Two people sit in a room. One, the client, in pain, seeks relief. The other, the therapist, wants to help. If the therapist believes that the client’s distress is partially or wholly related to their dysfunctional thinking (and what that is we’ll save for another time) then cognitive therapy is very much in order.

One of the central challenges however in setting up the treatment plan (and one of the main reasons that cognitive therapists run into trouble) is determining whose dysfunctional thinking needs to be included in treatment. We tend to assume that the client’s thoughts and cognitive processes are his own, as though he alone arrived at whatever dead-end conclusion. Yet, we all are influenced by the cognitive milieu, which by its perceived enormity, compels us to think in dead-end ways. My sociologist friends call this social contagion. My economist friends call it herd mentality. My political scientist friends call it conformity. When we try to help our miserable client think in new ways, we need to take into consideration his social environment. It can be very lonely, for example, to think in grey terms when your social environment indoctrinates to black and white thinking. That is why as cognitive therapists, we must not only guide, we must also use our care and friendship to support our clients as they find their way.