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.
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.
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.
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.