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Unread November 6th, 2004, 10:57 PM
James Pretzer James Pretzer is offline
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Default Why is it so hard to change the client's dysfunctional cognitions?

As you suggest, there can be a variety of reasons that it is "slow going" when we try to change the client's dysfunctional cognitions. Here are a number of points that come to mind:
  1. You refer to using "disputation" to change dysfunctional cognitions. One disadvantage of using REBT-type disputation is that this tends to intensify resistance. One of the reasons that Ct emphasizes guided discovery (Socratic questioning) is that this approach tends to reduce resistance rather than intensifying it.
  2. Often, the client's dysfunctional cognitions are strongly held. In addition, the client may have had many experiences that seem to support their dysfunctional cognitions. It is not easy (or quick) to change such cognitions.
  3. Sometimes clients fear the consequences of cognitive change (i.e. "If I give up my perfectionism I'll become mediocre") and resist giving up the dysfunctional cognitions until these fears are addressed.
  4. Sometimes Cognitive therapists slip into relying solely on verbal, in-the-office interventions. CT is much more effective when verbal interventions are coupled with experiential and behavioral interventions. Behavioral experiments often are much more effective that intellectual discussion.
  5. Some dysfunctional cognitions are harder to challenge than others. A dysfunctional belief such as "If I ask for what I want, no one will take me seriously" is easy to test, "I'm unloveable" is harder to test, and "If I don't pray right, I will roast in Hell" may be quite hard to challenge effectively.
  6. ...
Obviously, I think that there are quite a few reasons that cognitive interventions may go slowly. One important time when there is "slow going" with cognitive interventions is when some other mode of intervention is more appropriate. Remember that the Thought Sheet isn't the only tool that cognitive therapists have. If the client has OCD and we try to have them generate rational responses to each of their obsessions, this is likely to be ineffective or counterproductive. Exposure and response prevention is likely to be much more effective.

There are some problems, such as depression, where we spend quite a bit of time working directly to change dysfunctional cognitions. However, there are other problems where we spend much more of our time working towards behavior change, helping clients improve their coping skills, working towards acceptance, etc.
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