforcements work to increase desirable behaviour and
punishments work to decrease undesirable behaviours.

Table 6.1: Positive and Negative Reinforcements and Punishments

Positive Negative
(means adding) (means removing)
Removing something
displeasing to reward the
Adding some pleasurable
individual
Reinforcement things to reward the
(example: reduce bad body
(to increase the individual (example:
odour after showering; thus it
behaviour) giving chocolate to a child
reinforces taking shower that
for scoring 90% in a test)
removesthe negative stimulus
of bad smell)
Adding something Removing something pleasing
Punishment
displeasing (example: (example:not allowing the
(to decrease the
giving child a time-out for child to play video games for
behaviour)
128 throwing a tantrum) throwing a tantrum )
Social Learning Theory Cognitive and
Behavioural Approach
As opposed to the prevailing notions at the time, Albert Bandura (1977)
highlighted the importance of personal variables and observation in learning.
While he agreed that classical and operant conditioning were important
modes of learning, he laid emphasis on cognitive mediational processes i.e.
the role of thoughts, attitudes and values in learning. He also brought to light
the learning that occurs in humans just by virtue of being present in a certain
environment, through process like imitation and modelling and termed it
observational learning. These changes shifted the prevailing paradigm which
viewed children as being acted upon by their environment to their being a
reciprocal interaction between the environment and individual.

Cognition:The mental processes involved in gaining information, comprehending it and

storing it.

Cognitive mediational processes: Values, beliefs and attitudes of each individual towards the
stimuli. For instance, if the stimulus of a chocolate covered in a green wrapper is used and the
child has had a mint chocolate covered in a green wrapper before and disliked it, the child
would not salivate at seeing the chocolate or display behaviours showing a desire for the
chocolate.

6.3.4 Role of Client and Counselor/Therapist

Role of therapist in therapy

The therapist’s role is that of a teacher and model during therapy. His job
entails information collection, designing an intervention and continually
subjecting the outcomes of therapy to empirical validation. The process of
information collection would require the therapist to ask for presenting
problems, clarify them, synthesize an outcome behaviour with the client
which would subdue presenting problems, and create a therapy that would
lead to that outcome behaviour. The therapist is also responsible for
maintaining conditions favourable for behaviour change during the course of
the therapy and model ideal behaviour for the client.

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Theoretical Role of client in therapy
Approaches to B
Counselling
The client is an aware participant in the therapeutic process. She aids the
therapist in deciding what the outcome behaviour should be and participates
in therapeutic work through engagement, cooperation and self-monitoring.
These behaviours on the client’s behalf are essential for therapeutic work to
be successful. The client plays the role of an alert student during the therapy
and experiments with a variety of behavioural responses. This eventually
allows the client to increase her behavioural repertoire.

Relationship between client and counsellor

While behaviourists understand the appeal for warmth and empathy in a

therapy, they do not consider these attributes sufficient for change. Lazarus
(1989) considers a client’s respect towards the therapist as an essential
component of the therapeutic relationship as it allows the client to trust the
professional and engage in self-disclosure, both of which are invaluable for
therapy to translate into long lasting behavioural outcomes. Behaviourists
view counsellors as problem solvers who direct the client towards displaying
more adaptive behaviours.

6.3.5 Techniques
The following is a brief description of counselling techniques arising from
different behavioural approaches:

