Cognitive Interpersonal Therapy The Basics

Core Beliefs Relationship Rules SelfOther Am I worthy? Am I capable? Am I willing? Are you trustworthy? Are accessible? Are you capable? Are you willing?

IWM’s: Relationship Rules Secure Attachment Self Dimension I’m worthy of love I’m capable of getting the love I need Other Dimension Others are willing and able to love me I can count on you to be there for me Avoidant Attachment Self Dimension I’m worthy of love (false pride) I’m capable of getting love I want and need (false sense of mastery) Other Dimension Others are incompetent Others are untrustworthy Ambivalent Attachment Self Dimension I am not worth of love (I feel flawed) I’m not able to get love I need without being angry or clingy Other Dimension Capable but unwilling (bc my flaws) May abandon me (bc my flaws) Fearful Attachment Self Dimension I’m not worthy of love I’m unable to get the love I need Other Dimension Others are unwilling Others are unable Others are abusive, I deserve it Other Self + _ + __

Attachment and Feelings Secure Attachment  Full range  Good control  Self-soothes  Shares feelings  Ok with others’ feelings  Capable of accurate empathy Avoidant Attachment  Restricted Range  Too much control  Uses things to soothe self, prone to addictions  Keeps feelings at a distance  Doesn’t share feelings  Restricted empathy Ambivalent Attachment  Full range  Poor control  Can’t self soothe  Shares Feelings too much  Overwhelms others with their feelings  Uses feelings instrumentally to gain proximity Disorganized Attachment  Full Range, but few positive feelings  Poor control  Can’t self-soothe  Can’t really share with others  Overwhelmed by others feelings  Dissociates when in face of strong emotion

Attachment and Intimacy Secure Attachment  Comfortable with closeness  Shares feelings and dreams  Willing to commit  Balances closeness and distance Avoidant Attachment  Not comfortable with closeness  Withholds feelings and dreams  Difficulty with commitment  Distances Ambivalent Attachment  Desires closeness, but never seems to have enough  Wants to merge with other  Preoccupied with abandonment  Clings and criticizes  Crisis  attachment Disorganized Attachment  Desires closeness, but fears and avoids it  Wants to merge, then wants to distance  Terrified of abandonment  Sabotages closeness  Attracted to people who victimize

Key Neurobiological Outcome of Secure Attachment The ability to Mentalize/Mindsight – When interacting with another person, you have the ability to monitor how you are feeling and how the other person is feeling – You know what you are trying to accomplish in the interaction – You can monitor how your behavior is affecting the other person – You can see how other person is affecting you

Secure vs Insecure Person 1 Person 2 Insecure Models are to new information. Person 1Person 2Security recognizes the transactional Nature of relationships

Attachment and Marriage We rely on secure base relationships in marriage Two roles in attachment relationship: – Secure-base use—(attachment) – Secure base provision—(caregiving)

The Secure Base Scripts Secure Base User (Attachment) – Signals distress – Seeks comfort – Experiences calm – Healthy confidence Secure Base Script

Secure Base Scripts Secure Base Provider (Caregiving) – Interest = availability – Awareness = Sensitivity, Concern – Empathy = Understanding, comfort – Responsiveness = Care, helpfulness

Why Cognitive Interpersonal Therapy? When couples therapy is contra-indicated Limitations of Couples Therapy – When one or both partners suffer from significant psychopathology—chronic depression and/or anxiety, addictions, plus Axis II problems (narcissistic, borderline, dependent, passive- aggressive, self-defeating features) – Difficulties with therapeutic alliance – Couple’s therapy only works when you start with commitment…you can’t work to commitment

CBT vs CIT CBTCIT TargetDepression, Anxiety Anger, Conflict GoalIncrease Self- Esteem Increase Intimacy EmotionReducedAccepted ResistanceSecondaryPrimary FocusSelf-BlameOther-Blame

CBT vs CIT CBTCIT Thoughts Rational vs Irrational Functional vs Dysfunctional Distortions ChallengedAccepted

Basic Process and Flow of Therapy Identify relationship dispute in a close relationship (e.g., spouse, parent, close friend) and link it to negative emotions (e.g., anger, anxiety, depression) Invitation— – ”Do you want me to help you with this relationship?”

