Interpersonal Process in Cognitive Therapy

312 Pages·1996·29.199 MB·English

by  Jeremy Safran, Zindel V. Segal

Interpersonal Process in
COGNITIVE THERAPY

Interpersonal Process in
COGNITIVE
THERAPY
JEREMY D. SAFRAN
& ZINDEL V. SEGAL
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Lanham • Boulder • New York • Toronto • Oxford
A JASON ARONSON BOOK
ROWMAN & LITILEFIELD PUBLISHERS, INC.
Published in the United States of America
by Rowman & Littlefield Publishers, Inc.
A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706
www.rowmanlittlefield.com
PO Box 317, Oxford, OX2 9RU, UK
Copyright© 1996 by Jason Aronson Inc.
Copyright© 1990 by Jeremy D. Safran and Zindel V. Segal
First Rowman & Littlefield paperback edition 2004
The quotations on pages 1 and 248 are from Martin Bober, I and Thou, translated by Ronald
Gregor Smith. Copyright© 1958, renewed 1986, by Charles Scribner's Sons. Reprinted by
permission of Scribner, a division of Simon & Schuster.
The poem on page 223 is from Soiku Shigematsu, Zen Forest: Sayings oft he Masters.
Copyright © 1981 by Tanko-Weatherhill, Inc. Reprinted by permission of Tanko-Weatherhill,
Inc.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording,
or otherwise, without the prior permission of the publisher.
British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data
Safran, Jeremy D.
Interpersonal process in cognitive therapy I Jeremy D. Safran &
Zindel V. Segal.
p. em.
Originally published: New York: Basic Books, 1990.
Includes bibliographical references and index.
I. Cognitive therapy. 2. Interpersonal relations. I. Segal,
Zindel V., 1956-. II. Title.
RC489.C63S24 1996
616.89' 142-dc20 96-35422
ISBN 1-56821-858-3 (pbk.: alk. paper)
Printed in the United States of America
9"'
The paper used in this publication meets the minimum requirements of American
National Standard for Information Sciences-Permanence of Paper for Printed Library
Materials, ANSIINISO 239.48-1992.
To my teachers
-J.D.S.
To my parents, leek and Mania
-z.v.s.

Contents
Preface to the Softcover Edition xi
Acknowledgments XV
PART I. THEORY
1 INTRODUCTION
Cognitive Therapy in Evolution 3
Psychotherapy as a Human Encounter 4
A Process Perspective 5
The Nature of Reality 8
Metatheory 9
Supportive versus Insight-Oriented Therapy 10
Short-Term versus Long-Term Therapy 12
Psychotherapy Integration 13
The Plan of the Book 15
2 THE CoGNITIVE-BEHAVIORAL PERSPECTIVE ON THE
THERAPEUTIC RELATIONSHIP
Treatment Efficacy 18
Therapeutic Resistance 19
The Therapeutic Relationship 22
-Facilitating the Social Influence Process 23
-Positive Therapeutic Expectancies 24
-The Therapist as Role Model 24
-Collaborative Empiricism 25
-In-session Behavior as a Problem Sample 25
Developing a Systematic Cognitive Approach to the Therapeutic
Relationship 27
vii
Contents
3 TECHNICAL AND RELATIONSHIP FACTORS IN THERAPY
Technical versus Relationship Factors 30
Predicting Individual Differences 31
The Therapeutic Alliance 32
Therapist Competence 34
Implications for Cognitive Therapy 36
The Therapist's Role in the Therapeutic Interaction 40
4 A THEORETICAL MoDEL FOR INTEGRATION
Cognitive versus Interpersonal Processes 42
Experimental Cognitive Psychology 44
Problems with the Information-Processing Approach 47
The Concept of Motivation 49
Information-Processing Theory versus Drive Metapsychology 50
An Alternative Approach to Motivation 53
Action Patterns/Behavioral Systems 54
Attachment 55
Emotion and Behavioral Systems 56
The Coordination of Behavioral Systems 58
Development of the Self 59
Memory and Self-Knowledge 65
Representation of Self/Other Interactions 67
Hypothesized Memory Processes 69
Interpersonal Schemas and the Management of Anxiety 70
The Cognitive-Interpersonal Cycle 72
PART IT. PRACTICE
5 ASSESSMENT
Assessing Core CDgnitive Processes 79
Participant-Observation 80
Interpersonal Markers 81
The Inner Discipline of the Therapist 83
Empathy 85
The Alliance Rupture as a Focus for Exploration 88
Understanding the Patient's Interpersonal Schema 90
Assessing the CDgnitive-Interpersonal Cycle 93
General CDnsiderations Relevant to Cognitive Assessment 101
CDncreteness and Specificity 102
Awareness and Interpersonal Context 105
Intervening When Automatic Thoughts Are Blocked 105
Emotional Immediacy 109
Memory Retrieval and the Process of Change 112
viii
Can tents
6 EXPERIENTIAL DISCONFIRMATION AND DECENTERING:
I. OUT-oF-SEsSION Focus
Experiential Disconfirmation with an Out-of-Session Focus 114
Decentering with an Out-of-Session Focus 117
Awareness versus Challenging 118
The Role of Historical Reconstruction 119
Examples of Decentering with an Out-of-Session Focus 122
Comparison of the Two Change Processes 139
7 EXPERIENTIAL DISCONFIRMATION AND DECENTERING:
II. IN-SESSION Focus
Experiential Disconfirmation with an In-Session Focus 142
Unhooking from the Cognitive-Interpersonal Cycle 143
Decentering with an In-Session Focus 147
Metacommunication 151
The Focus on the Present 154
Making Links to the Past to Facilitate Decentering in the Therapeutic
Relationship 156
The Process of Healing an Alliance Rupture 157
Clinical Illustrations 161
8 ACCESSING ACTION-DISPOSITION INFORMATION
The Role of Empathy 188
Exploring Attitudes Prohibiting Emotional Experience 189
Duplicitous Communication and Responsibility 193
9 GENERAL CLINICAL IssuEs
Maintaining a Therapeutic Focus 203
Therapist Activity Level 205
The Role of the Rationale in Therapy 206
Therapeutic Engagement 207
Challenging Security Operation Cognitions 209
Issues Related to Termination 211
Premature Termination 215
The Therapist As Role Model (Revisited) 223
10 PATIENT SELECTION FoR SHORT-TERM CoGNITIVE THERAPY
jEREMY D. SAFRAN, ZINDEL V. SEGAL, BRIAN F. SHAW, AND
T. MICHAEL VALLIS
Selection Criteria for Cognitive Therapy 229
Our Approach 230
Reliability of the Coding Scheme 233
Factor Structure and Construct Validity 234
ix