An important characteristic of behavior therapy homework is that it

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Write 150 word response to the questions below. Need to cite and reference to support answer

Thanks for sharing the various approaches and you bring up a unique point about the Gestalt therapy. This particular approach helps the client or offender focus on the current or the now rather than the past. One of the most challenging pieces to this is helping the client deal with unfinished business.

What are the concerns with unfinished business in regard to this approach of counseling? Trivia from our reading for the class..... in this particular type of approach, we still ask questions of the client but there is one question that is often avoided.... what type of question is avoided and what is the reason for that?

5 Common Theoretical Counseling Perspectives

CHAPTER OBJECTIVES After reading this chapter, you will be able to: 1. Discuss behavioral approaches to counseling. 2. Identify common techniques used in behavioral therapy. 3. Discuss cognitive approaches to counseling. 4. Identify basic techniques used in cognitive therapy. 5. Discuss reality therapy. 6. Identify common techniques used in reality therapy. 7. Discuss Gestalt therapy. 8. Identify common techniques used in Gestalt therapy. INTRODUCTION A variety of counseling perspectives have been created since the birth of psychology and the helping professions. Counseling perspective is a particular approach to counseling based on specific assumptions regarding determinants of cognition and behavior. Most counseling perspectives also include specific techniques of intervention directly related to the perspective’s assumptions concerning human behavior. An important prelude to what follows is that each perspective contains unique contributions to help people identify and overcome psychological and emotional issues causing distress. The various causes of distress are broad and diverse. As a result we encourage students to maintain an open mind while critically reviewing each perspective. The extreme diversity within the offender population cannot be overemphasized. In addition, our society is becoming more diverse as different cultures are increasingly forced to interact due to spatial limitations as well as the process of globalism. Based on these facts we suggest the following intellectual framework as a foundation for readers of this chapter: 1. There is no right or wrong counseling perspective. 2. Each perspective contains parameters that may be useful under certain conditions with certain offenders. 3. Counselors should be flexible in their approach to help and should be able to draw techniques and reasoning from various perspectives. 4. In order to effectively help others counselors, themselves must have a good understanding of their own strengths and weaknesses. 5. As you examine each counseling perspective reflect on the following question: “How can this information help me to better understand my own intellectual perceptions and behavior?” In this chapter we present four counseling perspectives: (1) Behavioral Therapy, (2) Cognitive Therapy (including Cognitive Behavior Therapy), (3) Reality Therapy, and (4) Gestalt Therapy. Obviously, there are additional therapeutic approaches found throughout the literature. Some of these approaches are very specific aimed at particular types of dysfunction and prescribe specific types of treatment. The reason for our selections is that each perspective is used extensively within the offender population. We make no claim that one perspective is superior to the other. In fact, we urge the opposite and once again invite students to explore this information from a point of neutrality accompanied by personal introspection. Finally, we would like to point out that we rely heavily on the work of Corey (2005) in creating the foundation for much of the information contained in this chapter. PART ONE: BEHAVIORAL APPROACHES One of the most significant proponents of behavioral theory was B. F. Skinner (1904–1990). Skinner spent much of his career researching various behavioral techniques all of which are aimed at increasing one’s personal choices through the creations of new conditions of learning. Behavior therapy is heavily grounded in objectivity with the basic assumption that behavior can be learned. For example, behavior theorists posit that addiction is a learned behavior and because it is learned new behaviors can also be learned in order to replace the dysfunctional qualities of addiction. Corey (2005) provides 10 key factors related to behavior therapy that provides a robust foundation from which one is able to intellectually frame the basic underpinnings of behavior therapy. In addition to Corey (2005), several other authors including Kazdin (2001), Miltenberger (2004), as well as Speigler and Gueveremont (2003) have made significant contributions to the following factors. 1. As mentioned above, behavior therapy is primarily rooted in objectivity. As such, the scientific method of conducting research and experiments is central to behavior therapy. Corey (2005) notes, “the distinguishing characteristic of behavioral practitioners is their systematic adherence to precision and to empirical evaluation” (p. 232). The problem is clearly stated, the intervention is clearly identified, outcomes are empirically tested, and the entire process undergoes continual revision. 2. The primary interest of behavior therapy is the specific nature of the offender’s current problem. Past events may be useful at times but are not considered primary. For example, an offender suffering from substance abuse would be examined and treated based on the positive and negative reinforcers associated with the substance abuse. Ultimately, the goal is to find alternative behaviors that maximize positive consequences based on freedom to choose responses other than the use of substances. Behavior therapists are most interested in current behaviors associated with distress and the environmental stimulants that contribute to and maintain the behavior. Once the distressing behavior is identified the behavior therapist will then begin exploring various measurable techniques aimed at altering the environmental stimuli correlated with the problem behavior. 3. Behavior therapy requires specific actions from the offender aimed at altering and enhancing his or her possible responses to certain stimuli. Behavior therapy is not talk therapy. Action and learning is paramount. 4. Behavioral therapy relies heavily on educating a client in regards to new behaviors. Therapists take an active role in pointing out alternative behaviors that may produce more desired results. For example, an offender who routinely turns to marijuana when faced with anxiety-provoking decisions may be taught to exercise instead. 5. The focus of behavior therapy is on assessing behavior through which problems can be identified. Once identified, specific and measurable interventions are introduced and results are evaluated. 6. Self-control is central to behavior therapy. In order for behavior therapy to be effective clients must be able to identify problem behavior and then consciously choose to carry out learned behavior more capable of reducing distress and negative consequences. 7. There is no universal behavioral treatment protocol appropriate for all individuals. Instead, interventions and teaching are specific to the individual and the problem behavior. This is an important characteristic of behavior therapy. We must remain cognizant of the fact that human beings are extremely diverse and complex. 8. As mentioned above, behavior therapy relies heavily on the participation of the client. In essence, a partnership must be forged between the counselor and client where both are active participants in the path to change. The counseling process is open and clients are generally informed about the decisions and process of treatment. 9. The focus is on developing interventions aimed at reducing problem behavior that can be practically applied in all areas of one’s life. “Practicality” is the key word in this characteristic. Theoretical postulations that are unable to be measured in daily life are not generally part of the main focus. 