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Participants: Adults aged 25-50 who have been diagnosed with moderate to severe depression. These participants will be recruited from local mental health clinics in San Angelo.

Intervention: A 10-wekk CBT program consisting of weekly individual therapy sessions. The program will focus on techniques such as cognitive restructuring, behavioral activation, and mindfulness practices.

Measurement: Effectiveness will be measured using the Beck Depression Inventory (BDI) and the Hamilton depression Rating Scale (HDRS) before and after the intervention. Additionally, qualitative feedback will be gathered through participant interviews to assess perceived changes in mood and functioning.

Hofmann, S.G., Asnaani, A., Vonk, l.J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Metanalyses. Cognitive Therapy and Research, 427-440 https://pmc.ncbi.nlm.nih.gov/articles/PMC3584580/

Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., van Straten, A., & Ebert, D. D. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. Journal or Affective Disorders, 118-126

https://pubmed.ncbi.nlm.nih.gov/24679399/

Cristea, l. A., Huibers, M. J., David, D., Hollon, S. D., Andersson, G., & Cuijpers, P. (2015). The effects of cognitive behavior therapy for adult depression on dysfunctional thinking: A meta-analysis. Clinical Psychology Review, 62-71

https://pubmed.ncbi.nlm.nih.gov/26319193/

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Overview

Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy). You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.

CBT can be a very helpful tool - either alone or in combination with other therapies - in treating mental health disorders, such as depression, post-traumatic stress disorder (PTSD) or an eating disorder. But not everyone who benefits from CBT has a mental health condition. CBT can be an effective tool to help anyone learn how to better manage stressful life situations.

Why it's done

Cognitive behavioral therapy is used to treat a wide range of issues. It's often the preferred type of psychotherapy because it can quickly help you identify and cope with specific challenges. It generally requires fewer sessions than other types of therapy and is done in a structured way.

CBT is a useful tool to address emotional challenges. For example, it may help you:

Manage symptoms of mental illness

Prevent a relapse of mental illness symptoms

Treat a mental illness when medications aren't a good option

Learn techniques for coping with stressful life situations

Identify ways to manage emotions

Resolve relationship conflicts and learn better ways to communicate

Cope with grief or loss

Overcome emotional trauma related to abuse or violence

Cope with a medical illness

Manage chronic physical symptoms

Mental health disorders that may improve with CBT include:

Depression

Anxiety disorders

Phobias

PTSD

Sleep disorders

Eating disorders

Obsessive-compulsive disorder (OCD)

Substance use disorders

Bipolar disorders

Schizophrenia

Sexual disorders

In some cases, CBT is most effective when it's combined with other treatments, such as antidepressants or other medications.

Risks

In general, there's little risk in getting cognitive behavioral therapy. But you may feel emotionally uncomfortable at times. This is because CBT can cause you to explore painful feelings, emotions and experiences. You may cry, get upset or feel angry during a challenging session. You may also feel physically drained.

Some forms of CBT, such as exposure therapy, may require you to confront situations you'd rather avoid - such as airplanes if you have a fear of flying. This can lead to temporary stress or anxiety.

However, working with a skilled therapist will minimize any risks. The coping skills you learn can help you manage and conquer negative feelings and fears.

How you prepare

You might decide on your own that you want to try cognitive behavioral therapy. Or a doctor or someone else may suggest therapy to you. Here's how to get started:

Find a therapist. You can get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAPs). Or you can find a therapist on your own - for instance, through a local or state psychological association or by searching the internet.

Understand the costs. If you have health insurance, find out what coverage it offers for psychotherapy. Some health plans cover only a certain number of therapy sessions a year. Also, talk to your therapist about fees and payment options.

Review your concerns. Before your first appointment, think about what issues you'd like to work on. While you can also sort this out with your therapist, having some sense in advance may provide a starting point.

Check qualifications

Psychotherapist is a general term, rather than a job title or indication of education, training or licensure. Examples of psychotherapists include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, or other licensed professionals with mental health training.

Before seeing a psychotherapist, check his or her:

Background and education. Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a master's or doctoral degree with specific training in psychological counseling. Medical doctors who specialize in mental health (psychiatrists) can prescribe medications as well as provide psychotherapy.

Certification and licensing. Make sure that the therapist you choose meets state certification and licensing requirements for his or her particular discipline.

Area of expertise. Ask whether the therapist has expertise and experience treating your symptoms or your area of concern, such as eating disorders or PTSD.

The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.

What you can expect

Cognitive behavioral therapy may be done one-on-one or in groups with family members or with people who have similar issues. Online resources are available that may make participating in CBT possible, especially if you live in an area with few local mental health resources.

