Friends, most of our problems are in our heads. The problem of overeating is a problem of habits. And in our eating habits, we exercise diligently 3 times a day, and sometimes more often. Everything is embedded in the subconscious, and it is useless to fight it. But if you understand how it works, you can adapt and win the whole process.
Each chapter of the book contains a subtitle "What do you think?"
Judith Beck's important innovative idea to identify “sabotage thoughts.” Those habitual thoughts that lead to internal sabotage, breakdowns, and making weight loss impossible. Judith reveals this idea and gives tips on how to respond. Forewarned is forearmed.
Every day the task is to read the “Advantage Card” at least 2 times a day. And this is an incredibly powerful move - training the subconscious. We set up our subconscious to be slim, to want to achieve our goal with all our hearts. We give it direction, and then success is inevitable.
This is not a diet book. You can choose any healthy diet. You just need to plan your meals in advance, know when and what you will eat.
The book is full of practical advice that works.
- How to avoid the temptation to eat something extra?
- How not to retreat?
- What to do with emotions?
- What to do in case of a breakdown? and so on.
Dr. Judith Beck tried to prevent all the questions, all the difficulties that will arise for a person who is trying to cope with overeating. And she offers a solution.
We just need to follow the advice.
I hope the book helps you as it helps me!
Thank you for stopping by)
Cognitive Therapy:
Basics and Beyond
Judith S. Beck, Ph.D.
Foreword by Aaron T. Beck, M.D.
THE GUILFORD PRESS
Cognitive therapy
Complete Guide
Judith Beck, Ph.D.
Foreword by Aaron Beck, MD
Moscow St. Petersburg Kyiv
Publishing house "Williams"
Head by the editors N.M. Makarova
Translation from English and editing E.L. Chernenko
Scientific consultant Ph.D. psychol. sciences E.V. Krainikov
For general questions, please contact Williams Publishing House
at the following addresses:
http://www.williamspublishing.com
115419, Moscow, PO Box 783; 03150, Kyiv, PO Box 152
Beck, Judith S.
B42 Cognitive therapy: a complete guide: Trans. from English - M.: LLC "I.D. Williams", 2006. - 400 pp.: ill. - Paral. tit. English
ISBN 5-8459-1053-6 (Russian)
Book Cognitive Therapy: The Complete Guide represents the result of many years of research and clinical practice of the author. This comprehensive guide covers the basic concepts of cognitive psychotherapy and its indications. The main methods of the therapeutic process are outlined, their place in the correction of various cognitive distortions of patients and the treatment of psychological disorders is determined. A theoretical basis and step-by-step description of individual cognitive therapy techniques are provided. The book is richly illustrated with clinical examples. A separate chapter is devoted to the role of the psychotherapist’s personality in the practice of psychotherapy. Cognitive therapy is addressed to psychologists and psychotherapists adhering to the cognitive-behavioral tradition, specialists in other areas seeking to expand the boundaries of professional knowledge, and students of psychological faculties of higher educational institutions.
BBK (Yu) 88.4
All rights reserved. No part of this publication may be reproduced in any form or by any means, electronic or mechanical, including photocopying or recording, for any purpose, without permission in writing from Guilford Publications. , Inc.
All rights reserved. No part of this book may be reproduced, stored in retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher.
Russian language edition published by Williams Publishing House according to the Agreement with R&I Enterprises International, Copyright © 2006.
Authorized translation from English language edition published by Guilford Publications, Inc., Copyright
ISBN 5-8459-1053-6 (pyc.) © Williams Publishing, 2006
ISBN 0-8986-2847-4 (English) © The Guilford Press, 1995
_________________________________________________________
Chapter 1. Introduction 19
Chapter 2. Cognitive Conceptualization 33
Chapter 3. Structure of the first therapeutic session 47
Chapter 4. Second and subsequent sessions: structuring
and format 69
Chapter 5. Difficulties in structuring a therapy session 87
Chapter 6: Identifying Automatic Thoughts 101
Chapter 7: Identifying Emotions 121
Chapter 8: Assessing Automatic Thoughts 133
Chapter 9: Answering Automatic Thoughts 155
Chapter 10: Identifying and Changing Intermediate Beliefs 169
Chapter 11. Deep Beliefs 201
Chapter 12. Additional cognitive and behavioral techniques 231
Chapter 13. Figurative representations 271
Chapter 14. Homework 293
Chapter 15. Completion of therapy and prevention of relapse 319
Chapter 16. Creating a treatment plan 335
Chapter 17. Difficulties of therapy 355
Chapter 18. Professional development of a cognitive therapist 371
Appendix A: Case Study Worksheet 375
(and therapists) 383
Appendix D: Information for Cognitive Therapists 384
Bibliography 386
Subject index 393
Preface 13
Introduction 17
Chapter 1 . Introduction 19
Development of a cognitive therapist 29
How to use this book 29
Chapter 2. Cognitive conceptualization 33
Cognitive Model 34
Beliefs 35
Relationships, rules and assumptions 36
The relationship between behavior and automatic thoughts 37
Example case 39
Chapter 3. Structure of the first therapy session 47
Goals and structure of the first therapy session 48
Setting the agenda 50
Mood Score 52
Getting to know the patient’s complaints, identifying his current problems
and defining treatment goals 53
Teaching the patient a cognitive model 56
Expectations from therapy 59
Judith S. Beck, Ph.D., is the director of the Institute for Cognitive Therapy and Research, located in suburban Philadelphia. She also holds the position of Clinical Assistant Professor of Psychology and Psychiatry at Pennsylvania State University, where she teaches psychiatry. She received her doctorate from Pennsylvania State University in 1982.
Dr. Judith Beck is responsible for the three functions of the Beck Institute: education, clinical practice and research. She is currently involved in administrative work, supervision and training of cognitive therapists, treatment work, research and writing. In addition, she is a recognized lecturer who has organized numerous working groups and seminars both nationally and internationally on the use of cognitive therapy in the treatment of depressive, anxiety, panic and bipolar disorders, personality disorders and interpersonal disorders, as well as in the prevention of relapse of disorders after completion of therapy.
She is the author of three books, including a textbook on cognitive therapy “Cognitive Therapy. The Complete Guide" which has been translated into 12 languages. In addition, she is the editor of the Oxford Textbook of Psychotherapy and co-author of the book Cognitive Therapy for Personality Disorders, and has written numerous articles and chapters on the use of cognitive therapy in various situations. Dr. Judith S. Beck is the President of the Academy of Cognitive Therapy.
Books (1)
Cognitive therapy. Complete Guide
The book is the result of many years of research and clinical practice of the author. This comprehensive guide covers the basic concepts of cognitive psychotherapy and its indications. The main methods of the therapeutic process are outlined, their place in the correction of various cognitive distortions of patients and the treatment of psychological disorders is determined. A theoretical justification and step-by-step description of individual cognitive therapy techniques are provided.
