In the Field: Cognitive Therapy in Italy: The Debate on the Therapist-Client Relationship

Abstract

In Italy preparation is now under way on three volumes of works by cognitive therapists on the therapist-client relationship.1 This small-scale explosion in the publishing world is also reflected in the increasing number of cognitive therapists who participate in seminars, meetings and round tables on the subject of the therapist-client relationship. I believe the explanation for this lies in the fact that although theoretical views on clinical cogitivism are extremely varied, there exist a number of fundamental assumptions concerning trends in research and cultural influences which are shared by the great majority of cognitive psychotherapists. One of these assumptions is the belief in schema-theory as an explanation for individual conduct, linked to the idea that the schemas which most influence the emotional life of the individual are interpersonal schemata, as described in the recent work of Safran and Segal (1991). From these premises we may conclude that during the course of significant interpersonal relationships the main schemas of clinical interest are activated and modified. The therapist-client relationship can therefore be considered not only an excellent point of view from which to survey the patient's most important schemas in action, but also a powerful tool to modify some of these schemas or their overall structural arrangement. These authors have in various ways emphasized the following three aspects of the therapist-client relationship: its role as an instrument of investigation, an instrument of change in special schemas, and an instrument of change in the overall cognitive structure. Liotti (1991), for example, has suggested that the attachment theory (Bowlby, 1969) be regarded as an excellent way to understand the nature of the patient's interpersonal schemas, and the problems that this brings about in the relationship with the therapist. This way of thinking is derived from a simple syllogism: In situations where a need for help is felt, an appeal is made to a psychotherapist and, moreover, when a plea for help is made, it has the effect of activating attachment models. When a patient begins therapy his or her attachment models will thus be activated, and these will be applied first and foremost to the very person to whom the patient has turned for help, that is, to the psychotherapist. An interesting corollary of this hypothesis suggests that the therapist-patient relationship offers an invaluable opportunity for the patient to retreat to a critical distance from his or her interpersonal schemas. Authors such as Castelli, Gattinara, Isola, Morganti, and Pallini (1990) have in fact pointed out the "corrective" value of direct experience in the relationship. As Jacobson (1989) has already pointed out in the review, the authors mentioned above also maintain that this direct experience with the therapist can modify some of the patient's fundamental beliefs regarding himself and his relationship with others. One of the most interesting technical consequences of this arrangement is the great importance attached to the nonverbal aspects of communication with the therapist, and the implicit messages contained in his attitude during the relationship (Castelli et al., 1990). Semerari's (1991) recent work stresses not so much the modification of individual schemas as the structural changes attributable to the therapist-patient relationship. He reiterates a concept already expressed by Weiss and Sampson (1986) when he maintains that the application of the patient's interpersonal schemas to the therapist consist functionally of tests designed to check the trustworthiness and reliability of the therapist in the therapist-patient relationship. If we examine this pattern we see that the mechanism which alters the overall structure of the subject is the following: As the therapist gradually passes these tests, (s)he becomes such a reliable source of information that (s)he can influence the image the subject has of himself/herself. …