My present notion of cognitive therapy is that it is based on a theory of psychopathology (information processing model), and the techniques that are utilized are those that can help to ameliorate the dysfunctional aspects of the individual’s beliefs, interpretations, and avoidance behaviors, as well as dysfunction in attention and memory. Thus, in a given case, at a given time, the therapist might choose to focus on the beliefs, misinterpretations, safety behaviors, selective focus or selective attentional inhibitions, aberrations in memory, or defects in executive function. The selections of interventions will vary according to what seems to be most feasible for a given patient, and also, the therapist’s particular skills. Basically, the therapeutic armamentarium that is available will be utilized selectively. In general, however, the main thrust of the therapy will be to modify the dysfunctional cognitive processing.
I recently read an interesting case description on a professional listserv about a “difficult” client who was not fully adherent with treatment. Apparently he argued with his therapist and did little homework outside of the session. It was apparent to me that the therapist had made a mistake. She was continuing to try to deliver “standard” CBT treatment, without attending to the therapeutic relationship sufficiently. I hypothesized that the client had an interfering belief:
“If I refrain from arguing with my therapist and comply fully with treatment……[something bad will happen or it will mean something bad about me.” ].
I don’t have enough details about the case to understand how the client would finish this assumption, but some clients might answer:
“I’ll feel so distressed that I won’t be able to stand it,” or “it will mean she’s in control, and I’m not.”
Until such interfering beliefs are elicited, evaluated, and effectively responded to, this client is unlikely to make much progress.
–Posted by Judith S. Beck, Ph.D., Director, Beck Institute
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