The book is richly illustrated with clinical examples. A separate chapter is devoted to the role of the psychotherapist’s personality in the practice of psychotherapy.
Cognitive Therapy:
Basics and Beyond
Judith S. Beck, Ph.D.
Foreword by Aaron T. Beck, M.D.
THE GUILFORD PRESS
New York London
Cognitive therapy
Complete Guide
Judith Beck, Ph.D.
Foreword by Aaron Beck, MD
Moscow St. Petersburg Kyiv
BBK (U)88.4
Publishing house "Williams"
Head by the editors ^ N.M. Makarova
Translation from English and editing E.L. Chernenko
Scientific consultant Ph.D. psychol. sciences E.V. Krainikov
For general questions, please contact Williams Publishing House
To the addresses:
[email protected], http://www.williamspublishing.com
115419, Moscow, PO Box 783; 03150, Kyiv, PO Box 152
Beck, Judith S.
B42 Cognitive therapy: a complete guide: Trans. from English - M.: LLC "I.D. Williams", 2006. - 400 pp.: ill. - Paral. tit. English
ISBN 5-8459-1053-6 (Russian)
Book ^ Cognitive Therapy: The Complete Guide represents the result of many years of research and clinical practice of the author. This comprehensive guide covers the basic concepts of cognitive psychotherapy and indications for its use. The main methods of the therapeutic process are outlined, their place in the correction of various cognitive distortions of patients and the treatment of psychological disorders is determined. A theoretical basis and step-by-step description of individual cognitive therapy techniques are provided. The book is richly illustrated with clinical examples. A separate chapter is devoted to the role of the psychotherapist’s personality in the practice of psychotherapy. Cognitive therapy is addressed to psychologists and psychotherapists who adhere to the cognitive-behavioral tradition, specialists in other areas seeking to expand the boundaries of professional knowledge, and students of psychological faculties of higher educational institutions.
BBK (Yu) 88.4
All rights reserved. No part of this publication may be reproduced in any form or by any means, electronic or mechanical, including photocopying or recording, for any purpose, without written permission from the publisher. Guilford Publications, Inc.
All rights reserved. No part of this book may be reproduced, stored in retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher.
Russian language edition published by Williams Publishing House according to the Agreement with R&I Enterprises International, Copyright © 2006.
Authorized translation from English language edition published by Guilford Publications, Inc., Copyright
ISBN 5-8459-1053-6 (pyc.) © Williams Publishing, 2006
_________________________________________________________
Chapter 1. Introduction 19
Chapter 2. Cognitive Conceptualization 33
Chapter 3. Structure of the first therapeutic session 47
Chapter 4. Second and subsequent sessions: structuring
And format 69
Chapter 5. Difficulties in structuring a therapy session 87
Chapter 6: Identifying Automatic Thoughts 101
Chapter 7: Identifying Emotions 121
Chapter 8: Assessing Automatic Thoughts 133
Chapter 9: Answering Automatic Thoughts 155
Chapter 10: Identifying and Changing Intermediate Beliefs 169
Chapter 11. Deep Beliefs 201
Chapter 12. Additional cognitive and behavioral techniques 231
Chapter 13. Figurative representations 271
Chapter 14. Homework 293
Chapter 15. Completion of therapy and prevention of relapse 319
Chapter 16. Creating a treatment plan 335
Chapter 17. Difficulties of therapy 355
Chapter 18. Professional development of a cognitive therapist 371
(and therapists) 383
Bibliography 386
^ Subject index 393
Preface 13
Introduction 17
Chapter 1 . Introduction 19
Development of a cognitive therapist 29
How to use this book 29
Chapter 2. Cognitive conceptualization 33
Cognitive Model 34
Beliefs 35
Relationships, rules and assumptions 36
The relationship between behavior and automatic thoughts 37
Example case 39
Conclusions 44
Chapter 3. Structure of the first therapy session 47
Goals and structure of the first therapy session 48
Setting the agenda 50
Mood Score 52
Getting to know the patient’s complaints, identifying his current problems
And determining the goals of therapy 53
Teaching the patient a cognitive model 56
Expectations from therapy 59
Explaining to the patient the nature of his disorder 61
Summing up the session and defining homework 63
Feedback 65
Conclusions 67
^ Chapter 4. Second and subsequent sessions: structuring
and format 69
Brief assessment of the patient’s condition and mood 70
Relationship between the current session and the previous one 73
Setting the agenda 74
Homework analysis 76
Homework and periodic summing up 77
Final summary and feedback 83
Third and subsequent sessions 84
Chapter 5. ^ Difficulties in structuring a therapeutic session ; 87
Review of last week 89
Mood Score 90
Link to previous session 93
Setting the agenda 94
Homework Analysis 96
Discussion of agenda items 96
Defining New Homework 97
Final summary 98
Feedback 99
Problems arising from therapist cognitions 99
Chapter 6. ^ Identifying automatic thoughts 101
Features of Automatic Thoughts 101
Explaining to the patient the nature of automatic thoughts 104
Identifying Automatic Thoughts 106
Identifying a problem situation 112
Differences between automatic thoughts and interpretations 114
Differences between more and less significant automatic
Thoughts 115
Refining remembered automatic thoughts 115
Changing the form of "telegraphic" or interrogative thoughts 116
Teaching patients to recognize automatic thoughts 118
Chapter 7. Identifying Emotions 121
Difference between automatic thoughts and emotions 122
The Importance of Distinguishing Emotions 124
Difficulty in labeling emotions 126
Difficulty assessing the intensity of emotions 128
Using the Emotion Intensity Scale for Planning
Therapies 131
Chapter 8. ^ Assessing automatic thoughts 133
Selecting an automatic thought - a “target” 133
Working with automatic thoughts 135
Questions to Assess Automatic Thoughts 136
Using alternative questions 145
Identifying Cognitive Distortions 147
Assessing the Benefits of Automatic Thoughts 149
Effectiveness of assessing automatic thoughts 150
Conceptualizing failure to evaluate automatic thought 151
Chapter 9. ^ Answers to automatic thoughts 155
Worksheet for working with dysfunctional thoughts (RDM) 155
Motivating patients to use the RDM 164 form
When the RDM form is not effective enough 165
Additional Ways to Find Answers to Automatic Thoughts 166
Chapter 10. ^ Identifying and changing intermediate beliefs 169
Cognitive conceptualization 170
Identifying Intermediate Beliefs 176
Should Belief Change 180
Explaining to Patients the Nature of Their Beliefs 182
Transforming rules and relationships into the form of assumptions 182
Determining the Advantages and Disadvantages of Beliefs 183
Forming a new belief 184
Changing Beliefs 184
Chapter 11. Deep Beliefs 201
Revealing Deep Beliefs 206
Presenting the patient's core beliefs 207
Explaining to the patient the nature and influence of deep-seated beliefs 208
Changing core beliefs and formulating new ideas 212
Worksheet for Working with Deep Beliefs 213
Chapter 12. ^ Additional cognitive and behavioral techniques 231
Solving Problem 231
Decision making 233
Behavioral experiments 235
Monitoring and planning of activities 238
Distraction and switching of attention 250
Relaxation 253
Coping - cards 253
