Cognitive Models
Cognitive Behavioral therapy, as the term proposes, is a blend of both cognitive (Beck, Emery, Rush, Shaw, 1979) and behavior therapies (Myers, 483). It has grown in popularity as a result of the launch of Improving Access to Psychological Therapies (IAPT, 2007).The universal ideologies of Cognitive Behavioral Therapy can be traced to the early days of 1970.
The strength of Cognitive Behavior Therapy is built on the cognitive models. Ellis (1977), (according to the citation of Casey, Trower and Dryden, 2003) founded a model recounting the relations between cognitions (thoughts), behavior and feelings that explain what people do or don’t do. This was built upon by Rush, Beck, Emery and Shaw (1979), through its stress on the experimental inquiries of patients’ spontaneous cognitions, inferences, assumptions and conclusions. It is also founded on the evidence that clarification of an incident is crucial, because an individual’s thoughts controls the way he/she feels emotionally and the way how he/she reacts physically. A good instance of this are Garland and Williams (2002) employing the five capacities valuation. Behavioral constituents are also employed as a way of thought-provoking these beliefs, which include self-monitoring, homework assignments or scheduling activities, as well as graded job performance (Grist, 2011).
Collaborative Empiricism
The phrase ‘collaborative empiricism’ is employed in order to depict the way client and therapist work together. The method concentrates on the here-and-now approach relying on the client and therapist developing a communal perception of the discrete problem. According to Dattilio and Hanna (2012), the psychotherapy is a collective effort of a client and a therapist, allowing the two to work on recognizing and conceptualizing the problem. The patients are presumed to be the experts on the difficulties they have and the weight they ascribe to various events and experiences. It is a continually monitored, time limited, highly structured and evaluated therapy. According to Beck, et al., in the 1979 critique, the philosophy of the Cognitive Behavioral Therapy is that individuals are participating learners not only passive heritors (Beck, et al., 1979).
The therapeutic relationship has for long been acknowledged as a significant feature across the different therapies. Establishing a salutary relationship is considered as a basic ingredient. Hiskey (2012) and Kramer, Sohne and Hyper (2004), describe the significance of the salutary relationship offering an experimental explanation for a tie between a constructive client-therapist rapport and results of the therapy. For growth and progress to take place, the input of Carol Rogers is a basic ingredient, adding traits of regard, empathy, positive attitude, acceptance and warmth to the synthesis. This is backed by Beck in the 1979 critique, saying for cognitive psychotherapy to be successful, the psychotherapist has to develop an alliance via such qualities. Conversely, corresponding to Beck, et al., in their article, Cognitive Behavioral Therapy takes an interior stance and employs other innate components to augment rapport. Nevertheless, the significance of the salutary alliance should not be underestimated.
Socratic Method
Cognitive Behavioral Therapy exercises the Socratic Method. Clients are helped to understand the connotation of their interrelationships, thoughts, emotions and actions. It improves cognitive changes, self-awareness and problem solving, as according to Greenberg, Emery and Beck (2005). Helping clients alters their underlying views. Client retains control by involving the psychotherapist to walk in a thin line between directing the patient in the way he/she expects him to behave.
Exclusive Chart of Patients Presenting Glitches
Conceptualization is an exclusive chart of patients presenting glitches. It is an interpretation of why an individual is undergoing through the complications, as according to what Greenberg, Beck and Emery write (2005). It varies from an analysis (diagnosis), since it gives an explanation more exactly, as compared to a label. This is the core of situation conceptualization, where the psychotherapist comes up with a working premise of how complications developed and views that sustain them.
Preparation Assignments
Preparation assignments are the heart strength and the main component of the Cognitive Behavioral Therapy, according to Dozois in the 2010 critique. In the dairy errands that sustain certain skills, the client is provided with a clear description for handling the homework assignment. Older adults, people over the age of 65, are as much capable of enjoying life as the youthful adults are; people under the age of 65 are adjusting to alterations they encounter, although a number of them does not. According to ICD-9, the symptoms of depression are at times similar to the symptoms of other medical ailments; therefore, it often runs unrecognized in the older adults. Current studies have established that the Cognitive Behavioral Therapy’s results are similar for older and younger adults. There is a progressing body of proof showing its efficacy with older adults suffering from mild-moderate depression as Strate, Smit and Cuijpers wrote (2006).
