What is 'Cognitive Therapy'?

Dr Robert Rich, M. Sc., Ph. D.

    Cognitive Therapy was devised over 30 years ago, to help people who are plagued by Depression. It has since been adapted to fight many other kinds of problems: Anxiety, Guilt, Anger, Interpersonal Problems, to name a few. Its effectiveness is supported by a great deal of research.

    Cognitive Therapy works. It helps at least 80% of clients. It has limited benefit only for those who don't put in the effort to give it a fair go, or who are too distressed at the moment to concentrate on their thought processes.

    Depending on what strengths and resources the client already has, and on the nature and severity of the problem, Cognitive Therapy takes between 4 and 50 sessions to enable the client to:
*   deal with the distressing problems that led to the need for therapy;
*    live a happier and more fulfilling life;
*    effectively deal with future problems which arise after the client has decided to terminate therapy.

    Therapy is a matter of cooperation between client and therapist. Sessions are highly structured to ensure rapid improvement, and good value for time and money invested. In the first session client and therapist together:
*    Set an agenda (decide how to use the session to the client's best advantage). This includes the problems that need to be attacked.
*    As at the start of every session, the client reports on the current level of distress, and on the past week. This is put as a point on a scale, and records are kept so progress can be monitored.
*    Current problems are explored, and used to generate a goal list: what the client wants to achieve in order to solve these problems. This is written down in duplicate (one copy for each of client and therapist), and is an important tool for improving the client's situation.
*    Cognitive Therapy is based on the fact that emotions, thoughts and behavior are intertwined. How you feel, what you think, and what you do (or don't do) are all the one thing. Much of your current distress is the result of certain thoughts that 'pop into your head'. Most problems can be solved or at least reduced by paying attention to these thoughts. This is true for everybody, but is particularly important for those who have trouble coping, or are in a crisis situation. At times like that, our 'automatic thoughts' can be biased and inaccurate. In Cognitive Therapy, we look for these thoughts, and check them out to see how accurate they are. Part of the therapist's agenda is to explore how such thoughts may have contributed to the client's problems.
*    Another part is to examine the typical thought patterns that your particular distressing emotions suggest to you. For example, Depression usually whispers to you that 1. 'I am no good'; 2. 'The world is a cruel place and everything is unfair'; and 3. 'The future is hopeless'. These thoughts are not part of you, but the suggestions of Depression. They can be examined and tested for truth. Similarly, people who function less well than usual in certain situations may have Anxiety put thoughts in their head of one of these kinds: 1. 'I am powerless against these people'; or 2. 'I must achieve perfectly or I am a failure'; or 3. 'If I open my mouth they will see my incompetence'.
*    Throughout the session, therapist and client agree on home assignments for the following week. These 'homework tasks' are designed to give immediate relief for the most distressing of your current problems, and to start you on the road to reaching your long term goals, including being able to do self-therapy when new problems arise after you no longer need the therapist. These self-help tasks are the most important part of therapy. One hour is a very small proportion of a week. Long term habits can only be changed by sustained, every day application. Fortunately, some of this work will immediately make you feel better.
*    Finally, at every session, the therapist will ask you for feedback on how s/he can do the job of helping you better. This is important because it can improve the therapist's approach, and also it is a power-levelling act. Instead of the therapist being the powerful expert, s/he gives power to the client, who becomes a judge.


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