Informing the person who consults

Many people, like Juan, need help but do not know what a treatment is, and are logically afraid of the consequences of the uncertain. Psychotherapies today offer a varied range of different proposals, but if Juan has no information on the subject, the most likely thing is that he will be afraid when faced with a proposal of psychotherapy.

Cognitive therapy attaches great importance to informing the people who seek help for their emotional problems about the way in which work will proceed during the treatment and about the goals that will be set. The patient has the right to know what the type of therapy he is choosing consists of, and this knowledge is moreover useful in itself for therapeutic purposes. The reader of this article is likewise gaining information on a subject he does not know, or that he does know and that interests him; and if at this point he were to ask himself, “what then is this cognitive therapy?”, that would be a good indication of his motivation to learn something new.

In cognitive therapy, the therapeutic relationship rests on a learning model. The patient is thus expected to take on, little by little, the techniques the therapist teaches him.

With time, even after the end of the treatment, patients find themselves spontaneously taking on, in their daily lives, the role of their own therapists, in an internal dialogue that allows them to go on learning. This does not mean that they cannot turn to a professional when it is necessary. Quite the contrary: follow-up interviews (a check on the patient’s situation) are even recommended in the years following the end of the treatment.

Collaborative, active, directive

Cognitive therapy has emerged in recent years as a relatively short-term form of psychotherapy, characterised as collaborative, active and directive.

Collaborative refers to the fact that the patient is not thought of as receiving a therapy: the emphasis is on joint work by therapist and patient, as a team. In this sense, as in a sports or scientific team and so on, the alliance between its members in order to reach the goals is fundamental.

The idea of an active psychotherapy refers to the role of the therapist as much as to that of the patient. As regards the therapist’s attitude, he seeks to establish a bond of empathy and understanding through active listening and fluid dialogue. As regards the patient’s participation in the therapy, an attitude of investigative work is expected of him, to the extent that his emotional situation allows. The patient works during the sessions as well as during the interval that separates one session from the next, at the task of identifying and resolving his difficulty.

Characterising cognitive therapy as directive can be misleading, since one may believe that the therapist directs the patient in the sense of telling him what he must do. That is false. It is directive in the sense that it works at defining clear objectives. Therapist and patient work jointly at establishing shared objectives. In this way, goals or objectives set by one of the parties and not shared by the other are set aside. It may happen, for example, that one of the patient’s objectives is to be able to work eighteen hours a day, and that the therapist considers this to be beyond the patient’s possibilities, or not advisable for his emotional situation. It could also happen that the therapist wants to obtain for his patient an objective such as modifying a certain tendency to demand too much of himself, while the patient only wants to resolve his fear of flying, that kind of travel being necessary for his work.

To cure, or to learn?

The objective of cognitive therapy is to help the patient manage his life better. The goal is not considered to be “curing”, because for there to be a cure there must be something ill, and it is very often difficult to define the boundary between the healthy and the ill. In this sense, cognitive therapy sets out to teach a model for facing emotional problems (depression, fears, social difficulties, and so on) that the patient will then be able to use by himself.

As far back as the time of the Stoics, it was already held that the key to suffering lay in human conceptions of facts rather than in the events themselves. Thus, in cognitive therapy, the human being is conceived as holding the key to understanding and resolving his psychological problems, by correcting mistaken procedures with the same capacity he has shown at other moments for correcting his course and learning new paths. The therapist’s function is to restore in the client the capacity to use the key, so that he may open new doors in the relationship with himself and with the world.

Interview with Christine Padesky

Christine Padesky, Ph.D., director of the Center for Cognitive Therapy, Newport Beach, California.

Some therapies emphasise the importance of understanding, others that of feelings and emotions, others again the process by which these develop. I believe that cognitive therapy, without leaving that aside, has added the dimension of thought, which has proved very favourable for helping people in cases where emotion becomes excessive, as happens in depression, anxiety or panic, which recede within a short time thanks to the cognitive approach.

In our centre in Newport, we try to have a complex vision of therapy, taking into account developmental and cultural aspects, which are important in the formation of the “schemas” linked to identity.

A theme that interests me greatly, being a woman myself, is that of feminine identity and cognitive schemas. In a book we are currently writing on cognitive therapy with women, we posit that feminine identity arises from the culture it comes from, and we are particularly interested in the way the different dimensions by which we define culture affect the image a woman has of herself and of what she thinks is expected of her.

Knowing the cultural background in which their schemas originate allows us to approach cognitively the usual reasons for consultation among women, giving them the possibility of developing more flexible life options, by means of the “Socratic confrontation” of schemas.

The “collaborative” aspect of cognitive therapy makes it possible to help those who tend to place themselves in a relationship of dependence rather than of equality, by improving their self-esteem.

With a view to helping the client find a better balance in life, each therapy holds one part of the puzzle.

I think that in the future we shall arrive at an integration in psychotherapy, and that trained therapists will use the one the client specifically needs.