1) Relaxation training: This method focuses on achieving mental and

muscle relaxation. The clients are initially given extensive instructions
and then expected to practice it on their own. Relaxation training can last
anywhere between 4 to 8 hours of guided instruction (Corey, 2012), but
is also being administered in an “abbreviated format” now (McNeil and
Lawrence, 2002). Clients are taught the technique and expected to
practice it as homework. They may also be required to maintain a log of
their practice and experiences related to it.
2) Role play: After agreeing upon a behaviour which would be helpful,
client and counsellor engage in role play. For example, Kuhu has social
anxiety and finds it hard to communicate with strangers in public
situation. The counsellor in this case would assume the role of a stranger
(boy or girl) and Kuhu (the client) will try to exhibit the desirable
behaviour. She will go and say “hello” to the stranger and start
interaction with her. Role play allows the client to expose herself to the
stress-inducing situation in the safe environment of therapy. It also
allows her to correct responses she doesn’t like, and adapt to the varying
styles of conversations that the counsellor chooses. The counsellor can
be very kind, or rude or anxious like Kuhu herself!
3) Graded task assignment: This is a technique which is used in tandem
with other behaviour therapy techniques. An example of graded task
130 assignment during the role-play exercise above would be to first let Kuhu
 engage with a mild mannered counsellor-stranger. Step 2 would be to let Cognitive and
Behavioural Approach
her engage with someone who is loud and energetic and may be more
threatening to approach. Step 3 would be to let her engage with someone
who is hostile. The final gradation would be to have her reproduce the
results of the role play in the real world. Behaviourism also says that all
behaviours can be broken into smaller mini-behaviours. The gradation
technique uses this to break a complex task – i.e. talking to strangers –
into smaller and increasingly complex behaviours.
4) Activity scheduling: This refers to the creation of a daily routine or
activity list. The therapist and client together create this in order to
provide structure for the client. It helps an anxious client be aware of her
priority actions and also answerable to the counsellor for them. It also
stops a depressed client from falling back into inactivity and slumber.
5) Pleasure rating: This technique relies on the pleasure received from
positive reinforcement. The therapist asks the client to chart how much
pleasure she anticipates before performing the desired behaviour and the
amount of pleasure she actually feels after performing the desired
behaviour. If the pleasure felt after receiving the reinforcement (for the
desired behaviour) is more than anticipated, it provides a push for the
client to repeat the desired behaviour.
6) Systematic desensitization: This technique requires the client and
counsellor to chart the client’s anxiety provoking stimuli in a hierarchy –
from least threatening to most threatening. Let’s say that the client is
scared of rejection. The client is then exposed to the anxiety provoking
stimuli in an ascending order. Once the client begins to master facing the
least threatening stimuli (for example, just the thought of being rejected
by a stranger), then the therapist moves on to the next level (for example,
a person you wanted to befriend ignored you when you said “hi!”). This
technique can be employed through imagery – wherein the client and
counsellor imagine scenarios and calibrate a response for them or in vivo
(real life), wherein the client is asked to perform the behaviours in the
real world.
7) Flooding: Instead of rating the threatening stimuli in an ascending order,
this technique exposes the client to the most threatening stimuli directly
and fully after teaching relaxation to the client prior to it– which in the
above example could be the client approaching a stranger to befriend,
and then stranger not only refusing friendship, but also making fun of the
client. This technique uses the theory of classical conditioning. Classical
conditioning pairs natural stimulus (need for belonging) with a
conditioned stimulus (mockery by peers) to elicit a conditioned response
(feeling disheartened, alone and unloved). Flooding relies on the fact that
in the absence of the conditioned response (feeling disheartened, alone
and unloved), the conditioned stimulus would lose its effectiveness i.e. if
we can arrange for a client to feel loved and safe in a therapeutic
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Theoretical environment, mocking by peers wouldn’t cause debilitating anxiety after
Approaches to B
Counselling a while.
8) Aversion therapy: This technique is employed in order to discourage
unhealthy behaviours in clients. This is particularly helpful in cases
where clients have drinking, smoking and drug addictions. Here the
pleasurable stimulus (alcohol) is paired with a painful stimulus (e.g.,
mild electric shocks). The client is asked to consume alcohol while the
therapist and medical professionals administer mild electric shocks per
sips. These shocks act as positive punishment (addition of something
unpleasant) and decrease the problematic behaviour.
9) Eye Movement Desensitization and Reprocessing (EMDR): This
technique has been employed vastly as a solution for trauma. The goal of
this technique is to use minimum exposure to trauma and to re-write
one’s memories to be more adaptive and helpful narratives, instead of
anxiety provoking ones. Let’s take the case of Riya, a girl who was
physically abused by her father as a child and had to be hospitalised as a
result more than once. In this case, the therapist recognised through
intensive interviews and history taking that Riya’s memories cause her to
think “I deserved to be hit. I was a bad daughter”, which then leads to
anxiety attacks. EMDR would require Riya to perform three tasks almost
at the same time: 1) recall the memory 2) verbalise what she thinks when
she recalls the memory and 3) constantly look at the therapist’s index
finger which rhythmically moves back and forth at a quick pace. This
third task makes sure that though a traumatic memory is being recalled
and disturbing cognitions are arising from them, the client is actively
engaged in another task physically – looking at the therapist’s moving
finger. The technique’s aim is to rephrase these cognitions into more
adaptive statements like, “I was as good as I could be”, “I am safe now
and there is no need to worry”.

6.3.6 Evaluation
Contributions

• Applications: Behaviour therapy techniques can be used as interventions

for anxiety and phobias (flooding, systematic desensitization, etc.),
depression (activity logs, relaxation training, etc.) and even trauma
(EMDR).
• Critical evaluation of both therapy and client: Neither what the
therapist offers nor what the clients think are “unconditionally
accepted”. The therapist continually evaluates his interventions
empirically and also challenges the client’s assertions of limitations or
“problems in living”
• Ethical benefits of a positivistic inclination: A behaviour therapist has
clear-cut boundaries. They delve in a client’s life only to the extent to
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 impact behaviour – thereby don’t have to face many grey areas ethically. Cognitive and
Behavioural Approach
Ethicality of the therapeutic relationship therefore can be maintained
much more easily.
• Transfer of knowledge: Large groups of people can be trained to
provide behaviour therapy and as interventions can be learned by all
clients, it’s effectiveness increases.
• Time and money effective: As the therapy is time bound and short term
(compared to other modes of therapy), it is monetarily and temporally
convenient.
• Global reach: As the theoretical roots of this approach are well known,
behaviour therapy is available across the globe in in varying formats.

Limitations

• Power imbalance between the counsellor and client: This approach

views the therapist as the expert and the client as a “student” who must
“learn and imbibe” from the therapist. The power dynamics in the
therapeutic relationship are therefore lopsided – with the control residing
with the therapist. This can result in clients feeling obligated to “go
along” with whatever the therapist says, even when they are
uncomfortable with it. This can also lead to high attrition rates (clients
leaving therapy before completion).
• Symptom focussed solutions: Behaviour therapy aims to change
behaviour – the symptoms of a supposedly unobservable cause – through
theories of learning. The underlying causes however, are never really
brought forth. So even though behaviour therapy cause the behaviour to
change in specific situations, the cause continues to remain and may
continue to cause problems in the future.
• Lack of emphasis on client’s emotional world: The client’s emotional
world – how they feel about their problem or the therapy or the therapist
– are all not only irrelevant to therapy but not even discussed during the
course of therapy. The client’s emotional state can be very useful for
therapy and provide great insight to a therapist. Ignoring this aspect of a
client completely is one big lacking of behaviour therapy.

More to Know:

Clients leaving therapy before completion is very common. In a 2008 article,

Barrett et.al. discuss the many reasons why most therapies have a high rate of
attrition. The age, gender, ethnicity, distance to travel in order to receive
therapy, the waiting period and many more factors come together to
determine why clients leave therapy before completion.

1) What do you think happens when people withdraw from therapy before
completion?

133
Theoretical 2) Can you think of reasons why you or someone you know would lleave
Approaches to B
Counselling therapy?
3) Should they leave therapy or should they stay?
4) How would you as a counsellor deal with a client who wants to leave?

6.4 BEHAVIOUR MODIFICATION

Using theories of learning in therapy to eliminate or reduce undesirable
behaviours is called behavior modification. All the therapeutic interventions
mentioned in the section above can be called behaviour modification
techniques.

In 1977, an American psypsychotherapist,

chotherapist, Donald Meichenbaum, developed
Cognitive Behavior Modification (CBM). Much like the behavior
modification techniques described in the previous section, this technique also
aimed to change behaviour.

Fig. 6.1: Meichenbaum’s Cognitive Behaviour

our Modification

Unlike the above techniques however, this one focussed on a person’s inner
thoughts as a source of unhealthy behaviour and therefore believed in
changing those thoughts in order to change behaviours. Cognitive behaviour
modification is a ttherapy
herapy that employs a teaching approach wherein the
counsellor teaches the clients (or the client teaches herself) different skills.
CBM works in a 33-step step framework: (i) observing one’s thoughts, (ii)
changing thoughts which lead to maladaptive behavior an and (iii) acquiring
skills that help individuals to cope better. Meichenbaum focussed on helping
his clients develop skills to cope with stress, and made the term “stress
inoculation” famous. Like humans are vaccinated with weaker or dead
134 viruses to help the
them
m develop immunity against these viruses, Meichenbaum
thought that exposing people to smaller stressors, bit-by-bit, would help them Cognitive and
Behavioural Approach
develop tolerance towards bigger stressors.

Self Assessment Questions 1

1) What is the difference between systematic desensitization and flooding?

…………………………………………………………………………….
…………………………………………………………………………….
…………………………………………………………………………….
2) Name the major theories that provide the bases for behaviour therapy.
…………………………………………………………………………….
…………………………………………………………………………….
…………………………………………………………………………….
3) What is behaviour modification?
…………………………………………………………………………….
…………………………………………………………………………….
…………………………………………………………………………….

BEFORE WE GO AHEAD: Sorting Terminologies

The terms “Cognitive Behaviour Therapy (CBT)” and “Cognitive Therapy

(CT)” are often confused. Are they the same? Can we use them
interchangeably?

The answer is NO.

Cognitive Therapy (CT) was developed by Aaron Beck and is a type of

therapy. CBT on the other hand is an umbrella term used to describe the
many kinds of therapies that employ behavioural and cognitive tools to help
clients. CBT comprises of at least 20 different therapeutic styles, varying in
their techniques but sharing some bedrock assumptions like: the relationship
between therapist and client is collaborative, the basis of psychological
ailments are cognitive problems, their focus on psycho-education (teaching
client to cope better) as a means of changes and rely on the connection
between affect, behaviour and cognitions.

6.5 COGNITIVE THERAPY

6.5.1 Emergence
By the 1960s, behaviour therapy was slowly evolving to include
methodologies that worked on the unobservable – on thoughts, emotions and
the inner world. The influence of the inner workings of the mind was
undeniable. This led to a surge in theoretical perspectives which aimed to
135
Theoretical theorize the internal frameworks to study the relationship between cognition,
Approaches to B
Counselling behaviour and emotion.

Beck was on the path to empirically validate Freud’s theory when he began
his journey as a psychologist. Ultimately, not only he could not verify the
Freudian theory, but he began seeing a pattern in his results that led him to
create his own theory of psychological ailments. Beck’s research repeatedly
pointed towards faulty cognitions in patients with depression which
eventually le d him to describe a depressed client as one with “dysfunctional
led
thinking”
thinking”.. The empahsis here is on how do we interpret or perceive a
situation that in turn affects our actions and emotions. So one needs to be
aware of these negative interpretations and acc accordingly change their
cognition to engage in alternative ways of thinking and behaving.

6.5.2 Assumptions
1) People’s cognitions are made of both factual and inaccurate thoughts.
Both of these kinds of thoughts can co exist in a person. Psychological
co-exist
illnesses
esses are a result of the perpetuation of maladaptive behaviours
which result from these inaccurate thoughts. Thus it uses a cognitive
model to explain mental health related problems.
2) Humans’ minds are capable of conscious thinking (also called a
secondary process), as well as unconscious impulses (primary process).
Cognitive therapy (CT) aims to process all thoughts consciously. CT
believes that internal communications can be and should be audited, i.e.,
brought into conscious focus and examined for validi
validity.
3) The theory also relies on the notion of universality in cognition.
cognition
Cognition and all the structures that interact with it (emotions,
behaviours, etc.) are universal and do not differ from culture to culture.
4) Like behaviourism, cognitive therapy (CT) also relies heavily on
empirical testing
testing.. Therapists and clients are free to examine the
therapy’s outcomes objectively and reject the therapeutic structure if it
fails to produce results.
5) Unlike behaviourism, however, CT gives the client much more
autho
authority.. Client has the ultimate authority to describe what a particular
cognition (e.g., “I feel stupid”) means. The therapeutic framework also
strongly relies on the client’s motivation and efficacy for change.
6) Therapeutic goal is to change the core cognitive
cogniti schema of the client
136 which leads to personality change.
6.5.3 Theoretical Framework Cognitive and
Behavioural Approach

Beck (1976) points out three levels of cognition in the cognitive model which
characterize human cognition or the way we think. These are core beliefs or
schema, dysfunctional assumptions, and negative automatic thoughts.

Core Beliefs
Dysfunctional
Assumptions
Negative
Automatic
Thoughts

Fig. 6.2: Three Levels of Cognition

• Core Beliefs
The human mind consists of thousands of schemas or concept maps with
millions of linkages that help us process information quickly. Since the
schemas are mental representations of things/objects/people etc., they
can be subject to inaccuracies. For something as factual as the concept of
what a dog is, it is easy to correct the schema, but for something as
subjective as your worth in the eyes of your parents, the task is much
harder. Beck extended this understanding of (objective/factual) schemas
to subjective thoughts i.e. attitudes, opinions and beliefs. The base
schemas which individuals hold on these matters were labeled as their
core beliefs.
Thus schemas are deeply ingrained beliefs, our core beliefs which are not
easily changeable, are rigid and influenced by early experiences.Beck
describes the core beliefs in respect of the ‘self’ (e.g., “I am not
worthy”); ‘others or the world’ (e.g., ‘people are biased’); and ‘the
future’ (e.g., “I will never be happy”).
This cognitive triad is reflected in the cognitive theory of
depression.Beck theorised that depression is a result of three factors,
each of which cause and sustain the other two. According to him
depression is triggered when a client has (i) a negative view of herself,
(ii) tends to interpret most events in her life negatively or through a
pessimistic lens and (iii) has a bleak or dark expectation from her future.

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Theoretical
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Counselling

Fig. 6.3: Beck’s Conceptualization of Depression: The Cognitive Triad

Furthermore, he explained that people experiencing depression choose to

selectively ignore achievements and success that contradict their negative
self-concept.
concept. All of this leads to the manifestation of a negativity that
permeates all parts of the client’s life and is labelled as depression.

• Dysfunctional Assumptions/Beliefs
People make various assumptions about how to live their life. Sometimes
these assumptions reflect ‘conditional rules for living’ which are
unrealistic. These dysfunctional assumption
assumptionss or beliefs are maladaptive
in nature and lead to problems in interaction and functioning among
people.
• Negative Automatic Thoughts (NATs)
Negative automatic thoughts activated spontaneously without any
conscious control. These thoughts arise in response to specific situations,
for instance, in an interview situation, the person may have negative
automatic thought as ‘I am going to falter in the interview’.
Beck noticed how specific stimuli triggered an emotional response in
his patients and that emotion al response translated into a personalised
emotional
notion of the patient. These personalized notions which were formulated
while in the middle of an emotional response had a high likelihood of
being false.

Cognitive Distortions

Beck described many types of “e“errors

rrors in reasoning” that led clients into faulty
thinking. These illogical thinking processes or cognitive distortions are
unhelpful thinking habits which lead to biases in our thinking. These
distortions in our thoughts happen automatically. Hence we need to be aware
of them to modify them. Some of the cognitive distortions are described
below:

1) Magnification and Minimization: The tendency to perceive situations

more or less seriously than they are. For instance, failing in one subject
138
 and labelling oneself a “failure” would be magnification; and jumping a Cognitive and
Behavioural Approach
red light, crashing into a car and calling it a “tiny mistake” would be
minimization.
2) Labelling and Mislabelling: The tendency to describe oneself solely on
the basis of one’s failings. For instance, thinking “I’m a useless, washed
up athlete” after losing one race on Sports Day, even though you have
won medals in many other races and events.
3) Personalization: The tendency to hold yourself responsible for things
that rationally can’t be caused by you. For instance, believing that your
friend’s bad mood is definitely because of something you did, even
though your friend has denied it and she tends to be upset sometimes
because of her family.
4) Dichotomous thinking: Thinking in 1s and 0s – things can only be good
or bad, never grey. It is also called polarization for its “all or none”
approach. For instance, Anushka helped you with your practicum so
she’s the best! But she did not invite you to her birthday party later that
month, so she’s the worst and her previous help was fake!
5) Emotional reasoning: The tendency to believe that emotional validation
is equivalent to rational validation. For instance, thinking that because
you truly feel that this time your partner meant his apology and he won’t
abuse you again (even though it has been a repeated behaviour of abuse
and apology for a few months now), since you know it in your heart, it
must be right.
6) Arbitrary Inferences: Making judgements in the absence of any real data.
For instance, believing that because you didn’t take a call from a friend
who is dealing with depression, she is going to hurt herself and it will be
your fault.
7) Selective Abstraction: The tendency to pick isolated details and make
inferences from them that are largely out of context. For example, at a
party, Ankush’s friend remarks, “God Ankush! You’re a funny guy to
have around! You always make me laugh!” Ankush isolates “funny guy
to have around!” and starts thinking that the only reason his friends
invite him to events is because he entertains them and his only value is as
the joker of the group.
8) Over generalization: The tendency to make extreme assumptions on the
basis of a single data point; for instance, believing that all teachers think
of you as a naughty and disobedient student after being scolded in the
class once by the Mathematics teacher.

6.5.4 Therapeutic Technique

Cognitive therapy relies on the client much more than the behaviour therapy.
Client’s desire to change and the therapist’s knowledge about faulty
cognitions provide grounds for a collaborative framework. Both collaborators
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Theoretical ensure that they (a)prevent the personality from devolving (b) recognize
Approaches to B
Counselling cognitive anomalies,and (c) combat them rationally to bring about the goal of
therapy, that is, lasting and positive change in the personality.

Furthermore, it also emphasizes on the client-counsellor relationship. Beck’s

approach was among the first to focus on the relationship that the counsellor
builds with the client. He recognised the counsellor’s warmth, empathy,
acceptance, rapport building skills as pivotal to the output of therapy.

The techniques used in cognitive behavioural approach can be described

under cognitive techniques (focusing on changing the person’s ‘cognition’)
and behavioural techniques (focusing on changing the person’s ‘behaviour’).
Examples of some cognitive techniques are guided discovery, keeping a
positive data log (Padesky, 1994), and thought record, all of which aim at
making the individual aware about her thoughts, question their beliefs,
analyze evidence for their assumptions, explore alternatives, and look at
instances in support of a more positive and adaptive
belief/schema.Behavioural techniques include activity scheduling, graded
task assignment, behavioural experiments, and relaxation exercises. The
focus here is to plan out the day’s schedule, engaging in deliberate behaviour
and test one’s assumptions and beliefs.

Socratic questioning: This is a technique as part of Guided discovery,

wherein the therapist asks the client a series of open-ended, thoughtful and
pin-pointed questions, which encourage the client to reflect on her problems.
This requires the client and counsellor to have a well formed rapport and be
intensely focussed on the client’s issues.

6.5.5 Role of Client and Counselor/ Therapist

Role of the therapist in therapy: The therapist brings knowledge to the
therapy - knowledge about how cognitions function, how cognitive
distortions arise and how to combat them. The therapist does this by being
creative and using Socratic questioning, a method the therapist has honed
well. The therapist's knowledge, directive engagement, and questioning
together accelerate the process of the client's discovery of her problems. The
counselor/therapist’s role is to provide guidance to the client and co-
investigate issues that she is facing. Collaboration is a feature of cognitive
therapy which plays a role while deciding which thoughts are distorted and
which are not, what and how much homework would be appropriate for the
client, and even while devising novel ways to combat automatic thoughts.

Role of the client in therapy: A client undergoing CT is taught to recognize

cognitive distortions. Her job is to (a) realise biased information processing
from unbiased one, and (b) to systematically remove these distortions and
biases. Over the course of therapy, the client would learn to use conscious
control of her thoughts and override the automated distorting and devolving
140
processes. By the end of therapy, CT aims to make the clients their own Cognitive and
Behavioural Approach
therapist.

The counsellor-client relationship: The counsellor client relationship in

cognitie therapy is in between of the “student-teacher” approach of a
behavior-therapist and the “complete-agency-to-the-client” approach of a
humanistic-therapist. The counsellor is an expert in terms of cognitive
techniques, functioning of human cognition and techniques that modulate it,
but the client is responsible for giving meaning to all her thoughts and
contextualizing the therapist's knowledge into her own life. Both determine
whether the client’s cognitions are reasonable and useful for healthy
functioning, thereby preventing present and future dysfunction. The therapy
does follow the learning model, but sees the client as an agentic being.

6.5.6 Evaluation
Applications

• CT’s contributions to depression research: CT largely contributed to

the understanding of depression. The prevailing notion about depression
labelled it as “anger directed inwards. Beck started viewing depression as
a result of cognitive distortion too. To further his approach, he was able
to find evidence of distortions in the dreams of his depressed clients.
This helped formulate a cognitive theory of depression. Beck is also
credited with designing the Beck Depression Inventory and devising and
employing CT to specifically aid clients with depression.
• Other applications: CT is currently being used for family therapy
(where individual and combined family cognitions are scrutinised),
anxiety disorders, parent training, skills training and many more areas.
The nature of the therapy - brief, client empowering and structured -
makes it easy to transfer the basic techniques of CT across different
types of settings.

Limitations

1) Over-simplification of the inner world: One criticism of CT is that it

provides a very simplistic understanding of the inner world of humans.
The theoretical assumptions assume that mental processes occur in a
very linear fashion: first the individual would have a distorted thought →
which will lead to psychological distress → which can be brought to the
client’s notice → who will remove the distortions. As we are well aware,
just knowing about what is logically right doesn’t change the way we
think about it. This brings us to the second limitation.
2) Role of emotions overlooked: Much like behavior therapy, cognitive
therapy overlooks the role that emotions play in aiding and prohibiting
psychological distress. Though CT allows the client to discuss emotions,
it ignores them when it comes to devising an intervention.
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Theoretical Self Assessment Questions 2
Approaches to B
Counselling
1) How do cognitive therapists explai
explainn maladaptive behaviour?
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
2) What is a cognitive triad?
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
3) Given below are some cognitive distortions. Identify their type.
a) I could not prepare a healthy meal today. I can never stick to a
healthy lifestyle.
b) I am a failure. I failed in my maths test.
c) It's because of me that my brother is so rude.
d) I am feeling anxious.
ious. Something bad is about to happen.
e) A good player should always win.

6.6 RATIONAL EMOTIVE BEHAVIOUR

THERAPY
6.6.1 Emergence
Rational Emotive Behaviour Therapy was a type of cognitive behaviour
therapy pioneered by Albert Ellis. Ellis came out in strong opposition to the
then dominant approach of therapy (psychoanalysis), going so far as to say
that not only did the approach fai
faill to help the client feel better, but in most
instances, it made them feel worse.

Ellis realised that behavioural methods can also be applied to covert

processes and internal dialogues and came up with a therapy that helped
clients restructure their philo
philosophical
sophical and behavioural styles. Combining his
theoretical approach with empirical rigor, Ellis defined an educational
approach to provide psychological intervention.

142 Albert Ellis

“people have remarkable sameness in the ways in which they disturb Cognitive and
Behavioural Approach
themselves emotionally. They have thousands of specific irrational ideas and
philosophies which they creatively invent, dogmatically carry on, and cause
great distress and misery to themselves.”

6.6.2 Assumptions
1) The source of psychological problems are irrational thoughts. These
thoughts are generated by the clients themselves, and therefore,
according to REBT, the cause of psychological distress are the clients
themselves.
2) Cognitions, emotions and behaviours are interrelated and interact with
each other. Therefore, changes in cognition will eventually bring about
behaviour change.
3) Ellis also believed that an individual’s connectedness with other people
in her community also determines her psychological well being(Ellis
adopted this concept from the Adlerian concept of communality).
4) The process of therapy is an educational one, wherein the therapist is an
expert and the client takes on the role of a student.

6.6.3 Theoretical Framework

• The Birth of Irrational Beliefs
Ellis theorised that our first encounter with irrational beliefs is external.
A person of importance or a “significant other” introduces these
irrational to an individual during childhood. The individual then
“learns” these beliefs. Individuals are also capable of creating these
beliefs by themselves. Sustaining these beliefs is harmful to the
self.Various ways in which these beliefs are sustained involve giving
oneself auto-suggestions that these beliefs are beneficial; repetition, e.g.,
thinking “I am a failure” again and again at the slightest setback; and
enacting behaviours supportive of these beliefs, e.g., not participating in
competitive activities because you believe that “you’re a failure”.
• The Need for Acceptance
One of REBT’s most radical beliefs is that humans don’t need
acceptance in order to live healthily. It acknowledges that a lack of
acceptance from near and dear ones can cause an individual to develop
irrational, self-defeating beliefs, but it does not see receiving that
acceptance as a cure.
An REBT therapist would ask a client to face the emotions that come
with lacking acceptance - face the sadness, loneliness and even anger.
These emotions turn into internal dialogue which is often assigning
blame - “I should be loved by my father. If my father doesn’t love me, it

143
Theoretical must mean I am unworthy. But even if I am unworthy, a father should
Approaches to B
Counselling love his child unconditionally”.

Two things have happened in this emotion-to-thought change:

i) a blame has been assigned to self, along with the label of being
“unworthy”. This thought will now have a life of its own, amplifying and
validating itself, causing harm to the individual.
ii) The second thing that happened in the emotion-to-thought translation
was the creation of rigid and absolutist notions.

Emotions are fluid, we can feel very angry and after the heat of the moment,
the anger subsides. But thoughts have a tendency to be much more rigid.
Absolutist notions refer to those notions which are uncompromising and
don’t leave room for any flexibility.

Revisit the above statement and underline the words that show rigidity of
thought.

(Answer: “I should be loved by my father. If my father doesn’t love me, it

must mean I am unworthy. But even if I am unworthy, a father should love his
child unconditionally”)

Blame and rigidity of thought are what an REBT therapist aims to target and
change. The acceptance of another can not be obtained by any therapist, and
believing in the agency of an individual (the ability of an individual to act
and bring about positive change in her own life), the REBT therapist works
on the client instead.

• The A-B-C Model

Imagine you are strolling through the market and you come across a 6 or
7 year old child, who is crying and asking her mother to buy a teddy bear
for her. If you are asked the question “why is the child crying”, what
would you say?

You may say,

a) The child is crying because she wants a teddy bear and she is sad that she
can’t have one,
b) The child is crying she is throwing a tantrum to get the teddy, or
c) The child is crying because the mother is too strict or unresponsive.

Can you think of other children who are facing a similar situation but are not
responding to it by crying? What makes one child respond one way and
another respond in another?

The A-B-C model says every situation can have multiple emotional reactions
to it, depending upon the way a person chooses to process it.

144
 Cognitive and
Behavioural Approach

Fig. 6.4: The ABC Model

Whenever an incident happens (Activating event) event), our existing thoughts and
beliefs related to the event (Beliefs) impact the way we respond
(Consequences) to the incident. Ellis explains that it is our irrational beliefs
arising from how we interpret the situation/event, that leads to negative
consequences. So this modelmakes it possible for applying an intervention
(or therapy) to the beliefs (B), in order to bring about change in emotions and
behaviours.
s. Hence the focus here is on irrational beliefs of the individual,
wheras the focus in Beck’s theory is on the cognitive triad.

Fig. 6.5: The Mechanism of REBT

The (D) here represents the objective questions the clients and counsellors
ts to verify if they are true or false, (E) represents the effects
ask about thoughts
of therapy which eventually causes a change in the way one feels (F). Fig.
6.4 above shows how REBT works to change beliefs and bring change in
emotions and behaviours.

6.6.4 Techniques
Working on thoughts

1) Therapist’s interruption: This is part of the process when the client

shares her beliefs with the counsellor and the counsellor questions the
client objectively and corrects the irrational thoughts.

145
Theoretical 2) Self correction: Clients are also given homework, wherein they are
Approaches to B
Counselling encouraged to identify all their rigid and absolutist thoughts (the ones
with “must’s” and “should’s”). After identifying these thoughts, the
clients are encouraged to apply the A-B-C model to change them.
3) Becoming an REBT teacher: It is easier to identify the irrationality of
another person’s beliefs objectively than to identify one’s own. This is
the reason why clients are encouraged to practice observing irrational
beliefs in others as an exercise to become better at identifying them.

Working on behaviours

1) Language change: As it has been shown above, simple statements can

cause one to develop long-lasting, self-defeating thoughts. Consciously
changing one’s language to say statements which are less rigid, less
absolutist, less self blaming can have a similar long-last but self
supportive impact.

Working on emotions

1) Rational-emotive imagery: This is an intensive technique where clients

are asked to think, feel and act as they want their healed self to. They are
also asked to imagine worst-case scenarios, feel however they feel,
report those feelings and then try to feel less intensely and more
appropriately about such scenarios. It is thought that if clients mentally
practice these scenes, when they happen in reality, the clients will be
able to respond to them appropriately. (Appropriately here means that
even an incident evokes sadness, the client should feel sadness, but not
be traumatised)
2) Using Humour: According to REBT, emotional disturbance can also
result from an individual seeing herself too seriously and losing
perspective of the vastness of events in comparison to the whole picture.
This is why therapists encourage clients to use humour to tackle the
strength and intensity of their thoughts. Counsellors themselves employ
humor during therapy to respond to clients.
3) Shame-attacking: Ellis devoted much time to developing ways to rid his
clients of self-destructive shame. He created exercises and encouraged
his clients to stubbornly refuse to feel ashamed. Clients are given
assignments where they are asked to act slightly different from social
expectations, for instance wearing “loud” clothes, replying in a different
waythan the usual to an elder in the family who is rude to you or
returning a dish that was wrongly prepared at a restaurant. All these
exercises and assignments are aimed at helping the client realise that
while the emotion of shame has a role to play, excess of it can be
extremely detrimental to the self-image and life of an individual.

