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A little less talk, a little more action: a dialogical approach to cognitive therapy

Published online by Cambridge University Press:  11 November 2019

Matthew Pugh
Matthew Pugh*
Affiliation:
Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, London, UK
*
Corresponding author. Email: [email protected]
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Abstract

Reappraisal strategies such as ‘thought challenging’ and ‘cost-benefits analysis’ are a hallmark of cognitive therapy, but sometimes fail to bring about lasting changes in the cognitive-affective structures underlying psychopathology. Modern theories of information processing suggest that experiential, action-based interventions such as chairwork may be a more efficacious route to cognitive modification. Based upon this hypothesis, a ‘dialogical’ approach to cognitive therapy is presented, which aims to bring about change through evocative, here-and-now interactions with parts of the self (self-to-self dialogues) and other individuals (self-to-other dialogues). Implementation principles and facilitation skills which guide this approach are outlined. To illustrate how dialogical interventions are utilized in clinical practice, chair-based strategies for socializing clients to the cognitive behavioural model, restructuring cognitions, facilitating emotional processing, resolving ambivalence, addressing distressing memories, building character strengths, and overcoming therapeutic impasses are described.

Key learning aims

As a result of reading this paper, the reader should:

  1. (1) Understand the limits of ‘standard’ cognitive techniques.

  2. (2) Appreciate some of the advantages of experiential methods of intervention, namely chairwork.

  3. (3) Learn how dialogical interventions are conceptualized, implemented, and facilitated in cognitive therapy.

Keywords

chairworkcognitive therapyempty-chairexperientialrole-playtwo-chair
Type
Practice Article
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e47
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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References

Further reading

Dayton, T. (1994). The Drama Within: Psychodrama and Experiential Therapy. Deerfield Beach: Health Communications.Google Scholar
Kellogg, S. (2015). Transformational Chairwork: Using Psychotherapy Dialogues in Clinical Practice. Lanham: Rowman and Littlefield.Google Scholar
Pugh, M. (2017). Chairwork in cognitive behavioural therapy: a narrative review. Cognitive Therapy and Research, 41, 16–30.CrossRefGoogle Scholar
Pugh, M. (2019). Cognitive Behavioural Chairwork: Distinctive Features. Oxon: Routledge.CrossRefGoogle Scholar

