marlier.proThe Cognitive Therapeutic Relationship and some of the cognitive and behavioral techniques/strategies used
by the Cognitive therapist
October 9, 2003
The Cognitive Therapeutic Relationship and some of the cognitive and behavioral techniques/strategies used by the Cognitive therapist.
Cognitivism regards behavior disorders as well as neurotic symptoms as the consequence of dysfunctions of learning programs. Behavioral therapy helps people to change their behavior, while cognitive therapy focuses on thoughts. Cognitive therapy uses techniques based on the exposure and the management of anxiety. Cognitive dysfunctions and irrational or mal adjusted thoughts must be assessed and set aright. This therapy aims at reorganizing the mode of thinking and modifying the patient's view of situations and persons in his environment.
The cognitive therapeutic relationship is a collaboration between the therapist and the patient: the therapist assesses the dysfunctions and provides a warm support and active guiding to the patient, but the therapy also requires a minimum of self-control and a consequent involvement from the patient. The first session focuses on the patient's symptoms; a problem list and an agenda are generated. The patient is also assigned homework. Next, the patient's feedback is encouraged. On later sessions, the emphasis is on the patient's thoughts.
The thinking pattern is divided into automatic thoughts and rational thoughts. Automatic thoughts are neither controlled nor conscious. The individual is passive. His thoughts are imposed on him as predefined patterns – and their interactions – stemming from the subjective and corrupt observation by the individual himself of his environment. For instance: “this only occurs to me”, “anyway, I'm going to fail”, and “he cannot stand me”. This mode of thinking is automatic, immutable and constant: the patient is controlled by his thought. These thoughts are sustained by a set of abstract rules, or maladaptive assumptions, which need to be uncovered and eventually modified. Cognitive therapy attempts to make the patient aware of the effects of these dysfunctional thoughts and then helps him change them.
Then, there are the rational thoughts, a controlled and conscious mode of thinking (inasmuch as this is possible). This is a deliberate and more punctual mode of thinking. When confronted to an event, the individual does not react automatically, is not influenced by his past experience or wrong mechanical interpretations. He seeks some distance and a logical and rational action: the individual controls his thought.
What follows is a Socratic dialogue between the therapist and the patient; the therapist questions the patient's negative beliefs to see if they are based on reality. The techniques may consist for the patient in writing his thoughts on a board, having mirrors in the office to reflect his reactions, using memory associations, counting automatic thoughts in real life to help him distance himself from these thoughts. The aim is to replace automatic thinking with a more rational and reality-based way of thinking.
One step of this process is the decentering, that is the process of having the patient challenge the basic belief that he is the focal point of all events. The “What if” technique, or decatastrophizing technique, where the therapist and the patient hypothesize the worst possibility, is also use to relativize the gravity of the events feared by the patient. They also develop coping plans, that is a series a strategies that the person can use to manage the anxiety. The point is coping with the situation, not attempting to master it. Reattribution techniques allow the patient to rate the degree of responsibility he feels he has for the events. The patient often attributes to himself an excessive amount of responsibility. The therapist continually questions the patient to obtain more objective ratings. Then the patient becomes aware that he cannot control everything in a given situation, that some elements –possibly the most important ones– are beyond his control. One of the most used techniques is the use of positive phrases during the exposure to a stimulus which is the source of the patient's anxiety. Thus the patient can change his way to see this stimulus and minimize the anxiety associated with it.
Behavioral methods used in cognitive therapy may imply role-playing between the therapist and the patient, where the therapist may, for instance, criticize the patient's behavior. The patient needs exposure the criticism but cannot count on people in his environment to express it openly, hence this is done in the office. In the beginning, the patient will often feel destabilized by the criticism. In this case, the therapist will stop the role-playing, analyze the patient's emotional experience and automatic thoughts, provide active coaching until the patient is ready to start again.
We have already said that the patient leaves each session with homework. This homework is essential for cognitive therapy and behavioral therapy and is one of the reasons why cognitive therapy is often named cognitive behavioral therapy. “Homework gives a patient the best chance of getting better fast, and it is the therapist who conveys to him its importance.” ( Beck, Emery, & Greenberg, 1985, p. 172). For instance, if a patient feels isolated and unloved, the homework might be to call a friend to go to a movie. The mere fact that he can do the activity proves that his negative thoughts are unjustified.
In general, cognitive therapies are rather individual, while behavior therapies, which use other techniques, are often group therapies. Most of cognitivists are also behaviorists, though, and offer an association of both methods (individual sessions complemented by participation in group sessions).
Conclusion
Cognitive therapies can improve or cure numerous psychological troubles, among which anxiety disorders and mild or medium depression. On the contrary, melancholia, delirious troubles or manic-depressive psychoses represent a contra-indication. The patient must keep the sense of reality in order to challenge the depressed thoughts and build the link between emotions, thoughts and behaviors. On another hand, cognitive therapies require a minimum of self-control and a thorough implication from the patient.