In what way are younger adults different from older adults in terms of working with them homeopathically? Older adults basically bring identical problems similar to those of extra ages. Generally, the same remedy interventions apply, as according to Clarke and Walker (2001). The question is whether the certain modifications are needed in the delivery of the model, but not whether the Cognitive Behavioral Therapy is pertinent for the older adults. David, Satre and Knight’s (2006) records reporting on the features distinctive to the old adults must be considered, and particular adaptations in a number of the domains will capitalize on the treatment outcome. Laidlaw and Thompson (2003) accentuated that Cognitive Behavioral Therapy with the old adults may vary from the one with the younger individuals because the lifespan intricacies may fetch. Sadavoy (2009) backs this opinion that for the psychotherapy to be applicable, one must consider the 5Cs: Continuity, Complexity, Co morbidity, Context and Chronicity.
Particular Collections of Abilities
To deal with the needs, Thompson and Gallagher-Thompson (2010) state that major changes are not mandatory in the application of the Cognitive Behavioral Therapy. Constantly there are particular collections of abilities to be present in every phase, such as agenda setting, analysis of previous homework, using collective empiricism to reinforce the therapeutic alliance, concentrating on key issues to home practice and discussions. One should understand that age itself is not an upright determiner for whether modifications to Cognitive Behavioral Therapy are necessary or not, as according to Evans (2007). Modifications may be necessary to deal with particular age-related concerns that the old adults can bring, as according to Stanley, Kunik and Kraus (2007).
Recent research has abstracted a Cognitive Behavior Therapy model to care for the older adults. CBT incorporates a gerontology structure, which helps in treating the old (Laidlaw & McAlpine, 2008). Conceptualization with the older adults is usually complicated, as a result of the amount collected during the assessment. According to Laidlaw, et al. (2003), a typical conceptualization is arguably inadequate with the older adults. Laidlaw, et al. (2003), develops a conceptualization model that highlights the significance of the information required to develop a preparation, when working with the older adults (Laidlaw, et al., 2003). Permitting the psychotherapist to take into account physical health, social cultural context, and cohort beliefs and responsibility investment intergenerational connections information would not have been collected using a typical conceptualization. This serves to improve an understanding of a person’s life experiences, as well as how they might impact the individual therapy (Laidlaw & Knight, 2008).
Passing Into the Late Adulthood
Passing into the late adulthood is a complex stage that requires one to adapt to several transitions. The transitions include bereavement, having grandchildren, and retirement among others. Some individuals find it hard to adapt to these changes. It is hard to give up the roles, which were vital for the individual’s self-esteem and identity. According to Laidlaw, Thompson & Gallagher-Thompson (2004), there are many changes within the society and family demographics that the old adults treasure. The cognitive distortions, standard for depression, in the late life reflect the difficulties experienced to the extent of loss. In this case, Gallagher-Thompson and Thompson (2010) highlight that changes of roles might also establish a significant factor to assess in therapy. Therefore, it requires therapists to work on the individuals’ earlier capabilities of self-acceptance; so that they can help them to cope with the transitions they face at old age. This includes finding methods, in which the individuals still feel treasured and maintain self-esteem. Wisdom is a usual and positive element accompanying aging. The wisdom capitalizes the old adults’ recognizable years of expertise in problem solving. Therefore, the therapist uses this knowledge to help individuals to raise resilience. The resilience helps the older adults in the face of hardships (Thompson, 2010).
Law & Laidlaw (2010) point out that the attitudes the old individuals have towards their matters may also influence the delivery of Cognitive Behavior. In most societies, many old adults grew up before the psychoanalysis matters were established in healthcare services. Therefore, the individuals find it hard to seek help, when they have depression. They have traditional beliefs, which hinder them from seeking psychotherapy advice. Laidlaw, et al. (2003), have investigated the older adults and found out that they fear stigmatization. This makes them develop the understand capacity phenomenon, which makes them attribute depression symptoms to old age. The individuals do not have information or knowledge required to obtain an appropriate care for depression. Attitudes also prevent them from acquiring the depression care. It requires therapists to dispel myths the individual holds concerning aging. The therapist has to explain and provide reliable empirical proof of the effectiveness and efficiency of CBT in caring for old people with depression. In this case, it requires the therapist to explore the client’s social-cultural context, as the individual is introduced to the therapy (Gallagher-Thompson, 2004).
