Cognitive Behavioral Therapy For Clinicians by D Sudak

By D Sudak

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Green and the therapist agreed that the pattern that she had of not letting people get close to her was one that would be useful to change. Ms. Green was assigned the task of gradually increasing self-revealing statements in therapy and examining her automatic thoughts and the therapist's behavior in response to these revelations. She was instructed to identify increases in worry about saying the wrong thing as a signal that she was anxious about the therapist getting too close. Eventually, she and the therapist were able to understand this reaction as being linked to her prior history of sexual abuse.

Gray is behaving in a more skillful way. This pattern often happens with patients who have chronic interpersonal disturbances. Patients with borderline personality, for example, are often only attended to by the mental health system after extreme behavior (suicide attempts) and not when they are attempting to call or get help at other times. Motivational deficits can also occur because of the specific effects of psychopathology; if you are depressed, and the depression has made you think that things are hopeless, you will not try as hard to alter your situation.

Socratic questioning and examining evidence about the therapist and his or her behavior can be used to help the patient to recognize distortions in his or her thinking. Negative transference is extremely valuable information to the therapist. It provides direct access to patients' beliefs about other people and can be a source of direct and significant learning. MR. WHITE came to his therapy session 20 minutes late. He was visibly irritated and not forthcoming about what he wanted to discuss on the agenda.

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