An assessment of how patients idiosyncratically interpret various situations is part and parcel of the process of case conceptualization in cognitive therapy (Persons 1989). One such situation is therapy itself. Some patients expect that therapy will be an adversarial process, especially when they perceive their therapists to be from amore privileged socio-economic background. Here, they may perceive their therapists to be agents of the system who will continue to oppress them. Naturally, this viewpoint is laden with mistrust, and will need to be addressed in order for treatment to proceed in a collaborative and amicable fashion.

Another problematic belief about therapy to which some drug-abusing patients subscribe is that the process should always feel good. This belief ignores the fact that taking part in treatment is hard work, and often involves the discussion of emotionally painful issues. If this belief is unassessed and unaddressed, a patient may bolt from therapy at the first sign of discomfort, perhaps before a positive therapeutic alliance can even be established.

Yet another maladaptive cognitive stance that some patients adopt is that therapists cannot be of any help unless they have gone through the problem of substance abuse in their lives too. Therefore, instead of looking at their therapists as positive role models who have the personal and technical skills to help the patients with their problems, patients may discount the therapists' comments and reject their help because "they just don't understand."

Therapists need to be aware of some of these (and other) dysfunctional presuppositions that drug-abusing patients sometimes have about therapy and therapists. Towards that end, it is extremely useful in the first session for therapists to ask two series of question one during the early stages of the session and the other at the end of the session.

The first question is:

The second question is: