Teknik Konseling CBT Beck (Cognitive Behavior Therapy)

Teknik konseling CBT sangat mudah dipelajari. Sebelum itu, dalam bidang Kejiwaan (Aliran psikiatri, tasawuf, pekerja sosial, psikologi, bimbingan konseling) selalu memiliki teknik top masing-masing. Dan kami dalam S1, S2 Psikologi yang paling top secara statistik adalah CBT (Cognitive Behavior Therapy) ini. Dan yang perlu diperhatikan salah satu teknik konseling yang hampir serupa dengan CBT adalah REBT (dikenal juga dengan A-B-C) yang sering dicampur-adukan & disamakan. Sekarang Anda boleh fokus dalam gaya CBT ini agar Anda bisa sepenuhnya faham dari ajaran Aaron T. Beck ini.

Dalam praktek Aaron T. Beck juga anaknya Judith S. Beck dikenal dengan tiga tahapan dalam mensukseskan proses konseling tersebut yaitu;

(i) Modifikasi AUTOMATIC THOUGHT

(ii) Modifikasi INTERMEDIATE BELIEF

(iii) Modifikasi CORE BELIEF

Namun tidak semua jenis orang harus melalui 3 tahapan, ada juga yang hanya hingga INTERMEDIATE BELIEF sudah sukses ada perubahan psikologisnya, bahkan hanya saat modifikasi AUTOMATIC THOUGHT Dia.

Pertanyaan yang mungkin sedang Anda tanyakan adalah mengapa judul tekniknya COGNITIVE BEHAVIOR THERAPY atau disingkat CBT. Bukankah ada kata TERAPI yang berarti teknik untuk menterapi? Ya, benar. Teknik ini DAPAT diterapkan saat SESI TERAPI.

Perbedaan antara KONSELING dan TERAPI mungkin di artikel berikutnya akan saya bagikan. Secara mendasar tidak semua orang boleh melakukan praktek terapi psikologi, tetapi semua orang boleh melakukan konseling ke teman dekat atau siapapun. Jadi, manfaatkan teknik ini untuk tujuan proses konseling atau bahkan bercakap-cakap yang dapat bermanfaat. Untuk perbedaan dalam SESI TERAPI teknik CBT ini memang sama digunakan, namun ada beberapa hal, prinsip, tahapan, teknik, strategi, dan lain-lain yang disiapkan dan dilakukan. Saya sendiri belum, karena saya bukan ahli psikologi yang berlisensi psikolog, tetapi saya adalah ahli psikologi sarjana dengan pengalaman konseling. Semoga bermanfaat.

Baiklah, silahkan simak Teknik Konseling CBT Beck ini yang sudah saya buat sepraktis mungkin dengan 2 tahapan saja. Berikut:

SUPERFICIAL COGNITION [a.k.a AUTOMATIC THOUGHT]

Superficial Cognition (Proses Berpikir yang Dangkal) atau istilah yang cukup sama adalah pikiran yang terdistorsi. Pikiran terdistorsi dapat diketahui ketika seseorang berbicara atau bereaksi kepada Anda secara "minimnya informasi yang diberikan", atau "biasnya informasi yang ditunjukan", dan atau "tergeneralisasinya informasi yang disampaikan".

Dan untuk bisa memahami ketiga hal tersebut perlu jam terbang atau pengalaman subjektif masing-masing. Dan akan dengan sendirinya memahaminya.

Oke, saya yakin Anda bertanya apa istilah yang baik untuk diingat "AUTOMATIC THOUGHT", atau "SUPERFICIAL COGNITION", atau "PIKIRAN DANGKAL", ataukah "PIKIRAN TERDISTORSI" ? jawabannya adalah tidak perlu bingung, pilihlah salah satu. Jika Anda bertanya ke saya, maka saya memilih menyimpan di otak saya istilah "PIKIRAN TERDISTORSI". Alasannya tidak bisa saya bagikan di sini yang mungkin menjadi 1 artikel tersendiri cukup panjang.

Baiklah berikut adalah kasus-kasus dan sesi konseling di tingkat mengatasi/memodifikasi DISTORSI PIKIRAN pada seseorang klien/teman:

1. Evidence Q'

BECK: What's the evidence that Karen doesn't care what happens to you?

