Personality disorders involve abnormal functioning of the person that significantly interferes with all areas of his life. Addressing them is a complex issue, and currently there are few validated therapies specifically for each disorder.
Still, there are a large number of psychological therapies of different orientations that address personality disorders. Here we will know one of them, the Cognitive-Interpersonal Therapy of Jeremy Safran and Zindel Segal (TCI) .
We will learn what elements are part of the TCI and how to promote changes in the person to increase their quality of life.
Cognitive-interpersonal therapy by Safran and Segal: characteristics
Cognitive-interpersonal therapy by Safran and Segal (1990) is a cognitive therapy that also integrates the interpersonal tradition initiated by Sullivan in 1953.
In it an essential role is given to interpersonal aspects and to the therapeutic alliance in order to achieve the objectives of the psychological intervention. Although initially therapy was not specifically designed for personality disorders, it is currently a type of disorder that it addresses.
Safran and Segal’s Cognitive-Interpersonal Therapy (TCI) emphasizes the role of the therapeutic bond between therapist and patient, as well as the nature of the relationship between cognitive and interpersonal processes. As for the role of the therapist, this is not objective and neutral, but rather the therapist is understood as a human being with difficulties and strengths , which will interact with the patient’s problems and weaknesses. This is the constructivist epistemology.
On the other hand, TCI is based on an approach that promotes phenomenological exploration rather than interpretation.
In Safran and Segal’s Cognitive-Interpersonal Therapy three specific change mechanisms are used, responsible for the development of a new experience for the patient, which will involve “experiencing oneself and others” in new ways. These three mechanisms are:
It is about experiencing one’s role in the construction of reality.
2. Experiential disbelief
It consists of challenging dysfunctional beliefs about the self and others from new experiences.
3. Access to information on action provisions
It involves discovering aspects of one’s own existence or inner life, of which one was previously unaware.
The aim of the three mechanisms is not so much the understanding or rational analysis of reality, but ways of finding new ways of experiencing it , also in relation to oneself and to others.
The therapeutic relationship
As mentioned above, the therapeutic relationship is a central element in Safran and Segal’s cognitive-interpersonal therapy. All changes arising from the three mechanisms will be mediated by this relationship.
So, for example, let’s think of a patient with the obsession that everyone criticizes him. If the therapist tries to challenge such a belief in a critical way, he will reinforce the patient’s idea by acting as he thinks everyone does (against him) .
Theoretical models of therapy
Safran and Segal’s cognitive-interpersonal therapy starts from an interpersonal and cognitive approach.
It is interpersonal because it starts from the basic premise that human beings are by nature interpersonal and social beings , and that this has important implications for the development of the person, problems and psychotherapy.
On the other hand, it is a cognitive therapy because it emphasizes how people construct mental representations of what they are living, that is, of their experience.
In psychotherapy it is known that an adequate theoretical model together with an adequate application of its specific techniques, are essential elements to produce and understand the therapeutic change.
TCI structure: sessions
Another of the fundamental ideas of Safran and Segal’s cognitive-interpersonal therapy is that the cognitive processes that are separated from the affective experiences with which they were intertwined do not completely represent the patients’ experiences. That is, if cognition and emotion are separated, the patient’s experience will be neither complete nor real.
To address this, in the first sessions of the therapy (sessions 1-3) a mediated emotional exploration will be carried out, followed by cognitive-interpersonal restructuring (CIR) (in sessions 4-6). This ICR will focus on the patient’s dysfunctional ideas and on the maladaptive patterns of relationship. This is the core of Safran and Segal’s cognitive-interpersonal therapy.
In the following sessions (7-9), the aim will be to promote the generalisation of changes outside the consultation and in all areas of the patient’s life. In addition, it is logically sought that the changes last over time. All this will be done by exploring the patient’s interpersonal events (outside the consultation), as well as by elaborating and assigning behavioural experiments between sessions .
The last session (10) will focus on recapitulating the therapeutic process, providing relapse prevention strategies and closing the intervention.
Despite being a strong model in terms of its well-defined theoretical model, research has not currently demonstrated sufficient empirical support for ICT, or at least not that required in evidence-based clinical psychology.
Even so, there are different studies that support its effectiveness in the general clinical population (with some clinical disorder) and in personality disorders.
- Safran, J.D., & Segal, Z.V. (1990). Interpersonal process in cognitive therapy. New York: Basic Books
- Prado-Abril, J., García-Campayo, J., Sánchez-Reales, S. (2013). Functioning of cognitive-interpersonal therapy in personality disorders: a study of two cases. Journal of Psychopathology and Clinical Psychology, 18(2), 139-149.