Let’s resume 2020 with a new cycle of articles that will allow us to always be updated and to discover how the Single Session Therapy method can be applied in different ways and areas of intervention.
What is today’s article about?
Through the description of a clinical case we will illustrate how a serious symptom such as that of obsessive thoughts can be interrupted through a single meeting of cognitive therapy associated with religious faith (Gangdev, 1998).
Now you may be wondering what religious faith has to do with psychotherapy?
Psychology has devoted several studies to the interaction between religion and psychology. Lasure and Mikulas (1996) , for example, cite several examples of how behavior can change from the Bible; De Silva (1984; 1985) has highlighted the parallel between Buddhism and the modern practice of cognitive and behavioral transformation. Shamasundara (1995) has pointed out that Indian mythology can be useful in therapy. Furthermore, despite initial doubts about the applicability of Rational Emotive Therapy (RET) to religious patients (Wessler, 1994; Ellis, 1994), Christian RET has recently been developed(Johnson, 1992; 1993), and Beck ‘s own cognitive therapy has been used to treat Christian patients.
A 25-year-old married woman went to the psychotherapist because for three months she had persistent doubts about the fact that she had hit a pedestrian while driving (so much so that she had to go back to check) and about the fact that a girl with whom she had casually spoken could tell the police that she had been molested, leading to fears of being arrested for sexual abuse and giving up her unborn child. The woman also presented with insomnia, poor concentration and lack of motivation even though she denied having somatic symptoms, anhedonia and diurnal variation of her mood upon waking in the morning.
Following an initial evaluation, Temazepam was prescribed for insomnia, but with no improvement.
A few months before the call for help, she had resigned from her job because she had developed another lingering doubt related to the idea of being accused of theft by her employer. There had been no previous psychiatric or drug history in her life.
Since she and her husband were unable to conceive a child, she left him. However, she later became pregnant and they reconciled.
The woman had a tendency to check the locks several times and had returned from work on occasion to make sure the doors were locked.
Examination revealed an extremely tense woman who admitted to being haunted by doubts: the haunting of being accused of sexual abuse was much, much more frequent than the other doubt, but she could not tell how long it had been for these hauntings to emerge. Her mood was sad and she was anxious, but her perception and cognition were unaffected.
She was diagnosed with Obsessive-Compulsive Disorder (OCD) with a secondary depression, as the woman reported having mood swings due to her doubts.
Since she had become pregnant, she only wanted to be treated with psychotherapy as she did not want to expose her unborn child to drugs. After a brief discussion on the principles of CT, the session was conducted the following day: after identifying and discussing her cognitive biases (thought = action, arbitrary inference), she was advised to stop thinking, using a rubber band and pictures to relax and focus on positive thoughts.
Three days after the session the woman reported that she felt better, sleep and appetite had also returned to normal.
Her motivation had greatly improved, but she hadn’t used the rubber band technique. She claimed to have made a full recovery after accepting her mother’s explanation that she had told her that since she had lost faith in Christ, Satan had created doubts about her in her mind. Only if she returned to Christ would Satan be defeated and doubts cease to arise.
Then he began to fight the obsessions by stating to himself “No. Christ will help me drive safely!” “No. Christ will never let me do anything wrong!”
She immediately felt relaxed and made a complete recovery. Occasionally, her doubts returned, but they didn’t make her anxious.
Four months later, her GP informed the psychotherapist that shortly after the referral the patient had made a full recovery, was well, and her pregnancy had progressed uneventfully.
What type of intervention has been proposed through Cognitive Therapy?
From the analysis of the case it can be deduced that Cognitive Therapy techniques used for the treatment of OCD were proposed to the woman . The latter include:
- the stimulation of obsessive thoughts
- thought block
- the challenge of negative automatic thoughts (NAT).
What did the patient choose to do instead?
She did not use thought stopping to address her problem, but simply replaced her negative automatic thoughts (NAT) with positive automatic thoughts (PAT) . For this step to be effective, a strong belief must be at the basis of an automatic positive thought : without belief, thoughts would have no impact.
In TSS, for example, identifying and using the patient’s resources and strengths is of paramount importance , rather than teaching new ways of living (Hoyt & Talmon, 2014a) or specific techniques. The assumption is that people already possess resources, strengths, and coping strategies that can help them overcome many of the challenges they encounter in life (Bohart & Tallman, 2010, 1999), and religious beliefs are one of these.
This case highlights two important aspects capable of making an intervention rapid and effective at the same time: the first concerns the way in which religious beliefs can influence the outcome of the therapy ; the second , on the other hand, underlines how to induce changes in patients’ cognition and behavior it is not always necessary to challenge the patient’s beliefs . The latter if used in therapy can represent a fundamental resource for change .
Team Psychotherapist of the Italian Center
for Single Session Therapy
Cannistrà, F., & Piccirilli, F. (2018). Single-session therapy: Principles and practices . Florence: Giunti Editore.
Bohart AC, Tallman K. (2010), «Clients: The neglected common factor in psychotherapy». In BL Dubcan SD Miller BE Wampold MA Hubble (eds.), The heart soul of change. Delivery wath works in therapy (2nd ed.) , American Psychological Association, Washington, pp. 83 -112.
DeSilva, P. (1984). Buddhism and behavior modification. Behavior Therapy and Research , 22667-678.
DeSilva, P. (1985). Early Buddhist and modern behavior modification strategies for the control of unwanted intrusive cognitions. Psychological Record , 35:437443.
Ellis, A. (1994). Rational-emotional therapy (RET) and pastoral counseling: a reply to Richard Wesaler. Personnel and Guidance Journal , 62:266-267.
Gangdev, P.S. (1998). Faith-assisted cognitive therapy of obsessive-compulsive disorder. Australian and New Zealand Journal of Psychiatry , 32575578.
Hoyt M. F, Talmon M. (2014a) (eds.), Capturing the moment. Singel Session Therapy and walk-in services , Crown House, Bancyfelin.
Lasure, LC, Mikulas, WL (1996). Biblical behavior modification. Behavior Therapy and Research , 34563-566.
Johnson, W.B. (1992). Rational-emotional therapy and religiousness: a review. Journal of Rational-Emotive und Cognitive-Behuviour Therapy , l0:21-35.
Johnson, WB (1993). Christian rational emotional therapy: a treatment protocol. Journal of Psychology and Christianity , I2:254-26 1.
Shamasundara, C. (1995). Therapeutic wisdom in Indian mythology. American Journal of Psychotherapy Research , 47:443450.
Wessler, R. L. (1994). A Bridge Too far: incompatibilities of rational emotional therapy and pastoral counselling. Personnel and Guidance Journal , 62:264-266.