10. Counselors must be culturally competent in order to provide treatment protocols best suited for a particular client and the client’s problem behavior. Classical Conditioning Classical conditioning refers to a process of learning based on the idea of pairing. Ivan Pavlov, a Russian physiologist, is a central figure in classical conditioning based on his work with dogs. Through various experiments, Pavlov found that when food was presented to dogs they salivated. Pavlov considered both the presentation of food and the process of salivating to be unconditioned responses. Through additional experiments he found that a conditioned response could be generated through the pairing of an unconditioned stimulus with a conditioned stimulus. Specifically, Pavlov learned that after several repetitions of pairing food with a buzzer the dogs began to salivate in response to the buzzer even in the absence of food. And, maybe even more significant in the context of criminal offending is the fact that Pavlov also found that if the conditioned stimulus (buzzer) is repeatedly presented without the pairing of food the salivation response is reduced and over time is extinguished. Classical conditioning provides the foundation of one form of learned behavior. As noted by Gladding (1996) a variety of human emotions are often experienced as a result of classical conditioning via paired associations. Phobias are also often linked to paired associations. For example, a person may learn that he or she cannot trust others due to repeated exposure of disappointment by not being adequately attended to by caregivers. In fact, it could be argued that antisocial behavior, commonly used to describe criminal offending, is in part a result of classical conditioning. In essence, a person learns through paired associations that it is dangerous to overly rely on or openly present oneself to others. Operant Conditioning Whereas classical conditioning refers to what takes place prior to learning, operant conditioning describes learning in which behavior is influenced by the consequences that follow them (Corey, 2005). Generally, operant conditioning describes a process of learning that is heavily influenced by rewards and punishments. If a person is rewarded for a particular action it is more likely that the action will be repeated. When an action is followed by a punishment it is less likely to be repeated. Therefore people often learn to discriminate between actions that result in reward and those that result in punishment (Gladding, 1996). To once again contrast classical and operant conditioning, it could be said that classical conditioning is the conditioning of involuntary responses whereas operant conditioning is the conditioning of voluntary responses. People will often repeat behaviors that produce some type of desired attention, feeling, or emotional gain. Within the offender population one’s toughness is often viewed in high esteem. Therefore one may learn that the ability to intimidate or physically overtake others results in the elevation of status among peers. This is a very powerful motivator for someone who has nothing else to rely on for feelings of worth and acceptance, especially when this is due to inadequate early child care. The same is true in relation to money and the ability to obtain material possessions. The bedrock of operant conditioning as noted by Skinner (1953) is that individual behavior is primarily driven by one’s environment. Operationalizing Behavior Therapy with Criminal Offenders According to behavior theorists behavior that is learned can be unlearned. Therefore the goal is to help offenders identify problem/criminal behavior and replace it with socially acceptable law-abiding behavior. In order for behavior therapy to be effective there must be significant collaboration between the counselor and offender. Offenders take an active role in deciding which behaviors to address and also the formulation of specific goals. “Goals must be clear, concrete, understood, and agreed on … This process of determining therapeutic goals entails a negotiation between client and counselor that results in a contract that guides the course of therapy” (Corey, 2005, p. 234). The importance of collaboration in the therapeutic process cannot be overstated. In fact, Corey (2005) notes the work of Cormier and Nurius (2003) who provide five guiding principles illuminating the importance of collaboration: 1. The counselor provides a rationale for goals, explaining the role of goals in therapy, the purpose of goals, and the client’s participation in the goal-setting process. 2. The client identifies desired outcomes by specifying the positive changes he or she wants from counseling. Focus is on what the client wants to do rather than on what the client does not want to do. 3. The client is the person seeking help, and only he or she can make a change. The counselor helps the client accept the responsibility for change rather than trying to get someone else to change. 4. The cost–benefit effect of all identified goals is explored, and counselor and client discuss the possible advantages and disadvantages of these goals. 5. The client and counselor then decide to continue pursuing the selected goals, to reconsider the client’s initial goals, or to seek the services of another practitioner (p. 234). One of the most important tasks of a behavior therapist is to conduct a functional analysis of the problem behavior. Here, it is important to remember that all behavior serves some purpose. The goal is to identify environmental factors, parameters of the actions, and the results that accompany the problem behavior. For example, some offenders may use aggression to mask fear and anxiety. The aggression may consist of physically assaulting others to stave off appearances of being afraid. In certain cultures, this behavior is both acceptable and admired. Socially, however, it is disruptive and a criminal offense accompanied by sanctions. In this case, obviously the role of the counselor is to help the offender identify and define the problem of aggression; identify its destructive and dangerous nature; identify alternative responses to fear and anxiety that replace aggression; and evaluate the success of the alternative responses. The basic premise being dysfunctional behavior is learned and then integrated based on inappropriate reinforcement (Figure 5.1). Common Techniques of Behavior Therapy Systematic desensitization refers to the process of reducing anxiety primarily based on physical and mental relaxation. Systematic desensitization was developed by Joseph Wolpe (1958) and is a technique based on the principles of classical conditioning (Corey, 2005). Generally, a client will describe a particular situation that results in anxiety and then rank certain elements of the situation hierarchically ranging from little or no concern to extreme concern. The real task of the therapist is to help clients substitute feelings of anxiety with the competing response of relaxation. This is done by teaching the client to relax as successive elements of the anxiety-provoking circumstances are introduced beginning with those that are of little to no concern. Over time clients become desensitized and are then freer to make choices from an enhanced range of options. Masters (2004) notes systematic desensitization is often used with phobias, neurotic anxieties, interpersonal difficulties, as well as some forms of sexual problems. For specific steps in relaxation training see Wolpe (1990). FIGURE 5.1 Functional Analysis Source: SAMHSA TIP 34. Implosive therapy first introduced in the 1960s by Thomas Stampfl (Gladding, 1996) is a concept that describes the process of guiding clients through imaginary details of a situation that may have catastrophic consequences. The offender is asked to imagine in detail circumstances that create extreme anxiety and then verbalize them. The anxiety is extinguished over time due to the repeated exposure in the counseling setting absent of the feared results. Gladding (1996) notes this technique should not be used by beginning counselors. Implosive therapy can produce extreme anxiety and even trauma if not properly delivered. One