Re:double-bind in CBT

Our usual approach would be to start by getting each of the relevant beliefs clearly stated in the client's own words. For example, one person in your client's situation might believe:

"It is my responsibility to meet the needs of my friends and family members."

"If I do not meet their needs I am making them miserable."

"If I do not meet their needs I am being bad."

"If I do not call that shows that I do not care."

"If I do not call, I am stopping them from doing the things they want to do."

Once the beliefs are clearly stated (and written down so that we do not lose track of them) we have a number of options in terms of dealing with them. A good starting point is to take each belief one at a time and use guided discovery to help the client look critically at the belief (i.e. Do you believe this is true? What evidence convinces you that it is true? What evidence do you see which is incompatible with this belief? Does this rule apply to everyone else? Does your mother/sister/friend/... have an equal obligation to meet your needs? etc.)

This can be followed by asking "Can you think of an alternative view that might be closer to the truth?" and then helping the client examine the pros and cons of living by the old belief versus the pros and cons of living by the new belief. In particular, it is important to consider how others are likely to react if the client begins to treat them differently.

Once more adaptive alternatives have been identified and the advantages and disadvantages of changing have been considered, then it may be feasible to have the client start experimenting with treating others differently (in small ways at first) in order to discover if her expectations are accurate.

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