COGNITIVE PSYCHOTHERAPY:Â THERAPY IN ACTION
Cognitive therapy is a learning experience in which the therapist plays an active role in helping the client uncover and modify distorted and unhelpful thinking.Â This in turn modifies the emotions to allow the client to feel better and this success is reinforcing, so increasing the probability of permanent change.Â The client is expected to carry out work assignments between the therapy sessions which have been found to be most important.Â This also gives the client a greater feeling of control over his therapy, increases his ability to work alone and therefore as his own ‘therapist’ subsequently.
It is useful at this stage to remind ourselves of the types of faulty reasoning that we covered before:
- Arbitrary Inference: Interpreting an event in a negative way without considering possible alternatives, e.g., “The fact that my girlfriend didn’t ring me last night proves that she does not Â Â Â Â Â Â Â love me.”
- Selective Abstraction: Taking one fact out of context and basing a conclusion on it, whilst ignoring contradictory evidence, e.g., A wife’s response to her husband’s Sunday morning golf is, Â “He takes me for granted”, ignoring the fact that he spends the rest of his free time with her.
- Over-Generalisation: A sweeping statement about oneself in the face of single setback, e.g., Â Â Â Â Â Â Â Â “Since she won’t go out with me, I must be totally unattractive and no girl will ever be interested Â Â Â Â Â in me again.”
- Magnification: Distorting the evidence so that a minor setback is seen as a major disaster, e.g., Â Â Â Â Â “Since I only got a B for my essay there is no point in continuing with the course.”
- Minimisation: Distorting the evidence so that a positive achievement is not fully recognised, e.g., Â “So I got a distinction, so could anyone if they tried; it just shows how low the standard is.”
- Personalisation: Blaming oneself for someone else’s actions when there is no justification for so Â Â doing, e.g., “The fact that my wife is so tense is entirely due to having to put up with me.”
- Dichotomous Reasoning: Categorising oneself as a complete success or a complete failure.Â Â Â Â Â Â Â Â Â Â Â There are no shades of grey, just black or white, good or bad.
The therapist must pay close attention to the client’s superficial self-statements because they provide clues to the basis of the client’s cognitive system, for example:
Automatic thought:Â “Now that I have failed the exam I will never be able to complete the course.”
Underlying thought:Â “Unless I am a success in the academic field I will never be happy.”
It is this underlying thought that gives the automatic thought its potency.
During the first session with a client the rationale behind the treatment is explained, and it is stressed that it is a process of collaboration and learning with the aim that the client will eventually be able to work on his own.Â The client will provide the ‘raw data’ and the therapist will guide the client on what data to collect and how to use them therapeutically.Â The client learns to identify the ‘automatic thoughts’ that seem to come from ‘nowhere’, or from the ‘back of the mind’, and if they are unhelpful, think of better alternatives which could be tested for their validity.
The problem or problems should be defined as far as possible in that first session to make an estimate of what will be involved for the client.Â Of course other problems will probably arise as the therapeutic alliance is built up.Â Often the client may have a range of presenting concerns and symptoms which would suggest that he or she is working on a general faulty belief, so it could be more productive to work on that deeper level first rather than on specific issues.Â It will depend on how the client and the therapist decide they may best tackle the problem.
Each session within the overall treatment plan is usually started with setting an agenda.Â This means deciding which problems will be addressed, getting feedback on the previous session and reviewing the homework that has been done.Â An agenda is useful as it makes most efficient use of the therapy time and ensures that the necessary stages are included.Â Without such a structure very important issues could come up late in the session when there would be insufficient time to deal with them properly.
The aim of cognitive psychotherapy is to teach the client:
- To monitor his negative automatic thoughts or cognitions.
- To recognise the connection between cognition, affect and behaviour.
- To examine the evidence for and against his distorted automatic thought.
- To substitute more ‘reality-oriented’ interpretations for these biased cognitions.
- To learn to identify and alter the dysfunctional beliefs which predispose him to distort his Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â experiences. (Beck et al, 1979)