Defining the Core Processes of Psychotherapy

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

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.