of the delineating factors between implosive therapy and systematic desensitization is that implosive therapy techniques of relaxation are not introduced prior to the presentation of the anxiety-provoking circumstance. Assertive training is a process of teaching clients that they have the right to choose their own method of expression and do not have to continue with those responses that do not produce desired results. The major underpinning of assertive training is that a person should have the freedom to make choices without having to endure anxiety or emotional pain. Once a particular objective has been identified (speaking in front of groups, expressing true feelings, saying no to deviant peers), counselors will generally explore a client’s current behavior in regards to the objective. Feedback from the counselor is an important part of assertive training. Especially once the desired behavior has been identified it is important that counselors are able to help clients engineer clever ways of implementing and maintaining healthier and more productive responses. Coaching is a process of showing clients how to carry out or perform certain actions more conducive to healthy living. Sometimes referred to as modeling, coaching assumes that clients do not have to necessarily experience each aspect of a distressing circumstance in order to learn more effective behaviors. They can instead be taught by simply observing or watching others (Masters, 2004). Counselors are often in a powerful position to provide coaching. Corey (2005) notes, “Because clients often view the therapist as worthy of emulation, clients pattern attitudes, values, beliefs, and behavior after the therapist. It is essential that therapists be aware of the crucial role they play in the therapeutic process” (p. 235). Behavioral homework is the process of practicing a desired behavior usually after it has been appropriately modeled for the offender by the counselor (Gladding, 1996). Typically, the offender will receive feedback as the desired behavior is shaped. Homework is designed to help the offender practice the behavior in a more natural setting outside the counselor’s office. It is important that clients actively participate in this technique so that accurate reporting can be made on the outcomes of new behavior or responses. Accurate reporting is necessary so that further progress can be made in subsequent sessions usually in the form of modifications aimed at enhancing success and ultimately generalization of the more effective behavior. Finally, specific measurement is an important component of behavior therapy. One of the hallmarks of behavior therapy is the ability to quantitatively measure the progress of clients. Success is largely gauged by the frequency in which an offender is able to substitute problem behavior with that which is more likely to produce desirable results. This is precisely why behavior therapists are interested in identifying the specific problem behavior, how the behavior is carried out, the circumstances in which the behavior occurs, and the general results that accompanies the behavior. These factors are critical in order to determine how best to treat a client. In the end the success of behavior therapy is contingent on the numerical observations of employed corrective behaviors taking the place of former behaviors unable to elicit desirable outcomes. Through the process of quantifying results counselors are able to hone in on circumstances in which the corrective behaviors were not employed. In these occasions the specific circumstances are further explored in order to modify or develop new corrective behaviors that may prove useful. In behavior therapy the scientific model is closely followed in an attempt to broaden one’s repertoire of responses to aversive circumstances that are more likely to lead to healthier lifestyles and greater freedom to make choices. SECTION SUMMARY Behavior therapy is predicated on the assumption that behavior is learned and can therefore be unlearned. Classical and operant conditioning are the staples of behavior therapy and both describe types of learning. Classical conditioning refers to what takes place prior to learning and focuses largely on pairing. Operant conditioning focuses on learning that takes place based on the consequences that follow behavior. The types of reinforcements a person receives will determine whether the behavior is continued or extinguished. Behavioral interventions are individually tailored to the specific needs of a client. The relationship between client and counselor is one of collaboration and participation. Both must be active in the process of changing behavior. LEARNING CHECK 1. Objectivity is not a major concern of behavior therapy. a.True b.False 2. Classical conditioning describes learning in which behaviors are influenced by the reinforcements that follow them. a.True b.False 3. A very important aspect of behavior therapy is the functional assessment of behavior. a.True b.False 4. Behavior therapy places strong emphasis on self-control. a.True b.False 5. The primary goal of behavior therapy is to increase personal choice and create new conditions for learning. a.True b.False CASE VIGNETTE: Example of Behavioral Therapy Used with an Offender Convicted of Domestic Violence Gus has recently been convicted of domestic violence. He has been sentenced to probation for one year and also ordered to receive counseling for his aggressive and violent outbursts. The incident that led to Gus’s arrest happened one afternoon as he and his wife were watching television. Gus reports his wife began verbally assaulting him due to his lack of participation in carrying out household chores. Gus stated he had been drinking and when his wife failed to stop criticizing him he became violent and began to push and strike her. Gus stated that only after he initiates violence does his wife stop nagging him. Gus goes on to state that after the violent episodes he and his wife spend hours and even days not communicating. Gus claims to feel remorse for his violent actions and also extreme loneliness due to the lack of intimacy and connection following the violence. Gus also claims that he is concerned about his children growing up in an atmosphere of violence as he did. Gus states that while growing up he witnessed his father routinely batter his mother until finally his mother filed for divorce. Shortly after the divorce Gus’s father committed suicide. Gus states he must learn how to change his behavior before he, too, loses his family and permanently damages his children. The functional analysis of Gus’s behavior is carefully reviewed: COUNSELOR: When do you become violent? GUS: Usually, after I have been drinking and just want to relax. COUNSELOR: What typically triggers your violent outbursts? GUS: Usually, when my wife begins nagging me about something that needs to be done around the house. I try to tell her that I do not feel like doing it at the time but she continues to nag saying that I never feel like doing anything. COUNSELOR: How do you usually carry out the violence? GUS: I just finally have enough and get up and grab her by the shirt or hair. By this point I can't take anymore. Once I have grabbed her I shake her and yell that I am tired of her constant nagging. Sometimes I punch her in the stomach or back. I never hit her in the face. COUNSELOR: What does your violence accomplish? GUS: Well, it gets her to shut up. I can finally sit and relax and watch TV without hearing her criticize me. COUNSELOR: What else happens after your violent outbursts? GUS: Well, to be honest, I hate it. I hate being violent with my wife. I really love her and she is wonderful to my kids. And, after the violence is over she is so scared and hurt by what I have done. She does not talk to me or even look at me. I know how much it hurts her and disappoints her. I am a people person and have to live in the same house with my wife and kids and not communicating with them is terrible. And, after the last time she took my kids and went to her mom’s place for three days. She would not let me see or even talk to them. I can't take this anymore. COUNSELOR: Ok, it seems as though the specific behaviors we need to