Cognitive therapy is a structured, short-term therapy based on a thorough understanding of the specific disorder being treated and how the disorder has affected the patient. Therapists need to have in-depth knowledge of the disorder being treated and need to have basic skills in interviewing so that important and relevant symptoms and problems can be elicited from the patients. Therapists should convey to their patients that they have understood their problems and should be able to formulate the patients’ problems within the physical therapy framework.
The therapy is time limited and comparatively brief. In routine clinical work with a depressed patient, experienced therapists will probably treat an individual for around 4 months during which they may have had around 10 to 16 appointments.
The length of therapy will of course vary depending on the disorder being treated, with some problems, such as panic attacks, requiring much briefer treatment and others, such as personality disorders, requiring longer treatment. Each session tends to last 1 hour and is structured to maximize the use of time and to target relevant problems.
Follows an agreed agenda
Cognitive therapists set an agenda with each patient. Each session therefore begins with a brief outline of how the session will be structured, taking into account progress with presenting problems, a review of homework and comments from the previous session. The agenda helps to keep the therapy structured and is agreed by both patient and therapist. Each problem is assessed and is defined precisely. This clarity is important as therapy aims to ameliorate the presenting problems and these are reviewed regularly and form the main focus of all sessions. On the whole, cognitive therapy deals with the here and now and is historical.
One of the main characteristics of cognitive–behavioral therapy is the type of questions that are asked to elucidate and explore problems. This type of questioning has been called guided discovery. This is a series of questions designed to bring into the patient’s awareness feelings and automatic thoughts and to facilitate the promotion of alternative ways of thinking about problems and issues so that distress associated with the problem can be modified. A scientific method is used to assess and evaluate progress with problem resolution.
Experiments and homework
Patients and therapists generate hypotheses to account for the maintenance of problems. From these hypotheses, experiments are devised and carried out and the results evaluated to find out if the problem has ameliorated. Often these quasi- experiments are carried out as homework tasks. Homework tasks are designed for several purposes, such as collecting data about problems, experimenting with changes in behaviour (experiments), and practising cognitive techniques to capture and modify automatic thoughts and beliefs.
The patient’s problems are described in a cognitive formulation – a working hypothesis that ties together the problems, thoughts and feelings and hypothesized underlying beliefs within the cognitive model. Therapists should be able from the formulation to provide a possible explanation as to why problems may have arisen and are maintained. Although the main work of therapy is largely historical, the formulation is likely to use historical data gathered during the assessment period of therapy. The formulation should be shared with the patient to aid collaboration and understanding.
Specific therapeutic techniques
Specific cognitive and behavioural techniques will vary according to the problem or disorder being treated and the specific problems that the patient presents in therapy. Chapters on specific problems or disorders are included in this book, illustrating how cognitive therapy and the cognitive model have been adapted.