Successive approximation technique 255
Role-playing game 258
Pie technique 261
Functional Comparisons and Laudable Deeds 265
Chapter 13. ^ Figurative representations 271
Pattern detection 271
Explaining to the patient the nature of figurative representations 273
Finding an answer to spontaneous images 275
Response to spontaneously arising images 285
Cognitive therapy: imagery as a therapeutic technique 286
Chapter 14. Homework 293
Homework Definition 294
Increased likelihood of patient success
Homework 300
Conceptualizing difficulties 308
Chapter 15. ^ Completion of therapy and prevention of relapse 319
The therapist's actions at the first session 319
The therapist’s actions during therapy 321
The therapist’s actions before completing the course of therapy 325
Booster sessions 331
Chapter 16. Making a treatment plan 335
Achieving therapeutic goals in a broad sense 335
Planning Interventions Across Sessions 336
Development of a treatment plan 337
Scheduling Individual Sessions 338
Selecting a problem - a “target” 344
Changing the topic in session 349
Changing Standard Treatments for Specific Disorders 350
Chapter 17. ^ Difficulties of therapy 355
Identifying problems 355
Conceptualization of problems 358
Deadlocks 367
Solving problems that arise during therapy 368
Chapter 18. ^ Professional growth of a cognitive therapist 371
Appendix A: Case Study Worksheet 375
(and therapists) 383
Appendix D: Information for Cognitive Therapists 384
Bibliography 386
^ Subject index 393
^ To my father, Aaron T. Beck, MD
PREFACE
“What is the purpose of this book?” is a natural question that the reader of any book on psychotherapy asks himself, and this is precisely what should be discussed in the preface. To answer this question for future readers of Dr. Judith Beck's book Cognitive psychotherapy: a complete manualwatercraft, I need to go back to the origins of cognitive therapy and its subsequent development.
When I first began treating patients using a set of therapeutic techniques that I would later call “cognitive therapy,” I had no idea where this approach—so different from the psychoanalytic approach I was familiar with—would lead me. Based on my clinical observations and the results of some systematic clinical studies and experiments, I suggested that the basis of such psychiatric disorders as depression and anxiety is a thought disorder. We are talking about systematic distortions in the patient's interpretations of his life experiences. By calling the patient's attention to these distortions and offering him alternatives - that is, more plausible explanations for the traumatic situations - I found that I thereby achieved an almost immediate reduction in the symptoms of the disorder. To prevent relapse, I taught patients how to use these cognitive skills in everyday life. It turned out that solving the patient’s current problems in the “here and now” plane leads to almost complete relief from symptoms within 10-14 weeks. Further clinical studies conducted by my research group and other clinicians have confirmed the effectiveness of cognitive therapy in the treatment of depressive, anxiety and panic disorders.
By the mid-1980s, I could already argue that cognitive therapy had achieved the status of a “system of psychotherapy.” It consisted of:
14 Preface
Personality theory and psychopathology, the main postulates of which have been empirically confirmed;
A model of psychotherapy with a set of principles and strategies developed based on the theory of psychopathology;
Convincing empirical findings based on clinical trial results confirm the effectiveness of this approach.
Since the inception of cognitive therapy, a new generation of therapists/investigators/educators have conducted a number of basic studies of the conceptual model of psychopathology and applied cognitive psychotherapy in relation to a wider range of psychiatric disorders. Through systematic research, basic cognitive definitions of personality and psychiatric disorders have been discovered, principles of idiosyncratic processing and information acquisition in these disorders have been developed, and the relationship between cognitive vulnerability and vulnerability to stress has been studied.
The application of cognitive therapy to a variety of psychological, psychiatric, and physical disorders goes far beyond what I could have imagined when I treated my first patients with depression and anxiety with cognitive therapy. Based on research conducted around the world, but especially in the United States, it is reliably established that cognitive therapy is effective in treating an extremely wide range of conditions - from post-traumatic stress disorder to obsessive-compulsive disorder, from phobias of all types to eating disorders. When combined with medication, cognitive therapy is useful in treating bipolar disorder and schizophrenia. It has also been found that the use of cognitive therapy produces successful results in the treatment of a number of chronic physical conditions, such as low back pain, colitis, hypertension and chronic fatigue syndrome.
With so many uses for cognitive therapy, how can a passionate therapist learn its core principles? I would like to respond with the words of Alice from Wonderland: “Start at the beginning” and return to the question stated at the beginning of this preface. The purpose of this book, written by Dr. Judith Beck, one of the new generation of cognitive therapists (who, as a teenager, heard numerous discussions on her favorite topic), is to provide a clear basis for the practice of cognitive therapy. Despite the wide possibilities of using cognitive therapy, it is based on the same fundamental principles, which will be discussed in this work - a basic guide for cognitive therapists. (Other works, by some
Preface 15
I am here to guide a cognitive therapist through the labyrinth of each specific disorder.)
I hope that even experienced cognitive therapists will find this book very useful in improving their conceptualization skills, expanding their repertoire of therapeutic techniques, learning to plan treatment more effectively, and managing difficulties that arise during therapy.
Of course, no book on cognitive therapy can replace the supervision that can be obtained from qualified cognitive therapists (see Appendix D).
Dr. Judith Beck is well qualified to offer guidance to cognitive therapists. Over the past ten years, she has led working groups, seminars, and conferences, as well as given lectures on cognitive therapy, supervised many new and experienced therapists, participated in the creation of treatment protocols for various disorders, and conducted research on cognitive therapy. With such a remarkable wealth of knowledge and experience, she has written a book containing truly invaluable information that allows you to use cognitive therapy as effectively as possible in practice.
The practice of cognitive therapy is not easy. I have observed many clinical participants, for example those who are able to go through the process of therapeutic work with "automatic thoughts", without being aware of the patients' perception of their personal world and without the slightest sense of "shared empiricism." Dr. Beck's goal is to train both new and experienced cognitive therapists in the basics of cognitive therapy, and she has accomplished this mission admirably.