References

Aafjes-van Doorn, K., & Barber, J. P. (2017). Systematic review of in-session affect experience in cognitive behavioral therapy for depression. Cognitive Therapy and Research, 41, 807–828.CrossRefGoogle Scholar
Arntz, A. (2012). Imagery rescripting as a therapeutic technique: Review of clinical trials, basic studies, and research agenda. Journal of Experimental Psychopathology, 3, 189–208.CrossRefGoogle Scholar
Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: theory and practice. Behaviour Research and Therapy, 37, 715–740.CrossRefGoogle ScholarPubMed
Baker, R., Owens, M., Thomas, S., Whittlesea, A., Abbey, G., Gower, P. et al. (2011). Does CBT facilitate emotional processing? Behavioural and Cognitive Psychotherapy, 40, 19–37.CrossRefGoogle ScholarPubMed
Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. London, UK: Penguin Books.Google Scholar
Beck, A. T. (1991). Cognitive therapy as the integrative therapy. Journal of Psychotherapy Integration, 1, 191–198.CrossRefGoogle Scholar
Beck, A. T. (1996). Beyond belief: a theory of modes, personality, and psychopathology. In Frontiers of Cognitive Therapy (ed. Salkovskis, P.), pp. 1–26. New York, USA: Guilford Press.Google Scholar
Beck, A. T., Davis, D. D., & Freeman, A. (2016). Cognitive Therapy of Personality Disorders, 3rd edn. New York, USA: Guilford Press.Google Scholar
Beck, A. T., Wright, F. D., Newman, C.F., & Liese, B. S. (1993). Cognitive Therapy of Substance Abuse. New York, USA: Guilford Press.Google Scholar
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. New York, USA: Guilford Press.Google Scholar
Bell, T., Montague, E., Elander, J., & Gilbert, P. (2019). ‘A definite feel-it moment’: embodiment, externalization and emotion during chair-work in compassion-focused therapy. Counselling and Psychotherapy Research. https://doi.org/10.1002/capr.12248 CrossRefGoogle Scholar
Bennett-Levy, J. (2003). Mechanisms of change in cognitive therapy: the case of automatic thought records and behavioural experiments. Behavioural and Cognitive Psychotherapy, 31, 261–277.CrossRefGoogle Scholar
Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2015). Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. New York, USA: Guilford Press.Google Scholar
Blatner, A., & Blatner, A. (1991). Imaginative interviews: a psychodramatic warm-up for developing role-playing skills. Journal of Group Psychotherapy, Psychodrama and Sociometry, 44, 115–120.Google Scholar
Brewin, C. R. (2006). Understanding cognitive behaviour therapy: a retrieval competition account. Behaviour Research and Therapy, 44, 765–784.CrossRefGoogle ScholarPubMed
Carnabucci, K. (2014). Show and Tell Psychodrama: Skills for Therapists, Coaches, Teachers, and Leaders. Racine: Nusanto Publishing.Google Scholar
Castonguay, L. G., Pincus, A. L., Agras, W. S., & Hines, C. E. (1998). The role of emotion in group cognitive-behavioral therapy for binge eating disorder: when things have to feel worse before they get better. Psychotherapy Research, 8, 225–238.CrossRefGoogle Scholar
Chadwick, P. (2003). Two chairs, self-schemata and a person-based approach to psychosis. Behavioural and Cognitive Psychotherapy, 31, 439–449.CrossRefGoogle Scholar
Chesner, A. (2019). Working with addictions: the addictions compass and intergenerational action genogram. In One-to-One Psychodrama Psychotherapy: Applications and Technique (ed. Chesner, A.), pp. 68–80. Abingdon, UK: Routledge.CrossRefGoogle Scholar
Clark, D. A. (1995). Perceived limitations of standard cognitive therapy: a consideration of efforts to revise Beck’s theory and therapy. Journal of Cognitive Psychotherapy, 9, 153–172.CrossRefGoogle Scholar
Clarke, K. M., & Greenberg, L. S. (1986). Differential effects of the gestalt two-chair intervention and problem solving in resolving decisional conflict. Journal of Counseling Psychology, 33, 11–15.CrossRefGoogle Scholar
Coombs, M. M., Coleman, D., & Jones, E. E. (2002). Working with feelings: the importance of emotion in both cognitive-behavioral and interpersonal therapy in the NIMH Treatment of Depression Collaborative Research Program. Psychotherapy: Theory, Research, Practice, Training, 39, 233–244.CrossRefGoogle Scholar
Corsini, R. J. (2017). Role Playing in Psychotherapy. London, UK: Routledge.CrossRefGoogle Scholar
Dayton, T. (1994). The Drama Within: Psychodrama and Experiential Therapy. Deerfield Beach: Health Communications.Google Scholar
de Oliveira, I. R. (2015). Trial-Based Cognitive Therapy: A Manual for Clinicians. New York, USA: Routledge.Google Scholar
