The treatment rationale in cognitive behavioral therapy: Psychological mechanisms and clinical guidelines

Clinical experience and an accumulating body of research suggest that clien ts who enthusiastically buy into a cognitive-behavioral treatment (CBT) rat ionale show more favorable outcomes. But how should a therapist present and discuss a CBT rationale effectively? How does one respond to client concer ns and doubts? What are the psychological processes operating when discussi ng why a client is suffering and what to do about it? We suggest that the t reatment rationale is a considerably more subtle and complex process than h as previously been assumed. It involves generating expectations, negotiatin g control and assigning blame, and its function may vary depending on the s tage of treatment. We illustrate these points by considering common reactio ns to a CBT rationale and alternative therapist responses. We conclude that much closer attention should be paid to the treatment rationale in the con text of research and clinical practice.