SALLY: Well, when we passed on Locust Walk, she seemed like she was real rushed. She just quickly said, "Hi Sally, see you later", and kept going fast. She hardly even looked at me.

BECK: Anything else?

SALLY: Well, sometimes she's pretty busy and doesn't have much time for me.

BECK: Anything else?

SALLY: (Thinks.) No. I guess not.

BECK: Okay, now is there any evidence on the other side, that maybe she does care about what happens to you?

SALLY: (answering in general terms) Well, she is pretty nice. We've been friends since school started.

BECK: [helping Sally think more specifically] what kinds of things does she do or say that might show she likes you?

SALLY: Ummm... She usually asks if I want to go get something to eat with her. Sometimes we stay up pretty late just talking about things.

BECK: Okay. So, one the one hand, on this occasion yesterday, she rushed by you, not saying much. And there have been other times, too, when she's been pretty busy. But on the other hand, she asks you to eat with her, and you stay up late talking sometimes. Right?

SALLY: Yeah.

2. 2nd Perceptual Q'

BECK: Good. Now, let's look at the situation again. Could there be an alternative explanation for what happened, other than she doesn't care about what happenst to you?

SALLY: I don't know.

BECK: Why else might she have rushed by quickly?

SALLY: I'm not sure. She might have had a class. She might have been late for something.

3. Worst-Case Q' & Impact Q'

JERRY: Halo Di, darimana?ANDI: Barusan selesai matakuliah di gedung PSB.

JERRY: kamu punya uang 100 ribu gak? pinjam dong, besok aku kembalikan.

ANDI: Buat apa Ri?

JERRY: Mau nambah modal bisnis Poker. Siang ini turnamennya dimulai soalnya, ATM ku ketinggalan Di.

ANDI: Wah, sekarang sudah memulai bisnis nih, padahal masih masa kuliah. Kalau besar bisa sukses kamu Ri. Ohya Ri, aku penasaran bisnis pokermu barusan menang atau baru saja kalah? untuk nambah modal? [Andi sudah tahu dengan pasti bahwa 'Jerry pasti baru kalah']

JERRY: Kalah Di, lawannya dari Kanada semua, saya saja orang Indo.

ANDI: Oke Ri, aku turut berduka kamu baru saja kalah. Ohya Ri, aku punya uangnya, tapi aku gak bisa minjamin kamu sekarang.

JERRY: Kenapa Di? Ada syaratnya? ayolah...

ANDI: Karena aku khawatir kamu mengalami hal yang terburuk yang mungkin terjadi.

JERRY: Apa itu?

ANDI: Menurutmu setelah aku pinjamkan sekarang uangnya, kamu menang atau kalah? kalau kalah gimana? apa itu benar namanya hal yang terburuk bisa saja terjadi?

JERRY: Itu resikonya aku yang nanggung. Namanya juga poker. Aku bisa kalah dan rugi sewaktu-waktu.

ANDI: Oke, aku faham. Jadi, kau baik-baik saja dengan itu? dengan semua kemungkinan terburuk bisnis poker ini Ri?

JERRY: Yo'i bro.

ANDI: Tapi, apa yang membuatmu nyaman dan tenang dengan kerugian atau kemungkinan terburuk ini? bagian apanya tuh?

JERRY: Keuntungannya sih.

ANDI: Artinya kamu Ri memiliki pemahaman keuntungan lebih besar daripada kerugian?

JERRY: Ya, kalau untung aku bisa kaya Di. Kalau kalah cari modal lagi.

ANDI: Baiklah aku cek dompet ada gak uangnya.

JERRY: [melirik dan menunggu]

ANDI: Sorry Ri, aku berubah pikiran karena Poker menurutku 50:50

JERRY: Maksudnya Di?

ANDI: Keuntungan dan kerugian sama besar, artinya tidak ada kekayaan dari bisnis Poker, maaf aku tidak bisa membuatmu kalah lagi Ri.

4. Impact of Remain Q' & Impact of Changing Q'
JOHN: Pagi bu.WINDY: Hai John, masuk. Duduk sini.

JOHN: Terlihat sepi ya bu di sini, saya mau konsultasi bu?

WINDY: Iya boleh, sekarang jam istirahat masih panjang. Ada masalah apa John?

JOHN: Saya punya teman, dia sok sibuk banget padahal kemarin sore harusnya kelompok kami mengerjakan PR semuanya harus bersama-sama

WINDY: Oh, apa kamu yakin dia bertingkah sok sibuk ini karena disengajanya?

