Cognitive Therapy in Relationship Interpersonal Process in Cognitive Therapy Safran, Jeremy D., & Segal, Zindel V. New York: Basic Books, Inc., 1990. (294 pp.) $27.95 (hardback). The authors begin by expressing their dissatisfaction with what they refer to as traditional, pure forms of cognitive therapy (CT). Although they never explicitly state what they mean by traditional CT, it is clear from their critique that it is Beck's CT of depression which is the primary sounding board for their call for revision. Safran and Segal indicate that their intention is not to offer a new school of psychotherapy, but rather to stimulate a process of conceptual and therapeutic expansion within cognitive-behavioral forms of psychotherapy. In fact, they are very critical of the purer, more traditional forms of CT for downplaying the importance of the therapeutic relationship in the change process. They assert that this imbalance has a "seriously detrimental impact on practice" (p. 4). To readdress this oversight, Safran and Segal strongly advocate the recent trend toward psychotherapy integration, especially the integration of cognitive and interpersonal approaches. Thus the authors draw from a variety of psychotherapy approaches including psychodynamic, gestalt, client-centered and of course schema-based cognitive therapies to offer a psychotherapy perspective that considers the therapeutic relationship the critical mediating variable for change. The book is divided into two major sections. The first four chapters provide a critique of traditional CT and a rationale for adopting a more interpersonal perspective to therapy. Chapter two, in particular, is devoted to a critical analysis of traditional CT. Safran and Segal assert that traditional CT: (1) tends to downplay the importance of the therapeutic relationship, (2) adopts a limited view of emotion, (3) ignores important interpersonal and social aspects of psychological distress and suffering, (4) defers the patient's construction of reality to the therapist's definition of what constitutes irrational or dysfunctional thinking, and (5) emphasizes the more structured and technical aspects of therapy instead of important process-oriented and relational factors. Chapter three discusses the psychotherapy process research indicating that the quality of the therapeutic alliance accounts for much of the change seen in psychotherapy outcome studies. This then leads into chapter four which describes Safran and Segal's cognitive interpersonal model of human change. The theoretical model proposed draws heavily from Harry Stack Sullivan's interpersonal theory, Bowlby's attachment theory, D.N. Stern's theory of the self, and the more recent affect theories which view emotions as specific action dispositions. The central construct of this ognitive interpersonal model is the interpersonal schema. According to the authors, the interpersonal schema contains representations of both the self and others, and thereby functions to maintain our relatedness to others. A dysfunctional interpersonal schema will lead to cognitive-interpersonal cycles that tend to alienate the patient from others. This cognitive-interpersonal model, then, provides the conceptual framework for the therapeutic approach advanced in the next seven chapters. Chapters six, seven and eight discuss the central tenets of cognitive interpersonal therapy. According to Safran and Segal there are three main mechanisms of change in therapy. Chapters six and seven describe the processes of decentering and experiential disconfirmation. A necessary but not sufficient step toward change involves patients experiencing their own role in the construction of reality, a process Safran and Segal call decentering. It is essential that the cognitive therapist explore with patients their thoughts and feelings so they become aware of how they construct reality. Disconfirmation, on the other hand, involves the challenging and modification of dysfunctional beliefs about the self and others. …