by Kristen Tobias, M.A.
In my experience, it is not unusual to hear a client who comes to the Albert Ellis Institute say something about having already tried “talk therapy” and now wanting to pursue something different (i.e., cognitive-behavioral therapy, [CBT]). It is interesting to hear psychoanalysis conceptualized as “talk therapy,” whereas in the eyes of some consumers, CBT falls outside of this generic term. The truth is that all psychotherapies are talk therapies whereby therapists use dialogue to promote change. Talking is a necessary, but sometimes not sufficient part of psychotherapy. Perhaps the association between talk therapy and psychoanalysis is homage to the “talking cure,” coined by Breuer and popularized by Freud over 100 years ago.
When I query clients about their expectations of CBT, I often hear that they want to do something differently. This sentiment highlights the importance of the behavioral (or non-talking) component of CBT (although talking is needed to generate the goal). Clients hope to learn new tools (or skills) to decrease symptoms of distress or replace unhelpful behaviors. Tools such as deep breathing, progressive muscle relaxation, and mindfulness-based strategies are theoretically important components of all types of CBT.
REBT stresses the importance of rehearsing healthy behaviors, especially when they are used to replace unhealthy behaviors. Clients report that it is very hard to stop an unhealthy behavior such as cutting because they have not identified (or practiced) a replacement behavior. In this case, therapy will consist of working to define and develop helpful new behaviors while concurrently working towards cessation of unhelpful behaviors.
Talking again comes into play when discussing the implementation of new behaviors. For example, clients may have a difficult time in accessing or implementing new behaviors. Irrational beliefs such as “It’s too hard,” “I can’t handle it,” “I’m not good at it,” and “I failed and it’s awful,” or “I failed and I’m no good” may need to be restructured so that the client is thinking in a way that promotes practice and mastery of new behaviors. The irrational belief of frustration intolerance may be extremely apropos because the mastery of new behaviors is very hard!
Let’s try to practice the very helpful behavior of deep breathing, which Dr. Andrew Weil refers to as “…a natural tranquilizer for the nervous system.” In deep breathing, we want to engage the thoracic diaphragm, a skeletal muscle at the base of our lungs. Dr. Weil encourages a 4:7:8 ratio wherein you inhale quietly through your nose to the count of 4, hold the breath for 7 seconds, and exhale audibly through your mouth to the count of 8 (repeat full cycle 4 times). Visual imagery may be useful when practicing deep breathing. You might want to imagine a balloon filling up with air in your stomach as your try to engage your diaphragm, or inhaling to a beautiful field of flowers as you take a breath in. Rehearsal of this relaxation tool will make it more effective over time.
