Reflect on the Issues Surrounding the Therapeutic Use of Cognitive Behavioral Therapy Skills with a Client


Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that primarily deals with depression, though currently it is useful in the treatment of other mental disorders. CBT uses both cognitive and behavioral principles in dealing with depression and anxiety. According to Rimondini (2011), the technique has the primary basis of the belief that rational thought is not the solution to all the challenges. Rather, internal and external stimuli can condition a person in the environment that he or she lives in to solve the challenges that emerge. Research findings from many scholars note the effectiveness of CBT in the treatment of various mental disorders (Rimondini 2011).

One unique feature of the therapy is that both client and the therapist work in unison in solving the problem. The two parties examine the consequence of behaviors and thoughts on feelings and emotions (Gilson 2009). For instance, a client may have a firm belief that nothing works for them in life, thus begin to live in isolation. In such a case, the therapy commences the focus on behaviors like avoidance, poor social skills, and withdrawal. Another feature of CBT that makes it effective in the treatment of mental disorders is that it has a focus on two major issues that require addressing. One is the problem, and the other is action. Greenberger and Padesky (1995) say that CBT is “problem-focused” and “action-oriented.”

CBT is different from other psychoanalytical approaches because the therapist must look into the unconscious meaning of every behavior that a client displays. After that, the therapist must diagnose the patient and help in finding solutions. As the discussion highlighted, CBT combines cognitive and behavioral principles. Cognitive therapists use the principles of conscious thoughts and their influence on the behavior of a person while the behavioral therapist uses the principle of influence whereby avoidance and feared principles are the responses that affect the behavioral concept of a person (Greenberger and Padesky 1995). The combination of both principles results in Cognitive Behavioral Therapy (CBT).

Some of the conditions that are favorable in the use of CBT include psychotic disorders, tic, dependence, addiction, eating, personality, anxiety, and mood swings. Programs of CBT treatment are better than other psychodynamic treatments. In the case at hand, CBT is the best therapy to apply. The client is anxious. He is deep in debt and does not know what to do. He sees himself losing his home and family. He believes that he let his family down and is almost falling into depression. Anxiety and depression are the problems that he is battling with though anxiety is the bigger problem than depression. With the use of CBT, the client can overcome the anxiety that he is having and get well.

CBT skills effective in the case

There are various skills that I can apply when using CBT. To begin with, I must ensure that the client changes and evaluates his behavior focusing on specific thoughts. There are some clients that may fail to recognize negative thoughts. In such a case, it is my responsibility to help the client to identify such problems and help him in challenging them. One of the ways that I can help the client is by setting goals that are realizable such as engagement in social activities and learning how to be assertive. In this case, the basic skill that I require is the ability to convince. The man is deep in debt. If he continues isolating himself from his family because he fears he has failed them, he will fall into depression. For the moment, he is anxious about the outcomes of his actions. Therefore, I must have the convincing power that will convince the client to stop his isolation from other parties. According to Gilson (2009), the power of conviction is one of the basic skills that a CBT therapist must have. In the absence of that, then the client will fall deep into depression. In the same school of thought, I must teach the client how to be assertive and stop self-loathing and self-pity.

Another imperative skill that I must have to help the client is knowledge about anxiety management. For example, I must know how to help the client to apply relaxation techniques such as self-talk and deep breathing. Such techniques help the client to have destructions (Beck 2015). With the distractions, the client will relax and cope with the anxiety that he is having. The basic characteristic of the features that the client feels before application of the relaxation techniques are feeling of self-loathing and anxiety. By having knowledge about self-relaxation techniques I will help the client in a major way.

The other skill that I must apply in using CBT must is alertness. I must be alert so that I can identify the situations that may cause fear, thus negate any progress that the client made in the right direction. The client, being anxious about the present situation as well as the future, can become more anxious, go back to the former state in case I made any progress, and fall into the abyss of depression if I am not aware of situations or circumstances that may trigger such a consequence. Beck (2015) says that the therapist must have alertness skills if he or she is to be successful in using CBT to treat a patient that is anxious or has depression. The underlying factor in such a case is the ability of the therapist to note circumstances such as an increase in debt, the wife or relatives of the man reminding him that he made them lose the house or an insult that deeply wounds the patient. I must be able to recognize parties and situations that will negate the progress that the patient makes (Rimondini 2011).

