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Indeed Aaron Beck was the originator of cognitive behavioral therapy or CBT as we know it today (Corey, 2017; David et al., 2017; Edelstein, 2017). I agree with you that CBT has a place in family therapy especially with children suffering from autism spectrum disorder or ASD. In your reference to the YouTube video of Dr Judy and Kittleson, you make allusion to the reference to the patients’ thoughts as distorted. The patients in that case felt that they did not have any value and that no one wanted them. In other words, they had negative thoughts about themselves. This is further confirmed by the other video you mention about Michael Korea in which he confirms that CBT is all about the patterns of thought. This is a correct observation that you make and that is why I would add that CBT is about cognitive restructuring or remodelling. This means that the therapy strategy aims at fundamentally changing the patient’s way of thinking so that they can begin thinking positively (Corey, 2017). Of course it is therefore hoped that the positive thoughts will then transform their actions and behaviors accordingly in a positive direction. Discussion Reply Essay Paper

I agree with you that group therapy enhances learning through social behaviors and skills. You are also right when you point out that it is for groups of clients with a similar condition or common disorder. I concur with you that group therapy as opposed to individual therapy are cost effective and reduce stigma from the society. One therapist can take care of several clients who are treated as a group. This is different from individual therapy where each client must have their therapist or own time with the same therapist.

The challenges you mention with group therapy such as not being able to attend to every group member with the same effort, inability to offer equal attention and the fear of members to share intimate details with strangers are real. These may be overcome by strategies such as setting ground rules at the beginning of the group in the forming stage, using a semi-circular sitting arrangement allowing the therapist to see everyone, and active listening with eye contact amongst other strategies.

Respond to at least two of your colleagues by recommending strategies to overcome the challenges your colleagues have identified. Support your recommendation with evidence-based literature and/or your own experiences with clients.

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Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

Cognitive therapy is a collaborative process of empirical investigation, reality testing, and testing, and problem-solving between the therapist and the patient. Cognitive therapy evolved out of the work of Aaron T.Beck in the early 1960s at the University of Pennsylvania. Beck, who was originally trained in psychoanalysis, observed that individuals with depression had similar distortions in their making that created dysfunctional, inaccurate conclusions that fueled depressogenic emotions, thoughts and behaviors.(Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-to Guide for Evidence-Based Practice, 2020, p. 360)

The psychosocial treatment of choice in typically developing children is cognitive-behavioral therapy (CBT). Children displayed significant decreases on clinician and parent-rated anxiety, and improved family function and coping. Gains were maintained at follow-up.  Parent–child CBT is feasible for young children with Autism Spectrum Disorder. ASD plus anxiety that shows potential for similar efficacy as with neuro typical children. Driscoll et al., (2020).

In the YouTube video of Dr. Judy Ho and Kyle Kittleson, they refer patient’s negative thoughts as being “distorted”, this patient feels like is worthless and not good enough, not lovable or worthy of love. They talk of core beliefs as being the distorted untrue thoughts about one self. If one believes that they are worthless. They put a rule on themselves that is very limiting to match those core beliefs.

In the YouTube video by Micheal Korea, he speaks about CBT as thinking patterns and the role they play in mental illness. He mentions how Aaron Beck talked about people’s distorted view of self, others and future and called it cognitive triad. Beck tried to challenge people’s beliefs to help them to avoid all those negative beliefs by engaging in this kind of thinking patterns, then challenging these thoughts by trying to change them. In this video, CBT focuses on specific areas and there are specific goals on restructuring thoughts.

Group approaches for couples try to improve communication and other specific problems. Family therapy includes systems of relationships by all members of the family and the expectation of every member of the family. In group therapy, individuals work in groups set up with a common disorder. Group therapies encourage social behaviors and social skills, people get to hear others different view of a common issue. Group therapies are cost-effective, they reduce isolation and also reduce social stigma.

In the YouTube video by Micheal Korea, challenges that PMHNPs might encounter when using group CBT include not being able to give equal attention to all members of the group, not enough time to address every group member’s issues to their satisfaction, not all members are comfortable sharing their private matters in front of others and group members can learn negative behavior from each other. Discussion Reply Essay Paper

Several challenges exist in the use of assignments in CBT. Clients may be unwilling to complete activities that involve distressing thoughts or emotions. The mere term “homework” carries a burdensome connotation clients may subtly draw the therapist away from utilizing assignments by providing negative feedback or simply failing to complete the work. Research evidence shows that clinicians view homework to be less effective than other CBT interventions, potentially because of difficulties with implementation. Okamoto et al., (2019).

Still other challenges may arise from the group format. For instance, group leaders should keep in mind that comparing oneself to others is not always helpful. Whereas some people in the group may feel encouraged by such comparison, others can feel they have failed and even blame themselves for their perceived failure. Sandlund et al., (2018).

Both practitioners and clients confront practical and psychological challenges to all remote or a remote- and in- person hybridized model. Practical challenges include lack of access to the hardware, software, or data plans required for tele psychiatry; poor connections that disrupt the flow of a therapeutic encounter; and delays in the exchange of written therapeutic materials. Practitioners may also experience administrative burdens associated with revised work-flows, policies, and procedures. Kopelovich et al., (2021).

References

Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). (2020). Springer Publishing Company.

Driscoll, K., Schonberg, M., Stark, M. F., Carter, A. S., & Hirshfeld-Becker, D. (2020). Family-Centered Cognitive Behavioral Therapy for Anxiety in Very Young Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 50(11), 3905–3920. https://doi.org/10.1007/s10803-020-04446-y

Okamoto, A., Dattilio, F. M., Dobson, K. S., & Kazantzis, N. (2019). The therapeutic relationship in cognitive–behavioral therapy: Essential features and common challenges. Practice Innovations, 4(2), 112–123. https://doi.org/10.1037/pri0000088

Sandlund, C., Kane, K., Ekstedt, M., & Westman, J. (2018). Patients’ experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study. BMC Family Practice, 19(1), 111. https://doi.org/10.1186/s12875-018-0798-2

Kopelovich, S. L., & Turkington, D. (2021). Remote CBT for Psychosis During the COVID-19 Pandemic: Challenges and Opportunities. Community Mental Health Journal, 57(1), 30–34. https://doi.org/10.1007/s10597-020-00718-0

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