Conceptualization and Flexibility in Cognitive Therapy

Overview

Conceptualization in psychotherapy refers to the process of formulating and understanding a patient’s problems within a specific framework. In cognitive therapy, the conceptualization of a patient’s problems is a necessary aspect of therapy and an activity that usually precedes the implementation of specific therapeutic techniques. Much work has gone into developing cognitive conceptual frameworks to understand depression and anxiety. The view of depression as involving the perception of loss, and anxiety as involving the perception of threat, has been widely accepted. These general conceptual frameworks have been influential and useful in advancing the application and evaluation of cognitive therapy (Beck & Emery, 1985; Beck, Rush, Shaw, & Emery, 1979). It is equally important, however, in clinical work, to develop an idiosyncratic conceptualization which takes into account the patient’s own development and personal history, resources, and environment (Beck et al., 1979). From the extensive work that has been devoted to cognitive therapy, a number of frameworks have been developed from which to conceptualize a patient’s problems. Therapists are now faced with choices about which cognitive conceptualization to follow in a given case.

The purpose of this chapter is to provide guidelines for developing idiosyncratic conceptualizations, particularly when working with nontraditional populations. We use the phrase traditional populations to refer to unipolar depression and anxiety disorders. In presenting these guidelines, we review the different conceptual frameworks currently available . These frameworks involve conceptualizations based on cognitive content, cognitive content versus cognitive process versus structure (labeled the tripartite conceptualization), core versus peripheral cognitive processes, constructivist and developmental processes, and finally, cognitive-interpersonal processes. The process of conceptualizing in cognitive therapy will be illustrated with a clinieal example. The importance of flexibility in cognitive therapy with nontraditional patient groups will also be highlighted.