Principles of Cognitive Therapy (Part I)

The Dynamic Formulation of the Case in Cognitive Terms

The first fundamental principle states that therapy is not a simple collection of techniques applied haphazardly, but is based on a continuous and evolving formulation of the patient's problems.

This means that the therapist must translate the patient's complaints (pain, fatigue, conflicts) into cognitive terms: automatic thoughts, intermediate beliefs and core beliefs.

For example, if a patient named Javier comes to consultation reporting extreme exhaustion and desires to give up everything, the formulation does not stay with the symptom "exhaustion".

The therapist conceptualizes that Javier has the core belief "I am inadequate", which activates rigid rules such as "I must work twice as hard as others to be accepted", generating automatic thoughts of "I will never finish" and the consequent physiological response of fatigue.

This formulation is adjusted and refined session after session as more information is obtained.

Building a Strong Therapeutic Alliance

The second principle dictates that the success of the intervention depends on a relationship of trust, warmth and security, known as a therapeutic alliance.

Without this bond, the most sophisticated techniques lack impact. The therapist must demonstrate empathy, genuine interest and competence.

Imagine that a patient reveals an embarrassing secret about her past. If the therapist reacts with clinical coldness or judgment, the alliance is broken.

In contrast, a response that validates the emotion and shows human understanding ("It must have been very difficult to carry that alone for so long") strengthens the bond, creating a safe space where the patient dares to explore her most painful cognitions. This relationship is cultivated from the first contact.

Emphasis on Collaboration and Active Participation

CBT is distinguished by the fact that it is teamwork; it is not something that is done to the patient, but something that is done with the patient.

This principle of collaborative empiricism implies that both therapist and patient have active roles.

The therapist brings methodological expertise and the patient brings expertise in his or her own experience.

For example, in deciding what task to perform during the week, the therapist does not impose an order ("You must go for three walks").

Instead, he or she asks, "Based on what we have discussed about your isolation, what activity do you think would be a viable first step for you this week?"

This empowers the individual, encourages accountability, and reduces resistance, as solutions emerge from consensus rather than authority.

Summary

Therapy is based on a dynamic, developmental formulation of the patient's problems. The therapist translates vague complaints into specific cognitive terms, such as thoughts and beliefs, adjusting this conceptualization session by session.

The success of the intervention depends on building a strong and secure therapeutic alliance. Without a bond of trust, warmth and genuine empathy, the most sophisticated techniques lack impact and the patient does not open up.

It is distinguished by collaborative empiricism, where the work is an active team effort. Therapist and patient participate together, agreeing on tasks and decisions to foster responsibility, empower the individual and reduce resistance.