Re: Beck Meets Freud? (Cape Cod, July, 2005)
On a semi-related note -- has anyone from the cognitive/CBT "world" studied the possible use of the Thematic Apperception Test in identifiying automatic thoughts and/or intermediate and core beliefs? I would envision administering the assessment along the same lines as a psychodynamic therapist (i.e. show the patient a card and ask him or her to concoct and tell a story based on the picture); the difference would be in interpretation. Instead of viewing the exercise as projective, the results could be analyzed for patterns which may indicate pervasive cognitive distortions. This would tend to sidestep collaboration, of course, so it wouldn't be an assessment of choice, but perhaps it could be useful for difficult cases in which the patient shows a lack of ability to identify their automatic thoughts. (Who knows, it could help people for whom CT is otherwise contraindicated due to lack of "psychological-mindedness". Also might help jumpstart stalled treatments in which therapist and patient are having a difficult time identifying intermediate and core beliefs.)
A mini-example: After several sessions, Jerry, a patient suffering from depression, seems to understand the cognitive model and tries hard to identify his automatic thoughts in various situations. He's unsuccessful, however, and attempts by the therapist to work with "hot cognitions" in the course of the session have also failed. Both Jerry and his therapist are growing frustrated with these attempts, so the therapist shifts gears and teaches some behavioral techniques for dealing with stress and frustration. Toward the end of the session, she administers a few cards from the TAT. The following week, she continues to work on behavioral techniques and administers several more TAT cards. After analyzing the stories Jerry created for each of the cards, the therapist realizes that 4 of the 6 stories Jerry created were about situations in which the "main character" felt incompetent. During the following session, she talks with Jerry about her perception and they consider the possibility of automatic thoughts revolving around incompetence, failure, etc. (Perhaps they even discuss what impact this might have on Jerry's ability to accurately recognize and record his automatic thoughts.)
What do you all think? Sound crazy? Plausible?
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