Aaron T. Beck, MD
16 Preface
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INTRODUCTION
Over the past ten years I have participated in many working groups and seminars on cognitive therapy, both nationally and internationally. And three things have always surprised me. The first is the growing interest in cognitive therapy, one of the few holistic psychotherapies whose effectiveness has been empirically proven. The second is the persistent desire of psychologists, psychotherapists and psychiatrists to master the principles of cognitive therapy and thoroughly study the techniques so that they can be consistently applied in their practice, guided by a clear conceptualization. Third, there are countless misconceptions about cognitive therapy, the most common of which are: that it is solely a set of techniques, that it devalues the importance of emotions and diminishes the role of the therapeutic relationship, that it does not attach importance to rooted in childhood are the sources of many psychological difficulties.
Most patients feel more comfortable when they understand what to expect from therapy, when they are clear about their responsibilities as well as the authority of the therapist, and when they have an idea of how therapy will be delivered (both within a single session and as a whole). - course of treatment). The therapist strives to explain the structure of the sessions to the patient as clearly and clearly as possible and then strictly adhere to the established format.
Many working group participants told me that they had been using cognitive techniques for many years without calling them such. Others familiar with the first manual on cognitive therapy, “Cognitive Therapy for Depression” (A. Beck, A. Rush, B. Shaw, G. Imery), have not been able to use this form of therapy effectively enough in practice.
This book is addressed to a wide audience - from specialists who are not familiar with cognitive therapy, to those who are quite experienced, but want to improve their skills in cognitive conceptualization of patients, planning treatment, using a variety of techniques, assessing the effectiveness of treatment and identifying problems that arise. during therapy.
18 Introduction
In an effort to improve the presentation of the material, I chose one therapeutic case as an example for the entire book. Sally was my patient when I began working on this book several years ago. She turned out to be an ideal patient for many reasons. Her treatment clearly illustrates “standard” cognitive therapy for an uncomplicated single episode of depression. For ease of presentation, Sally and all other patients discussed in this book are presented as women, while the therapist in all of these cases is an imaginary man. In addition, I use the term “patient” rather than “client” because this definition is due to my medically oriented approach to my work.
This manual of cognitive therapy describes the process of cognitive conceptualization, principles of treatment planning, structuring sessions and diagnosing problems that are necessary when working with any patient. Although the book describes the treatment of simple depressive disorder, the techniques presented are applicable to the treatment of patients with a wide range of problems. The corresponding chapter provides guidelines for the treatment of a number of disorders, which serve as the basis for appropriate modification of therapy in accordance with the needs of individual patients.
This book would not have been created without the revolutionary work of the father of cognitive therapy, Aaron T. Beck, who is also my father and a distinguished scientist, theorist, practitioner, and extraordinary individual. The ideas presented are the result of my own many years of clinical experience, supplemented by reading, supervision and discussions with both my father and other professionals. Each supervision, each of my students and patients gave me invaluable experience. I am grateful to them all.
Finally, I want to thank everyone who helped me create this guide, especially Kevin Kuhlwein, Christine Padesky, Thomas Ellis, Donald Beal, E. Thomas Dowd, and Richard Busis. Thanks to Tina Inforzato, Helen Wells, and Barbara Cherry, who prepared the manuscript, and to Rachel Teacher and Heather Bogdanoff, who helped me put the finishing touches on it.
The book is the result of many years of research and clinical practice of the author. This comprehensive guide covers the basic concepts of cognitive psychotherapy and its indications. The main methods of the therapeutic process are outlined, their place in the correction of various cognitive distortions of patients and the treatment of psychological disorders is determined. A theoretical justification and step-by-step description of individual cognitive therapy techniques are provided.
The book is richly illustrated with clinical examples. A separate chapter is devoted to the role of the psychotherapist’s personality in the practice of psychotherapy.
About the author: Judith S. Beck, Ph.D., is the director of the Institute for Cognitive Therapy and Research, located in suburban Philadelphia. She also holds the position of Clinical Assistant Professor of Psychology and Psychiatry at Pennsylvania State University, where she teaches psychiatry. more…
With the book “Cognitive Therapy. Complete Guide" also read:
Preview of the book “Cognitive Therapy. Complete Guide"
Cognitive Therapy:
Basics and Beyond
Judith S. Beck, Ph.D.
Foreword by Aaron T. Beck, M.D.
THE GUILFORD PRESS
New York London
Cognitive therapy
Complete Guide
Judith Beck, Ph.D.
Foreword by Aaron Beck, MD
Moscow St. Petersburg Kyiv
2006
BBK (U)88.4
B42
UDC 616.89
Publishing house "Williams"
Head edited by N.M. Makarova
Translation from English and editing by E.L. Chernenko
Scientific consultant Ph.D. psychol. Sciences E.V. Krainikov
For general questions, please contact Williams Publishing House
at the following addresses:
[email protected] wiiamspubishing.com
115419, Moscow, PO Box 783; 03150, Kyiv, PO Box 152
Beck, Judith S.
B42 Cognitive therapy: a complete guide: Trans. from English - M.: LLC "I.D. Williams", 2006. - 400 pp.: ill. - Paral. tit. English
ISBN 5-8459-1053-6 (Russian)
The book Cognitive Therapy: A Complete Guide is the culmination of many years of research and clinical practice of the author. This comprehensive guide covers the basic concepts of cognitive psychotherapy and its indications. The main methods of the therapeutic process are outlined, their place in the correction of various cognitive distortions of patients and the treatment of psychological disorders is determined. A theoretical basis and step-by-step description of individual cognitive therapy techniques are provided. The book is richly illustrated with clinical examples. A separate chapter is devoted to the role of the psychotherapist’s personality in the practice of psychotherapy. Cognitive therapy is addressed to psychologists and psychotherapists who adhere to the cognitive behavioral tradition, specialists in other areas seeking to expand the boundaries of professional knowledge, and students of psychological departments of higher educational institutions.
BBK (Yu) 88.4
All rights reserved. No part of this publication may be reproduced in any form or by any means, electronic or mechanical, including photocopying or recording, for any purpose, without permission in writing from Guiford Publications. , Inc.
A rights reserved. No part of this book may be reproduced, stored in retrieva system, or transmitted, in any form or by any means, eectronic, mechanica, photocopying, microfiming, recording, or otherwise, without written permission from the publisher.
Russian English edition published by Wiiams Publishing House according to the Agreement with R&I Enterprises Internationa, Copyright © 2006.
