The therapist should assume neither that the patient is highly motivated for treatment nor that he or she is resistant and hostile. The best way to obtain valid data and at the same time demonstrate that the therapist cares to understand how the patient feels is to ask the patient directly about his or her experience of coming to the therapist's office.
Such questions can involve asking about
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the patient's doubts and concerns,
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as well as expectations, goals, and hopes for therapy.
If the patient expresses misgivings about being in treatment, these negative reactions can be addressed on the spot, thus reducing the risk of early dropout. At the same time, the therapist can utilize this interaction to begin to teach the patient the cognitive therapy model.
For example, a patient who expects to be disrespected by the therapist may harbor feelings of anger. By contrast, if the patient expects to be helped, he or she may feel a sense of relief and have a high degree of motivation. This example begins to demonstrate one of the central tenets of cognitive therapy, namely, that the patient's thoughts will influence his or her feelings, intentions, and actions.
