Negative Opinion

THERAPIST: When you said that you thought I would have a negative opinion about you and not want to work with you because you said you felt angry at your husband, it sounded as though you were really con- cerned that you would be harshly judged and punished for your statements.

DENISE: Yes, that’s right.

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THERAPIST: I don’t want to make too much out of this at the moment, but you also said that

after your friends had moved, you felt angry at them and judgmental of their decision. Even though you knew that each set of friends had to move for specific financial or health reasons and they had been in the pro- cess of completing their moves over several years, part of you still felt very angry with them. You mentioned that you strongly be- lieve that friends should be there for each other, especially in times of great need, and if a friend lets another friend down, that rela- tionship should end. Is that right?

DENISE: Right.

THERAPIST: So here, you largely have with- drawn from these important relationships and now you’re feeling quite lonely. The thought of talking to these friends again brings fears that they will now be angry and punitive with you for your reaction to them. You’re caught in a no-win situation. Is that right?

DENISE: Yes, that sounds right.

THERAPIST: So one of the things that can really grab hold of you—and make you feel terrible—is this notion that people, including yourself, should behave in specific ways, and if they or you don’t behave the “right” way, then harsh punishment should result. Is that correct?

DENISE: Yes, that sounds right. But hearing you say it makes me realize that it doesn’t really sound right.

THERAPIST: What do you mean?

DENISE: It’s too extreme. It’s too harsh. People are human and they have limitations and they make mistakes sometimes.

THERAPIST: It’s good that you are starting to notice and evaluate these thoughts rather than just responding to them automatically. What this tells us is that you have to be alert for whenever you have the sense that either you or others should be strongly punished for not behaving in a specified way. The idea that people should not be cut a break, even under very difficult circumstances, may not work very well in real life with real people. You mentioned that both friends told you they felt terrible about leaving you at this time, and both have called you regularly since leaving the area. Do you think that if you begin to respond to and return their calls, they might react differently—in the

same way that I reacted differently from what you expected?

DENISE: Yes, that is very likely.

About halfway through the session, the ther- apist asked the patient for feedback thus far:

THERAPIST: Now at this point, is there anything that we have discussed today that bothered you?

DENISE: That bothered me?


DENISE: I feel like I’m a bit of a freak.

THERAPIST: That is important. Can you . . .

DENISE: Well, I’m trying not to feel that way, but I do.

THERAPIST: Well, if you are, you are. Why don’t you just let yourself feel like a freak and tell me about it?

DENISE: Well, I’m feeling like I’m just so differ- ent from everyone else. Other people don’t seem to have my problems. They’re still hap- pily married and carrying on with life. I just feel so different from everyone.

This comment led to identification of a third theme, the social isolation/alienation schema. Denise had been viewing herself as increasingly different for the past couple of years. By this point, however, she was beginning to catch on to the idea of answering her thoughts more ra- tionally. After the therapist pointed out the negative thought in the preceding excerpt, the patient volunteered:

DENISE: I know what to do with the thought “I’m a freak.”

THERAPIST: What are you going to do with it right this minute?

DENISE: I am going to say to myself, “I’m not so different from other people. Other people have lost their mates. I’m not the only one. I’m just the first one in my group of friends. Eventually, they will all have the same situa- tion as me. It’s just a part of life.” Seeing you for help doesn’t mean I’m a freak. You prob- ably see lots of people and help them with problems like mine.


The same automatic thoughts arose later in the session, when Denise noticed the therapist’s wedding ring. In the extended excerpt below, the therapist helped her set up an experiment to test the thought “I’m so different from him.”

THERAPIST: OK, now let’s just do an experi- ment and see if you yourself can respond to the automatic thought, and let’s see what happens to your feeling. See if responding ra- tionally makes you feel worse or better.