Primary Assumption about Patient Psychopathology
The chronically depressed adult is perceptually disconnected from
the environment so that his/her behavioral consequences cannot
inform behavior. . The dilemma of the patient stems from a pervasive fear-avoidance predicament. Piagetian preoperational structural functioning
in the social-interpersonal arena maintains the disorder and causes
cognitive-emotional-behavioral patterns to remain on an immature
level. CBASP is the only therapy model developed specifically for
the treatment of chronic depression.
Etiology of Psychopathology
Developmental maltreatment and trauma derails/retards normal cognitive-emotional
development in the social-interpersonal arena in the early-onset
patient. The early-onset patient moves into adulthood functioning
in a preoperational manner. An out-of-control mood state in the
late-onset patient (23% of all late-onset Major Depression cases
do not recover regardless of the treatment administered) undermines
normal cognitive-emotional functioning, and the individual returns
to a preoperational structural level of perceiving and relating
to the world. CBASP therapy has effectively treated both early-
and late-onset types of chronic depression.
Goals of CBASP Psychotherapy
The first goal is the establishment of dyadic safety in the therapy relationship. The second goal is to establish a perceptual connection between the patient’s behavior and the consequences that are produced. It is strongly recommended
that all patients who begin CBASP therapy also begin a regime
of antidepressant medication. In psychotherapy,
patients are taught that their interpersonal behavior has specific
consequences and in learning to recognize what these consequences
are, patients become perceptually connected/reconnected to their
environment. Perceptual connectedness means that the person becomes
accessible to formative feedback from the environment (others).
This goal is accomplished through a technique known as Situational
Analysis (SA). In SA, the therapist directs the patient’s
attention (1) to the effect his/her behavior is having upon others
and (2) teaches the individual how his/her interpersonal behavior
is affecting the therapist. These procedures are carried out in
a systematic manner throughout treatment. A second goal is to help
the patient generate empathic behavior with the therapist and others.
(3) A third major goal is to heal the interpersonal trauma patients
bring to treatment. Again, this is done systematically and repeatedly
across therapy sessions. The Interpersonal Discrimination Exercise
(IDE) shows patients how the therapist
differs in comparative ways to maltreating significant others in
the individual’s life. Finally (4), Contingent Personal Responsivity (CPR) is
administered by the clinician to modify in-session inappropriate behavior.
Using Interpersonal Transference Hypotheses in CBASP
The
interpersonal healing process is addressed proactively by the construction of one transference hypothesis following
the second session. During session 2, an extensive personal history
is obtained of the patient’s relationships with significant
others. Usually, one transference hypothesis is constructed to
reflect the one salient and destructive interpersonal theme which
has been gleaned from the significant other history. In subsequent
sessions, this hypothesis becomes the focus and interpersonal subject
matter of the IDE. Four interpersonal domains may be targeted for
the transference hypothesis as they reflect common interpersonal
experiences encountered in the psychotherapy experience: (1) intimacy
moments between the therapist and patient; (2) moments when the
patient expresses felt emotional need or discloses highly personal
material; (3) occasions when the patient makes a mistake or commits
some observable error; (4) in-session moments when the patient
experiences and discloses either verbally or nonverbally some negative
affect toward the therapist (e.g. frustration, anger, shame, guilt,
sexual affect if it carries a negative connotation, etc.). The
IDE is used proactively whenever the patient-therapist encounter
moves into the targeted “hot spot” transference area.
The therapist assists the patient to compare and contrast his/her
reactions to the patient in the targeted interpersonal domain with
those of maltreating significant others. Once the discrimination
is made explicit, patients are then taught how to function in the
new interpersonal reality existing between himself/herself and
the clinician.