Therapeutic Relationship in Cognitive-behavioral Therapy : A Clinician's Guide (9781462531301) by unknow

Author:unknow
Language: eng
Format: epub
ISBN: 9781462531301
Publisher: Guilford Pubn

REVIEWING BETWEEN-SESSION INTERVENTIONS

At least three broad classes of factors help to explain a client’s level and type of engagement or nonengagement. These factors include client attributes (including their skills), their beliefs (and other features of their cognitive case conceptualization), and the therapeutic relationship. Clearly, there is potential for overlap on all three of these broad domains, so we discuss these issues here involving the case of Juliet.

As you may recall, at the outset of treatment Juliet had minimal ability to collaborate with her therapist. Her first major negative reaction during therapy occurred when the therapist attempted to position beliefs as being separate from “the self.” The therapist thought that if Juliet could view thoughts as not an exact reflection of the whole truth, but as being influenced by prior developmental experiences, then she might see that her ongoing self-criticism was unnecessary. However, the world was not logical for Julie at that point in treatment. It was more a matter of raw emotion. People often view the world in odd ways. With the benefit of hindsight, it’s not surprising that Juliet took offense to the therapist, as she viewed the concern about her self-criticism as a general debasement. This level of heightened sensitivity is not atypical, especially when clients are very distressed or have less developed interpersonal skills. This response also reflected some degree of defensiveness for Juliet, who was very nervous and feeling vulnerable about starting treatment with a new therapist. Hence, the frame of her “emotional response” needed to be considered in terms of her past experiences and her propensity to protect herself.

The process of having clients engage in between-session interventions can often reveal skill deficits. Further, even though we may try to help clients move away from linking their self-worth to such activities, they often fuse their self-worth with the work they produce for review at the beginning of sessions. For these reasons, we favor careful attention to the details so that the client has every chance for its execution, but limit the use of empathy for the challenges inherent in these interventions. Although we encourage positive expressions of support for all efforts made (no matter how small), therapists want to limit the use of praise over time, so that the natural reinforcement of the task can take over. We don’t want to foster a situation where the client engages in the intervention primarily to earn our positive appraisal.

Psychological theories consistently propose that clients are likely to engage in self-help or other treatment interventions when the benefits outweigh the costs. How many times has a concerned family member or friend given you advice—and how often have you ignored it? How many times have you failed to follow your dentist’s instruction to floss daily, or your physician’s advice to follow a course of medication through to the last pill? Unless there are clear benefits for us to engage in an activity, we typically follow advice either out of a sense of obligation or other need for a socially sanctioned approval, or because we decide to put our needs second to the needs of someone or something else.

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