CBT often includes:

Learning about your mental health condition

Learning and practicing techniques such as relaxation, coping, resilience, stress management and assertiveness

Your first therapy session

At your first session, your therapist will typically gather information about you and ask what concerns you'd like to work on. The therapist will likely ask you about your current and past physical and emotional health to gain a deeper understanding of your situation. Your therapist may discuss whether you might benefit from other treatment as well, such as medications.

The first session is also an opportunity for you to interview your therapist to see if he or she will be a good match for you. Make sure you understand:

His or her approach

What type of therapy is appropriate for you

The goals of your treatment

The length of each session

How many therapy sessions you may need

It might take a few sessions for your therapist to fully understand your situation and concerns, and to determine the best course of action. If you don't feel comfortable with the first therapist you see, try someone else. Having a good "fit" with your therapist can help you get the most benefit from CBT.

During CBT

Your therapist will encourage you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort.

CBT generally focuses on specific problems, using a goal-oriented approach. As you go through the therapy process, your therapist may ask you to do homework - activities, reading or practices that build on what you learn during your regular therapy sessions - and encourage you to apply what you're learning in your daily life.

Your therapist's approach will depend on your particular situation and preferences. Your therapist may combine CBT with another therapeutic approach - for example, interpersonal therapy, which focuses on your relationships with other people.

Steps in CBT

CBT typically includes these steps:

Identify troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger or symptoms of a mental health disorder. You and your therapist may spend some time deciding what problems and goals you want to focus on.

Become aware of your thoughts, emotions and beliefs about these problems. Once you've identified the problems to work on, your therapist will encourage you to share your thoughts about them. This may include observing what you tell yourself about an experience (self-talk), your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. Your therapist may suggest that you keep a journal of your thoughts.

Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and behavioral responses in different situations.

Reshape negative or inaccurate thinking. Your therapist will likely encourage you to ask yourself whether your view of a situation is based on fact or on an inaccurate perception of what's going on. This step can be difficult. You may have long-standing ways of thinking about your life and yourself. With practice, helpful thinking and behavior patterns will become a habit and won't take as much effort.

Length of therapy

CBT is generally considered short-term therapy - ranging from about five to 20 sessions. You and your therapist can discuss how many sessions may be right for you. Factors to consider include:

Type of disorder or situation

Severity of your symptoms

How long you've had your symptoms or have been dealing with your situation

How quickly you make progress

How much stress you're experiencing

How much support you receive from family members and other people

Confidentiality

Except in very specific circumstances, conversations with your therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety or when required by state or federal law to report concerns to authorities. These situations include:

Threatening to immediately or soon (imminently) harm yourself or take your own life

Threatening to imminently harm or take the life of another person

Abusing a child or a vulnerable adult - someone over age 18 who is hospitalized or made vulnerable by a disability

Being unable to safely care for yourself

Results

Cognitive behavioral therapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope with your situation in a healthy way and to feel better about yourself and your life.

Getting the most out of CBT

CBT isn't effective for everyone. But you can take steps to get the most out of your therapy and help make it a success.

Approach therapy as a partnership. Therapy is most effective when you're an active participant and share in decision-making. Make sure you and your therapist agree about the major issues and how to tackle them. Together, you can set goals and assess progress over time.

Be open and honest. Success with therapy depends on your willingness to share your thoughts, feelings and experiences, and on being open to new insights and ways of doing things. If you're reluctant to talk about certain things because of painful emotions, embarrassment or fears about your therapist's reaction, let your therapist know about your reservations.

Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip therapy sessions. Doing so can disrupt your progress. Attend all sessions and give some thought to what you want to discuss.

Don't expect instant results. Working on emotional issues can be painful and often requires hard work. It's not uncommon to feel worse during the initial part of therapy as you begin to confront past and current conflicts. You may need several sessions before you begin to see improvement.

Do your homework between sessions. If your therapist asks you to read, keep a journal or do other activities outside of your regular therapy sessions, follow through. Doing these homework assignments will help you apply what you've learned in the therapy sessions.

If therapy isn't helping, talk to your therapist. If you don't feel that you're benefiting from CBT after several sessions, talk to your therapist about it. You and your therapist may decide to make some changes or try a different approach.

Clinical trials

Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions.

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Becoming aware of inaccurate or negative thinking can help you view challenging situations more clearly and respond to them in a more effective way.