de Oliveira, I. R., Powell, V. B., Wenzel, A., Caldas, M., Seixas, C., Almeida, C. et al. (2012). Efficacy of the trial-based thought record, a new cognitive therapy strategy designed to change core beliefs, in social phobia. Journal of Clinical Pharmacy and Therapeutics, 37, 328–334.CrossRefGoogle ScholarPubMed
Edwards, D. (1989). Cognitive restructuring through guided imagery: lessons from gestalt therapy. In Comprehensive Handbook of Cognitive Therapy (ed. Freeman, A., Simon, K. M., Beutler, L. E. & Arkowitz, H.), pp. 283–297. London, UK: Plenum.CrossRefGoogle Scholar
Edwards, D. (2007). Restructuring implicational meaning through memory-based imagery: some historical notes. Journal of Behavior Therapy and Experimental Psychiatry, 38, 306–316.CrossRefGoogle ScholarPubMed
Ellis, A. (2001). The rise of cognitive behavior therapy. In A History of Behavioral Therapies: Founders’ Personal Histories (ed. O’Donohue, W. T., Henderson, D. A., Hayes, S. C., Fisher, J. E. & Hayes, L. J.), pp. 183–194. Reno: Context.Google Scholar
Ellis, A. (2004). Why I (really) became a therapist. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 22, 73–77.CrossRefGoogle Scholar
Epstein, N. B., & Zheng, L. (2017). Cognitive-behavioral couple therapy. Current Opinion in Psychology, 13, 142–147.CrossRefGoogle ScholarPubMed
Epstein, S. (2014). Cognitive-Experiential Theory: An Integrative Theory of Personality. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
Fennell, M. J. V. (1998). Cognitive therapy in the treatment of low self-esteem. Advances in Psychiatric Treatment, 4, 296–304.CrossRefGoogle Scholar
Gilbert, P. (2009). Overcoming Depression: A Self-Help Guide Using Cognitive Behavioural Techniques. London, UK: Robinson.Google Scholar
Goldfried, M. R. (1988). Application of rational restructuring to anxiety disorders. The Counseling Psychologist, 16, 50–68.CrossRefGoogle Scholar
Goldfried, M. R., Linehan, M. M., & Smith, J. L. (1978). Reduction of test anxiety through cognitive restructuring. Journal of Consulting and Clinical Psychology, 46, 32–39.CrossRefGoogle ScholarPubMed
Greenberg, L. S. (1979). Resolving splits: use of the two chair technique. Psychotherapy: Theory, Research and Practice, 13, 316–324.CrossRefGoogle Scholar
Greenberg, L. S. (1986). Change process research. Journal of Consulting and Clinical Psychology, 54, 4–9.CrossRefGoogle ScholarPubMed
Greenberg, L. S., & Pascual-Leone, A. (2006). Emotion in psychotherapy: a practice-friendly research review. Journal of Clinical Psychology, 62, 611–630.CrossRefGoogle ScholarPubMed
Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating Emotional Change: The Moment-by-Moment Process. New York, USA: Guilford Press.Google Scholar
Hauke, G., Lohr, C., & Pietrzak, T. (2016). Moving the mind: embodied cognition in cognitive behavioural therapy (CBT). European Psychotherapy, 13, 154–178 Google Scholar
Hermans, H. J. M. (1996). Voicing the self: from information processing to dialogical interchange. Psychological Bulletin, 119, 31–50.CrossRefGoogle Scholar
Hofmann, S. G., Asmundson, G. J. G., & Beck, A. T. (2013). The science of cognitive therapy. Behavior Therapy, 44, 199–212.CrossRefGoogle ScholarPubMed
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research, 36, 427–440.CrossRefGoogle ScholarPubMed
Holmes, E. A., & Mathews, A. (2010). Mental imagery in emotion and emotional disorders. Clinical Psychology Review, 30, 349–362.CrossRefGoogle ScholarPubMed
Hunt, M. G., Schloss, H., Moonat, S., Poulos, S., & Wieland, J. (2007). Emotional processing versus cognitive restructuring in response to a depressing life event. Cognitive Therapy and Research, 31, 833–851.CrossRefGoogle Scholar
Jaycox, L. H., Foa, E. B., & Morral, A. R. (1998). Influence of emotional engagement and habituation on exposure therapy for PTSD. Journal of Consulting and Clinical Psychology, 66, 185–192.CrossRefGoogle ScholarPubMed
Katzow, A. W., & Safran, J. D. (2007). Recognizing and resolving ruptures in the therapeutic relationship. In The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies (ed. Gilbert, P. & Leahy, R. L.), pp. 90–105. Hove, UK: Routledge.Google Scholar
Kellogg, S. (2015). Transformational Chairwork: Using Psychotherapy Dialogues in Clinical Practice. Lanham: Rowman and Littlefield.Google Scholar
Kellogg, S. (2018). Transformational chairwork: the four dialogue matrix. The Schema Therapy Bulletin. Retrieved from: https://schematherapysociety.org/Four-Dialogue-Matrix Google Scholar
Kelly, G. A. (1955). The Psychology of Personal Constructs: Volume One. New York, USA: Norton.Google Scholar