work on consist of violent outbursts directed at your wife. Is this correct? GUS: Yes. COUNSELOR: How often do you use violence to keep your wife from nagging you? GUS: Well, it depends on the nagging. Sometimes she says a few things and then stops. Other times, she just keeps going and says that she is not going to stop until I get up and do something. So when she says this I always get violent because my anger becomes too much. COUNSELOR: So, when your wife continues to nag you use violence about 100% of the time? GUS: Yes. COUNSELOR: To what percentage would you like to reduce your violent outbursts? GUS: 0% COUNSELOR: What is your main motivation for wanting to eliminate your violent behaviors? GUS: I want to save my marriage; I want to be closer to my wife and family; and I can't bear to think of my wife leaving me. I want my family to stay together. COUNSELOR: I want to begin by suggesting alternative responses to violence. First, how would you feel about getting up and walking out of the room? This would create distance between you and your wife and allow you to implement a very important skill-breathing techniques aimed at helping you relax. When you feel yourself beginning to get angry, I want you to leave the room and begin concentrating on your breathing. I want you to concentrate, specifically, on slowing your breathing and focusing on the consequences of using violence. GUS: I can try that. It will be difficult, but I think I can do it. See, where I grew up when the man said he had enough the woman knew to be quiet. The woman didn't keep talking because she knew what was going to happen. COUNSELOR: I understand, however, if you continue to rely on this learned behavior what will happen? GUS: I will end up in prison and I will lose my family. I get it. I am ready and willing to change my behavior. It is not worth it. COUNSELOR: Ok, I want you to describe a typical circumstance that is likely to lead to violence? Do this slowly and I am going to help you work through it without resorting to violence. I am going to help desensitize you so that you have a fuller range of options to respond that does not include violence. In fact, I would like to get a working contract with you. The contract states that under no circumstances are you to engage in violence with your wife. How do you feel about this? Are you able to engage in this contract? GUS: Yes, I can do it. I must do it. Usually, after I get home from work I like to sit around for a while and drink a few beers. I try to relax and unwind and let go of the stress. My wife stays home with the kids and if she wants me to do something she tells me to do it. This is where I usually begin to get upset. She could at least ask me instead of telling me. COUNSELOR: Do you ever resort to violence when you are not drinking? GUS: No, the only times I have been violent with my wife are after I have been drinking. I am able to relax after a few beers but I also get very angry and very quickly. COUNSELOR: If you were not drinking, do you think you would get as angry with your wife based on her telling you to do something as opposed to asking? GUS: Probably not. COUNSELOR: How hard would it be for you to not drink alcohol? GUS: Not that hard. As I get older, it is becoming harder to go to sleep after I have been drinking and it also makes me feel terrible in the mornings. I really need to stop drinking altogether. I am glad you brought this up because this is what I needed, to finally make the decision to stop. It is not helping me at all. COUNSELOR: I want you to imagine coming home from work and sitting down to watch TV. Let’s even assume that you are having a couple of beers. Your wife starts nagging at you to cut the grass. You tell her you do not feel like it and she continues. You feel yourself becoming angry. These are the steps I want you to follow: 1. Get up and create distance between you and your wife. 2. Begin to focus on your breathing. If you allow yourself to become enraged violence will be much more likely. 3. Think of the negative consequences of becoming violent. You will go to jail, and eventually lose your family. 4. In a calm voice, tell your wife that you need a little space to collect your thoughts. It is important to assert your rights in this instance because a violent outburst is at stake. Tell your wife that you would be happy to discuss household activities with her but you would like for her to please talk to you in a respectful manner. 5. If you feel as though violence is inevitable you will leave your house until you are able to return without engaging in violence. GUS: I can do this. I feel better with the thought of having more options. I really felt stuck. I felt as though I had no options. In this example, Gus must be lead from the point of no options other than violence to the point of having various options including leaving the house. Gus must understand that at no time is violence acceptable. In essence, Gus must begin to consider other options that are capable of producing the desired result. Gus would be given homework consisting of monitoring the interactions between him and his wife and the circumstances which produced the anger. Gus would be responsible for carrying out the objectives identified and evaluating their success. Based on the outcomes future sessions would be geared toward better enabling Gus to respond without violence. PART TWO: COGNITIVE APPROACHES Where behavior therapy is primarily concerned with behavior, cognitive therapy is primarily concerned with cognitions. Cognition is a concept that describes the process through which knowledge is acquired. The basic assumption of cognitive theory is that behavior is largely predicated on one’s thoughts, beliefs, and perceptions and that it is through faulty perceptions that much of dysfunctional behavior is predicated. Cognitive theory attempts to identify and correct faulty thinking patterns responsible for behaviors that are distressing, destructive, and criminal. Ultimately, faulty cognitions must be replaced with those that contain balance and flexibility that foster healthier behavior patterns and responses to certain stimuli. Cognitive therapy was developed by Aron T. Beck and resulted from his extensive work on depression (Corey, 2005). Psychoeducation plays a strong role in cognitive therapy as clients are taught how to identify internal cues and messages that are probably contributing to their distress. This process is often referred to as cognitive restructuring. Cognitive restructuring refers to a set of techniques that help people examine and reframe certain thoughts or beliefs that contribute to negative feelings or dysfunctional behavior (Beck, 1995). In essence, people’s reactions to situations are determined by their thoughts and beliefs in those situations in particular, and about the world and themselves in general (Beck, 1995). Cognitive restructuring is a strategy aimed at enhancing one’s awareness of one’s own thoughts and especially perceptions and then challenging those that generate strong negative feeling or emotion. Cognitive therapy builds on behavior therapy and attempts to account for the mental processes associated with behavior. In fact, although we keep the two separated in order to clearly depict the basics of each style, the combination of cognitive and behavior therapy techniques has led to one of the most robust therapeutic modalities known as cognitive behavioral therapy. Cognitive behavioral therapy has been researched extensively and is among the evidence-based modalities shown to be effective with a wide range of people including offenders. As noted by Corey (2005), Beck was primarily interested in automatic thoughts. Automatic thoughts are described as the often immediate intellectual reaction to some event or stimulus that culminates in an emotion-based response. Beck hypothesized that people suffering from emotional difficulties, especially depression, were highly prone to shift reality toward self-deprecation even in the absence of objectivity (Beck, 1967). “Cognitive distortion” is a term used to describe erroneous conclusions based on errors in reasoning. Cognitive restructuring, mentioned above, is the therapeutic response to cognitive distortion