In a previous post, I suggested that the breadth of cognitive treatment depends on the severity and chronicity of the disorder. In other words, the worse the disorder and the longer it’s influence on functioning the ‘more’ treatment required.
That seems straightforward, right?
It is but it needs to be broken down so that we understand three dimensions:
What is meant by severity.
What is meant by chronic.
What is the difference between ‘more cognitive therapy’ and ‘less cognitive therapy’. In other words, we want to understand how cognitive therapy alleviates the conditions that it aims to treat.
Let’s start with severity. As a convenient place let’s consider the global assessment of functioning of the DSM (you can see it here). The authors of the DSM direct us to consider the occupational, social, and psychological impact of the disorder in determining severity. This seems to be an eminently practical method (until one considers the ideological underpinnings of this approach but that’s for another time).
As a cognitive therapist however I find social functioning to be the most relevant for the simple reason that one’s ability to be part of a social fabric is a far more important indicator of health than occupational and psychological abilities. As I’ve stated in previous posts, psychological health and illness is far more influenced by our social connectedness than the neurotransmitters floating around our brains or the autonomous ideas held in our heads.
From this point of view, my work with clients is oriented towards this social connectedness above all else. From my experience, when people are more connected to others who positively influence their activities, ideas, and feelings they easily shed the dysfunctions of illness. And when their social connectedness is so sparse that they are allowed to ‘marinate’ in their own darkness they just get worse and worse.
To be continued.