JOHN: Yakin bu, orang dia aja di telpon gak diangkat, apalagi di SMS.

WINDY: Oke, lalu apa yang terjadi dengan mu sekarang John saat kamu menganggap dia 'sok sibuk' ini?

JOHN: Saya kesal bu, tugas yang berat harusnya semuanya ikut mengerjakan gitu.

WINDY: Dan, apa yang bisa terjadi denganmu John jika kamu tidak berpikiran begitu ke dia?

JOHN: Maksudnya bu?

WINDY: Kamu kan bilang memiliki masalah kesal dengan dia. Lalu, kamu mau nggak menghilangkan perasaan kesal itu?

JOHN: Ya tentu mau bu.

WINDY: Jadi, sekarang apa kamu masih ingin menyimpan pikiranmu John tentang 'sok sibuk' itu?

JOHN: Oke bu, saya makasih atas waktunya. Jika saya mampu menghilangkan rasa kesal itu, saya berterimakasih sekali ya bu. Assalamu'alaikum.

5. Close Friend/Family Q' & Apply to Self Q'

BECK: Sally let's say your friend Allison had a friend who sometimes was rushed, but seemed caring at other times. If Allison had the thought, "My friend doesn't care about me," what would you tell her?

SALLY: I guess I'd tell her not to put too much importance on the times she seemed rushed, especially if her friend was nice about it.

BECK: Does that apply to you?

SALLY: Yes, I guess it does.

6. Cog. /& Beh. Problem-Solv Q'

BECK: And what do you think you should do about this situation?

SALLY: Uh... I'm not sure what you mean.

BECK: Well, have you withdrawn any since this happened yesterday?

SALLY: Yeah, I think so. I didn't say much when I saw her this morning.

BECK: So this morning you were still acting as if that original thought were true. How could you act differently?

SALLY: I could talk to her more, be friendlier myself.

BELIEF [a.k.a INTERMEDIATE BELIEF & CORE BELIEF]

Belief adalah prinsip-prinsip dalam diri seseorang. Anda tidak perlu mengingat ada dua belief INTERMEDIATE dan CORE, karena akan memenuhi memori otak Anda saja (saya meyakini otak memiliki batasan kapasitas secara sudut pandang psikologis). Alasan saya mempermudah istilah-istilah dan mengubah istilah yaitu mengefisien-efisienkan memori subjektif agar secepat kilat mengingatnya dan faham baik secara teknikal maupun pola.

1. Terminology Q'

BECK: Okay, so you believed about 90% that if you ask for help, it means you're incompetent. Is that right?

SALLY: Yes.

BECK: Could there be another way of viewing asking for help?

SALLY: I'm not sure.

BECK: Take therapy, for example. Are you incompetent because you came for help here?

SALLY: A little, maybe.

BECK: Hmmm. That's interesting, because I usually view it in the opposite way. Is it possible it's actually a sign of strenghth and competence that you came to therapy? Because what would have happened if you hadn't?

SALLY: I might still be pulling the covers over my head.

BECK: Are you suggesting that asking for appropriate help when you have an illness like depression is a more competent thing to do than remaining depressed?

SALLY: Well, the one who goes for help.

2. Dissociated & Two Person Example Q' & Apply to Self Q'

BECK: Now how about another situation you've mentioned--your volunteer job. Again, we have two college students. This is their first tutoring experiences. They're not sure what to do because they've never done it before. One seeks help; the other doesn't, but continues to struggle. Who's the more competent?

SALLY: (hesitantly) The one who goes for help?

BECK: Are you sure?

SALLY: (Thinks for a moment) Yeah. It's not a sign of competence to just struggle if you could get help and do better.

BECK: How much do you believe that?

SALLY: Pretty much--80%

BECK: And how do these two situations--therapy and help in tutoring--apply to you?

SALLY: I guess they do.

3. Call to Action Q'

BECK: Okay, Sally, we've identified another belief: "If I ask for help, other will belittle me," and you believe that 60%. Of course, I haven't actually belittled you, have I?

SALLY: No, of course not. But that's your job, to help people.

BECK: True, but it would be useful to find out if other people, in general, are more like me or not. How could you find out?

SALLY: Ask other for help, I guess.

