CBT : Challenging and disputing irrational thoughts is (and should be) an essential part of a therapist’s approach

Many people who turn to therapists for recovery have a stereotyped imagination of what they can expect from the experience. Many have the image of a Freudian like character sitting in a leather chair, saying nothing and occasionally coming out with some masterpiece of intellect that brings realisation. While it can be said that this is true in some cases, CBT therapists employ a much more flexible, hands-on approach that calls for challenging clients belief systems in various ways. This disputing of the client’s  “window of reference” is sometimes hard for the client to take but is an essential part of a CBT therapist’s approach.

In general terms, the word ‘dispute’ carries a negative connotation associated with conflict, argument or row. In CBT, disputing means challenging the client to see irrational beliefs as unrealistic and encouraging  them to replace these with more rational, realistic versions. The aim is to replace long-standing false beliefs with a client driven flexible belief system in order to help them become less disturbed.  Clients often have problems  adopting this ‘verbal persuasion’ and sometimes change is only initiated over a long period. CBT therapists challenge clients in what is known as ‘multimodal disputing’. This means that it can take place across four spectrums. These being, cognitive, behavioral, imaginal and emotive. While these are all equally important in terms of the bigger picture and interdependent of each other, CBT therapists  will work mostly on cognitive disputing as this is seen as the ‘first among equals’. The aim of cognitive disputing, through interaction between client and therapist, is to lead the client into an atmosphere of self disputing and in essence to eventually become their own therapist. Disputing is generally done in five ways.

1. Rigidity versus  flexibility:

Classic all or nothing thinking, e:g, I must, I should and when not, my world will end. Therapists can challenge this thinking, making it more flexible meaning having strong desires but being prepared for setbacks.

2.Extremism versus non-extremism:

In other words, awfulizing. This means associating failures and setbacks with a generalized view that this setback proves the irrational thoughts around worthlessness and hopelessness correct. Non-extremism accepts that these failures makes things more difficult but they are not life-threatening.

3.Logical Reasoning:

This form of disputing is aimed at showing the client that feelings are not facts, e:g I feel terrible so I must be terrible. The goal is to show the client that there is no logical reason for these kind of thoughts by questioning the evidence for it.

4.Empirical Disputing:

A therapist can challenge a client to provide evidence that their demands on the world are realistic. When clients are perfectionist and expect  their demands to be fully met by themselves or someone else, questioning and experimenting can lead to more realistic beliefs. Some clients can also be  convinced that something terrible will happen to them…this can also be disputed using this technique.

5.Pragmatic disputing:

Clients who hold onto irrational beliefs over a long period often make these beliefs part of their personality or judgment system. By using ‘common sense’ questioning, a therapist can cast doubt on the wisdom  of holding onto these beliefs.

Novice CBT therapists often find the essential skill of disputing difficult in a number of ways.  Firstly, choosing the correct type of disputing can be difficult and  also which problem to dispute first. Secondly, it would be easy for the novice to be too directive with a client, get wrapped up in jargon and get lost when the standard approaches bring no result. One of the main criticisms of CBT is that therapists tend to talk too much and be too directive when disputing.

We have seen that cognitive disputing is often the first approach for CBT therapists. That is not to say that the other three mentioned earlier are not also important. It is wrong to assume that working on these will have an effect on the others but it can happen. Behavioral disputing challenges clients, usually in a homework exercise to change beliefs about behavior that is perhaps causing anxiety or relationship difficulties. Some clients respond better to visualizing their irrational beliefs in the form of images. Imaginal disputing uses such images to show the client the full force of their belief and then an image of how it might look when the belief was no longer there. The final and seen as most difficult is emotive disputing. The most recognized techniques here are the ‘shame-attacking ‘  exercise where clients are encouraged to act in exactly the way they fear in order to show that they over-exaggerate the reaction of others. Another technique is the ‘self-disclosure’ exercise where clients disclose information to others that they have kept hidden.

Dr. Nicholas Jenner is a Counseling psychologist in private practice working with individuals, couples, groups and companies. Apart from seeing clients face-to-face, Dr Jenner also runs a thriving online therapy business bringing help to those who are housebound or located in rural locations where therapy is difficult to find. For more information , follow the link to his website HERE

Want to know more about Dr Nicholas Jenner? Check out what his clients say….HERE

22 Comments

After reading this I suppose I should give my ex therapist credit for, in some instances, managing to clear some of my irrationality with a bit of common sense.
Thanks again for an informative post.

Although I certainly do much more than CBT, research shows, again and again, that it is one of the most effective treatments for anxiety and depression. It pays to review it, as you’ve so kindly done for me. Glad you find it effective in your practice, too.

    I often find that clients want goals, structure and an end plan. The days when clients want or can stay in therapy for years are gone. CBT offers the best possible framework to help clients see fairly quickly what has been troubling them for years.

Very interesting and informative. Thank you for this.

This is such useful information–thank you! Distorted thought patterns are so difficult to break, but knowing the different types and their technical names helps me understand them a bit better.

My therapy model of choice when I started practice was TA with Gestalt used to deal with the emotional components. I find the CBT process much like the process I used in using transactional analysis. I draw from both models today. I still find gestalt work productive also.
Good article Dr. Jenner.

I must be among the minority, given the popularity of CBT and the apparent impact it has on others, but I find it an incredibly patronising and invalidating form of therapy, the therapeutic equivalent of “pull yourself together”. It is based on the assumption that a depressive or anxious person is inherently irrational, which is not the case. There’s plenty of genuine and rational reasons for depression and anxiety.

    With due respect, I don’t believe that any good therapist of any persuasion would adopt a `pull yourself together method. I know that plays no role whatsoever in the way I employ CBT techniques. CBT should be a collaborative process between the therapist and client not in the style of doctor-patient. I challenge your theory of inherent irrationality. Successful CBT treatment implies that this irrationality is rather temporary and lasts as long as the depressive episode. CBT therapists attempt to bring more realistic thinking to this process with the aim of the client using these tools for their own benefit when therapy is over. CBT therapists are also trained to observe and listen without prejudice and with total positive regard for the client. Something which should eliminate patronisation and invalidation. I will accept that not all therapists are the same. Could it be that you have bad experience?

Thanks for following my blog, doctor. If the play on words in the quips prove that I need therapy, please advise.

a good concept for sure!

Wow, wonderful blog. I have been through CBT for many years, but I seem to forget to use the tools if I am not actively seeing a therapist who pushes me in that area. I am still out of my own country, and hoping I can find someone to see when I return to the U.S. who actually helps me to find my way out of negative patterns. It’s nice to vent, but that hasn’t gotten me anywhere so far.

Just started therapy. On 2nd visit, Dr. asked me to identify my irrational thoughts over the next two weeks. I’m filling up a notebook.

Some are so subtle, I hardly notice them, but I am now. Surprisingly, I am associating the corresponding behavior with the thought. A vicious circle!

So what do I do when I identify them? It’s not possible to cut them out and sew me back up.

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