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Participants: Adolescents with anxiety disorders

Intervention: Group CBT sessions

Measurements: Anxiety levels measured using the Beck Anxiety Inventory (BAI)

-Smith, J. A., & Jones, L. M. (2018). Effectiveness of group cognitive-behavioral therapy for adolescents with anxiety disorders. Journal of Counseling Psychology, 65(2), 123-135.

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Participants: Adults with major depressive disorder

Intervention: Individual CBT sessions

Measurements: Depression severity measured using Hamilton Depression Rating Scale (HDRS)

-Brown, K. P., & Green, H. R. (2020). Long term outcomes of cognitive-behavioral therapy for major depressive disorder. Clinical Psychology Review, 40(4), 210-222.

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Participants: Counseling professionals and graduate students in counseling programs from diverse cultural backgrounds.

Intervention: A series of workshops and training sessions designed to enhance cultural competence. The program will include lectures, role-playing exercises, and group discussions focused on culturally sensitive counseling techniques.

Measurement: The effectiveness of the intervention will be measured using pre- and post-training assessments such as the Multicultural Counseling Knowledge and Awareness Scale (MCKAS). Participants' self-reports confidence in handling multicultural issues will also be collected through surveys and interviews.

Sue, D. W., & Sue, D. (2016). Counseling the Culturally Diverse: Theory and Practice. John Wiley & Sons

Constantine, M. G., Hage, S. M., Kindaichi, M. M., & Bryant, R. M. (2007). Social justice and multicultural issues: Implications for the practice and training of counselors and counseling psychologists. Journal of Counseling & Development, 24-29

Sue, s. (2010). Cultural competency: From philosophy to research and practice. Journal of Community Psychology, 791-793

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What is Multicultural Counseling & Why Is It Important?

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Race, ethnicity, socioeconomic status, and gender identity can all influence mental health. Multicultural counseling acknowledges this fact.

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Participants: Immigrant Families

Intervention: Culturally adapted family therapy sessions

Measurements: Family cohesion measured using the Family adaptability and Cohesion Evaluation Scales (FACES)

-Lee, S, Y., & Chen, R. W. (2017). The impact of culturally adapted family therapy on immigrant families. Journal of Multicultural Counseling and Development, 45(3), 180-192.

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Participants: College students from diverse backgrounds

Intervention: Multicultural competence training for counselors

Measurements: Counselor effectiveness measured through client satisfaction surveys

-Garcia, M. T., & Nguyen, P. L. (2019). Enhancing multicultural competence in college counseling centers. Journal of Counseling & Development, 97(1), 45-58.

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Participants: Licensed counselors and therapists working in various settings, such as private practice, schools, and hospitals.

Intervention: An online continuing education course on ethical standards and practices in counseling. The course will cover topics such as confidentiality, informed consent, dual relationships, and professional boundaries through interactive modules and case studies.

Measurement: The effectiveness of the course will be assessed using pre-and post-course quizzes to measure knowledge acquisition. Participants will complete a survey on their confidence in applying ethical principals in their practice, and follow-up interviews will be conducted to gather qualitative feedback on how the course has impacted their professional behavior.

Barnett, J. E., & Johnson, W. B. (2015). Ethics Desk References for Counselors. American Counseling Association.

Knapp, S., & VandeCreek, L. (2012). Practical Ethics for Psychologists: A Positive Approach. American Psychological Association.

Welfel, E. R. (2012). Ethics in Counseling & Psychotherapy: Standards, Research, and Emerging Issues. Cengage Learning.

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Thoughtful and impactful counselors understand that developing a bond of trust and respect with their clients is critically important. This bond frees clients to feel as though they can be open and vulnerable without fearing judgment or a betrayal of confidence. Maintaining ethical standards is paramount to building trust, ensuring client welfare and upholding the profession's integrity. To help professional counselors understand how to safeguard themselves and best serve their clients, the American Counseling Association (ACA) publishes a set of ethical guidelines that promote respect, dignity and just treatment within the context of the counselor and client relationship. This Code of Ethics can assist professionals facing ethical dilemmas in counseling by offering a detailed set of protocols to help guide their course of action.

Unfortunately, ethical violations do occur. The American Psychological Association (APA) is the only organization that publishes statistical data on ethical complaints. Of the most common ethical complaints, the top two are sexual misconduct with adult clients, at 29% of the total, and insurance/fee problems, at 21% of the total. ¹ These statistics underscore the need for a strong ethical foundation in counseling practice.

This article will explore why ethics are crucial in counseling, how to navigate ethical dilemmas and the importance of continuing education in maintaining ethical standards.

