Psychoeducation

Cognitive therapists want to work with their patients and help them solve their problems. Unfortunately, different people obtain more or less education, training, and support as they grow up, so they have more or less information with which to approach life. In cases in which people clearly do not have the necessary information to address problems, the cognitive therapist may enlist the support of other experts and sources of information or provide education himself or herself. For example, if a couple’s concern is about the management of shared finances, the therapist might recommend a consultation with a financial planner or accountant. If the patient has a legal problem, referral to a lawyer might be the most effective and efficient strategy. A resourceful therapist will keep a list of current community agencies and services that can be recruited into therapy, when appropriate.

In some cases, education is clearly relevant to the problems that the patient brings into therapy, and the use of therapy time to provide information or instruction is likely to be beneficial. The therapist might use self-help books, CDs, DVDs, or other materials as an aid to therapy. The list of self-help books and patient manuals in the area of cognitive therapy is growing, and the therapist will likely want to keep some materials in the major problem areas that he or she works with on the bookshelf. Additional resources can be found online (see http://www.academyofct.org, click “Consumers”).

Even when external materials or resources are not involved in cognitive therapy, the therapist will typically educate the patient about the work that is being conducted. Thus, the therapist will share the overall model with the patient early in the course of therapy to see whether the patient accepts the model and to show its relevance to the case. The cognitive therapist frequently will explain the rationale for the specific techniques that are selected and applied over the course of therapy. In general, the therapist wants to ensure that the patient has a good understanding of all the techniques and knows how to use them effectively and adaptively so that they can be reused, even after treatment has ended. In principle (although not in practice), the patient should be sufficiently conversant with the techniques so that he or she could actually treat another person.

Technical Eclecticism

One of the striking features of cognitive therapy is that a wide range of specific techniques, including the hallmark cognitive therapy techniques, are incorporated (Leahy, 2003; McMullin, 2000; W. T. O’Donohue & Fisher, 2009). The interventions chosen in cognitive therapy might just as easily emphasize behavioral assessment or change, emotional assessment or change, or assessment or change of physiological parameters (e.g., diet, exercise, sleep). A creative therapist is not restricted in the use of techniques as long as the methods can be framed within the overall cognitive case conceptualization and are structured to promote change in the patient’s problem areas.

The technical eclecticism that is part of cognitive therapy presents something of a conundrum for therapists in training. Most often, trainees want to know what to do and when to do it. They often prefer a prescriptive manual to an open system of therapy, as a manual provides structure and support for their work. Manuals have their place. They are particularly useful when patients with similar concerns are being treated or when the nature of the problem is reasonably similar from case to case, even if the content of therapy varies. However, the individual application of cognitive therapy rests more on case conceptualization and understanding of the cognitive model. Knowledge of the model permits the therapist to create or adapt interventions as needed.