Klein, S. B., & Gangi, C. E. (2010). The multiplicity of self: neuropsychological evidence and its implications for the self as a construct in psychological research. Annals of the New York Academy of Sciences, 1191, 1–15.CrossRefGoogle ScholarPubMed
Kolts, R. L. (2016). CFT Made Simple: A Clinician’s Guide to Practicing Compassion-Focused Therapy. Oakland, CA, USA: New Harbinger Publications.Google Scholar
Kramer, U., & Pascual-Leone, A. (2015). The role of maladaptive anger in self-criticism: a quasi-experimental study on emotional processes. Counselling Psychology Quarterly, 29, 311–333.CrossRefGoogle Scholar
Lang, P. J. (1983). Cognition in emotion: concept and action. In Emotion, Cognition, and Behavior (ed. Izard, C., Kagan, J. & Zajonc, R.), pp. 192–226. New York, USA: Cambridge University Press.Google Scholar
Leahy, R. L. (2016). Emotional schema therapy: a meta-experiential model. Australian Psychologist, 51, 82–88.CrossRefGoogle Scholar
Leahy, R. L., Tirch, D., & Napolitano, L. A. (2011). Emotional Regulation in Psychotherapy. A Practitioner’s Guide. New York, USA: Guilford Press.Google Scholar
Lee, D. A. (2005). The perfect nurturer: a model to develop a compassionate mind within the context of cognitive therapy. In Compassion: Conceptualisations, Research and Use in Psychotherapy (ed. Gilbert, P.), pp. 326–351. Hove, UK: Routledge.Google Scholar
Mahoney, M. J. (1991). Human Change Processes: The Scientific Foundations of Psychotherapy. New York, USA: Basic Books.Google Scholar
McManus, F., Van Doorn, K., & Yiend, J. (2012). Examining the effects of thought records and behavioral experiments in instigating belief change. Journal of Behavior Therapy and Experimental Psychiatry, 43, 540–547.CrossRefGoogle ScholarPubMed
Mennin, D. S., Ellard, K. K., Fresco, D. M., & Gross, J. J. (2013). United we stand: emphasizing commonalities across cognitive-behavioral therapies. Behavior Therapy, 44, 234–248.CrossRefGoogle ScholarPubMed
Mooney, K. A., & Padesky, C. A. (2000). Applying client creativity to recurrent problems: constructing possibilities and tolerating doubt. Journal of Cognitive Psychotherapy: An International Quarterly, 14, 149–161.CrossRefGoogle Scholar
Moreno, J. L. (1987). The Essential Moreno: Writings on Psychodrama, Group Method and Spontaneity. New York, USA: Springer.Google Scholar
Mueser, K. T., & Bellack, A. S. (2007). Social skills training: alive and well? Journal of Mental Health, 16, 549–552.CrossRefGoogle Scholar
Neimeyer, R. A. (2012). Chair work. In Techniques of Grief Therapy: Creative Practices for Counselling the Bereaved (ed. Neimeyer, R. A.), pp. 266–273. New York, USA: Routledge.CrossRefGoogle Scholar
Owen-Pugh, V., & Symons, C. (2013). Roth and Pilling’s competence framework for clinical supervision: how generalizable is it? Counselling and Psychotherapy Research, 13, 126–135.CrossRefGoogle Scholar
Padesky, C. A. (1990). Clinical tip: presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13–14.Google Scholar
Padesky, C. A. (1997). A more effective treatment focus for social phobia? International Cognitive Therapy Newsletter, 11, 1–3.Google Scholar
Padesky, C. A., & Mooney, K. A. (2012). Strengths-based cognitive therapy: a four-step model to build resilience. Clinical Psychology and Psychotherapy, 19, 283–290.CrossRefGoogle ScholarPubMed
Paivio, S. C., & Nieuwenhuis, J. A. (2001). Efficacy of emotion focused therapy for adult survivors of child abuse: a preliminary study. Journal of Traumatic Stress, 14, 115–133.CrossRefGoogle Scholar
Parker, Z. J., & Waller, G. (2019). Psychotherapists’ reports of technique use when treating anxiety disorders: factors associated with specific technique use. The Cognitive Behaviour Therapist, 12, 1–12.CrossRefGoogle Scholar
Perls, F. (1969). Gestalt Therapy Verbatim. Gouldsboro: Gestalt Journal Press.Google Scholar
Perls, F. (1973). The Gestalt Approach and Eye Witness to Therapy. Oxford, UK: Science and Behavior Books.Google Scholar
Pitzele, P. (1991). Adolescents inside out: intrapsychic psychodrama. In Psychodrama: Inspiration and Technique (ed. Holmes, P. & Karp, M.), pp. 15–31. London, UK: Routledge.Google Scholar
Polster, E., & Polster, M. (1973). Gestalt Therapy Integrated: Contours of Theory and Practice. New York, USA: Vintage Books.Google Scholar
Pos, A. E., & Greenberg, L. S. (2012). Organizing awareness and increasing emotional regulation: revising chair work in emotion-focused therapy for borderline personality disorder. Journal of Personality Disorders, 26, 84–107.CrossRefGoogle ScholarPubMed
Pugh, M. (2017). Chairwork in cognitive behavioural therapy: a narrative review. Cognitive Therapy and Research, 41, 16–30.CrossRefGoogle Scholar