Authorized translation from Engish English edition published by Guiford Publications, Inc., Copyright
© 2006
ISBN 5-8459-1053-6 (pyc.) © Williams Publishing, 2006
ISBN 0-8986-2847-4 (English) © The Guiford Press, 1995
_________________________________________________________
Chapter 1. Introduction 19
and format 69
Chapter 7: Identifying Emotions 121
(and therapists) 383
Bibliography 386
Subject index 393
Preface 13
Introduction 17
Chapter 1. Introduction 19
Development of a cognitive therapist 29
How to use this book 29
Chapter 2. Cognitive Conceptualization 33
Cognitive Model 34
Beliefs 35
Relationships, rules and assumptions 36
The relationship between behavior and automatic thoughts 37
Example case 39
Conclusions 44
Chapter 3. Structure of the first therapeutic session 47
Goals and structure of the first therapy session 48
Setting the agenda 50
Mood Score 52
Getting to know the patient’s complaints, identifying his current problems
and defining treatment goals 53
Teaching the patient a cognitive model 56
Expectations from therapy 59
Explaining to the patient the nature of his disorder 61
Summing up the session and defining homework 63
Feedback 65
Conclusions 67
Chapter 4. Second and subsequent sessions: structuring
and format 69
Brief assessment of the patient’s condition and mood 70
Relationship between the current session and the previous one 73
Setting the agenda 74
Homework analysis 76
Discussion of agenda items, determination of new
homework and periodic summing up 77
Final summary and feedback 83
Third and subsequent sessions 84
Chapter 5. Difficulties in structuring a therapy session 87
Review of last week 89
Mood Score 90
Link to previous session 93
Setting the agenda 94
Homework Analysis 96
Discussion of agenda items 96
Defining New Homework 97
Final summary 98
Feedback 99
Problems arising from therapist cognitions 99
Chapter 6: Identifying Automatic Thoughts 101
Features of Automatic Thoughts 101
Explaining to the patient the nature of automatic thoughts 104
Identifying Automatic Thoughts 106
Identifying a problem situation 112
Differences between automatic thoughts and interpretations 114
Differences between more and less significant automatic
thoughts 115
Refining remembered automatic thoughts 115
Changing the form of "telegraphic" or interrogative thoughts 116
Teaching patients to recognize automatic thoughts 118
Chapter 7: Identifying Emotions 121
Difference between automatic thoughts and emotions 122
The Importance of Distinguishing Emotions 124
Difficulty in labeling emotions 126
Difficulty assessing the intensity of emotions 128
Using the Emotion Intensity Scale for Planning
therapy 131
Chapter 8: Assessing Automatic Thoughts 133
Selecting an automatic thought - a “target” 133
Working with automatic thoughts 135
Questions to Assess Automatic Thoughts 136
Using alternative questions 145
Identifying Cognitive Distortions 147
Assessing the Benefits of Automatic Thoughts 149
Contents 9
Effectiveness of assessing automatic thoughts 150
Conceptualizing failure to evaluate automatic thought 151
Chapter 9: Answering Automatic Thoughts 155
Worksheet for working with dysfunctional thoughts (RDM) 155
Motivating patients to use the RDM 164 form
When the RDM form is not effective enough 165
Additional Ways to Find Answers to Automatic Thoughts 166
Chapter 10: Identifying and Changing Intermediate Beliefs 169
Cognitive conceptualization 170
Identifying Intermediate Beliefs 176
Should Belief Change 180
Explaining to Patients the Nature of Their Beliefs 182
Transforming rules and relationships into the form of assumptions 182
Determining the Advantages and Disadvantages of Beliefs 183
Forming a new belief 184
Changing Beliefs 184
Chapter 11. Deep Beliefs 201
Categories of deepest beliefs 204
Revealing Deep Beliefs 206
Presenting the patient's core beliefs 207
Explaining to the patient the nature and influence of deep-seated beliefs 208
Changing core beliefs and formulating new ideas 212
Worksheet for Working with Deep Beliefs 213
Chapter 12. Additional cognitive and behavioral techniques 231
Solving Problem 231
Decision making 233
Behavioral experiments 235
Monitoring and planning of activities 238
Distraction and switching of attention 250
Relaxation 253
Coping - cards 253
Successive approximation technique 255
Role-playing game 258
Pie technique 261
Functional Comparisons and Laudable Deeds 265
Chapter 13. Figurative representations 271
Pattern detection 271
Explaining to the patient the nature of figurative representations 273
Finding an answer to spontaneous images 275
Response to spontaneously arising images 285
Cognitive therapy: imagery as a therapeutic technique 286
Chapter 14. Homework 293
Homework Definition 294
Increased likelihood of patient success
homework 300
Conceptualizing difficulties 308
Chapter 15. Completion of therapy and prevention of relapse 319
The therapist's actions at the first session 319
The therapist’s actions during therapy 321
The therapist’s actions before completing the course of therapy 325
Booster sessions 331
Chapter 16. Creating a treatment plan 335
Achieving therapeutic goals in a broad sense 335
Planning Interventions Across Sessions 336
Development of a treatment plan 337
Scheduling Individual Sessions 338
Selecting a problem - a “target” 344
Changing the topic in session 349
Changing Standard Treatments for Specific Disorders 350
Chapter 17. Difficulties of therapy 355
Identifying problems 355
Conceptualization of problems 358
Deadlocks 367
Solving problems that arise during therapy 368
Chapter 18. Professional development of a cognitive therapist 371
Appendix A: Case Study Worksheet 375
Appendix B: Recommended Reading for Therapists 380
Appendix B: Recommended Readings for Patients
(and therapists) 383
Appendix D: Information for Cognitive Therapists 384
Bibliography 386
Subject index 393
To my father, Aaron T. Beck, MD
PREFACE
“What is the purpose of this book?” is a natural question that the reader of any book on psychotherapy asks himself, and this is precisely what should be discussed in the preface. To answer this question for future readers of Dr. Judith Beck's book Cognitive Psychotherapy: A Complete Guide, I need to go back to the origins of cognitive therapy and its subsequent development.
When I first began treating patients using a set of therapeutic techniques that I would later call “cognitive therapy,” I had no idea where this approach—so different from the psychoanalytic approach I was familiar with—would lead me. Based on my clinical observations and the results of some systematic clinical studies and experiments, I suggested that the basis of such psychiatric disorders as depression and anxiety is a thought disorder. We are talking about systematic distortions in the patient's interpretations of his life experiences. By calling the patient's attention to these distortions and offering him alternatives—that is, more plausible explanations for his traumatic situations—I found that I achieved an almost immediate reduction in the symptoms of the disorder. To prevent relapse, I taught patients how to use these cognitive skills in everyday life. It turned out that solving the patient’s current problems in the “here and now” plane leads to almost complete relief from symptoms within 10-14 weeks. Further clinical studies conducted by my research group and other clinicians have confirmed the effectiveness of cognitive therapy in the treatment of depressive, anxiety and panic disorders.
By the mid-1980s, I could already argue that cognitive therapy had achieved the status of a “system of psychotherapy.” It consisted of:
14 Preface
Personality theory and psychopathology, the main postulates of which have been empirically confirmed;
a model of psychotherapy with a set of principles and strategies developed based on the theory of psychopathology;
compelling empirical findings based on clinical trial results supporting the effectiveness of this approach.
