The treatment rationale in cognitive behavioral therapy: Psychological mechanisms and clinical guidelines

Clinical experience and an accumulating body of research suggest that clients who enthusiastically buy into a cognitive-behavioral treatment (CBT) rationale show more favorable outcomes. But how should a therapist present and discuss a CBT rationale effectively? How does one respond to client concerns and doubts? What are the psychological processes operating when discussing why a client is suffering and what to do about it? We suggest that the treatment rationale is a considerably more subtle and complex process than has previously been assumed. It involves generating expectations, negotiating control and assigning blame, and its function may vary depending on the stage of treatment. We illustrate these points by considering common reactions to a CBT rationale and alternative therapist responses. We conclude that much closer attention should be paid to the treatment rationale in the context of research and clinical practice.