under many circumstances due to the assumption that healthy behavior is unlikely if one is experiencing perceptions and thoughts not properly aligned with reality. Table 5.1 contains a list of many of the most common cognitive errors. TABLE 5.1 Common Cognitive Errors 1. Filtering—taking negative details and magnifying them, while filtering out all positive aspects of a situation 2. Polarized thinking—thinking of things as black or white, good or bad, perfect or failures, with no middle ground 3. Overgeneralization—jumping to a general conclusion based on a single incident or piece of evidence; expecting something bad to happen over and over again if one bad thing occurs 4. Mind reading—thinking that you know, without any external proof, what people are feeling and why they act the way they do; believing yourself able to discern how people are feeling about you 5. Catastrophizing—expecting disaster; hearing about a problem and then automatically considering the possible negative consequences (e.g., “What if tragedy strikes?” “What if it happens to me?”) 6. Personalization—thinking that everything people do or say is some kind of reaction to you; comparing yourself to others, trying to determine who’s smarter or better looking 7. Control fallacies—feeling externally controlled as helpless or a victim of fate or feeling internally controlled, responsible for the pain and happiness of everyone around 8. Fallacy of fairness—feeling resentful because you think you know what is fair, even though other people do not agree 9. Blaming—holding other people responsible for your pain or blaming yourself for every problem 10. Shoulds—having a list of ironclad rules about how you and other people “should” act; becoming angry at people who break the rules and feeling guilty if you violate the rules 11. Emotional reasoning—believing that what you feel must be true, automatically (e.g., if you feel stupid and boring, then you must be stupid and boring) 12. Fallacy of change—expecting that other people will change to suit you if you pressure them enough; having to change people because your hopes for happiness seem to depend on them 13. Global labeling—generalizing one or two qualities into a negative global judgment 14. Being right—proving that your opinions and actions are correct on a continual basis; thinking that being wrong is unthinkable; going to any lengths to prove that you are correct 15. Heaven’s reward fallacy—expecting all sacrifice and self-denial to pay off, as if there were someone keeping score, and feeling disappointed and even bitter when the reward does not come Source: Beck, 1976. Adapted from TIP 34. The Effects of Depression and the Cognitive Triad As mentioned, much of Beck’s work focuses on depression and the debilitating consequences of this disorder. According to Beck (1987) what triggers depression is the coexistence of three main components he calls the cognitive triad. The triad consists of (1) a negative view of oneself, (2) negative interpretations of experiences, and (3) a negative view of future outcomes. When one generally views oneself from a negative standpoint, it is very difficult to experience the actions and words of others from a balanced or accurate perspective. In essence, the starting point for any interaction is always negative. Negative views of oneself, especially when objective evidence does not support such a view, is usually the result of not being properly attended to in earlier formative years. And, this is the case for many offenders. The unfortunate reality is that many offenders, especially those engaged in persistent criminality, have experienced significant neglect and trauma. Common cognitions include, “I am not good enough; I must be wrong; No one will take me serious; if people really knew who I am they would not want to be around me.” Especially, when something goes “wrong,” or not as planned, the immediate reaction is that it is based on their failures. The list of examples is legion. The important element is that the negative view is central to one’s mental landscape even in the absence of evidence. The result of having a negative view of oneself manifests into negative interpretations of experiences. Regardless of the encounter, the default perception is lined with negativism. Beck (1987) referred to this tendency as selective abstraction. Generally, one will focus on negative aspects of an encounter and ignore anything positive. For example, “You have done a good job, overall. Your work ethic is good and you are always on time. Also, the quality of your work is exceptional and beyond that routinely performed by your colleagues. The only negative comment, worthy of mention, is that you are not always clear in your communication. If you could improve this aspect of your performance it would greatly enhance your overall contribution.” A generally balanced and psychologically healthy individual is likely to interpret the above example as a positive review. Individuals with negative views of themselves, however, will focus solely on the suggestion to communicate clearer and construe this element as being an example of their failure. They will selectively abstract the one piece of information that is not positive and view their performance as a complete failure. The third component of the triad relates to one’s negative views of future experiences. A depressed person simply does not see the “light at the end of the tunnel.” Most if not all of their conscious thoughts are centered around past, perceived failures, and the likelihood that nothing will change. Everything is grist for the mill. Even past attempts to change their faulty perceptions or behavior will be used to foster their negative perceptions. Thoughts such as, “I am going to begin working on aspects of my life that I can improve” are often met with judgmental retorts such as, “Yeah right, I said that a million times before and still haven't done anything.” Corey (2005) provides several examples of generally depressed people that do a good job of illuminating the core framework from which they operate. Depressed people often set goals that are impossible to attain, not only for them but for anyone. They are often very rigid and lack flexibility. If some event or circumstance does not go as planned they see it as a complete failure. Their worth is judged almost solely on external sources. In other words, what is most important is the view of others and anything short of perfection is not tolerable. Depressed people often hold rigid expectations of others as well. And, in the event that one is not able to meet certain expectations there is a profound feeling of disappointment. Failure is almost always anticipated. One way to guard against failure, for the depressed person, is to make exhaustive efforts to control all variables related to one’s life or experience. This, too, however, is a futile attempt. The reality is that one is never able to control all circumstances. Trust is a very scary thought for someone suffering from depression. In essence, they have been “let down” so many times in the past that the only response they know is to not believe in anyone in a misguided attempt to stave off sadness, disappointment, and pain. Finally, depressed people often exaggerate the extent of their responsibilities and external demands. They feel overwhelmed which is accompanied by the expectation that they will not be able to get it done on time. Beck Depression Inventory Clearly, depression is among the most robust antecedents of psychological and emotional distress. As a result Beck (1967) created an instrument to objectively measure depression in an attempt to pinpoint the severity of a client’s depression as well as possible origins. The Beck Depression Inventory (BDI) consists of 21 variables that depict common symptoms and basic beliefs of depressed people. The depth of one’s depression is generally considered to be reflective of the scores provided for each of the variables. The variables measured in the BDI consist of the following: 1. Sadness 2. Pessimism 3. Sense of failure 4. Dissatisfaction 5. Guilt 6. Sense of punishment 7. Self-dislike 8. Self-accusations 9. Suicidal ideation 10. Crying spells 11. Irritability 12. Social withdrawal 