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Unit 23: Psychotherapy: Cognitive Approach

that were okay. But, instead, she stays at home, brooding about her failure to go in and ends up Notes
thinking: “I’ve let everyone down. They will be angry with me. Why can’t I do what everyone else
does? I’m so weak and useless.” That woman probably ends up feeling worse, and has even more
difficulty going in to work the next day. Thinking, behaving and feeling like this may start a
downward spiral. This vicious circle can apply to many different kinds of problems.

23.4.2 Origination of Negative Thoughts
Beck suggested that these thinking patterns are set up in childhood, and become automatic and
relatively fixed. So, a child who didn’t get much open affection from their parents but was praised
for school work, might come to think, “I have to do well all the time. If I don’t, people will reject
me.” Such a rule for living (known as a dysfunctional assumption) may do well for the person a lot
of the time and help them to work hard.
But if something happens that’s beyond their control and they experience failure, then the
dysfunctional thought pattern may be triggered. The person may then begin to have automatic
thoughts like, “I’ve completely failed. No one will like me. I can’t face them.”
Cognitive-behavioral therapy acts to help the person understand that this is what’s going on. It
helps him or her to step outside their automatic thoughts and test them out. CBT would encourage
the depressed woman mentioned earlier to examine real-life experiences to see what happens to
her, or to others, in similar situations. Then, in the light of a more realistic perspective, she may be
able to take the chance of testing out what other people think, by revealing something of her difficulties
to friends.
Clearly, negative things can and do happen. But when we are in a disturbed state of mind, we may
be basing our predictions and interpretations on a biased view of the situation, making the difficulty
that we face seem much worse. CBT helps people to correct these misinterpretations.

23.5 Different Sessions of Cognitive Treatment (CBT)

Cognitive-behavioral therapy differs from many other types of psychotherapies because sessions
have a structure. rather than the person talking freely about whatever comes to mind. At the beginning
of the therapy, the client meets the therapist to describe specific problems and to set goals they want
to work towards. The problems may be trouble some symptoms, such as sleeping badly, not being
able to socialize with friends, or difficulty concentrating on reading or work. Or they could be life
problems, such as being unhappy at work, having trouble dealing with an adolescent child, or being
in an unhappy marriage.
These problems and goals then become the basis for planning the content of sessions and discussing
how to deal with them. Typically, at the beginning of a session, the client and therapist will jointly
decide on the main topics they want to work on this week. They will also allow time for discussing
the conclusions from the previous session. And they will look at the progress made with the homework
the client set for him- or herself last time. At the end of the session, they will plan another assignment
to do outside the sessions.
Doing Homework
Working on homework assignments between sessions, in this way, is a vital part of the process .
What this may involve will vary. For example, at the start of the therapy, the therapist might ask the
client to keep a diary of any incidents that provoke feelings of anxiety or depression, so that they
can examine thoughts surrounding the incident. Later on in the therapy, another assignment might
consist of exercises to cope with problem situations of a particular kind.

The importance of structure
The reason for having this structure is that it helps to use the therapeutic time most efficiently. It
also makes sure that important information isn’t missed out (the results of the homework, for instance)
and that both therapist and client think about new assignments that naturally follow on from the
session.

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