Abstract

The current lecture will seek to address the theme of The IIIrd Congress of Cognitive Behavioral Psychotherapies, Living with Uncertainty, using the early-onset chronically depressed patient as the example of a person living with uncertainty. The early-onset Persistent Depressed Disorder (PDD) patient presents an appropriate pathological example of one who perpetually lives out a lifestyle of existential uncertainty. The dilemma derives from an etiological developmental history of maltreatment which has inhibited maturational growth in the cognitive and emotional areas; it has left the individual functioning in a preoperational manner [1-9]. These cognitive and emotive limitations make the person a difficult candidate for therapy unless psychotherapists begin treatment cognizant of the patient’s maturational problems. CBASP is an interpersonal model of treatment designed specifically to address the idiosyncratic immature problems of the chronic patient. Patients begin therapy dominated by a fear-avoidant lifestyle which has separated them perceptually from any informing input from the interpersonal environment. Their isolation stems from toxic early experiences learned while living with maltreating caregivers.

Several CBASP treatment techniques such as the Significant Other History, the Interpersonal Discrimination Exercise, Situational Analysis, and the therapist’s role of Disciplined Personal Involvement will be described to show how they address the uncertainty problems of the patient. Patients who are unable to control their emotions and who are perceptually disconnected from the environment face uncertainty at every turn. Their modal interpersonal styles of rigid detachment, withdrawal, and submission further potentiate felt isolation. These stylistic interpersonal patterns make the patient unable to compete effectively on any level with their peers-in the family, at work, or in social areas. The good news is that these immature individuals may maturate over the process of treatment and achieve formal operational thought as well as learn effective assertive behavior.