13. Indecision 14. Distorted body image 15. Work inhibition 16. Sleep disturbance 17. Fatigue 18. Loss of appetite 19. Weight loss 20. Somatic issues 21. Loss of libido Based on information gleaned through the BDI, cognitive therapists are able to focus specifically on problem areas and attempt to understand the origins of the symptoms. In essence, the BDI serves as a tool to provide clarity and direction for treating clients suffering from depression. As noted by Corey (2005) the goal is to persuade clients to buy into the idea that enacting some type of change is more likely to alleviate powerful pangs of distress rather than continuing with past behaviors. Cognitive Behavioral Therapy Cognitive behavioral therapy (CBT) is a therapeutic modality that combines various aspects of several different therapeutic approaches including behavioral, cognitive, rational, emotive, and others. The hallmark of CBT is the assumption that distress is a result of improper or faulty cognitive framing that provides the foundation for self-defeating thoughts that lead to maladaptive behaviors. Over the last couple of decades CBT has been the focus of extensive research aimed at validating its theoretical foundation and therapeutic techniques. Much of the research reports favorable outcomes within a variety of settings as CBT is often considered among the most diverse therapeutic modalities available to practitioners. CBT is the logical extension to behavioral and cognitive therapy. It combines the basic components of behavior and cognitive therapy in an attempt to better attend to a fuller range of psychological and emotional stressors that significantly influence behavior. Mahoney and Lyddon (1988) argue that many of the most exciting and advanced therapeutic techniques developed since the 1970s have been within the theoretical construct of CBT. Ultimately, a person’s behavior is driven and guided by a combination of external and internal events. External events driving behavior are well accounted for with the theoretical foundation of behavior therapy. Classical and operant conditioning, when combined, account for behavior that occurs prior and subsequent to learning usually in the form of a reward or punishment. Internal events are more complex and “sneaky” in the manner in which they drive behavior. Internal event refers to internal dialogues that take place within a person’s cognitive structure as a result of some stimuli. For example, “You should put in for that award.” “Oh no, Gosh, if they really knew how screwed up I am. Well, you are doing a great job with the offenders. Yes, but these offenders are really doing all of the work. I am just lucky I have them on my caseload. Really, there is nothing that I have done that makes a difference.” The internal message within this hypothetical is one of not being good enough and low self-esteem among others. The result of this basic cognitive structure is likely to limit one’s ability to reach his or her fullest potential which results in stress that accumulates and demands some type of release. The type of release is what is critical and we would argue that the type of release is related to the level of one’s dysfunction and distress. For example, one would be hard pressed to find a human being who is so well adjusted that he or she does not experience anxiety or depression. We are all flawed; however, the extent is what is critical. Criminal offenders, especially those whose criminality has persisted over time, are likely to have the most negative and destructive internal dialogues. The result of these negative dialogues is often criminality, a behavioral act considered wrong by society as well as our legal system. The essence on which the following information is constructed is that most people who engage in persistent criminal behavior over prolonged periods of time and have experienced various correctional responses from incarceration to probation are likely to possess the most negative and destructive internal dialogues that must be restructured if criminal behavior can realistically be expected to be reduced or eliminated. Bartol and Bartol (2008) provide direct support for our basic thesis by stating, “CBT has become the preferred treatment approach for dealing with certain groups of offenders, including sex offender, violent offenders, and a variety of persistent property offenders” (p. 621). Cognitive Restructuring “Cognitive restructuring is a process through which offenders are taught to identify, evaluate, and change self-defeating, or irrational thoughts that negatively influence their behavior” (Gladding, 1996, p. 274). Irrational thoughts often occur in the form of “shoulds,” “oughts,” or “musts.” Many offenders have developed a powerful cognitive structure that demands they appear tough, strong, smart, and powerful. These demands have been learned via social processes throughout one’s life usually from caretakers and those in his or her immediate environment that seem to garner the most respect. What makes these cognitive schemas so powerful is they are backed by emotional punishments if disobeyed. For example, an offender who has learned that it is important to be tough may feel extreme shame in the face of showing weakness or “backing down.” The experienced shame is very powerful because it is directly related to a prototype the offender views as more powerful than him. The offender who has internalized and accepted the cognitive structure of having to be tough at all times may have heard this from his father. He may have heard his father refer to others perceived as weak in a derogatory fashion. Furthermore, the offender may have even received instruction from his father that he better not find out his son is weak and that no son of his will ever be “seen” as weak. This type of dialogue and learning is extremely powerful due to the authority of the source. This experience manifests itself into the creation of powerful prototypes (authoritative sources) that continuously provide cognitive messages even when they are not physically present. If the offender does not obey the “must” to be tough he has in essence let down his father. For some offenders the emotional pain resulting from such a circumstance may be sufficient to warrant extreme violence. Within the offender population the concept of respect is so powerful that it is likely a factor within the context of most murders. How does CBT attempt to restructure these dysfunctional cognitions? Meichenbaum (1977) provides a well accepted three-phase process. Phase one is self-observation where the offender begins the process of learning how to identify faulty cognitions and dysfunctional behavior. This can be a very challenging phase for correctional counselors because the task is to disassemble the structure of the dysfunctional, internal message that was crafted and sealed by an important source of authority within the offender’s life. The real task of phase one is to get the offender to realize that many of the cognitive structures and internal dialogues governing his life are faulty and will never lead to an existence described as psychologically and emotionally healthy. Phase two is the process of re-creating internal dialogues that are more adaptive and less likely to lead offenders into conflict. They may begin to recreate the dialogue pertaining to respect. It may be that the new dialogue says that if someone disrespects me it does not mean that I have to engage in violence to “save face.” This is not the only option I have. In phase three new skills are taught and learned. This is where offenders are taught specific behavioral responses to aversive stimuli that in the past have led to problems. For example, instead of violence the offender may be taught to immediately remove himself from the situation. SECTION SUMMARY CBT is a robust therapeutic modality that has received favorable results among many empirical tests. Cognitive and cognitive behavior therapy both focus on the importance of cognition and internal dialogues. Within the offender population a large percentage operate from a skewed cognitive structure heavily influenced by various associations with authoritative sources. The hallmark of CBT is that offenders learn to