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Unread January 12th, 2006, 07:39 PM
alexandra_k alexandra_k is offline
Join Date: Jan 2006
Posts: 106
Default Re: Is it important to change the client's dysfunctional cognitions?

Lol! What’s in a name? You can say that ‘cognitive therapy’ is in contrast to ‘behaviour therapy’ and then the behaviourists can talk about how distressing emotional responses can result from conditioning without cognition, and the cognitivists can cite studies where changing cognition results in a change in distressing emotional state. Or you can say that ‘cognitive behaviour therapy’ takes the insights from both. If you want to know what is distinctive about cognitive therapy (as opposed to other varieties of therapy) then I would have thought the focus on changing the clients cognitions was the most salient feature. And ACT’s focus on acceptance is what is distinctive about that. But in practice… Wise to be a little eclectic I would have thought.

The ‘disputation’ vs ‘socratic’ approach is interesting to me. I agree with JustBen’s point that terms are bandied about without their meanings being made clear. While we shouldn’t hold off using the terms until necessary and sufficient conditions are forthcoming it would help matters somewhat if people could gesture towards what they mean by those terms and also provide some concrete examples of differences in the approaches thus going someway towards operationalising them. I mean… Is it that ‘disputation’ tends to me met with resistence while ‘collaborative empiricism’ tends to result in the client being happily engaged? If this is the difference then I’m sure everyone would agree that ‘collaborative empiricism’ is preferable (and is ultimately likely to be more productive) than ‘disputation’. It is an interesting point that Socrates was made to drink Hemlock because people felt upset in response to his method of questioning…

How do you feel when I tell you that you have lots of irrational thoughts? How about maladaptive thoughts? How about thought distortions? Perhaps… It is the labelling of the clients thoughts as ‘irrational’, ‘maladaptive’, and / or ‘distorted’ that functions to get the client on the back foot resisting the therapists attempt to change them. Is it thought that you need to ‘unsettle’ the client before they will be prepared to work towards change?

The trouble with truth… Is you have to clarify what you mean by truth. Truth might be correspondence with reality, truth might be coherence with the clients web of beliefs, truth might be what is useful (pragmatic). The sad fact is that the rationality that people exhibit in general is far from ideal. All of us are prone to a variety of ‘irrational’, ‘maladaptive’, and / or ‘distorted’ thoughts. Yet not all of these thoughts are the focus of therapy (not should they be). Rather… It is a certain subset of the clients thoughts that are targeted by the therapist and these thoughts do not seem to be inherently more ‘irrational’, ‘maladaptive’, and / or ‘distorted’ than countless other thoughts that we exhibit in our daily lives that are not considered problematic. Hence… It would seem to me that cognitive resturucturing is less about ‘truth’ than it is about how unhelpful the therapist judges some of the clients thoughts to be. And perhaps the Socratic approach… Involves questioning so that the client can figure out for themselves what thoughts are unhelpful to them rather than being provided with a list of thoughts that the therapist has already decided are targets for change.

>… Hayes argues emphatically that we should not try to challenge the content of dysfunctional cognitions, just focus on changing their relationship to the cognitions.

I don’t think… We choose what thoughts will pop into our heads. If I direct you ‘don’t think about oranges’ then you will find yourself thinking about oranges in order to understand what I’m asking you to do (it is an ironic process). I wouldn’t have thought that cognitive restructuring would mean that those thoughts just don’t present in the clients conscious experience anymore. If anything, cognitive resturucturing might be more likely to have them recur to the client. What it seems to aim to do, however, is to reduce the ‘assent’ that the client feels when the thought occurs to them. We think a lot of things that we do not believe. At least… I do.

But my guess would be… It is coming up with the more helpful alternative thoughts… Alternative thoughts that the client may be able to bring themselves to believe that would be the most profitable. But judging the utility of thoughts / beliefs… Perhaps the thought is to emphasise that the client needs to be the judge of that...
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