Another problem deriving from the misapplication of cognitive therapy techniques occurs when the therapist uses a particular technique inflexibly. It is often necessary for the therapist to try out several behavioral or cognitive techniques before finding an approach to which a patient responds well. The cognitive therapist must stay with a particular technique for a while to see whether it works, but he or she must also be willing to try an alternative technique when it becomes apparent that the patient is not improving. To give a specific example, behavioral homework assignments are sometimes more helpful with particular patients, even though the therapist has every rea- son to predict in advance that cognitive assign- ments will be more effective.
In some instances in which it appears that lit- tle progress is being made in therapy, it turns out that the therapist has selected a tangential problem. The cognitive therapist should be alert to this possibility, especially during the early stages of therapy. When there appears to be little or no significant change in depression level, even when the patient seems to have made considerable progress in a problem area, the therapist should consider the possibility that the most distressing problem has not yet been uncovered. A typical example of this kind of difficulty is the patient who presents diffi- culty at work as the major problem, when it turns out that couple problems are contribut- ing significantly to the work difficulties. The real issue may be withheld by the patient be- cause it seems too threatening.
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