Cognitive-Structural Psychotherapy: what is it and how is it used with patients?

This therapy proposed by Guidano and Liotti focuses on the interpretation we make of things.

Constructivism is an approach in psychotherapy that considers reality not as true or false, but as variable, and gives an active role to the individual in his or her own experience. Specifically, Cognitive-Structural Psychotherapy was born from this approach by Guidano and Liotti..

We are going to know the characteristics of this type of psychotherapy, which gives an essential role to the personal identity in the construction of the knowledge about ourselves and the world.

Constructivism

Cognitive-Structural Psychotherapy was created by Guidano and Liotti from the constructivist approach. Constructivist models were born in the 1980s.

This approach is based on the way in which people generate knowledge from their experiences.. It gives a proactive role to the individual in his or her own experience, and in creating unique meaning systems; thus, there are as many realities as there are people. In this way, it is not possible to affirm a valid knowledge (true or false), but a viable one.

According to this approach, knowledge is interpersonal, evolutionary and proactive.. It understands reality as a social construction of belief systems and of our "realities". On the other hand, it recovers the role of non-conscious or tacit processes.

On the other hand, constructivism understands the therapeutic relationship from expert to expert.

Cognitive-Structural Psychotherapy: characteristics

In Cognitive-Structural Psychotherapy, Guidano and Liotti consider the individual's cognitive system as a scientific theory that attempts to describe the world of the individual. a scientific theory that attempts to describe the world (creates models of reality) and to oneself (progressive self-knowledge creating a model of self). In this way, the knowledge that we have of ourselves also includes the knowledge that others have of us; the construction of our self includes others and the world (Guidano, 1991). Cognitive-Structural Psychotherapy relates problems to the lack of complexity of the cognitive system.

On the other hand, this type of psychotherapy gives special relevance to timing. gives special relevance to the therapeutic timingthat is, the moment in which the various techniques are used and when the different problems of the patient are addressed.

On the other hand, Guidano and Liotti used Bowlby's theory (1969) as a basis and starting point to establish the criteria for distinguishing cognitive organizations. According to the authors, the origin of individual differences is to be found in the different developmental itineraries, which make it possible to describe the structural aspects, cognitive, emotional, behavioral characteristics and strategic processes of each patient.

Levels of self-organization

Cognitive-Structural Psychotherapy establishes two levels of self-organization of knowledge. Personal identity is constituted as an intermediate structure that integrates the two levels. These levels are:

1. Tacit or deep.

These are knowledge integration frameworks derived from early attachment bonds (Bowlby). (Bowlby). In relation to Bowlby's attachment theory, we know that the child recognizes him/herself through the people around him/her. Of vital importance for Cognitive-Structural Psychotherapy are interpersonal relationships to create self-knowledge.

2. Explicit, superficial or structural

These are the beliefs about oneself, the valuation of one's own emotions and behaviors, the evaluation of situations, self-esteem, etc.the evaluation of situations, self-esteem, etc. This level is developed from language and involves the construction of models of representation of reality.

Dynamic balance

On the other hand, Cognitive-Structural Psychotherapy proposes the concept of dynamic equilibrium to allude to a dissipative self-organizing process, which encompasses two concepts: an evolution (progressive changes) and processes of maintenance of experience.

The therapy itself consists of overcoming developmental imbalances (discrepancies) and avoiding regressive change or stagnation.. To achieve this, two types of changes occur, which are not mutually exclusive:

1. Superficial changes

These are the first to appear. In general, it is not possible to move on to the second (deep) changes without achieving them. This type of changes generally involve alterations in the attitude towards reality, without strongly involving the attitude towards oneself.. They are generally sufficient to achieve most of the goals in therapy.

2. Profound changes

They appear later, starting from the attitude towards the self, that is, towards oneself. Profound changes are usually accompanied by a painful process, as the subject carries out important variations in the attitude towards the self.They are usually accompanied by a painful process, since the subject carries out important variations in his identity, in the attitudes and beliefs that he has always held about himself.

This type of change is not recommended unless the patient asks for it and voluntarily assumes its cost in all senses.

Processes in therapy

Thus, and in relation to the above, there are two types of processes (first and second level) in therapy:

1. first level processes.

Work is done at the level of tacit or deep organization, i.e., in the deep structures of tacit self-knowledge of the person; these, in turn, bidirectionally related to the person's attitude towards himself/herself, and the latter with two conceptsand the latter with two concepts: self-identity and self-esteem.

These two attitudes ultimately determine the patient's attitude towards reality. The attitude towards reality is formed by the rules of assimilation of experience (how we assimilate what we experience) and by problem-solving procedures.

2. Second level processes

These operate on the explicit structural levelThey are based on two types of models: models of the self (personal identity) and models of reality. The explicit structural level, in turn, acts on a par with the level processes, on self-identity, self-esteem and, in short, attitude towards reality.

Bibliographical references:

• Guidano, V. (1991). The Self in Process. Guilford Press. El Sí-Mismo en Proceso [The Self in Process, Paidós, 1994].
• Bas, F. (1992). Cognitive-behavioral therapies: a second critical review. Clínica y Salud, COP Madrid, 3(2).
• Moltedo, A. (2008). The Evolution of Vittorio Guidano's work and Model: Historical and Biographical Notes. Journal of Psychology, 17(1), 65 - 85.