Pugh, M. (2018). Cognitive behavioural chairwork. International Journal of Cognitive Therapy, 11, 100–116.CrossRefGoogle Scholar
Pugh, M. (2019). Cognitive Behavioural Chairwork: Distinctive Features. Oxon, UK: Routledge.CrossRefGoogle Scholar
Pugh, M., & Salter, C. (2018). Motivational chairwork: an experiential approach to resolving ambivalence. European Journal of Counselling Theory, Research and Practice, 2, 1–15.Google Scholar
Safran, J. D., & Greenberg, L. S. (1982). Eliciting ‘hot cognitions’ in cognitive behaviour therapy: rationale and procedural guidelines. Canadian Psychology, 23, 83–87.CrossRefGoogle Scholar
Safran, J. D., & Greenberg, L. S. (1986). Hot cognition and psychotherapy process: an information-processing/ecological approach. In Advances in Cognitive-Behavioral Research and Therapy, volume 5 (ed. Kendall, P. C.), pp. 143–177. Orlando, FL, USA: Academic Press.CrossRefGoogle Scholar
Salas-Auvert, J. A., & Felgoise, S. H. (2003). The rational-experiential information processing systems model: its implications for cognitive therapy. International Journal of Clinical and Health Psychology, 3, 123–140.Google Scholar
Samoilov, A., & Goldfried, M. R. (2000). Role of emotion in cognitive-behavior therapy. Clinical Psychology: Science and Practice, 7, 373–385.Google Scholar
Shurick, A. A., Hamilton, J. R., Harris, L. T., Roy, A. K., Gross, J. J., & Phelps, E. A. (2012). Durable effects of cognitive restructuring on conditioned fear. Emotion, 12, 1393–1397.CrossRefGoogle ScholarPubMed
Speed, B. C., Goldstein, B. L., & Goldfried, M. R. (2018). Assertiveness training: a forgotten evidence-based treatment. Clinical Psychology: Science and Practice, 25, 1–20.Google Scholar
Stone, H., & Stone, S. (1989). Embracing Our Selves: The Voice Dialogue Manual. Novato: Nataraj Publishing.Google Scholar
Stott, R. (2007). When head and heart do not agree: a theoretical and clinical analysis of the rational-emotional dissociation (RED) in cognitive therapy. Journal of Cognitive Psychotheraoy: An International Quarterly, 21, 37–50.CrossRefGoogle Scholar
Teasdale, J. D. (1996). Clinically relevant theory: integrating clinical insight with cognitive science. In Frontiers of Cognitive Therapy (ed. Salkovskis, P.), pp. 26–47. New York, USA: Guilford Press.Google Scholar
Teasdale, J. D. (1997). The relationship between cognition and emotion: the mind-in-place in mood disorders. In The Science and Practice of Cognitive Behaviour Therapy (ed. Clark, D. M. & Fairburn, C. G.), pp. 67–93. Oxford, UK: Oxford University Press.Google Scholar
Teasdale, J. D. (1999). Emotional processing, three modes of mind and the prevention of relapse in depression. Behaviour Research and Therapy, 37, S53–77.CrossRefGoogle ScholarPubMed
Teasdale, J. D., & Barnard, P. J. (1993). Affect, Cognition, and Change: Re-Modelling Depressive Thought. Hove, UK: Lawrence Erlbaum Associations.Google Scholar
Tomasolu, D. J. (2019). The virtual gratitude visit (VGV): using psychodrama and role-playing as a positive intervention. In Positive Psychological Intervention Design and Protocols for Multi-Cultural Contexts (ed. Van Zyl, L. E. & Rothmann, S. , Sr). Cham: Springer Nature.Google Scholar
Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., & Russell, K. (2007). Cognitive Behavioural Therapy for Eating Disorders: A Comprehensive Treatment Manual. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
Watkins, E. R. (2016). Rumination-Focused Cognitive-Behavioral Therapy for Depression. New York, USA: Guilford Press.Google Scholar
Watson, J. C., & Bedard, D. L. (2006). Clients’ emotional processing in psychotherapy: a comparison between cognitive-behavioral and process-experiential therapies. Journal of Consulting and Clinical Psychology, 74, 152–159.CrossRefGoogle ScholarPubMed
Wenzel, A. (2018). Cognitive reappraisal. In Process-Based CBT: The Science and Core Clinical Competencies of Cognitive Behavioral Therapy (ed. Hayes, S. C. & Hofmann, S. G.), pp. 325–337. Oakland, CA, USA: New Harbinger Publications.Google Scholar
Westen, D., & Morrison, K. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69, 875–899.CrossRefGoogle ScholarPubMed
Whelton, W. J., & Greenberg, L. S. (2005). Emotion in self-criticism. Personality and Individual Differences, 38, 1583–1595.CrossRefGoogle Scholar
Yaniv, D. (2012). Dynamics of creativity and empathy in role reversal: contributions from neuroscience. Review of General Psychology, 16, 70–77.CrossRefGoogle Scholar
Yardley-Matwiejczuk, K. M. (1997). Role Play: Theory and Practice. London, UK: Sage Publications.Google Scholar
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