Cognitive-Behavioral Therapy and Treatment: Psychotherapy Techniques and Psychological Theory

NYC Psychologist, Westchester Psychotherapist

NY and CT licensed psychologist, psychotherapist, and counselor, Robert M. Fraum, Ph.D discusses cognitive behavioral psychological theory and treatment methods. Cognitive Behavioral Therapy (CBT) is an effective primary treatment for Depressive and Anxiety Disorders as well as stress and anger management problems. CBT techniques can optimize outcomes in individual psychodynamic psychotherapy, couple and family therapy, marriage counseling, and in executive and life coaching. Dr. Fraum's treatment offices are located in New York City, Greenwich, CT and Westchester, NY.


Cognitive behavioral therapy is widely known as CBT, refers to behavioral and cognitive techniques and treatments developed by Lazarus, Ellis, Beck, and others. CBT is often employed by psychologists, counselors and psychotherapists in the treatment of fears, anxiety, depression, dysphoric moods, and disturbed emotional reactions. Cognitive behavioral treatment is used to eliminate psychological symptoms, change the thoughts or behaviors that support dysfunctional reactions, and create more adaptive behaviors.

My solutions focused psychotherapy and counseling practices in White Plains and NYC draw upon a variety of cognitive behavioral therapy techniques. i will discuss the two major CBT theoretical approaches: Albert Ellis' Rational-Emotive Behavioral Therapy and Aaron Beck's Cognitive Therapy.

Rational-Emotive Behavioral Therapy (REBT)

Rational-Emotive Behavior Therapy (REBT), also referred to as Rational-Emotive Therapy (RET), was conceived by Albert Ellis. RET was the first systematic attempt to create a comprehensive psychotherapy based upon cognitive-behavioral theory. Developed in the 1950's in New York City, Rational Emotive Behavior Therapy was the preeminent cognitive-behavioral therapy method in the New York, New Jersey, Connecticut Metro area. REBT has since influenced the treatment methods and practices of several generations of behavioral as well as eclectic psychologists nationwide. Ellis's ideas are readily accessible, practical and widely applicable.

REBT was developed, in part, in reaction to the then-popular psychoanalytic approach, which emphasized the importance of exploring unconscious motivation, feelings, fantasies and historical factors. Psychoanalytic clinical theory held that emotional catharsis and, especially, emotional insight were necessary for authentic change. Changing or influencing a client's symptoms through educational or behavioral means was dismissed as mere "suggestion" or "transference cure."

By contrast, Rational Emotive Behavioral Therapy considers the client's current, irrational thoughts as the primary basis of psychological problems and actively targets them for change. RET teaches the client to challenge these harmful but often unexamined, irrational imperatives. Ellis's style was energetic, confrontational, and directive, as opposed to the nondirective method required by psychoanalysis and related, insight-oriented psychotherapies.

REBT is based on Ellis' s parsimonious cognitive theory of emotional disturbance: life is not easy, and people have hurtful experiences. We can choose to respond with either rational or irrational beliefs to our negative experiences. We create appropriate emotional consequences when we respond to undesirable events with rational beliefs. We set ourselves up for psychological problems when we react to disappointing or hurtful events with irrational beliefs about ourselves, others, or the world.

Irrational beliefs also tend to be accompanied by "shoulds" and "musts". Many people's lives are dominated by a set of irrational imperatives ("shoulds") that create anger, anxiety, depression, low self esteem, or interpersonal or professional problems. For example, a person may believe that he must have the love of a particular person, or that he should not have to go on multiple job interviews and risk rejection, or that he should never have to suppress anger, or that he must have the continual, unfailing devotion of loved ones...or it is the end of the world.

Rational Emotive Therapy helps to make clients aware of how their irrational beliefs (and unexamined values) contribute to their unhappiness. The Rational Emotive Behavioral therapist helps the client change their unrealistic thoughts and expectations, give up irrational demands, and replace them with more appropriate and realistic thinking. REBT relies on a number of cognitive and behavioral methods including direct confrontation of irrational beliefs, contingency contracting, in vivo desensitization, response prevention, and psycho-educational methods.

Cognitive Therapy (CT)

Aaron Beck's Cognitive Therapy is also premised on the notion that how one thinks determines how one feels and behaves. Dysfuntional thoughts inevitably result in bad consequences.

Cognitive and behavioral methods are used to modify dysfunctional thoughts and beliefs. The therapist and client engage in a laid back, collaborative process of testing the validity of dysfunctional thoughts. The objective of treatment is to change the client's dysfunctional worldview, self concept, automatic negative thoughts and distorted cognitive processes.

Cognitive Therapy techniques

The CT client learns to identify the negative, automatic thoughts that occur in upsetting situations, to examine their validity, and to replace them with more useful, reality based thinking.

Cognitive therapy clients are helped to identify and change the elements of their belief system (world view, self concept) and the cognitive distortions (errors in reasoning like catastrophic thinking) that lead to negative automatic thoughts.

CT counselors empower clients by teaching them to consider a variety of alternative explanations for the cause of an event, by helping them restate problems in behavioral terms that give a client some control over it and to create strategies for dealing with fearful possibilities.