Furthermore, I must have the skills to cheer up the client such as engagement in exercises, social activities, and hobbies that will help the patient to temporarily forget his situation. Rimondini (2011) calls this skill “social skill” whereby the therapist encourages the patient to enjoy the outdoor or even indoor activities that will cheer him up and enable him to recuperate. I must have the ability to help the client to enjoy other activities, and not just talking. CBT involves cognitive and behavioral factors. Activities are both cognitive and behavioral because they help the person to relax. I must also have the ability to track behaviors, thoughts, and feelings of the patient so that he can note any changes in them. If the sessions go on, and the client becomes receptive, I must be able to track the thoughts, feelings and behavior of the client from the onset when he steps into the office to the time that he is completely healed. Changes in the three factors may be of concern because they may be a show of either failure or success of the therapies. They also show me to take action by either changing the treatment strategies or complementing them for them to be successful. If the strategies that I am using are successful, then such ability enables me to know it and encourage him to continue using them.

CBT for anxiety must commence with the education about the condition. It will help the client fathom the symptoms thereof and know that it is an illness. Strategies of treatment include assisting the patients to have an establishment of daily activities and have an awareness of changes in their moods and the challenges that come with negative thoughts. I must also teach the client the benefits of taking part in pleasurable activities. There must be unison of both the client and I in working together. The man must work with me if he is to get treatment for his anxiety.

In case I use behavioral therapy alone, the patient will not have an effective change in his behavior because behavioral therapy has an assumption that maladaptive thinking leads to effective behavioral change. However, such is inapplicable to the man because his behavior is not the single matter of concern. Anxiety is also a cognitive problem. He is sad and anxious. By the fact that he is deeply in debt, he has worries that his family will consider him as a failure. He is also anxious about what will happen in the coming days in the future because if his family loses the house, he will be the one to blame. His mind is lost on any positivity, and the primary concerns are the negativities of the debts that he is in. Behaviorally, he is in isolation. He is afraid to face his family. So is maladaptive thinking the case or the complete change in the same the best way of perception? To answer this question, I must follow the steps of CBT.

Steps of CBT

Greenberger and Padesky (1995) argue that the goal of CBT is not to diagnose a particular disorder or disease, but it is to examine the whole problem as a whole. The assessment of CBT are in four steps;

  1. Identification of the critical behavior.
  2. Determination whether the critical behavior is in deficit or excess.
  3. Evaluation of the critical behavior for intensity, duration, and frequency.
  4. The attempt to decrease the intensity, duration, or frequency if in excess and vice versa if in deficit.

By examination, I will first identify the kind of critical behavior that the man has. An anxious person displays some particular behavior such as signs of overwhelming panic, hyperventilation, feeling of loss of control, and choking sensation (Beck 2015). Also, the person may rapidly shake or tremble. I will look out for the signs. When I establish that he is displaying three or more of the symptoms, I will move to the next step. The second step only takes place after I identify that he is anxious. Therefore, the question in step two that I will answer in evaluating my patient is whether the anxiety is in excess or deficit. For the case, it is in excess. The third step that will take place is the evaluation of the baseline for the anxiety. The baseline will be the intensity. The man displays a considerable amount of high intensity of anxiety. To cure his condition, I will sue my skills to decrease the intensity of the anxiety that he is having before he falls into depression, which is a common occurrence among patients that are anxious (Beck 2015).

Phases of CBT

There are modern and diverse forms of CBT such as commitment and acceptance therapy, dialectical behavior therapy, relaxation training, cognitive therapy, cognitive processing therapy, and exposure therapy. There are practitioners that use only one form while there are others that sue more than one. CBT has six phases that I will apply in enabling the man to control his anxiety. The first phase is the psychological assessment. In the phase, I will first assess the intensity of the anxiety to the patient. It is significant in establishing the kind of strategies that I will implement in healing the man. Psychological assessment reveals the duration, time, and intensity of the patient’s condition. It also reveals the probable impacts of the same to the patient and to the relationships that he has with his family, friends, and colleagues.