Four Basic Phases Identification and Invitation Enhance Motivation and Commitment (Will Set) Skill Acquisition Phase (Skill Set) Skill Application and Follow-Through

Phase I Identification and Invitation Identification—linking emotional distress-- e.g., anxiety, depression, addiction—to Interpersonal Conflict Help client see connection between relationship conflict and ongoing symptoms Invitation— – “Would you like me to help you with this relationship?”

Phase II Enhance Motivation and Commitment These are all volitional commitments – The Price of Intimacy – Choosing from three options – Giving—up intimacy-incompatible attitudes and behaviors

The Price of Intimacy Burn’s definition of Intimacy – You willingness to endure the negative feelings you will get when you get close to another person

Three Options One: – Status Quo—continue trying to change the other person Two: – Leave the relationship Three: – Stay, but take 100% responsibility to change the way you deal with conflict

Giving-up Intimacy Incompatible Attitudes and Behaviors Giving-up Blame – Your right to punish another person when they hurt you Giving-up being Right – Your right to be viewed by the other person as being right

Dealing With Resistance Essential component of CIT Two Kinds of Resistance – Process – Outcome Key Principles: – don’t resist resistance – Go with it Using Paradoxical Cost-Benefit Analysis

Remember Do not progress to the next phase unless person is able to make all three commitments “I’d love to help you with this relationship, but unfortunately I don’t have any way to help without your commitment”

Phase Three Skill Acquistion Three Sets of Skills – Core Communication Skills – Getting a Situational Description – Completing Relationship Event Questionnaire

Core Communication Skills Quick Peek Empathy—Acknowledging and accepting how another person feels and why they feel that way Assertiveness—expressing your feelings, wants, needs Respect—being kind and valuing your relationship with other person

Empathy Inquiry Feeling empathy—what the other person is feeling Thought empathy—Why the other is feeling that way Disarming—seeing grain of truth in other person’s criticism

Two Laws The law of reciprocity—The Golden Rule The law of opposites

Assertiveness Expressing you feelings— – When you______________, I feel__________. – Expressing what you need/want – Expressing your own negative feelings about your own behavior—humility I’m really angry with myself for doing x. This is really painful to hear, but there is a lot of truth in what you are saying

Respect DO’s – Being Kind – Overtly valuing the relationship – Giving person benefit of doubt Don’t – Blame – Judge – Use sarcasm

Getting Situational Description Moving beyond global, transitional description Anchoring relationship events into an actual place and an actual time frame Identifying a slice of time: with a beginning, a middle, and an end. Block commentary/interpretations Identify hotspot in the conversation Move to Relationship Event Worksheet

Sample Narrative My husband doesn’t appreciate me. Nothing I do interests him. He cares more about his video games than me. He’s always had sort of an addictive personality…he gets totally absorbed in things…he doesn’t care about anyone but himself…I guess it’s just me. If I try to say something to him about how I feel he just goes off and starts putting me down. It’s useless for me to say anything to him about my feelings. They don’t matter to him.

Sample Narrative The other evening I decided to tell my husband my feelings about him spending so much time playing the video game. I told him that I felt he was addicted to the game and even told him there is research on how these games work like addictions. I also told him it was like he had a mistress and I couldn’t stand it anymore. He told me I was overreacting and that I blow everything out of proportion. I told him I was just trying to tell him my feelings. He told me I needed to get a life and walked off.

Relationship Event Worksheet Five Steps 1.What exactly did the other person say? 2.What exactly did you say? 3.How, exactly, did other person respond to your statement 4.Evaluate what you said in step 2. 1.Empathy? 2.Assertive? 3.Respectful? 5.Consequences: Did your response at 2 make things better or worse? Why? 6.Revise 2

Working Through Deal with Resistance Use various forms of role, especially reverse role play – Very strong neurobiological challenge to the prefrontal cortex – Increases mentalization— The ability to think about how you and other states of mind interact

Teaching Repair Process Healthy couples engage in repair process Instead of avoiding emotionally charged situations, approach them skillfully Use empathy proactively, especially disarming skills

Worksheet Step One: – He said, “you blow everything out of proportion.” Step two: – You said, “I’m just trying to tell you how I feel.” Step Three: – He said, “you just need to get a life.” Step Four.