I recently read an interesting case description on a professional listserv about a “difficult” client who was not fully adherent with treatment. Apparently he argued with his therapist and did little homework outside of the session. It was apparent to me that the therapist had made a mistake. She was continuing to try to deliver “standard” CBT treatment, without attending to the therapeutic relationship sufficiently. I hypothesized that the client had an interfering belief:
“If I refrain from arguing with my therapist and comply fully with treatment……[something bad will happen or it will mean something bad about me.” ].
I don’t have enough details about the case to understand how the client would finish this assumption, but some clients might answer:
“I’ll feel so distressed that I won’t be able to stand it,” or “it will mean she’s in control, and I’m not.”
Until such interfering beliefs are elicited, evaluated, and effectively responded to, this client is unlikely to make much progress.
–Posted by Judith S. Beck, Ph.D., Director, Beck Institute