146
6.6.5 Role of Client and Counselor/Therapist Cognitive and
Behavioural Approach

Role of therapist in therapy: The role of an REBT counsellor is complicated.

Ellis expected REBT to accept the client unconditionally, but also reject their
irrational beliefs openly. This means that the counsellor must come to view
the client as a person who makes mistakes, but nevertheless is capable of
leading a healthy and successful life. Another aspect of the therapist is that
unlike other counselling schools, Ellis did not believe that warmth of a
counsellor played a significant role in the success of therapy. He even cited
instances where warmth could be harmful. So an REBT counsellor wouldn’t
spend much time building a warm relationship with the client. REBT requires
the counsellor to be good communicators, well-versed in techniques of
REBT, competent, active and directive during therapy. They must also be
able to diffuse sessions with the timely use of humour.

Role of the client in therapy: The client plays an active and diligent role in
therapy. The client is supposed to work hard to continually grow throughout
and even after therapy. All clients entering therapy are expected to
acknowledge that a problem exists. Additionally a client entering REBT is
expected to also accept that irrational beliefs are the core of the problem.
Clients are expected to learn and practice REBT techniques, in order to
change their beliefs and they are also expected to use these techniques
outside the scope of therapy, i.e. if one is going to therapy to deal with
marital conflict, the REBT therapist would expect the client to apply those
techniques to change irrational beliefs in other domains as well (like
problems with friends etc.).

The counsellor-client relationship: As mentioned above, the counsellor-

client relationship is that of complete acceptance. Another feature of this
relationship is complete honesty from the therapist and an expectation of the
same from the client. The counsellor does not hold back objective truths in
order to indulge a client’s feelings, nor does she encourage long cathartic
(when one vents all her emotions by talking) expressions of the client. Ellis
saw all these behaviours as obstacles in achieving the true therapeutic goal.

6.6.6 Evaluation
Applications

1) REBT can be applied to marital, family and individual counselling. It has

produced outcomes for individuals with anxiety, depression, psychotic
disorders, hostility and many more.
2) REBT can also be applied in group sessions, as it employs a teaching
mode and requires clients learn some basic techniques to challenge
irrational beliefs.
3) REBT is best suited for mild to moderate psychological ailments that
require brief intervention.
147
Theoretical Limitations
Approaches to B
Counselling
1) Power imbalance: The counsellor in REBT is considered an expert. The
mode of therapy is itself labelled “teaching”. All of this combined gives
the therapist a lot of power over the client. Not only can this be misused
by the therapist, it can also be a problem if the therapist is not well
trained or competent.
2) Ignoring clients’ problems: REBT places emphasis on a primary
problem that needs intervention. The related problems or what are
labelled as “secondary problems” are left outside the scope of therapy.
This may not be the best approach to bringing about lasting change.
3) Confrontational style: REBT encourages therapists to challenge clients’
irrational beliefs. This confrontational style may not suit all clients.
Moreover, given that this is a brief therapy format that doesn’t focus on
building a warm relationship, it becomes more difficult to accept a
therapist’s confrontations.
4) Balancing the past and the present: While all forms of behaviour and
cognitive therapies focus on the present concerns, completely ignoring
the past and early childhood hinders therapy in the long run.

Self Assessment Questions 3

1) Expand the acronym ABCDE as used in Rational Emotive Behaviour

Therapy.
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
2) Give one cognitive, one emotional and one behavior technique as used in
REBT.
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………

6.7 LET US SUM UP

In this unit we studied different approaches to counseling from the behavioral
and cognitive perspectives. While the behavioral approach looked at the
problems of the clients only in terms of maladaptive behaviors, cognitive
therapies take into consideration the maladaptive and erroneous thoughts as
the basis of client’s issues and problems. The unit outlines the theoretical
bases of behavioral counseling and cognitive counseling as well as their
techniques and therapeutic relationship.

148
6.8 KEY WORDS Cognitive and
Behavioural Approach

Operant Conditioning refers to the model of learning that focuses on

rewarding individuals for displaying desirable behaviours and penalising
them for displaying undesirable ones.

Negative Reinforcement refers to removing something displeasing/

unpleasant to reward the individual and increase the likelihood of behaviour.

Positive Punishment refers to adding something displeasing/unpleasant to

decreas or reduce the behaviour.

Cognitive Triad consists of negatve view of oneself, negative interpretations

about others/the world around, and negative perception of the future.

Cognitive Distortions are illogical thinking processes orunhelpful thinking

styles which lead to biases in our thinking.

Dichotomous Thinkingrefers to polarization in thinking, and follows an “all

or none” approach, that is, things can only be good or bad.

The ABC Model involves an Activating event orincident; Beliefs, our

existing thoughts and beliefs related to the event; and Consequences, the way
we respond to the event/incident.

6.9 ANSWERS TO SELF ASSESSMENT

QUESTIONS
Self Assessment Questions 1

1) Both systematic desensitization and flooding are behavioral techniques.

In systematic desensitization the client is exposed to least threatening
anxiety provoking situation/stimulus and is trained to feel secure in it
before moving on to more threatening stimulus.While in flooding the
client is exposed to anxiety provoking threatening stimulus all at once, in
a safe environment and not gradually.
2) Pavlov’s Classical Conditioning, Skinner’s Operant conditioning and
Bandura’s Social Learning theories form the bases for behaviour therapy.
3) Behaviour modification is the change in behavioural patterns through the
use of learning principles and techniques like reinforcement.

