Re:self-knowledge/self-understanding in cognitive therapy

While we don't use the terms "self-knowledge" or "self-understanding" a great deal, much of what we do in CT can be seen as promoting self-knowledge and self-understanding.

Cognitive Therapy's emphasis on thoughts, schemas, core beliefs, etc. presents us with a practical problem since none of these can be directly observed. We need to understand the individual's thoughts, feelings, assumptions, interpersonal strategies, and overt behavior. However, individuals are often oblivious to many of their thoughts, feelings, assumptions, strategies, and even actions. When an individual seems to be able to report this information we are faced by the problem of deciding to what extent their self-reports are inaccurate, biased, or censored.

Throughout therapy we rely on the individual's ability to provide us with the information we need (i.e. their self-knowledge and self-understanding). However, we do not presume that the individual's self-perception is so accurate that they can simply sit down and accurately tell us about their thoughts, beliefs, etc. We help them learn to observe themselves accurately and put quite a bit of time into correcting misperceptions and misunderstandings.

CT can be a self-correcting process if therapist and client work together to collect needed information, implement therapeutic interventions based on the resulting conceptualizations, and then use the results of their interventions as a source of corrective feedback. Successful interventions both accomplish desired changes and provide evidence of the clinical utility of the conceptualizations on which the interventions were based. Unsuccessful or partially successful interventions highlight areas in which the current conceptualizations are not adequate. Observations regarding the actual effects of the unsuccessful interventions and the factors which influenced this outcome can serve as a basis for a revised conceptualization which can again be tested in practice. When clinical assessment is integrated with intervention in this way, this self-correcting process can make the most of rich data, even if the reliability and validity of a particular observation or self-report are uncertain.

Some approaches to therapy assume that self-knowledge and self-understanding (aka "insight") will automatically be therapeutic. CT does not make this assumption. In fact, we assume that insight alone is not likely to result in lasting change

Our view is that many dysfunctional cognitions persist because: a) many individuals are unaware of the role their thoughts play in their problems, b) the dysfunctional cognitions often seem so plausible that individuals fail to examine them critically, c) selective perception and cognitive biases often result in the individual's ignoring or discounting experiences which would otherwise conflict with the dysfunctional cognitions, d) cognitive distortions often lead to erroneous conclusions, e) the individual's dysfunctional interpersonal behavior often can produce experiences which seem to confirm dysfunctional cognitions, and f) individuals who are reluctant to tolerate aversive affect may consciously or non-consciously avoid memories, perceptions, and/or conclusions which would elicit strong emotional responses. This view suggests that cognitive interventions should be directed towards identifying the specific dysfunctional beliefs which play a role in the individual's problems and examining them critically while correcting for the effects of selective perception, biased cognition, and cognitive distortions, and helping the individual to face and tolerate aversive affect. Logical or intellectual analysis of dysfunctional cognitions is usually not sufficient to accomplish substantive change. Individuals often find that within-session interventions can be intellectually convincing but that to be convinced "on the gut level", and to have the change in cognitions be manifested in their behavior, it is usually necessary to test the new cognitions in real-life situations. These "behavioral experiments" are often much more convincing than any amount of intellectual insight.

When dysfunctional cognitions are strongly supported by interpersonal experience, it may be necessary to accomplish changes in interpersonal behavior and/or in the individual's environment in order to challenge the cognitions effectively. It is our view that many dysfunctional behaviors persist because: a) they are a product of persistent dysfunctional beliefs, b) expectations regarding the consequences of possible actions encourage behaviors which actually prove to be dysfunctional and/or discourage behaviors which would prove adaptive, c) the individual lacks the skills needed to engage in potentially adaptive behavior, or d) the environment reinforces dysfunctional behavior and/or punishes adaptive behavior. This view suggests that to change dysfunctional behavior it may be necessary to modify long-standing cognitions, to examine the individual's expectations regarding the consequences of his/her actions, to modify the individual's environment, or to help the individual master the cognitive or behavioral skills needed to successfully engage in more adaptive behavior.

In short, we believe that self-knowledge/self-understanding is necessary but not sufficient. In therapy we actively work to help individuals see themselves accurately, understand themselves realistically, and apply these understandings effectively in real life.

Replies:

There are no replies to this message.

| Behavior OnLine Home Page | Disclaimer |

Copyright © 1996-2004 Behavior OnLine, Inc. All rights reserved.