Schizophrenia: Cognitive Theory, Research, and Therapy by Aaron T. Beck & Neil A. Rector & Neal Stolar & Paul Grant

Author:Aaron T. Beck & Neil A. Rector & Neal Stolar & Paul Grant
Language: eng
Format: mobi
Tags: Psychology
ISBN: 9781606230183
Publisher: The Guilford Press
Published: 2008-10-28T22:00:00+00:00

Fostering the Therapeutic relationship

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addressing any concerns that have come up over the week. The therapist

is also attentive to other aspects of care that might impact on the client’s

mood states, such as medication adherence and attendance at other key ser-

vices over the previous week. The mood check can take longer in the cogni-

tive therapy of psychosis, as part of the monitoring may involve socializing

and educating the patient about the nature of moods and factors that cause

their fluctuation. Further, if the patient is able to spontaneously link mood

changes to his or her experience of psychotic symptoms, then the therapist

can use this opportunity to sharpen the agenda for the session, returning to

the aspect of the client’s life that is an important source of distress.

Pacing

The therapist also displays flexibility in the pacing of the session. Par-

ticularly with patients who have prominent negative symptoms, cognitive

therapy can be a relatively slow process. The therapist needs to attend to

the patient’s speed of processing thoughts and feelings and adjust his or

her own speed accordingly. Although some sessions will require consider-

able patience on behalf of the therapist, appropriate slowing down will

serve to enhance the alliance. For instance, many patients with negative

symptoms feel as if they are being forced to increase their activity level by

family and carers. Patients experience considerable pressure around these

demands, which only serves to perpetuate their disengagement, and they

may experience the therapist as similarly controlling and demanding. The

therapist who effectively demonstrates patience and pacing is communicat-

ing acceptance and empathy for the patient. In contrast, the patient who

is extremely talkative and easily distracted, and makes it difficult to get a

word in edgewise, may just require greater space to continue with his or her

fast pace. However, as noted in the earlier section, the therapist will need

to interject questions and clarifying summaries to keep the session focused

and moving toward some clinical goal. In summary, the pacing of the ses-

sion is flexible and is always geared toward reducing distress and enhancing

the therapeutic relationship.

Setting and Reviewing Homework

There is considerable variability in the quantity and quality of homework

in the cognitive therapy treatment of schizophrenia, as there is the treat-

ment of nonpsychotic disorders (Helbig & Fehm, 2004). Common factors

that interfere with homework compliance in patients with schizophrenia

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Schi zophr e n i a

include low motivation, trouble taking initiative, and lack of energy. In a

survey of psychologists’ use of homework with patients with schizophrenia,

Deane, Glaser, Oades, and Kazantzis (2005) found that the top five barriers

to homework completion were little motivation, ineffective decision mak-

ing, social withdrawal, distractibility, and difficulty initiating activities. In

a study that focused on patients’ experience and perspective of homework

tasks in cognitive therapy (Dunn, Morrison, & Bentall, 2002), factors cited

as affecting homework compliance also included low motivation, putting

off the assignment, and lack of effort. However, cognitive therapy can con-

tribute to the reduction of negative symptoms by helping patients learn to

identify and reduce the triggers for their activation and/or develop strate-

gies for the alleviation following onset. Common strategies include the use

of activity schedules, graded task assignments, assertiveness training, and

thought records to target negative expectancies. Much of

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