Beside Cognitive-Behavioral,
which other therapies do you use and why?

 

There are a few other techniques I use that come from theoretical persuasions other than Cognitive-Behavioral (CBT).  I often find myself employing techniques from the Gestalt, Schema Focused, Solution Focused, and Rational Emotive Behavioral Therapy (REBT) modalities.  Cognitive-Behavioral is the most understandable to me, and the most comfortable for me to use, but while I might be good at it, not all clients are candidates for this approach. The good news is that, most often, my new clients can sense their own ability or lack of ability to work with CBT, as I describe it to them in our first session.  This allows us to entertain other modalities early in therapy.

CBT candidates need to be able to easily report their feelings and thoughts within the therapy session.  Some, if not many, have been functioning for a long time in a manner that makes this approach seem too foreign to grasp.  In order for CBT to work, clients must learn the basic concept of what needs to take place, and be able to identify the sought after thoughts and feelings.  For some, it can take several sessions just to become aware of the "automatic thoughts" that have been flying around in their heads all their lives but have gone unnoticed.  For others, especially many men, the only emotion they might be able to identify in their history is anger.  This means the other five basic emotions have gone unrecognized most of their lives.

For others, they are unable to clarify the problem that brought them into counseling.  They try ever so hard to identify it, but the problem is of such a nature that doing so alludes the client.  For CBT to work, we need a clearly identifiable problem.  There are other counseling approaches that work much better for these clients, and when I lack enough skill in those other modalities to be of help, I refer them to someone who is.

Some clients have such disturbed relationship traits that they first focus on the therapist, not their thinking patterns or behaviors.  They are studying the therapist's reaction to them in order to gauge how well or not well they are doing personally.  CBT practitioners are not usually trained well enough to use these therapeutic relationship qualities to their advantage.  The result is a client working in one arena, and the CBT counselor in another.  Nothing gets accomplished here other than a stalemate and bad taste in the mouth of each.

There are additional indications of whether CBT is appropriate or not for a client  but I think enough has been said to get the point across.  To try to force all clients to work within the CBT mindset is unreasonable and hardly indicative of a client focused enterprise.  It might be possible to do so, but then why use a 10 pound hammer for every type of nailing task in building a house when other sizes are available?  Some jobs benefit by such a hammer, but finish carpentry would be an exercise in futility.