Mental health articles

 This is perhaps the most difficult part of cognitive restructuring because the practitioner may be able to see the alternatives, but needs to facilitate the individual client to arrive at these alternatives using one or more of the techniques outlined below. The alternative interpretation or constructive idea is phrased as a hypothesis, i.e. a theory or assumption for which we need to come to a conclusion about how accurate it is compared to the initial interpretations and ideas, and/or how helpful it may be in changing the way we feel and behave. At this stage, we may choose not to judge or add value to the alternatives until the next step of cognitive restructuring when we test them for accuracy and helpfulness. Remember, the objective is not to show that we are right and the other person is wrong but to show that there are other options that could be considered. Prompt sheet Using a prompt sheet (Figure 25.4), the client could write down their key thoughts (my interpretations and ideas are …), what made them think this way (these are based on the following observations and experiences …), and then identify whether there are any information processing errors inherent in these thoughts (In my interpretations and ideas, am I … e.g. overlooking some facts?). Several alternative interpretations or ideas could derive from rephrasing the initial thoughts so that they do not contain any informationprocessing errors. Distancing It is difficult to see different perspectives when we are ‘tangled’ in a web of our own emotions and thoughts, therefore, creating some distance from our emotional state could be useful in arriving at alternative thoughts and ideas. To this end, we could ask questions such as, ‘How would someone else think in your place?’ or ‘What advice would you give to a friend who experiences the same difficulties as you do?’ Alternatively, we could advise our client to write a script of two friends talking, where one is expressing their thoughts and the other is suggesting alternatives ideas. Role reversal he therapist will argue in favour of a thought and the patient against it in the place of the therapist. In this way, the therapist could demonstrate an understanding of the patient’s point of view and the patient would have the opportunity to identify other perspectives. The patient and therapist could swap chairs, the patient could take notes, or use a flipchart like the therapist may do, and in the end, patient and therapist assume their original positions and discuss the learning outcome of the exercise. Metaphors We could use metaphors or everyday examples to demonstrate that our perception of a situation is affected by our emotional state, i.e. anxiety or low mood might cloud our judgement or our ability to appraise a situation objectively. Then we could ask the person to draw parallel links to their specific situations and thoughts. Advantages and disadvantages Considering the advantages and disadvantages of holding a certain idea could elicit useful information not about its factual accuracy but about how helpful or unhelpful it is in light of the person’s difficulties and needs. This could be very important for engaging a client to consider alternatives when their beliefs are associated with cultural or religious norms. In this case, alternatives are considered not because the beliefs are ‘flawed’ but because they are unhelpful for the specific problem we are addressing. Alternative ideas, which could be more helpful in overcoming the problem, are then considered within the same cultural and religious framework.