Interpersonal issues and relationship problems form an important part of what clients bring to therapy. Interpersonal difficulties might present as clients’ current concerns, unintended consequences of their coping strategies, as symptoms of another problem, or they may play out directly within the therapeutic relationship.
Interpersonal issues can be conceptualized effectively using components of Beck’s generic cognitive model (Beck et al,1979). Beliefs about relationships (interpersonal beliefs) scaffold and influence how an individual perceives events involving other people. Interpersonal styles reflect safety behaviors that they use to protect themselves from perceived negative consequences in relationships. Other people react to these interpersonal styles, and the individual appraises these reactions: often in ways which confirm (or fail to disconfirm) the original beliefs. For example, a client who holds the assumption “I must entertain people or they will think I am boring” is likely to perceive social events as a threat. They habitually make jokes and ‘play the fool’ to protect themselves from this fear, and other people respond in superficially positive ways. This positive reaction reinforces the client’s original assumption.
Flecknoe & Sanders (2008) discuss interpersonal beliefs in the context of CBT. They argue that interpersonal beliefs can be helpfully categorized according to the following broad themes:
- Trust (e.g. “People cannot be trusted”, “If I confide in people I will be hurt”)
- Intimacy (e.g. “People either ‘click’ right away or not at all”, “True intimacy means sharing everything”)
- Assertiveness (e.g. “If I stand up for what I want I’ll be hurt”, “I must never be taken advantage of ”)
- Authority and power (e.g. “It is unacceptable to be told what to do by someone younger than me”)
Interpersonal beliefs can operate at different levels of cognition: beliefs (e.g. others can’t be trusted), assumptions (e.g. If I trust others they will hurt me) and thoughts (e.g. She’s betrayed me). Dysfunctional assumptions about relationships are particularly important because they drive behavior associated with patterns that repeat across relationships. This behavior (interpersonal styles) stems from interpersonal beliefs, and may cause repeated difficulties in relationships. Examples of interpersonal styles includes positive traits such as being authentic, genuine, open, honest, as well as potentially more problematic traits such as being compliant, hostile, critical, flippant, demanding, superior, or passive.
Interpersonal Beliefs And Styles is a worksheet designed to help clients to explore their interpersonal beliefs and interpersonal styles. Therapists should consider using this tool when clients want to focus on relationship difficulties in therapy, when clients get stuck with unhelpful behaviors in interpersonal scenarios (e.g. being defensive or critical of others; or people pleasing and neglecting own needs) or when the therapist has identified examples of interactions in relationships and suspect that a pattern is operating. It is a useful framework to help clients to understand why they keep encountering repeating patterns in interpersonal relationships. It gives therapist and clients a framework for understanding what keeps interpersonal relationship patterns ‘stuck’ and to identify targets for change: the framework leads very naturally to interventions such as testing client beliefs and assumptions with behavioral experiments.
A good time to use this tool is when the client and therapist have identified difficulties in relationship as a presenting problem. Relevant examples may already have been discussed and at this point the therapist may have already have made a hypothesis about the client’s beliefs about other people, relationships, or about interactions with others. Use the prompts below to help complete the Interpersonal Beliefs and Styles worksheets.
“People often experience issues repeating across different relationships. I wonder if we could use this tool to explore some of your experiences, and see if we can make sense of them?”
1. Interpersonal beliefs
Interpersonal beliefs are the thoughts, beliefs, and assumptions that we hold about other people, about relationships, and about interactions with others. Clients can find it helpful to understand that beliefs can operate at any level of cognition:
- Beliefs are often absolute statements such as “Other people are cruel”, “Relationships are dangerous”.
- Assumptions are rules, predictions, or heuristics which help an individual to make sense of their interactions with others. Examples might include “If I confide in someone they will betray me” and “If I assert my needs I will be rejected”.
- Automatic thoughts (and images) are cognitions about here-and-now situations. Examples might include the thought “I can’t trust what they are saying” or an image of being humiliated by a group of people (with the meaning “they will use what I say against me”).
Helpful questions to elicit interpersonal beliefs and assumptions might include: • Tell me about how you feel trusting people in relationships?
- How do you feel when you are told what to do by other people?
- What do you think would happen if you stood up for your rights?
- How of you feel when you are vulnerable with others?
- Complete this sentence for me “If I tell them what I really think, then …”.
Further helpful techniques for identifying beliefs might include “downward arrow” questioning, sentence completion (“I am…”, “Other people are…”), or conjunctive phrasing (e.g. “And that would mean …?”, “If that were true …?”).
2. Interpersonal styles
An individual’s interpersonal styles are the behaviors they enact to protect themselves from the consequences of their beliefs and assumptions. For example, someone who believes “I’m boring” and holds the assumption “If I entertain people they will tolerate me” might consistently make jokes or act in ways which amuse others. The therapist is particularly interested in interper- sonal safety behaviors which act to confirm (or prevent disconfirmation) of underlying beliefs. Questions to explore interpersonal styles include:
- What do you do to keep yourself safe from other people?
- What do you do in relationships to cope?
- Tell me about any habits you have in relationships that make you feel more comfortable with others?
- In social situations how would others describe your behavior?
- If I was a fly on the wall, what would I see you doing (or not doing) in social situations).
3. Reactions of others
Every action has a consequence. Other people will react to an individual’s interpersonal styles. At this stage the therapist is interested in the client perceive others reacting to them. Questions to explore these reactions include:
- How do others react to you when you behave that way?
- What do you notice when you act in that way?
- What do other people do or say when you act in that way?
- What *don’t* other people do or say when you act in that way?
- If I was a fly on the wall, what would I notice about other people’s reactions?
4. Interpretation of their reaction
At this step the therapist is particularly interested in how the client appraises the reactions of other people, and how it affects their existing beliefs and assumptions. For example, the client who held the assumption that “If I entertain people, others will tolerate me” experienced other people acting warmly towards him when he made jokes. He took this as confirmation of his assumption, but his underlying belief “I’m boring” went unchallenged. Questions to explore interpretations include:
- How does their reaction affect your belief?
- Does their reaction make your original belief stronger or weaker? How or why?
- What sense do you make of their reaction?
5. Possible next steps
A particularly helpful aspect of this formulation is that client’s interpersonal beliefs can be framed as a hypothesis or a theory about how relationships work. Once interpersonal patterns have been explored, some options for follow-up interventions might include:
- Exploring the helpfulness and/or accuracy of the client’s beliefs and assumptions about interpersonal relationships.
- Generating or exploring healthier alternative interpersonal beliefs and assumptions (theory A theory B).
- Testing old or new interpersonal beliefs and assumptions with behavioral experiments.
- Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). The cognitive therapy of depression. New York: Guilford Press.
- Flecknoe, P., Sanders, D. (2004). Interpersonal difficulties. In: Bennett-Levy, J., Butler, G., Fennell, M., Hackman, A., Mueller, M., & Westbrook, D. (Eds.). 2004. The Oxford guide to behavioural experiments in cognitive therapy, 393-412. New York: Oxford University Press.