What is cognitive conceptualization? - Chapter 3

This chapter will discuss cognitive conceptualization through the use of subquestions.

What is cognitive conceptualization?

A cognitive conceptualization provides the framework for understanding clients. The therapist begins to construct the cognitive conceptualization during the first contact with the client. He formulates hypotheses that may explain the underlying dynamics of the presenting problem in order to formulate an appropriate treatment plan. The conceptualization is fluid, and has to be reconsidered when the client presents the therapist with new information. The therapist should always check out the conceptualization with clients, to assure that it is accurate and to help clients understand themselves and their difficulties.

A cognitive conceptualization is very important in CBT, because it helps the therapist:

• Understand clients: what are their strengths and weaknesses? Their aspirations and challenges?
• Know why clients developed a psychological disorder with dysfunctional thinking and maladaptive behavior.
• With strengthening the relationship with the client.
• Plan treatment within and across sessions.
• Choose the right interventions and change treatment as needed.

What is the cognitive model?

Cognitive behavior therapy is based on the cognitive model. The cognitive model states that people’s emotions, behaviors, and physiology are influenced by their perception of events. The situation itself does not immediately determine how people feel or what they do. Their emotional response is mediated by their perception of the situation. Situation--> Automatic thoughts --> Reaction. One person may construe a situation differently than another person. Automatic thoughts are come across as spontaneously and are often rapid and brief. The themes in people's automatic thoughts always make sense once the therapists understands the beliefs of the client.

What different sort of beliefs are there and how do they influence people?

People develop certain ideas about themselves already at a young age. Their most central beliefs are called core beliefs. These core beliefs are deep and enduring understandings of the world that people see as absolute truths. People do often not articulate them, even to themselves. When a belief is activated, a person interprets situations through the lens of this belief, even though the interpretation may be invalid. People tend to focus on information that confirms their core belief. This may lead to a distorted way of processing information. If information doesn’t fit the schema of the core belief, people tend to change the shape of the data in order to fit the schema again, rather than that they change their core belief.

Core beliefs about the self that are negative tend to fall into three categories:

• Helplessness.
• Unlovability.
• Worthlessness.

The beliefs of clients can fall in one, two or all three categories. It is also possible for clients to have more than one belief in a given category.

Core beliefs are the most fundamental level of belief. Automatic thoughts are the most superficial level of cognition. Intermediate beliefs are the class of thoughts that intermediates the two.

Intermediate beliefs consist of attitudes, rules and assumptions. Intermediate beliefs are influenced by core beliefs. It is threatening for clients if their therapist questions their core beliefs. Therefore the usual course of therapy is to start with the modifying of automatic thoughts. The deeper modification of more fundamental beliefs will follow, and will make clients less likely to relapse.

What is the correlation between behavior and automatic thoughts?

The hierarchy of cognition can be illustrated as follows: Core beliefs --> Intermediate beliefs --> Situation --> Automatic thoughts --> Reaction. Thinking, mood, environment, behavior and physiology can all affect one another. It is important as a therapist to put your self in your client’s shoes to understand how they perceive the world, given their history and beliefs.

What cognitive conceptualization diagrams are usable during treatment?

Using cognitive conceptualization diagrams help therapists to organize all the data they receive from clients. It is wise to develop both a strengths-based and a problem-based conceptualization:

• The Strengths-based cognitive conceptualization diagram helps the therapist pay attention to and organize the client's patterns of helpful cognitions and behavior. This diagram shows the relationship among important life events and adaptive core beliefs; adaptive core beliefs and the meaning of the client's automatic thoughts; adaptive core beliefs and adaptive coping strategies; and situations, adaptive automatic thoughts and adaptive behaviors.
• The Problem-based cognitive conceptualization diagram (the traditional one) organizes maladaptive information the therapists gets from clients. This diagram shows the relationship among important life events and core beliefs; core beliefs and the meaning of the automatic thoughts of clients; cre beliefs, intermediate beliefs and dysfunctional coping strategies; trigger situations, automatic thoughts and reactions.

It is important that the themes of clients' automatic thoughts in the completed diagram are part of an overall patterns, otherwise the diagram will be misleading. It is also important to remember that most coping strategies are patterns of normal behaviors. The difficulty clients experience is in the inflexible overuse of these strategies at the expense of more adaptive strategies in certain situations.