PROBLEMS IN CONCEPTUALIZATION WITHIN COGNITIVE THERAPY - AN ILLUSTRATIVE CASE-STUDY

This paper discusses problems in case conceptualization in Cognitive T herapy, particularly in relation to the concept of a 'core belief'. It is argued that this concept is ill-defined and that its ambiguity can create problems for the clinician. Changes in core beliefs should be associated with the most therapeutic leverage, thus it becomes vital t o have reliable ways of identifying them. An illustrative case example is presented of the treatment of a young woman for depression. In our formulation, she held a number of self-referent beliefs which appeare d to be differentially responsive to challenge. For example, her doubt s about competence at work were much more easily modified than her bel ief that she was unattractive. This suggested that the latter belief w as more central of 'core' to our client's view of herself. This approa ch, together with the charting of how modification of beliefs was rela ted to the alleviation of depression, was taken in the current paper i n order to highlight the need for clinical tools to aid conceptualizat ion in distinguishing between core and peripheral processes. (C) 1997 John Wiley & Sons, Ltd.