In Cognitive–Affective Behavior Therapy, Dr. Marvin R. Goldfried shows how this approach works. Although primarily a cognitive–behavioral approach, this therapy also incorporates elements of experiential therapy so as to increase the possibility of the client having connective experiences between sessions. In this session, Dr. Goldfried works with a 31-year-old woman who is struggling with expressing her feelings and being vulnerable in the most serious relationship she has had since her divorce 8 years ago.
This DVD features a client portrayed by an actor on the basis of actual case material.
The client, Janet, has thought on and off about seeing a psychologist for 4 or 5 months. She has been feeling depressed about her relationships with others; she is tired of feeling frustrated and unhappy, and she wants to change. A colleague at work suggested that she see Dr. Goldfried.
Janet has been in a relationship with Larry for about 6 months. She has had many relationships since her divorce 8 years ago, but none of them lasted for more than 7 or 8 months. Often these relationships were with married men or men who were in some way "not real possibilities." Janet believes that her relationship with Larry has the potential to be "the real thing." In Larry, she has finally met someone with whom she feels she might be able to really open up; someone whom she can trust; to whom she might be able to show "her real self," but she doesn't know how.
Janet doesn't want to "blow it" with Larry. She wants to be able to express herself, to get angry, to tell him what she wants in the relationship. But she can't, and Larry is getting frustrated with Janet's inability to express her feelings. When he tries to get her to talk about herself, Janet shifts the conversation back to him. Sometimes she gets very distant, inexpressive, and removed. Sometimes she has fits of temper and just blows up over small things. When she gets angry, she is afraid of her anger and often feels that it is inappropriate. She would like to share her feelings but she is afraid of expressing what she wants, but then she is afraid of losing Larry if she doesn't open up. They seem to fight about insignificant things, like Larry being late or forgetting to call her. Janet says that she "feels trapped" by her inability to express her feelings, but she is afraid "to open the door."
Session 1: Dr. Goldfried began the session by asking, "Tell me, what prompted you to get in contact with me at this particular time?"
Janet described her concerns about her relationship with her boyfriend.
Dr. Goldfried asked Janet about her recent past with other men and about her marriage. Janet told him about her other relationships in the 8 years since her marriage. She rarely stayed in a relationship for more than 7 or 8 months, by which time it would become too strained and stressful for her. During each of Janet's relationships, she was monogamous.
Toward the end of the session, Dr. Goldfried described what would happen in therapy. He told Janet that he would spend the first two sessions and part of the third session getting to know her as a person. He informed her that by the third session he would share with her what he thought.
He described the therapeutic alliance that they would seek to achieve, which was composed of three parts:
- a bond between the patient and the therapist, in which the patient must feel comfortable and assured that the therapist is in tune with the patient and that the therapist has the patient's interests at heart;
- establishment of goals for the therapy; and
- agreement about the means of therapy.
Dr. Goldfried asked Janet to fill out a biographical questionnaire and mail it back to him before their second session, and he requested that she complete the Beck Depression Inventory, which he also wanted her to mail back to him before their second session.
Dr. Goldfried saved the last 5 to 10 minutes to ask Janet whether she has any questions for him. She had a few questions about his background and training, which he answered. Finally, he asked Janet if she was interested in working with him. She answered yes.
Session 2: Dr. Goldfried used the information from the biographical questionnaire Janet mailed to him as a launching point for their second session. He asked her specific questions about things that stood out in her "history," such as her relationship with her father and mother, the death of her father, her previous marriage, and why she only went to college for 3 semesters. Janet told him about the financial situation after her father's death and being unable to afford to finish college. She told him about secretarial school and her work history as a highly successful legal secretary.
Session 3: In the third session, Janet and Dr. Goldfried explored in greater detail her relationships with men, focusing on Larry as the initial example and her marriage and two other 8-month relationships as further examples. Dr. Goldfried looked for themes and patterns of overlap in her experiences with men. A pattern of cycling monogamous relationships emerged.
Dr. Goldfried returned Janet to a discussion about her relationship with Larry. With a goal of slowing down the deterioration of her relationship with Larry, Dr. Goldfried suggested that he might want to have a session with Larry. Because Larry is supportive of Janet's being in therapy, Janet agreed that a meeting between Dr. Goldfried and Larry might be useful.
Dr. Goldfried then turned to a further discussion of the therapeutic alliance. He restated the need for the bond between Janet and him, a sense within her that he understands what they are discussing.
He explained that they would work to establish a priority of goals for the therapy. Janet clearly identified three goals (in order): her relationship with Larry, eventual resolution of her interpersonal problems at work, and a better long-term relationship with her mother, if possible.
Dr. Goldfried described the process of the therapy. He explained that Janet needed to learn how to tune into what she needs and to find a means of expressing those needs. She and Dr. Goldfried would attempt to achieve this through role-playing as an imaginary rehearsal of behavior in the hope of removing Janet's barriers. Dr. Goldfried described the various "risk-taking" scenarios that Janet would act out between sessions. Each role-play or risk-taking homework assignment would focus on one small step in Janet's hierarchy of fears, based on her readiness to do so.
Session 4: to be viewed.