Primary Assumption about Patient Psychopathology
The chronically depressed adult is perceptually disconnected from the environment so that his/her behavioral consequences cannot inform behavior. . The dilemma of the patient stems from a pervasive fear-avoidance predicament. Piagetian preoperational structural functioning in the social-interpersonal arena maintains the disorder and causes cognitive-emotional-behavioral patterns to remain on an immature level. CBASP is the only therapy model developed specifically for the treatment of chronic depression.

Etiology of Psychopathology
Developmental maltreatment and trauma derails/retards normal cognitive-emotional development in the social-interpersonal arena in the early-onset patient. The early-onset patient moves into adulthood functioning in a preoperational manner. An out-of-control mood state in the late-onset patient (23% of all late-onset Major Depression cases do not recover regardless of the treatment administered) undermines normal cognitive-emotional functioning, and the individual returns to a preoperational structural level of perceiving and relating to the world. CBASP therapy has effectively treated both early- and late-onset types of chronic depression.

Goals of CBASP Psychotherapy

The first goal is the establishment of dyadic safety in the therapy relationship.  The second goal is to establish a perceptual connection between the patient’s behavior and the consequences that are produced.  It is strongly recommended that all patients who begin CBASP therapy also begin a regime of antidepressant medication. In psychotherapy, patients are taught that their interpersonal behavior has specific consequences and in learning to recognize what these consequences are, patients become perceptually connected/reconnected to their environment. Perceptual connectedness means that the person becomes accessible to formative feedback from the environment (others). This goal is accomplished through a technique known as Situational Analysis (SA). In SA, the therapist directs the patient’s attention (1) to the effect his/her behavior is having upon others and (2) teaches the individual how his/her interpersonal behavior is affecting the therapist. These procedures are carried out in a systematic manner throughout treatment. A second goal is to help the patient generate empathic behavior with the therapist and others. (3) A third major goal is to heal the interpersonal trauma patients bring to treatment. Again, this is done systematically and repeatedly across therapy sessions. The Interpersonal Discrimination Exercise (IDE) shows patients how the therapist differs in comparative ways to maltreating significant others in the individual’s life. Finally (4), Contingent Personal Responsivity (CPR) is administered by the clinician to modify in-session inappropriate behavior.

Using Interpersonal Transference Hypotheses in CBASP
The interpersonal healing process is addressed proactively by the construction of one transference hypothesis following the second session. During session 2, an extensive personal history is obtained of the patient’s relationships with significant others. Usually, one transference hypothesis is constructed to reflect the one salient and destructive interpersonal theme which has been gleaned from the significant other history. In subsequent sessions, this hypothesis becomes the focus and interpersonal subject matter of the IDE. Four interpersonal domains may be targeted for the transference hypothesis as they reflect common interpersonal experiences encountered in the psychotherapy experience: (1) intimacy moments between the therapist and patient; (2) moments when the patient expresses felt emotional need or discloses highly personal material; (3) occasions when the patient makes a mistake or commits some observable error; (4) in-session moments when the patient experiences and discloses either verbally or nonverbally some negative affect toward the therapist (e.g. frustration, anger, shame, guilt, sexual affect if it carries a negative connotation, etc.). The IDE is used proactively whenever the patient-therapist encounter moves into the targeted “hot spot” transference area. The therapist assists the patient to compare and contrast his/her reactions to the patient in the targeted interpersonal domain with those of maltreating significant others. Once the discrimination is made explicit, patients are then taught how to function in the new interpersonal reality existing between himself/herself and the clinician.
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