BECK: Okay, whom could you ask and for what kind of help?

SALLY: Ummm. I'm not sure.

BECK: Could you ask your roommate?

SALLY: Yeah, actually I already do. And I guess I could ask my resident adviser for help with something.

BECK: Good. How about your academic adviser?

SALLY: Uh-huh. I could also ask my brother. No. I won't ask my roomate or my brother. I know they wouldn't belittle me.

BECK: Oh, so you know already there are some exceptions?

SALLY: Yes. But I guess I could go to my adviser or my teaching assistants.

BECK: What could you ask for help with?

SALLY: Well, the teaching assistants ... I could ask questions about the papers I have due or about the readings. The resident adviser, I don't know. My academic adviser ... I would feel a little funny going to her. I don't really even know what I want to major in.

4. Metaphor Statement (e.g. You might kill two birds with one stone)'

BECK: That would be an interesting experiment--going for help in deciding a major to the person whose job it is to help students make those kinds of decisions.

SALLY: True ...

BECK: So, you might kill two birds with one stone--testing the belief that you'll be belittled and getting some guidance for a real-life problem problem you have.

SALLY: I guess I could.

5. Cognitive Continuum Q' & Expressing Written Continuum & Validty Q'

BECK: Okay, you believe pretty strongly that if you're not a superior student, you're a failure. Let's see what that looks like graphically. (Draws a number line.)

BECK: Now, where does the superior student go?

SALLY: Up here. I guess 90-100%

BECK: Okay. And, you're a failre. Where are you?

SALLY: At 0%, I guess.

BECK: Now, is there anyone else who more realistically belongs at 0% than you?

SALLY: Ummm ... Maybe this guy, Jack, who's in my economic class. I know he's doing worse than I am.

BECK: Okay.We'll put Jack at 0%. But I wonder if there is anyone who's doing even worse than Jack?

SALLY: Probably.

BECK: Is it conceivable that there is someone who is failing almost every test, every paper?

SALLY: Yeah.

BECK: Okay, now if we put that person at 0%, a real failure. where does that put Jack? Where does that put you?

SALLY: Probably Jack's at 30%. And I'm at 50%.

BECK: Now, how about a person who is actually failing everything, and he isn't even showing up at any classes or doing any of the reading or turning in any papers?

SALLY: I guess he would be at 0%

BECK: Where does that put the student who is at least trying but not passing much?

SALLY: I guess he would be at 10%

BECK: Where does that put you and Jack?

SALLY: Jack goes to about 50%; I guess I'm at 75%.

BECK: How about for homework if you see whether even 75% is accurate? Even if it is for this school, perharps for schools and student in general, you would rank higher. In any case, how accruate is it to call someone a failure who is at the 75% mark?

SALLY: Not very.

BECK: Maybe the worst thing you can say is that he or she is 75% succesful.

SALLY: Yeah. (Brightens visibly.)

BECK: Okay, to get back to your original idea, how much do you believe now that if you are not a superior student, you're a failure?

SALLY: Not as much. Maybe 25%

BECK: Good!

PENUTUP

Apakah Anda memperhatikan kasus di atas pihak konselor sering menunjukkan sikap bertanya dan membuat pertanyaan? Ya. Bagus Anda memahami jika menyadari hal ini. Inilah keunikan dari teknik CBT ini. Sebagian besar teknik CBT dapat memodifikasi psikologis kliennya adalah dengan bertanya, bukan dari menyatakan/menasehati/menyarankan (baca: sebagian kecilnya adalah Metaphor Statement) . Secara otomatis teknik ini menjadi self-therapy bagi sang klien, artinya sang klien merasa dirinya lah ingin berubah dan tidak ada stimulus disuruh berubah oleh orang lain (baca: konselor). Semoga bermanfaat bagi calon konselor maupun ahli psikologi dan ahli kejiwaan terus membuka pandangan dan mengembangkan keterampilannya menjadi manfaat bagi yang meminta bantuan.

REFERENSI

Sumber Teknik: *Sebagian besar dari review buku Judith S.Beck (anak dari Aaron T. Beck) yang berjudul Cognitive Behavior Therapy, Second Edition: Basics and Beyond (2011, 2nd ed.) dengan saya rubah sedikit nama tekniknya agar memudahkan mengingat secara teknikal dan beberapa contoh kasus dari buku tersebut.

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