Self Assessment Questions 2

1) Cognitive therapists explain maladaptive behavior primarily on the basis

of irrational or erratic thoughts and beliefs.
2) Aron Beck developed the notion of the cognitive triad to describe how
depressed adults tend to think about the self, world, and future. They
tend to have negative views in all the three domains.
149
Theoretical 3) (a) Overgeneralization (since on the basis of a single incidence you are
Approaches to B
Counselling making a conclusive judgment about yourself)
b) Labelling
c) Self blame
d) Emotional reasoning
e) Dichotomous or polarization (all or none thinking)

Self Assessment Questions 3

1) A-activating event, B- belief, C - consequences, D- disputing

interventions, E-Effect of intervention, F - New feeling
2) Cognitive technique - Self correction
Emotional technique - Rational Emotive Imagery
Behaviour technique - Language Change

6.10 UNIT END QUESTIONS

1) Discuss the assumptions of behaviour therapy.
2) Descrie the techniques of counseling under behavioural approach.
3) Explain the cognitive distortions with examples.
4) Discuss the techniques under Rational Emotive Behaviour Therapy.
5) Discuss the contributions and limitations of cognitive therapy.
6) Explain the role of client and counselor/ therapist in REBT.

6.11 REFERENCES
Alexander, G. M., Wilcox, T., & Woods, R. (2009). Sex differences in
infants’ visual interest in toys. Archives of sexual behavior, 38(3), 427-433.

Bandura, A. (1962). Social learning through imitation. In M. R. Jones (Ed.),

Nebraska Symposium on Motivation, (p. 211–274). Univer. Nebraska Press.

Bandura, A., & McClelland, D. C. (1977). Social learning theory (Vol. 1).
Prentice Hall: Englewood cliffs.

Barrett, M. S., Chua, W. J., Crits-Christoph, P., Gibbons, M. B., &

Thompson, D. (2008). Early withdrawal from mental health treatment:
Implications for psychotherapy practice. Psychotherapy: Theory, Research,
Practice, Training, 45(2), 247.

Beck, A.T. (1976). Cognitive therapy and the emotional disorders. New
York: Penguin.

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Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and Cognitive and
Behavioural Approach
unique elements. Psychiatry (Edgmont), 3(9), 62.

Corey, G. (2012). Theory and practice of counseling and psychotherapy.

Nelson Education.

Dimeff, L., & Linehan, M. M. (2001). Dialectical behavior therapy in a

nutshell. The California Psychologist, 34(3), 10-13.

Fall, K. A., Holden, J. M., & Marquis, A. (2017). Theoretical models of

counseling and psychotherapy. Taylor & Francis.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006).
Acceptance and commitment therapy: Model, processes and outcomes.
Behaviour research and therapy, 44(1), 1-25.

Lazarus, A. A. (1993). Tailoring the therapeutic relationship, or being an

authentic chameleon. Psychotherapy: Theory, Research, Practice, Training,
30(3), 404.

Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., & Linehan, M.
M. (2006). Mechanisms of change in dialectical behavior therapy:
Theoretical and empirical observations. Journal of clinical psychology, 62(4),
459-480.

McNeil, D. W., & Lawrence, S. M. (2002). Relaxation training. Encyclopedia

of psychotherapy, 2.

Meichenbaum, D. (1977). Cognitive behaviour modification. Cognitive

Behaviour Therapy, 6(4), 185-192.

Padesky, C. (1994). Schema change processes in cognitive therapy. Clinical

Psychology and Psychotherapy, 1, 267-278. Doi: 10.1002/ cpp.5640010502

Ruiz, F. J. (2012). Acceptance and commitment therapy versus traditional

cognitive behavioral therapy: a systematic review and meta-analysis of
current empirical evidence. International Journal of Psychology &
Psychological Therapy, 12, 333-357.

Skinner Burrhus, F. (1938). The behaviour of organisms. Appleton-Century-

Crofts, Nueva York.

Swales, M. (2012). Dialectical Behaviour Therapy. In W.Dryden (Ed.),

Cognitive Behaviour Therapies (pp. 93-114). London: Sage Publications.

Thorndike, E. L. (1927). The law of effect. The American journal of

psychology, 39(1/4), 212-222.

Watson, J. B. (1913). Psychology as the behaviorist views it. Psychological

Review, 20, 158–177.

Wolpe, J., & Lazarus, A. A. (1966). Behavior therapy techniques: A guide to

the treatment of neuroses. 151
Theoretical
Approaches to 6.12 SUGGESTED READINGS B
Counselling
• Capuzzi, D. andGross, D. R. (2007). CounsellingandPsychotherapy:
TheoriesandInterventions, New Delhi: Pearson.
• Corey, G. (2013).Theory and Practice of Counseling and Psychotherapy.
Wadsworth
• Sommers-Flanagan, J. & Sommers-Flanagan, R. (2015). Counseling and
psychotherapy theories in context and practice: skills, strategies and
techniques, 2nd ed. NJ: John Wiley & Sons, Inc.
• Gladding, S.,&Batra, P. (2018).Counselling: A comprehensive
profession. New Delhi:Pearson.
• Nelson,R. J. (2012).Theory and Practice of Counseling and Therapy.
New Delhi: SageSouth Asia. (Practicals).
• Sharf, R. S. (2012). Theories of Psychotherapy and Counseling:
Concepts and Cases.5thEdition. Belmont: Brooks/Cole (Cengage
Learning).

Web Resources

 https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-
therapy/about/pac-20384610
 https://positivepsychology.com/what-is-cbt-definition-meaning/

152