· "Cognitive Therapy Background," located below.
· Therapy Session 1: Read the case of Gwen on page 302. And answer at least three questions for reflection on Page 303.
· Therapy Session 2: the cognitive therapy session between Karen and Dr. McAuliffe below. Take notes on the interaction between Karen and Dr. McAuliffe.
· Complete the written assignment according to the assignment directions.
Cognitive Therapy Background
Cognitive therapists believe in changing clients’ inaccurate perceptions of themselves and their environments by uncovering faulty beliefs that are causing personal and interpersonal problems. Coming from the behavioral tradition, cognitive therapists believe thoughts can be considered behaviors which can be modified. Such modification occurs through the “disputation” of thoughts and by experimenting with new behaviors.
Many cognitive therapists believe that problems in living are caused by cognitive schemas or “floor plans” that influence how people make sense of the world. Once these cognitive schemas have been identified, the therapist helps the client uncover the moment-to-moment automatic thoughts that fuel the continuation of the schema. The counselor then helps the client discover the cognitive errors in those automatic thoughts. Examples of just a few of these include: all or nothing thinking, such as believing that life is either great or horrible; overgeneralization, such as believing that one must be fearful of flying because planes have crashed; and personalization, or seeing oneself as the cause of negative events such as believing that one was the reason for his or her parents’ divorce.
Today, most cognitive therapists believe in establishing a therapeutic alliance through careful listening and by collaborating with the client as they help him or her understand the cognitive therapy process. Cognitive therapists use questions to probe the client’s way of thinking. Eventually, therapists help the client acquire more adaptive thoughts and assist the client in devising a plan that includes practicing new behaviors that will reinforce new thoughts.
Cognitive therapists believe clients can make dramatic changes in how they think and act; however, they tend to focus on coping, not curing the client. Changing embedded ways of thinking and behaving does not occur easily.
Let’s see how Dr. Garrett McAuliffe helps Karen identify cognitive distortions as she works on issues related to how fear of loss has led her to avoid commitments in her life.
Cognitive Therapy Session
Dr. McAuliffe: Karen, hi again.
Karen: Hi
Dr. McAuliffe: We met once before and we talked about your fear of loss, and how it connects to your fear of commitment at this time in your life. I asked you to monitor some thoughts you might have had around specific incidents in your relationship and write down those thoughts when you felt a sense of dread about the current relationship with John, your partner. What have you noticed this week?
Karen: Um, I did try to think about my thoughts and one example I was remembering as I was driving over here was when John made reference to the fact that I don’t clean out the refrigerator, that I don’t you know, worry about that as something that I need to do. And um, I remember thinking, um the feelings that came up were like “See, I’m not good at everything. I don’t do the refrigerator, you know, things like that he’s not gonna like, it’s gonna negatively affect the relationship.” And I mean it just led from one thing to another um, and that feeling came back you know that the relationship will somehow end. It just kinda all builds together.
Dr. McAuliffe: How likely is that to be true?
K: Well, based on just the refrigerator incident, probably not very likely. Um, and I know that, but somehow those little things just build up and you know that fear feeling comes up when they happen.
Dr. McAuliffe: So you generalize from before.
Karen: Yes, yes.
Dr. McAuliffe: You’ve lost a father when you were very young, and a little brother when you were quite young, and you talked last week about a stepfather when you were an adolescent and then your older brother in your life. And so those are genuine losses that have happened to you. But what’s different about this relationship?
Karen: That’s where I get confused because I know that this relationship is different. But the feelings of loss that come up, just remind me that I don’t want to have to experience that again. So I know it’s different, um, but I don’t want to experience loss again.
Dr. McAuliffe: You’re afraid of feeling that pain again. You’re saying to yourself on some deep level, “Every time I get close, I’ll experience loss. Every time there’s a problem, things will end.” Is it true that every time there’s a problem, you will experience loss?
Karen: Well, not every time. I mean, you know he could die, but not every time, no.
Dr. McAuliffe: Right, relationships do end, but not every time that there’s a minor problem. You are generalizing and that’s one word that you can use, overgeneralizing from the past and another word that maybe you can remember is catastrophizing from those situations as if they’re the same as the current one. Do you see how you’re doing this?
Karen: Yes, yes. Um, cause every time there’s that little problem I get that pain so, yeah.
Dr. McAuliffe: So that pain’s a cue for you and then you start worrying. The pain comes from deeply embedded, now maladaptive thoughts, that really maybe were effective at the time but aren’t anymore. There’s a word for that called a cognitive schema, or a cognitive floorplan. That you’re operating from as if it’s true now what was true then. You’re saying to yourself, “If there’s any problem, then a relationship is going to end.”
Karen: Yes.
Dr. McAuliffe: It’s so embedded that you don’t catch the thoughts in the present, as if they’re different now, but you still can come back to them.
Karen: Wow
Dr. McAuliffe: With new more adaptive thoughts, not maladaptive thoughts, but not generalizing like you’re doing or catastrophizing. What type of thoughts do you think that you can have now?
Karen: Well, um, I guess when that feeling comes up I know that I can say, you know that this relationship is different and that we can talk about things. And I know that John’s not gonna leave me, I feel very confident about that. Like I said, other than if he dies. Um, and he’s willing to work with me so I know I can…I have to just say those things.
Dr. McAuliffe: Good, then let’s work on what I’ll call a homework assignment. Is that okay with you?
Karen: Yes, I will work on it
Dr. McAuliffe: What situation with John might bring up these thoughts?
Karen: Um, it will probably be some complaint about the dog.
Dr. McAuliffe: Mmhm, and what will you say to him? To yourself.
Karen: I will try to remember and say, you know, “We can talk about this. He’s not going to leave, and just because we have a disagreement over the dog doesn’t mean that it’s going to lead to a loss.”
Dr. McAuliffe: Great! You’re reminding yourself not to catastrophize; that this relationship is different from all of those other experiences in the past. And one thing I think it’s important to remember is how long did it take to develop this fear of loss, this floorplan.
Karen: Well, my dad died when I was three so, my whole lifetime.
Dr. McAuliffe: So it’s gonna take some hard work to combat these embedded, we’ll call them, thoughts, your cognitive floorplan. It’s gonna have to slowly change.
Karen: Right, I see. I’m really gonna have to work on this.
Dr. McAuliffe: I have a suggestion. I’d like you to write down every incident that brings up those thoughts and then how you’ve combated each incident with the new thoughts that we’ve talked about today. Is that something you think you can do?
Karen: Yes. Yes, I can do that
Dr. McAuliffe: Great, I look forward to seeing how you do it.
Karen: Thank you. It’s gonna take a lot of work.