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Increasing the Validity of Self-Reports in CT
Jim Pretzer · 4/9/98 at 6:04 PM ET
One of the limitations we face in Cognitive Therapy is that we have to rely on clients’ self-reports as one of our primary sources of data. Unfortunately, self-reports are not necessarily reliable or valid. Here are some suggestions for increasing the validity of self-reports (From: Pretzer, J. & Beck, A.T. (1996). A cognitive theory of personality disorder. In: J. Clarkin & M. Lenzenweger Major Theories of Personality Disorder. New York: Guilford.)
Guidelines for Increasing the Validity of Self-Reports
- Motivate the client to be open and forthright. Make sure that it is clear that providing full, honest, detailed reports is in the client's interest by: a) providing a clear rationale for seeking the information, b) demonstrating the relevance of the information being requested to the client's goals, and c) demonstrating the value of clear, specific information by explicitly making use of the information.
- Minimize the delay between event and report. This will result in more detailed information and will reduce the amount of distortion due to imperfect recall. For events occurring outside of the therapist's office, use an in vivo interview or self-monitoring techniques when possible.
- Provide retrieval cues. Review the setting and the events leading up to the event of interest either verbally or by using imagery to improve recall.
- Avoid possible biases. Begin with open-ended questions which ask the client to describe his or her experience without suggesting possible answers or requiring inference. Focus on "What happened?" not on "Why?" or "What did it mean?". Do not ask clients to infer experiences they cannot remember. Wait until after the entire experience has been described to test your hypotheses or ask for specific details.
- Encourage and reinforce attention to thoughts and feelings. Clients who initially have difficulty monitoring their own cognitive processes are more likely to gradually develop increased skill if they are reinforced for accomplishments than if they are criticized for failures. Some clients may need explicit training in differentiating between thoughts and emotions, in attending to cognitions, or in reporting observations rather than inferences.
- Encourage and reinforce acknowledgement of limitations in recall. If the therapist accepts only long, detailed reports, this increases the risk of the client's inventing data in order to satisfy the therapist. It is important for the therapist to appreciate the information the client can provide and to encourage the client to acknowledge his or her limits in recalling details, since incomplete but accurate information is much more useful than detailed reports fabricated in order to please the therapist.
- Watch for indications of invalidity. Be alert for inconsistency within the client's report, inconsistency between the verbal report and non-verbal cues, and inconsistency between the report and data obtained previously. If apparent inconsistencies are observed, explore them collaboratively with the client without being accusatory or judgmental.
- Watch for factors which may interfere. Be alert for indications of beliefs, assumptions, expectancies, and misunderstandings which may interfere with the client's providing accurate self-reports. Common problems include: a) the fear that the therapist will be unable to accept the truth and will become angry, shocked, disgusted, or rejecting if the client reports his or her experiences accurately, b) the belief that the client must do a perfect job of observing and reporting the experiences and that he or she is a failure if the reports are not perfect from the beginning, c) the fear that the information revealed in therapy may be used against the client or may give the therapist power over him or her, d) the belief that it is dangerous to closely examine experiences involving strong or "crazy" feelings for fear that the feelings will be intolerable or will "get out of control".
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