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Frequently Asked Questions about
Cognitive Therapy
How Long Does
Therapy Take?
Cognitive therapy is a short-term
treatment model. Although treatment is always tailored to the
individual’s unique difficulties and circumstances, the course of
therapy for most disorders is 8-15 sessions. Some clients respond more
quickly to treatment, while others require a longer course of therapy to
attain optimal results. Booster sessions are often encouraged to
prevent a relapse of symptoms and to reinforce client’s self-help
skills. Clients like short-term, focused therapy to alleviate problems,
which saves them time and money.
What
Happens during the Course of Therapy?
First Session
The
therapist’s most important job is to promote a strong working alliance
with the client. This is primarily done by conveying empathy and
understanding of the client’s problems. The client is helped to
explore the difficult thoughts and feelings that may need to be altered.
The initial session is usually
devoted to determining if cognitive therapy is the suitable treatment
and identifying problem areas with accompanying goals of treatment. We
also consider whether medication might be a helpful adjunct to
treatment.
In the initial session we develop a
list of the client’s problems and symptoms and begin to translate these
into target goals. The client is given feedback on his difficulties and
how cognitive therapy might be helpful.
What Happens in the Second
Session?
By the end of the second session, we have
begun to identify the distortions in thinking and unproductive behavior
patterns that contribute to the client’s difficulties. A treatment
plan that spells out the steps and techniques to help reduce symptoms
and solve the client’s problems will be presented. The client
should have a clear understanding of the course of therapy through a
case formulation that includes:
(1) a detailed listing of the
client’s problems and symptoms
(2) the relevant distortions in
thinking and unproductive behavior patterns that contribute to the
client’s difficulties
(3) agreed-upon realistic
treatment goals
(4) a clear-cut treatment plan
which spells out the steps and techniques to help solve the client’s
problems and reduce symptoms.
What's Next?
During the next several sessions,
the client and therapist work in a collaborative manner to address the
client’s immediate concerns and to reduce suffering. The cognitive
therapist is active and directive. The client is taught a range of
emotional and behavioral self-control skills. We try to provide clear
rationales for treatment strategies and give the client explicit
feedback about his or her problems and possible solutions. Progress
toward treatment goals is measured.
Sessions
typically have the following structure:
1. Client and therapist collaboratively set
an agenda for the session, which involves
trying to resolve a current concern.
2.
The therapist facilitates problem-solving by choosing from a
range of cognitive, behavioral,
and experiential strategies.
3. Therapist and client review the session and consider “homework”
that might be helpful.
Near the end of therapy, we help the client identify the basic attitudes
and assumptions that may need to be altered to reduce future episodes of
distress. We also teach specific relapse prevention techniques.
In the final stage of
treatment, we help the client identify those basic beliefs and
assumptions that may need to be altered to reduce future episodes of
distress. We also teach specific relapse-prevention techniques.
Is Medication
Used?
Treatment effectiveness for some difficulties may be enhanced with the
use of medication. We will discuss the pros and cons of using
medication, as well as provide information about research on the
usefulness of medication with different disorders. If a client is
already on medication, we will coordinate treatment with that provider.
If a client is considering medication, we will refer the client to a psychopharmacologist, a
specialist who can provide guidance and treatment.
How Is
Progress Assessed?
Two key features of cognitive therapy
are measurement and feedback. We administer mood scales and other
psychological tools to measure progress objectively. We encourage
ongoing feedback regarding progress and any perceived obstacles to
treatment.
What is
the Theory behind Cognitive Therapy?
Cognitive therapy is based on the
seminal work of Drs. Beck and Ellis.
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Dr. Aaron Beck |
and
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Dr. Albert Ellis |
Drs. Beck and
Ellis, although originally trained in psychoanalysis, developed
treatment models highlighting the direct role of thinking in emotional
distress. A good deal of research and clinical observation has
validated the link between negative, dysfunctional thinking and human
suffering.
The key finding in the cognitive model
is the recognition that much of this negative thinking is distorted to increase suffering. When these twisted thinking
patterns can be identified and replaced with more accurate and flexible
thinking, significant improvement can occur.
The cognitive model developed by Dr.
Beck and the “Rational-Emotive Therapy” model of Dr. Ellis emphasize the
critical role of core beliefs. Core beliefs are basic and fundamental
ways we view ourselves and the world. Individuals with harsh and rigid
core beliefs are particularly vulnerable to mood or behavioral
difficulties. Examples of core beliefs include: “I am worthless”, “I
am incompetent”, “No one could love me”, “I must excel in my work”,
“ It’s too dangerous to express my feelings”, “I must do whatever it
takes to get others approval” Bringing such maladaptive beliefs out
in the open and helping clients develop more compassionate and
constructive frameworks promotes deeper and more durable change.
We want to express our
appreciation to these pioneers of
cognitive therapy, Dr. Beck and Dr. Ellis, and to those who
developed newer proven treatments, such as Dr. Jeffrey Young for
schema-focused therapy and Dr. Leslie Greenberg for emotion-focused
therapy.
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SM