Since the inception of cognitive therapy, a new generation of therapists/investigators/educators have conducted a number of basic studies of the conceptual model of psychopathology and applied cognitive psychotherapy in relation to a wider range of psychiatric disorders. Through systematic research, basic cognitive definitions of personality and psychiatric disorders have been discovered, principles of idiosyncratic processing and information acquisition in these disorders have been developed, and the relationship between cognitive vulnerability and vulnerability to stress has been studied.
The application of cognitive therapy to a variety of psychological, psychiatric, and physical disorders goes far beyond what I could have imagined when I treated my first patients with depression and anxiety with cognitive therapy. Based on research conducted around the world, but especially in the United States, it is reliably established that cognitive therapy is effective in treating an extremely wide range of conditions - from post-traumatic stress disorder to obsessive-compulsive disorder, from phobias of all types to eating disorders. When combined with medication, cognitive therapy is useful in treating bipolar disorder and schizophrenia. It has also been found that the use of cognitive therapy produces successful results in the treatment of a number of chronic physical conditions, such as low back pain, colitis, hypertension and chronic fatigue syndrome.
With so many uses for cognitive therapy, how can a passionate therapist learn its core principles? I would like to respond with the words of Alice from Wonderland: “Start at the beginning” and return to the question stated at the beginning of this preface. The purpose of this book, written by Dr. Judith Beck, one of the new generation of cognitive therapists (who, as a teenager, heard numerous discussions on her favorite topic), is to provide a clear basis for the practice of cognitive therapy. Despite the wide range of applications of cognitive therapy, it is based on the same fundamental principles, which will be discussed in this work - a basic guide for cognitive therapists. (Other works, by some
Preface 15
I am, will guide a cognitive therapist through the maze of each specific disorder.)
I hope that even experienced cognitive therapists will find this book very useful in improving their conceptualization skills, expanding their repertoire of therapeutic techniques, learning to plan treatment more effectively, and addressing difficulties that arise during therapy.
Of course, no book on cognitive therapy can replace the supervision that can be obtained from qualified cognitive therapists (see Appendix D).
Dr. Judith Beck is well qualified to offer guidance to cognitive therapists. Over the past ten years, she has conducted working groups, seminars, and organized conferences, as well as lecturing on cognitive therapy, supervising many new and experienced therapists, participating in the creation of treatment protocols for various disorders, and conducting research on cognitive therapy. With such a remarkable wealth of knowledge and experience, she has written a book containing truly invaluable information that allows you to get the most out of cognitive therapy in practice.
The practice of cognitive therapy is not easy. I have observed many clinical participants, for example, who are able to go through the process of therapeutic work with "automatic thoughts", without awareness of the patients' perception of their personal world and without the slightest sense of "shared empiricism." Dr. Beck's goal is to train both new and experienced cognitive therapists in the basics of cognitive therapy, and she has accomplished this mission admirably.
Aaron T. Beck, MD
16 Preface
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INTRODUCTION
Over the past ten years I have participated in many working groups and seminars on cognitive therapy, both nationally and internationally. And three things have always surprised me. The first is the growing interest in cognitive therapy, one of the few holistic psychotherapies whose effectiveness has been empirically proven. The second is the persistent desire of psychologists, psychotherapists and psychiatrists to master the principles of cognitive therapy and thoroughly study the techniques so that they can be consistently applied in their practice, guided by a clear conceptualization. Third, there are countless misconceptions about cognitive therapy, the most common of which are: that it is purely a set of techniques, that it devalues the importance of emotions and the role of the therapeutic relationship, that it does not emphasize the childhood sources of many psychological difficulties.
Most patients feel more comfortable when they understand what to expect from therapy, when they are clear about their responsibilities as well as the therapist's authority, and when they have an idea of how therapy will be delivered (both within a single session and as a whole course). treatment). The therapist strives to explain the structure of the sessions to the patient as clearly and clearly as possible and then strictly adhere to the established format.
Many working group participants have told me that they have been using cognitive techniques for many years without labeling them as such. Others familiar with the first manual on cognitive therapy, "Cognitive Therapy for Depression" (A. Beck, A. Rush, B. Shaw, G. Imery), have not been able to use this form of therapy very effectively in practice.
This book is addressed to a wide audience - from those who are new to cognitive therapy to those who are quite experienced but want to improve their skills in cognitively conceptualizing patients, planning treatment, using a variety of techniques, assessing the effectiveness of treatment, and identifying problems that arise during therapy.
18 Introduction
In an effort to improve the presentation of the material, I chose one therapeutic case as an example for the entire book. Sally was my patient when I began working on this book several years ago. She turned out to be an ideal patient for many reasons. Her treatment clearly illustrates "standard" cognitive therapy for an uncomplicated single episode of depression. For ease of presentation, Sally and all other patients discussed in this book are presented as women, while the therapist in all of these cases is an imaginary man. In addition, I use the term “patient” rather than “client” because this definition is due to my medically oriented approach to my work.
This manual of cognitive therapy describes the process of cognitive conceptualization, principles of treatment planning, session structuring, and problem diagnosing, which are essential when working with any patient. Although the book describes the treatment of simple depressive disorder, the techniques presented are applicable to the treatment of patients with a wide range of problems. The relevant chapter provides guidelines for the treatment of a number of disorders, which provide the basis for appropriate modification of therapy according to the needs of individual patients.
This book would not have been created without the revolutionary work of the father of cognitive therapy, Aaron T. Beck, who is also my father and a distinguished scientist, theorist, practitioner, and extraordinary individual. The ideas presented are the result of my own many years of clinical experience, supplemented by reading, supervision, and discussions with both my father and other professionals. Each supervision, each of my students and patients gave me invaluable experience. I am grateful to them all.
Finally, I want to thank everyone who helped me create this guide, especially Kevin Kuhlwein, Christine Padesky, Thomas Ellis, Donald Beale, E. Thomas Dowd, and Richard Busis. Thanks to Tina Inforzato, Helen Wells, and Barbara Cherry, who prepared the manuscript, and to Rachel Teacher and Heather Bogdanoff, who helped me put the finishing touches on it.
Chapter 1
INTRODUCTION
Cognitive therapy was developed by Aaron Beck at the University of Pennsylvania in the early 1960s as a structured, short-term, present-focused psychotherapy designed to treat depressive disorders. The main goal of cognitive therapy was to solve the actual problems of patients, as well as to change dysfunctional, distorted thinking and behavior (Beck, 1964). Over the years, A. Beck and his followers have successfully used cognitive therapy, adapting it to treat a number of mental disorders. Numerous changes have affected the focus of therapy, the duration of treatment and the techniques themselves, but the theoretical foundations of cognitive therapy have remained unchanged. In general, the cognitive model suggests that the basis of all psychological personality disorders is distorted, or dysfunctional, thinking (which in turn distorts the patient's emotions and behavior). Realistic assessment and change of such thinking leads to improved well-being and harmonized behavior. So, in order to achieve sustainable results, it is necessary to identify, evaluate and change the dysfunctional attitudes and beliefs that underlie any psychological disorder.