Ethics in counseling serve as the backbone of the profession, guiding counselors in making decisions that prioritize the well-being of their clients. ² Building trust is essential in the counselor-client relationship, and adherence to ethical guidelines is key to establishing and maintaining this trust. Clients must feel confident that their counselor will act in their best interests, respect their confidentiality and provide a safe space for them to express their thoughts and feelings. ²

Respecting professional boundaries is another critical aspect of ethical counseling. Counselors must navigate the fine line between professional and personal relationships, ensuring that their interactions with clients remain appropriate and focused on each client's needs. Crossing these boundaries can lead to dual relationships, conflicts of interest and potential harm to the client. Clear communication of boundaries at the beginning of a counselor-client relationship is key. To avoid misunderstandings, set expectations and discuss boundaries, confidentiality and the counselor's role. It may be helpful to provide clients with a contract to sign that clearly lays out boundaries and appropriate behavior of both the counselor and the client. ³

Client welfare is at the heart of ethical counseling. Counselors are obligated to act in the best interests of their clients, which includes providing competent services, avoiding harm and advocating for their clients when necessary. Ethical standards also require counselors to stay within their scope of practice, referring clients to other professionals when issues fall outside their expertise. ² Counselors' main goal should always be to provide the clients with the support they need, regardless of where it comes from.

The ACA Code of Ethics outlines various ethical scenarios for counselors and offers guidelines for navigating ethical dilemmas in counseling. If you face a delicate situation in your work as a counselor, these guidelines can help you assess how to serve your clients and your profession appropriately and effectively.

Counselors must keep the welfare of the client in mind and establish boundaries that make the client-counselor relationship clear. This means that clients need to understand the counseling process and have clearly established counseling goals. ² Counselors must maintain and safeguard client records in an accurate and timely manner. They must always maintain professional boundaries. There should never be a romantic or sexual relationship between counselors and clients. Session fees should be affordable for the client, and the counselor must make the fees clear from the start. ⁴

Counselors need to safeguard the individual rights and privacy of their clients. Trust is the cornerstone of the counseling relationship, and counselors are responsible for maintaining a trustworthy partnership. Clients should be made aware if information about them has to be shared with others outside the counseling relationship, and only essential information should ever be revealed to outside parties. Counselors are required to disclose client behaviors that indicate the potential for self-harm or harm to others. ² Lastly, if sessions are to be recorded or observed, counselors must first obtain the permission of the client.

All counseling practices and treatments should be grounded in research and accepted practice. The ACA encourages counselors to offer pro bono work as a part of their professional activity. Counselors also must participate in continuing education to maintain awareness of changing practices and procedures in the field. ³

The ways in which professional counselors interact with their peers will influence their clients' access to services. Counselors must strive to provide clients with the most comprehensive clinical and support services available, which means that they should have a basic knowledge of which additional services are available locally. All positive working relationships with colleagues should be grounded in respect, even if professional approaches differ. ³

Without an accurate assessment of a client's presenting situation, the individual may not receive appropriate treatment. Professional counselors must understand the context of the client's beliefs, behaviors and cultural background. When diagnosing, counselors must carefully consider whether the associated treatment and potential outcomes will do more harm to the client than good. ³

Whether you are a counseling student or instructor, boundaries within your professional relationships are also crucial to ethical counseling behavior. Supervisors must maintain professional relationships with their students, whether sessions are held virtually or in person. Teachers and supervisors must be fair, honest and accurate when assessing students and supervisees. Counselor educators and supervisors must apply pedagogically sound instructional models. In addition, counseling educators should actively recruit and retain a diverse body of students to support a commitment to improving diversity in the counseling field. ³

Benefits to clients will only be realized if important research advancements in the field of counseling are shared with practitioners. Professionals have an ethical obligation to contribute to that knowledge base whenever possible and to keep aware of its current advancements. ³

Current trends in technology have changed the field, and today, face-to-face interaction is not always necessary. While online counseling has removed roadblocks to counseling services for some, it also comes with new and evolving ethical considerations. Counselors have to understand new platforms and resources in order to determine whether they will better serve their clients. These new service delivery formats also bring increased concerns regarding confidentiality and privacy that professionals should be mindful of. It may seem obvious, but counselors must never share confidential information on social media. ³

For the good of the client, the counselor and, ultimately, the profession, ethical dilemmas must never be ignored. Not only should professional counselors follow a strict personal code of ethics in their work, but they should also hold peers accountable to high ethical standards. The best practice is always to take action and, if necessary, cooperate with any investigations into alleged wrongdoing. ³

Ethical dilemmas are an inevitable part of counseling, given the complex and often sensitive nature of the work. Common ethical challenges in counseling include biases, confidentiality issues and managing dual relationships. ² Identifying these dilemmas early is crucial to resolving them effectively and minimizing potential harm to the client.

