Exploring The Life Story in CBT: A Prerequisite to Change?

Patients usually come to psychotherapy because they are having a difficult time in the present moment. This difficulty may seem to replay problems in previous relationships or work settings, but the issue that spurs them to seek therapy is something current. 

Knowledge of cognitive behavioral therapy (CBT) has entered the popular media, so people do not expect to spend years and years “on the couch” as it were. Gone are the days when someone would expect to start with his* earliest childhood memory and work interminably up to his adult self. 

With CBT, we explore the irrational beliefs that underlie patients’ actions and stay focused on the here-and-now situations that are the source of their problems and discomfort. However, I’ve become convinced that by only exploring these dysfunctional beliefs and behaviors, the patient may feel defective for having them in the first place. 

Now, after establishing rapport and hearing enough to understand the patient’s perception of the situation that is causing the current problems, I ask him* to tell me about himself as a child. I assure him that we will not be spending a whole lot of time in childhood and explain that I think it is essential to discover some of the factors in how he has come to be who he is now – that those factors in childhood are prologue to the adult self. 

Of course, the story the patient tells is HIS story—his perceptions of situations. It’s always been interesting to me that two siblings close in age and raised in the same family can tell such different stories. Researchers are exploring ‘narrative psychology’, literally the development of a life-story model of human identity (1,2). This approach has come naturally to me from my background in nursing, with its long tradition of qualitative research into “the lived experience” of participants (3). 

In the narrative told by the patient, we can see precisely how perceived life events interacted with this patient’s temperament traits to lead to the ideas and behaviors that are causing grief now. Then, we can validate that it is no wonder he adopted those ideas, but that he, as an adult, now can choose whether to continue to believe them or not. 

And then the real work of therapy can begin: the recognition of those beliefs in current situations and the work to refute them. 

As an example, years ago a young man came to therapy with the complaint that, although he liked his work and got good evaluations, he didn’t feel that he was part of the work group, and he had a hard time making friends. Everyone was friendly to him but no one asked him to join them when they went out after work. Young women he met seemed to like him but only as a “friend”, not in a romantic way. 

When he talked about his family, he described parents who rather explicitly taught him that the world is a dangerous place, people cannot be trusted, and that it is better to “stick with your own” rather than try to make friends outside the family. Having a rather compliant temperament (meaning he wasn’t inclined to go against the grain), he learned these “rules” well, and he realized he was somewhat standoffish with others. This tendency to keep others at arms length was playing a major factor in his social and work isolation. When he realized how he had come to believe (and act upon) these beliefs, he could begin to make changes. 

In the next blog, I will describe an action rather than a belief that stood in this young man’s way. 

References

1. McAdams, D. P.  (2006).  The redemptive self:  Stories Americans live by.  New York:  Oxford University Press.

2. Bering, J. What’s your story? The psychological science of life history research, Scientific American, May 5, 2009.

3. Hagemaster, JN. Life history: A qualitative method of research. J Adv Nurs. 1992 Sep;17(9):1122-8.

 *For convenience in this blog, the patient will be male.

Leslie Durr, PhD, RN, PMHCNS-BC is an advanced practice psychiatric-mental health nurse with a private psychotherapy practice in Charlottesville, Virginia.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.