identify self-defeating messages and behaviors, begin the process of altering faulty messages, and then adapt new behaviors that are more likely to lead to positive results. LEARNING CHECK 1. Overgeneralization is when someone holds extreme beliefs based on many past incidents. a.True b.False 2. Cognitive therapy attempts to alleviate distress by teaching offenders new behavior. a.True b.False 3. According to Beck, people with emotional distress often tilt objective reality toward self-deprecation. a.True b.False 4. The cognitive triad describes a pattern that triggers depression. a.True b.False 5. The first phase of Michenbaum’s approach is to immediately begin a new internal dialogue. a.True b.False CASE VIGNETTE: An Example of CBT with an Offender John a 23-year-old male residing in an urban area on the west coast has been arrested numerous times for a variety of charges. His most recent charge involves domestic violence as a result of him assaulting his girlfriend after she failed to return home within 30 minutes of completing her shift at work. Sally, John’s girlfriend, works for a fast-food restaurant approximately 15 minutes from her apartment (depending on traffic). On the afternoon of John’s arrest, Sally was 45 minutes late which infuriated John. When Sally did return home John demanded to know exactly why Sally was late. Sally seemed confused and unsure as to how to answer John because she was late due to her stopping off to pick up John a surprise gift. Sally did not want to ruin the surprise so she hesitated when pressed about her whereabouts. To John, the fact that Sally did not have a definitive and immediate answer proved that she had something to hide. John became convinced that Sally was hiding something from him and was likely cheating on him. In fact, John had been suspicious of one of Sally’s co-workers for some time. This was the final bit of evidence he needed. At this point, in John’s mind, Sally was being unfaithful and this was not acceptable. John was raised in an environment where men were dominant and made all important decisions. In addition, the men in John’s life were free to come and go as they pleased but the females were not allowed the same freedom. In fact, the females were expected to be home and tend to domestic duties. In John’s upbringing he was taught that a female who was not obedient needed to be put in her place. John was arrested for twice striking Sally in the back of her head. COUNSELOR: Can you tell about the day of the incident for which you were arrested? JOHN: Yes, my girlfriend was late. She did not have any explanation for why she was late. I know that she was probably with another guy. I am a man, and she is not going to disrespect me that way. I will not tolerate it. She is going to understand that I am incharge. COUNSELOR: Do you have any evidence that your girlfriend was with another man? JOHN: No, but what would you think if your wife was 45 minutes late? COUNSELOR: Well, I would probably begin by asking her if she is ok? JOHN: Asking her if she is ok, man, where I come from a woman is not late and if she is she better have a good reason and she better not start hesitating when questioned. At this point the counselor has identified several important cognitive structures from which John is operating that are faulty. In this case the counselor will probably have to spend a significant amount of time, maybe several sessions, establishing a strong therapeutic alliance with John. For some counselors John’s cognitive framework may be very troubling. This must be worked through in order to avoid any hint of judgmentalism. In order to form a strong therapeutic alliance, John will have to grow to trust the counselor and feel that the counselor has valuable information. This will be the foundation on which the counselor is able to slowly begin to teach John how to begin the process of cognitive restructuring. First, the counselor will need to train John to be attentive to his basic internal dialogues. Second, John will need to develop new internal dialogues that are more functional and reflective of objective reality. Finally, John will need to identify behaviors that are first, not illegal and second more conducive to establish meaningful connections with significant others. COUNSELOR: John, as you were standing in the yard, furious, and waiting for Sally, what was going through your mind? JOHN: Well, I kept thinking about how my dad used to say that no woman should be allowed to disrespect her man. He used to say that it was not tolerable for a woman to be late and if she was she was probably up to no good. I also started thinking, what is wrong with me? What is it that some other guy has that I don't? COUNSELOR: Where is your dad? JOHN: He is in jail. He has been married three times and his last wife just left him. He began drinking one night and when he came in the house she was hanging up the phone. She was said she was talking to her mother but he did not believe her. He roughed her up and the neighbors heard what was going on and called the police. He is probably going to spend some time in prison for this charge because this is like the fifth time he has been arrested for domestic violence. COUNSELOR: How long have you been in jail? JOHN: I have been locked up for three weeks because I do not have the money to make bail. And, I hate it in here. I hate to admit it but I am scared. I see people getting beaten up all the time. COUNSELOR: Ok, John, are you ready to begin working on bettering your life and ultimately identifying healthier responses to certain aversive stimuli? JOHN: Yes, but how do I do it? COUNSELOR: First, you have to begin closely monitoring your internal messages regarding such issues as respect and self-worth. Can you envision a scenario where Sally may be late from work but yet have a very valid reason? Can you envision a time where Sally may not immediately come home from work simply because she wanted to go shopping for a while? Can you begin to envision a time where you do not relate such incidents to your self-worth or to the concept of respect? JOHN: Yes, I think so, but it will be hard. COUNSELOR: I understand it will be difficult. It is hard to let go of deep, entrenched thought processes that are laced with “shoulds,” “oughts,” and “musts.” However, it will be necessary to change the basic messages you send and receive to yourself regarding the appropriate behavior of Sally or any other woman with whom you may engage in a relationship. JOHN: So, what types of thoughts should I have? How do I not immediately get angry because I feel disrespected? COUNSELOR: You can begin by first recognizing that it is never acceptable to strike another person. Regardless of the circumstance, it is never legal to assault another person because you feel disrespected. Your father has engaged in this type of behavior and look where he is at. You have tried it and look where you are at. JOHN: Yes, you are right. I do not want to spend my life in jail. I also do not want to go through several divorces. I want to marry someone I love and I want to remain with them. COUNSELOR: What if you tried something different when you begin to feel angry? For example, what if you said to yourself, ok, I am feeling angry because Sally has not yet returned home. But, I am not going to overreact. I am going to wait to hear from Sally. It is possible that there is a valid reason for her not being home yet. JOHN: Yes, I think I can do this because, really, Sally has never done anything to hurt me. I hate that I scared her so bad and got so angry with her. All I can think about is telling her how sorry I am. And, you know, I really want to be different. I remember my dad telling my mom he was sorry but then he would hit her again the next time he got mad. I want to change so that we can be happy. COUNSELOR: Ok, so far we have accomplished two important tasks: (1) You have learned that you must be aware of and monitor your internal dialogues. Such messages like a woman’s place is in the home and a woman should never be late are not healthy messages from which to make decisions or base your actions; (2) you have learned that it is ok for Sally to be late. It does not mean that she does not respect you. It