Other forms of cognitive therapy have been developed by renowned scientists. Of particular note are rational-emotive therapy by Albert Ellis (Eis, 1962), cognitive-behavioral modification by Donald Meichenbaum (Meichenbaum, 1977), multimodal therapy by Arnold Lazarus (Lazarus, 1976). Many other theorists have made significant contributions to the development of cognitive therapy, including Michael Mahoney (1991) and Vittorio Giudano and Giovanni Liotti (1983). Historical reviews of the development of cognitive therapy show that it has developed in many directions (Arnkoff & Gass, 1992; Hoon & Beck, 1993).
In this paper, we present to readers cognitive therapy as it was originally developed by Aaron Beck.
Cognitive therapy is unique in that it incorporates a holistic theory of personality and psychopathology based on strong empirical evidence. The range of its application is extremely wide, which is also confirmed by empirical evidence.
Since the first treatment outcome study was published in 1977 (Rush, Beck, Kovacs, & Hoon, 1977), cognitive therapy has been extensively researched. Controlled experiments have confirmed its effectiveness in the treatment of depression (see meta-analysis: Dobson, 1989), generalized anxiety disorder (Buter, Fenne, Robson, & Geder, 1991), panic disorder (Barow, Craske, Gerney, & Kosko, 1989; Beck, Soko, Cark, Berchick, & Wright, 1992; Cark, Sakovskis, Hackmann, Middeton, & Geder, 1992), social phobia (Geernter et al., 1991; Heimberg et al., 1990), substance use disorder ( Woody et al., 1983), eating disorders (Agras et al., 1992; Fairburn, Jones, Peveer, Hope, & Do, 1991; Garner et al., 1993), relationship problems (Baucom, Sayers, & Scer, 1990) and hospital depression (Bower, 1990; Mier, Norman, Keitner, Bishop, & Dow, 1989; Thase, Bower, & Harden, 1991).
Cognitive therapy is now used throughout the world as a sole or complementary treatment for many other disorders. These include obsessive-compulsive disorder (Sakovskis & Kirk, 1989), post-traumatic stress disorder (Dancu & Foa, 1992; Parrott & Howes, 1991), personality disorders (Beck et al., 1990; Layden, Newman, Freeman, & Morse, 1993 ; Young, 1990), recurrent depression (R. DeRubeis, personal communication October 1993), chronic pain syndrome (Mier, 1991; Turk, Meichenbaum, & Genest, 1983), hypochondriacal disorder (Warwick & Sakovskis, 1989), and schizophrenia. (Chadwick & Lowe, 1990; Kingdon & Turkington, 1994; Perris, Ingeson, & Johnson, 1993). Cognitive therapy is successfully used not only in the treatment of psychiatric patients, but also in working with people serving sentences in prison, with schoolchildren, with patients suffering from various diseases, and many other categories of the population.
Persons, Burns, and Peroff (1988) found that cognitive therapy is effective for patients regardless of their background, education level, or income. It has been adapted for use with patients of all age groups, from preschoolers (Kne, 1993) to older adults (Casey & Grant, 1993; Thompson, Davies, Gaagher & Krantz, 1986). Although this book focuses exclusively on individual therapy, cognitive therapy has also been modified to work with groups of patients (Beuter h zip., 1987; Freeman, Schrodt, Gison, & Ludgate, 1993), and to address relationship problems (Baucom & Epstein, 1990). ; Dattiio & Padesky, 1990), as well as family therapy (Bedrosian & Bozicas, 1994; Epstein, Schesinger, & Dryden, 1988).
Introduction 21
A natural question may arise; How, despite so much controversy, does cognitive therapy remain recognizable? The fact is that in all forms formed from the primary model of A. Beck, the basis of treatment is the cognitive formulation of a specific disorder and its application to the conceptualization, or understanding of the patient by the therapist. During treatment, the therapist encourages the patient in a variety of ways to make cognitive changes—restructuring their thinking and belief systems—to achieve lasting emotional and behavioral improvements.
In order to present to readers both the theoretical concepts and the process of cognitive therapy in more detail and more accessible, throughout the book we present fragments of one therapeutic case. Sally, 18, is a patient who is ideal for cognitive therapy for many reasons. Her treatment process perfectly illustrates the principles of cognitive therapy. Sally saw a therapist at the end of her second semester of college because she had been feeling depressed and anxious for the past four months. She had difficulty with everyday activities. As it turned out, Sally's condition met the criteria for depression of moderate severity according to the Diagnostic and Statistica Manua of Mental Disorders, Fourth Edition, Text Revision, 2000 (DSM-IV-TR; American Psychiatric Association, 2000). A more complete psychological portrait of Sally is presented in the next chapter, as well as in Appendix A.
To illustrate the features of a typical cognitive therapy intervention, here is an excerpt from the transcript of Sally's fourth therapy session. The therapist identifies the patient's current problem, identifies and evaluates dysfunctional thoughts associated with this problem, thinks through a rational plan, and evaluates the expected effectiveness of the therapeutic intervention.
22 Chapter 1
Therapist: So, Sally, you say you want to solve your problem finding a part-time job?
Patient: Yes. I need money... but I'm not sure.
T: (Noting the girl’s sad appearance.) What are you thinking about? Right now?
P: I can't do the job.
T: How do you feel when you think about it?
P: I'm sad. And sad.
T: So you thought, “I can’t do the job,” and you felt sad. Tell me, why do you think you can’t do the job?
P: Because I find it difficult to even study.
T: I see. Something else?
P: I don’t know... I’m so tired. I can’t imagine how I’ll look for this job, much less go somewhere every day...
T: Let's figure it out. Maybe in reality it will be difficult for you to look for a job: study offers from employers, evaluate different options, and not work at all? Anyway, are there any other reasons why you won't do the job if you get it?
P: ...Nothing comes to mind.
T: And evidence to the contrary? How can you handle the job?
P: I already worked, last year. And then I combined work with school and other things. But now... I don't know.
T: Is there any other evidence that you can do the job?
P: I don’t know... Maybe if it doesn’t take up a lot of my time... And it’s not too difficult.
T: What kind of work could this be?
P: Maybe sales? Last summer I worked as a sales agent.
T: Where can you find such a job?
P: For example, in the [university] bookstore. I saw a recruitment ad there.
