A Cognitive Therapy Perspective on Therapists’ Feelings and Interpersonal Processes

Abstract

Within the field of cognitive therapy, the importance of the therapist’s emotions in the context of the therapeutic relationship is increasingly recognised. Feelings such as tension, fatigue, and irritation in the therapist are of particular concern during the initial sessions. The pilot study described here found that such feelings may arise when the patient shows high levels of interpersonal distance, detachment, distrust, dependency, or incompetence, suggesting difficulty in building an effective therapeutic alliance. If perceived by the patient, negative feelings on the part of the therapist may confirm expectations of rejection or abandonment, she may feel overwhelmed, or her sense of personal inadequacy and incompetence may seem corroborated. Rather than relating the patient’s attitudes to himself, the therapist should regulate his emotional reaction and use empathic skills to promote the patient’s trust. In subsequent stages of therapy, after the working alliance has been established, continuous monitoring of the quality of the alliance and the therapist’s own emotional reactions will allow early recognition and identification of problematic patterns in the therapeutic relationship, so that problems can be managed through inner discipline procedures. Key steps in this process are tolerating relational discomfort, avoiding actions detrimental to therapy, and understanding the patient’s experience. Consideration of every mental state of the therapist as indicative of an aspect of the patient is not justified; nor is viewing every inner experience of the therapist as ‘diagnostic’. A key therapist’s skill is being able to observe his own mental state, recognise it, and ask how much it has to do with himself, versus the patient or the current nature of the relationship. Knowing how to observe and manage one’s own feelings, rather than neglecting them or always uncritically ascribing them to the patient’s characteristics and problems, is a key technical aspect of the therapeutic process.