When challenges do arise, the way forward may not immediately be clear. Your action or inaction in any situation involving ethics will affect all parties involved, so let the foundational principles of counseling guide your decisions: ²

Autonomy: Counselors should encourage and enable clients to take control of the direction of their own lives wherever possible

Nonmaleficence: Counselors' chosen action or inaction should never intentionally cause harm

Beneficence: Mental health and well-being should be a priority for the good of the individual and for society more broadly

Justice: Counselors should treat all people fairly and equitably

Fidelity: Counselors should honor all personal and professional commitments, promises and responsibilities

The ACA has put together an Ethical Decision-Making Model to help counselors make decisions when challenging ethical dilemmas arise.

1. Identify the dilemma: Gather as much information as possible in order to recognize when a situation presents an ethical challenge. This requires a strong understanding of ethical guidelines and the ability to apply them to real-world scenarios.⁵

2. Consult the ACA Code of Ethics: Refer to the ACA Code of Ethics or other relevant professional guidelines to determine the appropriate course of action. These codes provide a framework for resolving ethical issues and protecting client welfare. Read them carefully and follow the course of action to reach a resolution.⁴

3. Determine the nature of the dilemma: Examine the dilemma at length to ensure that all its dimensions have been explored. This can be done by using the foundational principles to determine which one takes priority in the situation, reviewing relevant literature, discussing with an experienced counselor or supervisor or consulting state or national associations.⁴

4. Generate options: Consider as many courses of actions and potential outcomes of different actions as possible.⁴

5. Evaluate options: Evaluate all options from the previous step, keeping in mind how the consequences will affect all parties involved. Focus on the options that will produce the desired results. Choose the best one.⁴

6. Evaluate the selected option: Review the course of action to ensure it passes the tests of justice (would you treat others the same), publicity (would you want this behavior reported) and universality (would you recommend this to another counselor).⁴

7. Take action: Once a decision is made, act in accordance with ethical guidelines and document the steps taken. Once the action has been taken, follow up to ensure it produced the appropriate consequences.⁴

Staying current with ethical standards and practices is essential for counselors, given the evolving nature of the field. Continuing education provides opportunities for counselors to deepen their understanding of ethics, refine their skills in handling ethical dilemmas and improve their quality of care. ²

Numerous resources are available for continuing education in counseling ethics, including workshops, online courses and conferences. ²

The American Counseling Association (ACA) offers webinars, conferences and online courses covering a wide range of ethical topics⁶

The National Board for Certified Counselors (NBCC) provides continuing education opportunities, including ethics-focused courses that fulfill licensure requirements⁷

The American Psychological Association offers online courses and on-demand video programs to earn continuing education credits through a variety of topics⁸

Regularly discussing cases with peers allows counselors to receive feedback, gain new perspectives and ensure that their practice aligns with ethical guidelines. These collaborations can also provide counselors with new strategies to navigate ethical concerns that arise. Peer supervision can function as a support network, helping counselors manage the emotional and professional challenges they may encounter. In peer supervision sessions, counselors can present ethical dilemmas they have faced, explore potential solutions and learn from the experiences of others. This collaborative approach fosters a culture of continuous ethical development and growth, ensuring that counselors remain accountable and committed to the highest standards of practice. ²

Take a deep dive into the professional, ethical and legal matters you may encounter in counseling. Learn from a world-class faculty of experts as you explore unique concentrations in School Counseling or Clinical Mental Health Counseling, with a specialization in Military and Veterans Counseling, in the Online Master of Education in Counseling program from William & Mary.

When you are ready to start your career journey in counseling, schedule a call with an admissions outreach advisor to learn more.

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The Importance of Ethics in Counseling: A Comprehensive Guide

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Thoughtful and impactful counselors understand that it is critically important to develop a bond of trust and respect with their clients. It is this bond that frees clients to feel as though they can be open and vulnerable without fearing judgment or a betrayal of confidence.

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Participants: Licensed professional counselors

Intervention: Ethics training workshops

Measurements: Ethical decision-making skills assessed through case study analyses

-Williams, A. L., & Davis, E. T. (2016). The role of ethics training in professional counseling. Ethics & Behavior, 26(5), 379-391.

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Participants: mental health professionals

Intervention: Online ethics courses

Measurements: Knowledge retention measured through pre- and post- course assessments

-Thompson, J. R., & Miller, B. S. (2021). The effectiveness of online ethics education for mental health professionals. Journal of mental health Counseling, 43(2), 150-164.