may be because she is not ready to come home and that is ok. Or, it may be that she has somewhere to go prior to coming home. Regardless of the circumstance, it does not mean that you are being disrespected. At this point, the counselor may check with John to ensure that the therapeutic alliance is still strong. It may also be beneficial to probe John as to whether he is truly able to internalize these suggestions and new cognitive structures. If so, the counselor is ready to proceed to the final phase which is helping John identify new behaviors. If not, the counselor may need to spend more time with John talking about his concerns as there may be additional information that will need to be explored prior to John being ready to proceed. JOHN: So what type of suggestions do you have that can help me change my behavior? COUNSELOR: First, remember that it is never acceptable to assault another person. So that is the first step, to commit to the fact that violence is not an option. And, when you feel yourself beginning to feel threatened that you remember that you will at least talk to Sally before concluding that she is doing something hurtful. JOHN: Ok, I get it. I know that I can not hit Sally. And, I have committed to never doing this again. Like I said before, I do not want to spend my life in jail. I am better than that. And, I don't have to believe everything I learned from my dad. Look where he is at. And, even when he is not in jail he is not happy because he is constantly worried about making sure he is the “man” of the house. COUNSELOR: Yes, and you may try this also: When you feel yourself getting worked up and anxious tell Sally how you are feeling. Begin the conversation by first acknowledging that you are feeling angry or fearful. Let Sally begin to help you work through this. Instead of immediately attacking Sally for something she probably did not do, tell her that you are angry and that you are going to do all that you can to remain calm but that you may need some help. Tell Sally that you are working very hard to not buy into the old cognitive structures that demand you not be disrespected. If necessary, you may also take a little time to gather your thoughts before talking with Sally. In fact, you may create distance between you and Sally until you feel ready to talk in a nonthreatening manner. JOHN: It will not be easy but at least now I have a new way of thinking about things. In the past I was not open or familiar with any alternatives other than feeling disrespected and feeling as though I must do something about it or I was not a real man. I realize that this is crazy and will only lead to trouble. PART THREE: REALITY THERAPY Reality therapy was created by William Glasser, born in 1925 in Cleveland, Ohio. Glasser’s initial training was in chemical engineering where he received a degree from Case Institute of Technology. He then decided to attend graduate school and in so doing began studying clinical psychology. After completing his master’s degree, Glasser then chose to attend medical school graduating in 1953 from Western Reserve University. Glasser specialized in psychiatry and was board certified in 1961. By 1962 Glasser had created the structure for what he called reality therapy (Corey, 2056; Gladding, 1996). The foundation of Glasser’s reality therapy is predicated on a few central postulates. First, Glasser and Zunin (1979) delineated old and new brain needs. Formerly, humans were mostly guided by physical needs to survive. Paramount concerns included those related to food and drink. In modern times, however, most humans do not experience these same concerns. Therefore, with basic (old brain) needs mostly met humans began grappling with the powerful pangs and often elusive new brain needs. According to Gladding (1996) new brain needs consist of the following four psychological needs: 1. Belonging—the need for friends, family, and love 2. Power—the need for self-esteem, recognition, and competition 3. Freedom—the need to make choices and decisions 4. Fun—the need for play, laughter, learning, and recreation (p. 279). How do we best satisfy each of these new brain needs? According to reality therapy new brain needs are best satisfied through healthy relationships with others. Therefore, the second major postulate is the realization that modern humans need to establish nurturing, loving, and lasting relationships with others. Without satisfying relationships through which people are able to connect in meaningful and fulfilling ways modern human needs can not be met. When humans are not able to establish meaningful connections with others most will begin to engage in maladaptive behaviors that are misguided attempts to fulfill basic needs. For reality therapists this is the crux of most dysfunctions. People are either not meaningfully connected to others or the connection is unsatisfying. And, it is from this basic framework that Glasser largely rejects the medical model related to mental illness (Glasser, 2003) and adamantly denounces the use of medication to treat emotional and psychological symptoms related to a lack of satisfying human connections (Corey, 2005). The third major postulate of reality therapy is that people make choices in relation to how they respond to various stimuli. This is an important component of reality therapy. In essence, behavior is purposeful and based on conscious thoughts that direct us in ways we feel are most likely to get our needs met. Total behavior is a concept used by reality therapists that describe four interrelated components of all behaviors: 1. Doing—the outward, overt, physical act of taking some form of action 2. Thinking—the thought process of driving the specific physical actions we choose to carry out 3. Feeling—the feelings associated with our thoughts and actions that can be either positive or negative 4. Physiology—the physiological reactions related to what we do, think, and feel. Similar to feelings, physiological reactions can be positive or negative. An example could include the energized feeling one gets as a result of exercise (Corey, 2006; Gladding, 1996). Fundamental to reality therapy is its emphasis on personal responsibility. Especially, with offender populations this concept is critical. Many offenders avoid taking responsibility for their actions and instead adopt the role of victim. Choice therapy, however, operates from the assumption that people do have choices and it is based on these choices that one will achieve our most basic desire—closeness with another. In order to accentuate this concept, Glasser published Positive addiction (1976) and also the Identity society (1972). The essence of both of these works is fundamentally related to the idea of choice as well as the need for identity. We all have a basic psychological need to establish an identity that is unique and meaningful. Glasser (1972) made these points clear in what he called the success identity. Central to developing a success identity is being accepted for who you are, including faults and imperfections, by others. When one feels accepted by others there is usually a transfusion of feelings of love and worth, both of which are central components to a success identity. The antithesis is a failure identity usually developed in the absence of love and acceptance. Common characteristics of a failure identity include a basic sense of insecurity where one’s conclusions based on some stimuli are often erroneous. In addition, people suffering from a failure identity usually lack confidence to try new things and tend to give up easily. In essence they see life as a string of failures and come to accept this as normal. Common verbiage coinciding with a failure identity may include, “Why try, I never succeed. I guess my family was right, I am useless.” The Function and Role of the Therapist Reality therapists work to create success identities and help offenders gain psychological strength. The first and most important goal is to establish a strong therapeutic alliance. This is important to understand when one considers that most offenders are offenders because they never felt truly accepted by their caregivers. Most offenders have developed a failure identity as a result of being abused and/o