References
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books.
by the Cognitive therapist
October 9, 2003
The Cognitive Therapeutic Relationship and some of the cognitive and behavioral techniques/strategies used by the Cognitive therapist.
Cognitivism regards behavior disorders as well as neurotic symptoms as the consequence of dysfunctions of learning programs. Behavioral therapy helps people to change their behavior, while cognitive therapy focuses on thoughts. Cognitive therapy uses techniques based on the exposure and the management of anxiety. Cognitive dysfunctions and irrational or mal adjusted thoughts must be assessed and set aright. This therapy aims at reorganizing the mode of thinking and modifying the patient's view of situations and persons in his environment.
The cognitive therapeutic relationship is a collaboration between the therapist and the patient: the therapist assesses the dysfunctions and provides a warm support and active guiding to the patient, but the therapy also requires a minimum of self-control and a consequent involvement from the patient. The first session focuses on the patient's symptoms; a problem list and an agenda are generated. The patient is also assigned homework. Next, the patient's feedback is encouraged. On later sessions, the emphasis is on the patient's thoughts.
The thinking pattern is divided into automatic thoughts and rational thoughts. Automatic thoughts are neither controlled nor conscious. The individual is passive. His thoughts are imposed on him as predefined patterns – and their interactions – stemming from the subjective and corrupt observation by the individual himself of his environment. For instance: “this only occurs to me”, “anyway, I'm going to fail”, and “he cannot stand me”. This mode of thinking is automatic, immutable and constant: the patient is controlled by his thought. These thoughts are sustained by a set of abstract rules, or maladaptive assumptions, which need to be uncovered and eventually modified. Cognitive therapy attempts to make the patient aware of the effects of these dysfunctional thoughts and then helps him change them.
Then, there are the rational thoughts, a controlled and conscious mode of thinking (inasmuch as this is possible). This is a deliberate and more punctual mode of thinking. When confronted to an event, the individual does not react automatically, is not influenced by his past experience or wrong mechanical interpretations. He seeks some distance and a logical and rational action: the individual controls his thought.
What follows is a Socratic dialogue between the therapist and the patient; the therapist questions the patient's negative beliefs to see if they are based on reality. The techniques may consist for the patient in writing his thoughts on a board, having mirrors in the office to reflect his reactions, using memory associations, counting automatic thoughts in real life to help him distance himself from these thoughts. The aim is to replace automatic thinking with a more rational and reality-based way of thinking.
One step of this process is the decentering, that is the process of having the patient challenge the basic belief that he is the focal point of all events. The “What if” technique, or decatastrophizing technique, where the therapist and the patient hypothesize the worst possibility, is also use to relativize the gravity of the events feared by the patient. They also develop coping plans, that is a series a strategies that the person can use to manage the anxiety. The point is coping with the situation, not attempting to master it. Reattribution techniques allow the patient to rate the degree of responsibility he feels he has for the events. The patient often attributes to himself an excessive amount of responsibility. The therapist continually questions the patient to obtain more objective ratings. Then the patient becomes aware that he cannot control everything in a given situation, that some elements –possibly the most important ones– are beyond his control. One of the most used techniques is the use of positive phrases during the exposure to a stimulus which is the source of the patient's anxiety. Thus the patient can change his way to see this stimulus and minimize the anxiety associated with it.
Behavioral methods used in cognitive therapy may imply role-playing between the therapist and the patient, where the therapist may, for instance, criticize the patient's behavior. The patient needs exposure the criticism but cannot count on people in his environment to express it openly, hence this is done in the office. In the beginning, the patient will often feel destabilized by the criticism. In this case, the therapist will stop the role-playing, analyze the patient's emotional experience and automatic thoughts, provide active coaching until the patient is ready to start again.
We have already said that the patient leaves each session with homework. This homework is essential for cognitive therapy and behavioral therapy and is one of the reasons why cognitive therapy is often named cognitive behavioral therapy. “Homework gives a patient the best chance of getting better fast, and it is the therapist who conveys to him its importance.” ( Beck, Emery, & Greenberg, 1985, p. 172). For instance, if a patient feels isolated and unloved, the homework might be to call a friend to go to a movie. The mere fact that he can do the activity proves that his negative thoughts are unjustified.
In general, cognitive therapies are rather individual, while behavior therapies, which use other techniques, are often group therapies. Most of cognitivists are also behaviorists, though, and offer an association of both methods (individual sessions complemented by participation in group sessions).
Conclusion
Cognitive therapies can improve or cure numerous psychological troubles, among which anxiety disorders and mild or medium depression. On the contrary, melancholia, delirious troubles or manic-depressive psychoses represent a contra-indication. The patient must keep the sense of reality in order to challenge the depressed thoughts and build the link between emotions, thoughts and behaviors. On another hand, cognitive therapies require a minimum of self-control and a thorough implication from the patient.
References
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books.
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