Principles of Cognitive Therapy (Part II)

Goal Oriented and Problem Focused

Cognitive therapy is teleological; that is, it is directed toward specific goals. From the outset, the patient is asked to list his or her problems and set specific goals.

It is not about "feeling better" in the abstract, but about defining what that means. A clear example would be a patient who wishes to "improve her self-esteem".

The therapist helps to operationalize this into behavioral and cognitive goals: "To be able to express my opinion in work meetings without paralyzing myself" or "To reduce self-criticism by making minor mistakes".

This structure allows progress to be measured and keeps therapy focused, preventing sessions from becoming aimless chats about the week's events.

Educational Character and Relapse Prevention

The ultimate goal of CBT is for the patient to become his or her own therapist. Thus, the process is inherently psychoeducational.

The therapist explicitly teaches the cognitive model, explains how emotions are formed, and trains the patient in the use of tools (thought logs, breathing techniques).

If a patient suffers from panic, it is not enough to help him or her overcome a crisis in the office.

He must be taught the physiology of fear and how his catastrophic interpretations feed the cycle.

By understanding the mechanism, when the patient experiences symptoms in the future (relapse prevention), he will not be dependent on the therapist, but will be able to apply the tools learned to regulate himself autonomously.

Focus on the Present and Temporal Limitation

Unlike long-term therapies that explore childhood indefinitely, CBT emphasizes the here and now.

Work is done on current problems and situations that generate discomfort today.

The past is explored only when necessary to understand the origin of ingrained beliefs or when the patient requires it to make sense of his or her history, but the focus quickly returns to how those past experiences affect present functioning.

In addition, therapy tends to be time-limited (usually between 4 and 15 sessions for non-complex personality disorders).

This generates a sense of purpose and productive urgency, motivating the patient to actively work between sessions to see results.

Summary

Therapy is teleological and oriented toward specific, concrete, problem-focused goals. It seeks to operationalize well-being into measurable behavioral objectives, avoiding aimless chatter and maintaining a productive focus.

The process is inherently psychoeducational, with the patient becoming his or her own therapist. Models and tools are taught to prevent relapses, fostering future autonomy in emotional regulation by understanding the mechanism of distress.

The work on the present is emphasized, limiting the exploration of the past to what is necessary. Therapy is usually brief in time, generating a sense of productive urgency and motivation to work actively between sessions.