The second phase of CBT is Reconceptualization (Gibson 2009). Reconceptualization refers to re-examination and analysis of the psychological wellbeing of the patient. According to Rimondini (2011), reconceptualization is a deeper kind of psychological assessment that reveals more information about the patient than the first step. I will analyze the psychological, cognitive and behavioral wellbeing of the patient so that I get more information about him. I will do that by asking him questions, playing psychological games, examining his view on matters, and even outdoor activities engagement. The revelations that the reconceptualization will reveal are imperative in determining the course of treatment to take in accomplishing the treatment goals of the patient.

The third phase is “skills acquisition” (Rimondini 2011). It refers to imparting the skills that the patient needs to get well and eliminate the anxiety that he has. For example, I will talk to him about other cases of anxiety that are worse than his and tell him how one can stop being anxious. One of the lessons that I will give him is how to use exercise and outdoor activities to get rid of the anxiety. I will teach him the value of exercise. Besides that, I will teach him how to be social with other parties especially his family so that his isolation can end. I will ensure that I give him many skills to deal with his condition. The skills refer to the strategies that I decide in phase two to implement to help him after realizing the extent of his disorder.

The fourth phase is “Skill application and consolidation training” (Greenberger and Padesky 1995). In this phase, the most significant activity will be watching the patient apply or implement the skills that I taught him in phase two so as to get well. I will constantly communicate and converse with him so that I gauge his progress in applying the skills that I taught him. One of the ways that I will accomplish this task is by giving him activities to do. For example, I will tell him to use the best mode of communication to talk to each member of his family, beginning with his wife because his wife is likely to help him deal with his condition. In addition to that, I will tell him to go for morning jogs so as to relieve himself of the pressure that he may face that day dealing with financier and other parties, together with the thoughts of failure that he has. Besides that, I will ensure that he applies the skill for changing the thinking that he has from that of a failure to that of a person that just underwent a challenge that is solvable. I will ask his family, especially his wife to give him support during this time because if he does not receive the kind of support that he needs, he will fall into depression, a worse order than the anxiety that the man has.

The fifth phase is “maintenance and generalization” (Greenberger and Padesky 1995). This step is not as involving as the first four. According to Beck (2015), it does not require many activities, just ensuring that the patient continues in his regular activities and maintains the skills that I taught him to help him deal with the anxiety that the man has. in the phase, I will gauge the progress that he is making, his family, his friends, and their relationships with him, as well as how he is using the skills that I gave him. Finally, the last phase is “post-treatment follow-up and assessment” (Beck 2015). In the phase, my responsibility is to ensure that the patients continue using the skills that I taught him so as to cure the disorder. Before the implementation of the phase, the CBT must prove to be successful. The last phase is purely to ensure that the patient does not get back to his original anxious self.

Limitations of CBT

According to Greenberger and Padesky (1995), CBT is mechanistic and rigid. That is to say, its cynosure is the setting of goals and the use of an educational approach. Therefore, the likely result is the lack of exploration of the problem in a bigger picture than when a therapist uses it. For example, if I strictly follow the steps and phases of CBT, I may not include the man’s emotions, issues, family, and other relationships because he steps and phases do not have inclusion of such factors sin the treatment of anxiety. Moreover, there is relatively little information and knowledge about the treatment. Only practitioners that have enough skills have its knowledge. Thus, it may not be applicable to other situations that may need further assessment and treatment. Indeed, the approach is effective for illnesses that are not recurrent. Nonetheless, it is ineffective in disorders that recur because it does not proved room for interventions that are repeatable. However, it must be clear that it is useful for many other disorders and conditions. Another limitation of the use of the approach is that it has complex structures that may not be easy to implement in some cases (Beck 2015).


CBT was successful in treating the man with the problem of anxiety. One problem that I got while using it was the fact that it does not give room for the inclusion of relations in healing patients. I had to go out of course to indeed the man’s wife and family members in helping him, out of the procedural steps and phases to follow when implementing CBT. My recommendation is that more research on the approach be considered in order to present a more comprehensive approach than there is in the present. Nonetheless it is effective.
















Beck, A. (2015). Cognitive behaviour therapy for anxiety and depression: A practical guide.

Gilson, M. (2009). Overcoming depression: A cognitive therapy approach : therapist guide. Oxford: Oxford University Press.

Greenberger, D., & Padesky, C. A. (1995). Mind over mood: A cognitive therapy treatment manual for clients. New York: Guilford Press.

Rimondini, M. (2011). Communication in cognitive behavioral therapy. New York: Springer.




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