Cohort beliefs affect people’s life. This is because people are born, grow and mature within a given period. This influences cohort beliefs and ultimately the individual’s social life. Berk (2001) explains that people born in a particular period of time share cultural and historical conditions that influence them in the same way (Berk, 2001). These conditions partially shape older adults’ valves and thought processes. According to Knight and David (2006), cohorts that are born later, can easily adapt to psychological therapies, while the cohorts, which were born when the individual was young, hold stereotypical interpretations of depression and see it as just old and untreatable. Therefore, it is significant to understand the cohort impacts when enhancing therapy impacts (Knight, David, 2006).
Hesitant Views Concerning the Older Adults
Since time in memorial, the society has been holding hesitant views concerning the older adults. There are many prejudices and stereotypes held against the older adults due to their age. In fact, Freud believed that the old can hardly benefit from psychotherapy, since they lack mental plasticity. There are many sayings and beliefs regarding old age. The society believes it is terrible to grow old. The old are seen as rigid and not possible to teach (Laidlaw, et al., 2003). However, this assumption is wrong and destructive. The old should be treated and taken care of just like children, youth and other adults. Treatment interventions should be administered to all people, irrespective of their age (Walker & Clarke, 2001). Givens, et al., conducted a qualitative study, which revealed how old people express an inclination for a therapy. When an individual recognizes beliefs and attitudes, assessing treatment outcomes becomes easier. Therapeutic nihilism can result from the complexity the older adults bring to therapy. This is discouraging and has to be addressed in order to avoid such outcomes.
It is likely for older adults to suffer age-related variations. Therefore, accommodating sensory impairment, summary and repetition should be frequent throughout the sessions. Decelerating in cognitive memory and processes changes is one of the imposing changes in the Cognitive Behavior Therapy (Secker, Kazantzis & Pachana, 2004). This requires being possible and realistic, especially when working with mounting pleasurable activities. The therapist has to understand any outcomes and illness and practically adapt the therapeutic sessions in order to meet the client’s needs. When the client offers a lot of historical data, it is advisable to offer extensive details in exchange. Older adults have a tendency to reminiscence, which makes it difficult for the therapist to follow the client’s history. To keep the sessions focused, it is important to maintain adhering and settings. There is increased framework of the CBT, which has advantaged the older adults despite their complicated issues of age (Laidlaw & Knight, 2008). According to Kennedy and Tanenbaum (2000), the older person is receptive to short-term focused framework. This is because they might mistakenly anticipate the nature of the CBT model to be like that of their past experiences. Working collaboratively with the old adults enhances their therapeutic relationship. It also encourages them making them feel respected for what they have done in life. The therapist has to be realistic. Negotiating with clients on what is possible during the session helps them to adjust appropriately. The therapist and clients should have joint goals, which will help the older adults to cope with old age challenges. The uncertainty in therapy is lessened by handling the process gradually. Adaptations in the sessions make the learning experience easy (Kennedy, Tanenbaum, 2000).
Conclusion
In conclusion, CBT has comprehensive characteristics that help to work with older people with mild-moderate depression. Additionally, CBT has main elements that have developed after outcome studies and rigorous research. Treatment interventions have proved to be comparable for people with depression despite their age. This indicated that both the old and the young should be treated and cared for when depression attacks. The overall components of the Cognitive Behavior Therapy are similar to the clients of all ages. However, appropriate adaptations are important, when dealing with older adults. There are continuous messages emerging from the research, which point that CBT requires to be adjusted appropriately for maximum treatment for the old. For the therapist to understand the client’s experience it is vital to have familiarity of the aging process, which adds richness and depth to the comprehension. It is a challenging and exciting time for the psychoanalyst to be psychologically optimistic and flexible.
