114 COGNITIVE THERAPY IN CLINICAL PRACTICE

‘She’s not as attractive as I’d like her to be.’

‘Sex is normal. We experiment. We both have a wide outlook, but I think I’m missing out. It’s not fair.’ ‘I just want someone different.’

‘She’s not really what I want. I’d like her to have more confidence.’ ‘If she was brighter in herself, I’d rather be seen with her.’

At the same time, the client said about his wife that he could not have a better one, that she loved him completely, that they enjoyed their sex life, and he could not want for more.

Session seven

The aim of the session was to test the three main points emerging from the re-analysis and, if confirmed, to challenge the second two, which are groups of automatic thoughts, and generate alternatives. The process can be illustrated by dialogue:

Dependency

C: It did me good to come and see you. I’ve lost some of the urges. T: How has that happened?

C: I know I can cope because I’ve coped with this latest episode.

T : [Inductive question.] How do you make yourself believe you can cope? What evidence do you have about coping?

C:Once I get to a certain pitch, once another pressure comes in, I stop. What I hadn’t realised was that if I get worried enough about the situation, the problem disappears on its own.

T:It’s good that you’ve realised that. But that means you have to start exposing yourself in order to worry about it before you can stop.

C: Mmm.

T: And the worry is what you want to be rid of anyway.

C: Yes, I’m quite low again now. It’s just getting into the habit of reminding myself I can cope.

It seemed from this exchange that the hypothesis was confirmed. The client was still taking some responsibility for helping himself, but was not confident he could do it without further sessions.

The issues of wanting to expose and pleasure

T: What’s your view about your ability to cope now?

C:I know I can cope, but not over a longer period. It’s difficult to overcome what you really want.

T: [Inductive question.] So you really want to do it?

C: Not really. I believe I can let it go if I really want to.

T: What would help you to let go of it?

C: If I’m in the right circumstances, things are going well at

T:So what happens if you haven’t got enough excitement and are not happy?

C: I give in to it as a substitute.

T: [Inductive question.] If you didn’t do it, what would happen then?

C:I’d have to accept things the way they are and not expect too much out of life.

T: [Inductive question.] And how would you feel then, compared to when you were doing it?

C: When I’m not doing it I’m happier anyway.

T: Do you have any evidence of that?

C:After I’ve done it I feel worse anyway. It’s only then that it torments me, I don’t sleep…

T: [Challenge.] So is it really a substitute for not being happy?

C:No, because I don’t get any permanent pleasure out of it. Nothing’s any different in the long run.