Personality disorders involve abnormal functioning of the person which significantly interferes in all areas of their life. Its approach is a complex one, and there are currently few validated therapies specifically for each disorder.
However, there are a large number of psychological therapies of different orientations which treat personality disorders. Here we will meet one of them, Cognitive-interpersonal therapy by Jeremy Safran and Zindel Segal (TCI).
We will find out what elements are part of ICT and how changes can be promoted in the person to improve their quality of life.
Safran and Segal cognitive-interpersonal therapy: characteristics
Safran i Segal’s Cognitive-Interpersonal Therapy (1990) is cognitive therapy that also incorporates the interpersonal tradition that Sullivan began in 1953.
in an essential role is given to the interpersonal aspects and the therapeutic alliance to achieve the goals of psychological intervention. Although therapy was not initially designed specifically for personality disorders, it is currently a type of disorder it addresses.
Safran i Segal Cognitive-Interpersonal Therapy (TCI) emphasizes the role of the therapeutic link between therapist and patient, as well as the nature of the relationship between cognitive and interpersonal processes. As for the role of the therapist, it is not objective and neutral, but the therapist he is understood as a human being with difficulties and strengths, Which will interact with the patient’s problems and weaknesses. It is a constructivist epistemology.
On the other hand, TCI is based on an approach that favors phenomenological exploration rather than interpretation.
Mechanisms of change
In the cognitive-interpersonal therapy of Safran and Segal three specific change mechanisms are used, Responsible for developing a new experience for the patient, which will involve “living oneself and others” in new ways. These three mechanisms are:
It is about experiencing your own role in the construction of reality.
2. Experiential denial
consists of refute dysfunctional beliefs about oneself and others new experiences.
3. Access to information on the measures to be taken
It is about discovering aspects of one’s own existence or inner life that were previously unknown.
The end of the three mechanisms is not so much the understanding or rational analysis of reality, but ways to find new ways to experience, Also in relation to oneself and to others.
The therapeutic relationship
As discussed, the therapeutic relationship is a central element of the cognitive-interpersonal therapy of Safran and Segal. All changes arising from the three mechanisms will be driven by this relationship.
So, for example, we think of a patient with the obsession that everyone criticizes him. If the therapist tries to question such a belief critically, reinforce the patient’s idea by acting the way he thinks they all do (against him).
Theoretical models of therapy
Safran and Segal’s cognitive-interpersonal therapy is part of an interpersonal and cognitive approach.
It is interpersonal because it starts from the basic principle that human beings by nature are interpersonal and social beings, And that this has important implications for the person’s development, problems and psychotherapy.
On the other hand, it is cognitive therapy because it emphasizes how people construct mental representations of what they are going through, that is, their experience.
In psychotherapy, it is known that an appropriate theoretical model associated with a correct application of its specific techniques are essential elements to produce and understand therapeutic change.
Structure of the TCI: sessions
Another of the fundamental ideas of the cognitive-interpersonal therapy of Safran and Segal is that cognitive processes that separate from the emotional experiences with which they were linked they do not fully represent the experiences of patients. In other words, if cognition and emotion separate, the patient experience will be neither complete nor real.
To solve this problem, during the first therapy sessions (sessions 1 to 3) will be carried out mediated emotional exploration, To subsequently perform cognitive-interpersonal restructuring (RCI) (in sessions 4-6). This RCI will focus on the patient’s dysfunctional ideas and inappropriate relationship models. It is the heart of the cognitive-interpersonal therapy of Safran and Segal.
In the following sessions (7-9), the aim will be to promote the generalization of changes outside the consultation and in all areas of the patient’s life. In addition, we logically try to make the changes last over time. All this will be done through the exploration of the interpersonal events of the patient (external to the consultation), as well as with the development and assignment of behavioral experiences between sessions.
The final session (10) will focus on recapitulating the therapeutic process, providing relapse prevention strategies and closing the intervention.
Although this is a strong model in terms of a well-defined theoretical model, current research has not demonstrated sufficient empirical support for ICT, or at least not that required in evidence-based clinical psychology.
However, there are different studies that support its effectiveness in the general clinical population (with certain clinical disorders) and in personality disorders.
- Safran, JD and Segal, ZV (1990). Interpersonal process in cognitive therapy. New York: Basic Books
- Prat-Abril, J., García-Campayo, J., Sánchez-Reales, S. (2013). How cognitive-interpersonal therapy works in personality disorders: a study of two cases. Journal of Psychopathology and Clinical Psychology, 18 (2), 139-149.