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The American Journal of Psychiatry, VOL. 162, No. 8

Letter to the Editor | August 01, 2005

Defining the Core Processes of Psychotherapy

JITENDER SAREEN, M.D., F.R.C.P.C.; KURT SKAKUM, M.D., F.R.C.P.C.

Am J Psychiatry 2005;162:1549-1549. 10.1176/appi.ajp.162.8.1549

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To the Editor: Janis L. Cutler, M.D., et al. (1) presented an excellent clinical case conference comparing approaches to the treatment of an individual using three different types of psychotherapy (cognitive behavior therapy, interpersonal psychotherapy, and psychodynamic therapy). Dr. Cutler commented that cognitive behavior therapy and interpersonal psychotherapists "do not believe it necessary to explore or interpret transference" (p. 1572). We would disagree with this statement with regard to cognitive behavior therapy. As cognitive behavior therapy supervisors training psychiatry residents, we often find that supervisees and psychodynamic therapy supervisors have the perception that transference is not examined in cognitive behavior therapy. In our opinion, this is one of the major misconceptions of cognitive behavior therapy that has been identified by various experts (2–5).

Although the word "transference" is not part of the jargon of cognitive behavior therapy, examination of the cognitions related to the therapist with respect to past significant relationships is an integral part of the assessment and treatment in cognitive behavior therapy. Developing a cognitive behavior therapy case conceptualization of patients is recommended for treating every patient with cognitive behavior therapy (3); cognitive behavior therapists examine the thoughts, feelings, and behaviors related to a wide range of situations (including reactions to the therapist) and relevant childhood experiences to understand the underlying core beliefs and conditional assumptions of each patient. In addition, Beck et al. (5) stated that a cognitive therapist must be

particularly sensitive to…the patient’s hypersensitivity to any action or statement that might be construed as rejection, indifference or discouragement. The patient’s exaggerated responses or misinterpretations may provide valuable insights but the therapist must be alert to their occurrence and prepare the framework for using these distorted reactions constructively.

We believe that it is important to underscore that transference issues are examined carefully, in an upfront fashion, in cognitive behavior therapy and must be an integral component of the complete management of every patient undergoing cognitive behavior therapy.

References

Cutler JL, Goldyne A, Markowitz JC, Devlin MJ, Glick RA: Comparing cognitive behavior therapy, interpersonal psychotherapy, and psychodynamic psychotherapy (clin case conf). Am J Psychiatry 2004; 161:1567–1573[PubMed][CrossRef]

Beck J: Cognitive Therapy: Basics and Beyond. New York, Guilford, 1995

Persons J: Cognitive Therapy in Practice: A Case Formulation. New York, WW Norton, 1989

Gluhoski V: Misconceptions of cognitive therapy. Psychotherapy 1994; 31:594–600[CrossRef]

Beck AT, Rush AJ, Shaw BF, Emery G: Cognitive Therapy of Depression. New York, Guilford, 1979

Beck J: Cognitive Therapy: Basics and Beyond. New York, Guilford, 1995

Persons J: Cognitive Therapy in Practice: A Case Formulation. New York, WW Norton, 1989

Gluhoski V: Misconceptions of cognitive therapy. Psychotherapy 1994; 31:594–600[CrossRef]

Beck AT, Rush AJ, Shaw BF, Emery G: Cognitive Therapy of Depression. New York, Guilford, 1979

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JITENDER SAREEN, KURT SKAKUM; Defining the Core Processes of Psychotherapy. American Journal of Psychiatry. 2005 Aug;162(8):1549-1549.

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