How a relational perspective can help understand and resolve ruptures or strains in Cognitive Behavioural Therapy and other collaborative models of therapy.
I really like the idea of interventions as relational acts – that is, the same intervention can be experienced differently depending on a client’s characteristic ways of relating to themselves and others. This can mean for example, that a therapist who provides minimal structure might be experienced as self-affirming by a client who experienced controlling and restricting parenting. On the other hand, the same therapist may be felt as withholding and abandoning by another whose parents rarely offered emotional support and guidance.
Put another way strains in the therapeutic alliance may manifest as disagreements about tasks and goals but also could reflect tensions at a relational level. For example, a client may express uncertainty about the value of thought monitoring. This may need direct clarification or encouragement from the therapist, but it may also reflect a client feeling pressured to impress which could be a core relational theme.
Like CBT, cognitive analytic therapy (CAT) is a task focused and time limited collaborative therapy with homework as a regular feature through the course of therapy. When working with either model, I try to keep in mind that different interventions place different demands on clients and they may carry an implicit meaning at a relational level. So rather than following theory rigidly to inform interventions, I try to be guided by asking what a particular intervention might mean to the client at that moment – often influenced by core relational themes.
I explore the importance of these ideas and many others in this CAT informed workshop designed to help therapists work better when the therapeutic relationship gets stuck.
Saturday 15th December. Book at:
Dr Robert Watson, Clinical Psychologist, and Accredited Cognitive Analytic Therapy Supervisor & Therapist.