Restructuring Cognitions (Chapter 7)

Leaving It At The Office


Chelsea Schnorrbusch and Leah Ward

Key WORDS

Anxiety Management Allowing yourself to experience anxiety but also processing the internal skills to control and understand anxiety so that it does not bleed over into responses to patients
Assuming Causality Incorrectly assigning the blame or responsibility for adverse events to ourselves
Catastrophizing Anticipating the worst outcome
Cognitive Errors Exaggerated or irrational thinking patterns that often cause psychological distress
Cognitive Restructuring A technique to combat errors in thinking; reframing cognitive errors in a way that is more realistic
Conceptualizing Ability The ability to draw on professional theory and to comprehend the patient’s dynamics in relation to the therapeutic alliance
Countertransference Internal and external reactions in which unresolved conflicts are implicated
Dichotomous Thinking Either-or thinking which is both a cause and result of psychotherapist distress
Empathy Allows the therapist to focus on the patient’s needs despite the difficulties they may be experiencing
Musturbations The belief by some individuals that they must absolutely meet often perfectionist goals in order to achieve success, approval, or comfort
Selective Abstraction The mistake of believing that the only events that matter are failures and that you should measure yourself by errors
Self-insight The extent to which the therapist is aware of their own feelings, including countertransference, and understands their basis
Self-monitoring Using thoughtful reflection, collecting data on our assumptions, concerned sharing with significant others, and other methods that may alert us to the self-deceptions we hold in our thoughts

Key takeaways

  • As human beings, we (including psychotherapists) experience cognitive errors, musturbations, and countertransference reactions. Recognizing these and managing them essential components of self-care as a psychotherapist.
  • It can be helpful for clinicians to get another therapist’s viewpoint on our thinking (as a second step to self-monitoring) to inspire self-awareness and insight into our potential cognitive errors..
  • “Intellectual insight by itself is about as efficacious as providing a starving person with only a dinner menu. But awareness and insight begin the process of cognitive restructuring” (p. 117).
  • Albert Ellis’s list of 5 common therapist “musturbations”:
    1. I must be successful with my patients, practically all of the time.
      1. I must always make brilliant interpretations or empathetic responses.
      2. I must help my clients more.
      3. I must not fail with any of my clients, but if I do, it is my fault and I’m a lousy person!
    2. I must be one of the world’s most outstanding therapists.
      1. Every therapy session with clients (including difficult clients) must be good.
      2. I must be an eminent therapist.
    3. I must be liked and respected by all my clients.
      1. I must like all my clients, but if I do not, I must not allow myself to have negative feelings toward them.
      2. I must not insist my clients work too hard in therapy.
      3. I must avoid sensitive issues that might disturb or upset my clients.
    4. Since I am a hard-working therapist, my clients should be equally persevering.
      1. My clients should be tractable, not impossible!
      2. My clients should always have their homework assignments done on time.
      3. I should only have YAVIS (young, attractive, verbal, intelligent, and successful) clients! Don’t hard-working, successful therapists deserve hard-working, successful patients?
    5. I must be able to enjoy myself during therapy.
      1. I must use therapeutic techniques that I enjoy regardless of their benefit to the client.
      2. I must use only simple techniques that will not drain my energy.
      3. My sessions can be used to solve my own problems as well as the client’s problems.
  • To combat these, authors recommended, “… practicing rational beliefs, practicing appropriate emotions (such as annoyance instead of misery), and practicing desirable behaviors” (p. 120).
  • Five skills for managing countertransference (Gelso & Hayes, 2002):
    1. Self-insight
    2. Self-integration
    3. Empathy
    4. Anxiety management
    5. Conceptualizing ability
  • Self-monitoring of internal dialogue is the first step of cognitive restructuring.
  • Solution focused therapy suggests that we switch from a problem to a solution mindset. We should focus on what is controllable and changeable with the client, rather than focusing on their negative reactions or labeling client’s problematic way of being.
  • Humanistic Therapy suggests we should cognitively restructure our reactions to clients via empathy.
  • We alleviate emotional distress by practicing: (a) rational beliefs, (b) appropriate emotions, and (c) desirable behavior.
  • Cognitive errors common to psychotherapists:
    1. Selective abstraction
    2. Overwhelming tasks
    3. Assuming causality
    4. Catastrophizing
    5. Dichotomous thinking