T: Okay. Imagine that you were hired at this bookstore. What's the worst that can happen?
P: The worst thing is if I fail.
T: Can you survive this?
Introduction 23
P: Of course. I'll just quit this job.
T: What's the best thing that could happen if you get this job?
P: Hm... I will succeed.
T: Which scenario is the most realistic?
P: At first, of course, it will be difficult for me... But perhaps I can handle it.
T: Please remember how the initial thought “I can’t do the job” affects you?
P: I feel sad and sad... I lose all desire to even try to look for a job.
T: How do you feel now that you have changed your thinking? Having realized that it is possible for you to succeed?
P: I feel better. I will definitely try to get a job there.
T: What are you going to do about this?
P: Go to this bookstore. Today.
T: What is the likelihood that you will actually go there?
P: I’ll definitely go.
T: How do you feel now?
P: A little better. I'm a little more nervous. But I have hope.
Sally is now able to use standard questions (see Chapter 8) to identify and evaluate her destructive thought, “I can’t do my job.” Many patients facing similar difficulties require much more therapeutic effort to become motivated to take action and change their behavior.
Although each patient's treatment must be individualized, there are certain general principles underlying cognitive therapy.
Principle 1: Cognitive therapy is based on an evolving formulation of the therapeutic case in cognitive therapy terms. Sally's therapist seeks to make sense of her difficulties in three time frames.
To begin with, he identifies her current thinking, which causes sadness and melancholy (“I’m a failure, I’m good for nothing, I’ll never succeed”), as well as her problematic behavior - the desire to isolate from others, the reluctance to get up with bed, refusal to seek help. (Note that these problematic behaviors are driven by, and in turn reinforce, her destructive thinking.)
24 Chapter 1
The therapist then identifies predisposing factors that influence Sally's perceptions and contribute to the onset of depression (for example, recent leaving the parental home and the desire to do well in school despite internal beliefs of self-worth).
Next, the therapist formulates a hypothesis about the formative events and the patient's persistent ways of interpreting these events that may have led to the onset of depression. (For example, Sally was always inclined to attribute her achievements to luck, while treating her own (relative) weaknesses as a reflection of her “true” essence.)
The therapist builds his assumptions based on the data that Sally provides him already in the first session. As he receives new information, he refines his ideas about the patient. The therapist shares his opinion with Sally about key issues to make sure his guesses are correct. Moreover, during therapy he teaches Sally to view her experiences through the lens of a cognitive model. The girl learns to identify her own thoughts associated with destructive emotions, evaluate them and create more adaptive responses to them. Gradually her health improves and her behavior becomes more and more functional.
Principle 2: Cognitive therapy requires the creation of a strong therapeutic alliance. Like many patients with uncomplicated depression and anxiety, Sally has difficulty establishing trust and cooperation with her therapist. This happens despite the fact that the therapist shows warmth and empathy, expresses concern, sincere attention and competence - everything that is necessary to create a trusting atmosphere. He not only listens carefully and sympathetically to the patient, but also accurately summarizes her thoughts and feelings, demonstrates realistic optimism, and never judges the patient. He also asks Sally for feedback at the end of each session to see if she was happy with the session and if she felt the therapist understood her.
Other patients, especially those with personality disorders, require much more empathy to form in treatment with the therapist (Beck et al., 1990; Young, 1990). If Sally had been one of these patients, the therapist would have had to spend more time and effort building the therapeutic alliance and be more creative. For example, he could periodically discuss with Sally her attitude towards the therapist himself.
Principle 3: Cognitive therapy emphasizes collaboration and active participation. The therapist encourages Sally to view therapy as a team effort; they decide together what topics to devote to each session, how often to meet and what Sally should do in between
Introduction 25
between sessions as homework. Initially, the therapist is more active in developing the agenda and summing up after each session. When Sally’s condition begins to improve little by little, the therapist encourages the girl to take a more active part in the therapy process. Now she herself suggests topics for conversations, identifies her own distortions of thinking, sums up the main results of sessions and determines the content of homework.
Principle 4: Cognitive therapy is goal-oriented and problem-focused. In the first session, the therapist asks Sally to list her problems and define goals for therapy—what she would like to achieve. For example, the first problem reported was feelings of loneliness. With the help of her therapist, Sally defines her goal in behavioral terms: making new friends and improving relationships with existing ones. The therapist also encourages Sally to evaluate thoughts that interfere with goal achievement (such as “I am worthless. I have nothing to offer other people. No one needs me”) and respond to them appropriately. To do this you need:
assess the validity of problematic thoughts directly at the session, based on your own experience;
check your thoughts more carefully during live communication with friends and acquaintances.
By identifying the distortions in her thinking and learning to correct her thoughts, Sally not only resolves a pressing problem for herself, but also improves her relationships with people around her.
Thus, the therapist pays special attention to the obstacles that prevent the patient from solving problems and achieving his goals. Many patients who have successfully coped with various life circumstances before the onset of the disorder do not need special problem-solving training. It is much more useful for them to learn to adequately perceive their own dysfunctional thoughts, because of which they are unable to use previously acquired skills. Other patients who are not accustomed to solving their own problems need to be consistently taught to use appropriate strategies. So, the therapist must first address the patient's individual specific difficulties and outline the required level of therapeutic intervention.
Principle 5: Cognitive therapy focuses on the present, especially at the beginning of treatment. In most cases, the treatment process should be clearly focused on current problems and specific situations that disable the patient. Analysis and/or more realistic assessment of the aspects of life that are most traumatic for the patient at the moment usually
26 Chapter 1
lead to a weakening of painful symptoms and an improvement in his well-being. Thus, the cognitive therapist usually begins therapy by identifying the patient’s problems that lie in the “here and now” plane, postponing diagnosis until later. The therapist's attention shifts to the past in the following cases:
the patient experiences a strong inclination to do one way and not another;
work aimed at solving current problems does not lead to tangible results in the cognitive, behavioral and emotional spheres;
The therapist is convinced that in this case it is important to determine how and when significant dysfunctional ideas arose and how they affect the patient at the present moment.
For example, the therapist discusses events from her childhood with Sally to help her recognize the attitudes and attitudes she internalized as a child: “If I succeed, I will prove that I am something” or “If I fail to succeed, , it would mean that I am a nonentity." The therapist helps Sally evaluate the validity of these beliefs, both past and present, and form more realistic beliefs. If Sally had a personality disorder, the therapist would talk to her more about her life and discuss the childhood origins of certain beliefs and behaviors.
Principle 6: Cognitive therapy is an educational therapy whose goal is to teach the patient to be his or her own therapist. Cognitive therapy places special emphasis on relapse prevention. At the first session, the therapist explains to Sally the nature and course of her disorder, explains the essence of the cognitive therapy process, and introduces the cognitive model (showing