Cognitive Modification

Cognitive Modification

Effective behavior is sometimes inhibited by faulty beliefs and assumptions. In DBT cognitive modification is based on logical consistency or consistency with one's true or wise-mind beliefs (e.g., “Is this belief what I believe in my wisest moments?”) and on effectiveness (“Is this this belief useful to meet my goals?” This emphasis on finding what is valid is due in part to clients' sensitivity to invalidation. Focusing intervention on what is wrong with the client's interpretations, especially through Socratic questioning, is too evocative and aversive for many. Although the DBT therapist may sometimes challenge problematic beliefs with reason or through dialectical persuasion – conversations that create the experience of the contradictions inherent in the client's position. For example., in the last chapter a client described getting immediate relief from emotional pain when she burnt herself with a cigarette; she said it was no big deal. The therapist the asked the client would she burn her little niece's arm to help feel better, if the child was in great emotional pain? The client replied, “I just wouldn't do it. It's not right.” The conversation heightened the client's emotional tension and discomfort of holding a double standard. In dialectical persuasion, the therapist highlights the inconsistencies among the client's own action, beliefs, and values.

In addition, the therapist helps the client develop guidelines on when to trust and when to suspect her interpretations. For example, the skill “check the facts” distills many basic cognitive modification strategies into a self-help intervention. Further, in DBT, the therapist actively teaches the client to become better able to discern contingencies, clarifying the if-then effects of their behavior in the therapy relationship as well as in the client's other relationships. Clients learn to observe and describe their own thinking style, and implicit rules, to notice when their thinking is ineffective, and to confront and challenge problematic thoughts in order to generate a more functional or dialectical sense of truth. The client leans to increasingly rely on wise mind, an intuitive knowing that.

Yet change interventions can be experienced as highly invalidating. The therapist's attempts to help can  feel critical and can seem to confirm that the client has not tried hard enough – just as others have always said. Clients with histories of pervasive invalidation can be exquisitely sensitive. For this reason, active, disciplined, and precise validation of what is “right” or “correct” about the client's current responses in required to motivate emotion regulation and thereby create conditions for other change.

From Doing Dialectical Behavior Therapy (A Practical Guide by Kelly Koerner).

Reflections about our life... Photo by Elena.