Behavioral therapy techniques

Behavior therapy intervention methods include diversion techniques to diminish negative thinking and emotionality, activity scheduling to increase positive emotion and mastery, homework and graded task assignments, which entail incremental steps of increasing difficulty to reach goals, and role play and rehearsal to try out and practice new behaviors and roles to be used in the real world.

Additionally, cognitive behavioral psychologists teach clients how to use self-monitoring techniques, where the client records information about a target behavior, and stimulus control, the building, modification, or elimination of a stimulus-response connection so that a target response is increased or eliminated.

There is a great deal of research supporting the effectiveness of Cognitive Therapy in treating distressing symptoms including anxiety and depression. I often select cognitive and behavioral therapy methods to play a key part in a client's a psychotherapy treatment plan, especially for a person struggling with stress, trauma, anger management issues or a Depressive Disorder or Anxiety Disorder.

Exposure with Response Prevention, also known as ERP, is an effective cognitive behavioral method I use to treat anxiety disorders like OCD, GAD, Panic Disorder, simple phobias, and social phobia. For example, a client with symptoms of phobia is encouraged to expose himself to the thing or situation he fears, try to tolerate it, and not run away. The client with compulsive hand cleaning symptoms is encourage to abstain from hand washing for increasing periods of time. Exposure with response prevention can be performed in graded, incremental steps with the initial guidance of a therapist and then on one's own. ERP can be practised as as an imaginative exercise and then run in vivo.

How I use Cognitive Behavioral Treatment

Effective psychological treatment requires that we understand the nature and cause of a client's problem in order to pick the best treatment strategy. My training and experience as a clinical psychologist enables me to evaluate and formulate the client's key issues, and develop an effective treatment plan. I find cognitive behavioral therapy to be a useful primary therapy modality (or additional therapeutic component) in most treatment strategies.

In the initial phase of treatment, Cognitive behavioral counseling, coaching and educational interventions can be very practical and helpful. Often, I find it best to choose CBT techniques to treat acute symptoms. Clients often require some cognitive reorientation, or need to make behavioral changes to in order to achieve timely symptom relief or address a troubling situation effectively.

Some psychological conditions are primarily characterized by painful symptoms or debilitating consequences. These include depression, anxiety disorders like phobia, rage reactions, and destructive habits. I often select cognitive behavioral therapy as the primary treatment modality because of its powerful focus on symptom relief and behavioral change. Based upon our clinical evaluation, I might also, as a solutions-focused psychologist, include other psychological perspectives or provide practical counseling, information, and coaching to bring symptoms or destructive reactions under my client's control.

Some psychological conditions will not be effectively treated unless we go beyond behavioral change or symptom control. For example, after I help a client to overcome symptoms of anxiety, rage or depression at the outset of treatment, it may be necessary to help him or her understand and change some of the unaddressed issues that will create further stress and unhappiness and lead to relapse or new symptoms. These may include relationship, family, professional or other issues. My practical, multimodal approach helps my client and I to identify the key problem areas, set tangible goals and pick the best psychotherapy methods to achieve them.

When I do not select Cognitive Behavioral techniques for my clients

Some problems in living do not seem to benefit as much from the cognitive behavioral model of treatment. In many cases, the issues go beyond overcoming distinct symptoms. These may include higher order, more complex clinical, developmental and existential issues like those related to personal growth, relationships, identity, purpose, and some personality disorders.

Some clients may not relate to the language of cognitive psychology or are turned off by its methods or techniques. For example, they may be unreceptive to the idea that their problems are caused by their "irrational thoughts" or "cognitive distortions" or may not be interested in discussing these ideas.

Cognitive behavioral therapy has a strong focus on technique and instruction, and some clients may experience treatment interventions as unnecessarily controlling or restrictive of the therapeutic dialogue.This may alienate clients who need to express or clarify their feelings and have them responded to empathically as a precondition of trust in the therapist and his/her treatment approach. Some may not ready to take action and move on until they truly feel that their therapist empathically "gets them" as a person. So I match my approach to my client's clinical needs, personality, communication style and core values.

Finding Cognitive Behavioral Treatment in New York City, Greenwich, CT and Westchester County, NY

I offer CBT for anger management, depression, anxiety, anxiety disorders and other clinical issues, from two practice locations in Midtown Manhattan and White Plains, New York. I will open a Greenwich, CT treatment office soon.

You can find my cognitive behavioral therapy practice in NYC at Park Avenue and 38th Street; or the cognitive behavioral practice in White Plains location off Exit 6 of I-287, which is convenient to Fairfield County, CT and Rockland County.

I am currently in the process of trying to find a psychotherapy and counseling office in downtown Greenwich, CT.

Please feel welcome to call me for more information about my solutions focused approach to psychological treatment and how CBT counseling methods can help you to overcome symptoms and achieve your goals.

Greenwich Counselor - CT Therapy
2 Benedict Place
Suite 2E
Greenwich, CT 06830

(914) 980-6961
New York Psychologist Manhattan
71 Park Avenue
Suite 1D
New York, NY 10016

(212) 213-6593
Westchester Therapist
499 North Broadway
Professional Suites
White Plains, NY 10603

(914) 997-7458

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© Robert M. Fraum, Ph.D., 2002 - 2013
Connecticut and New York Licensed Psychologist
Licensed Psychotherapist CT-003154, NY-005306