Psychological intervention is a process of construction of a change (acceptance of a duel, overcoming an infidelity, strategies for personal growth, etc.) that affects the three pillars of study of psychology: thought, emotion and conduct.
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To achieve the goals that a patient proposes in therapy, we will necessarily work on these three points, using tools and knowledge that can be focused more on one or the other depending on the difficulty that arises..
For example, one of the most used and most effective techniques in cognitive-behavioral therapy is the well-known cognitive restructuring, whose focus of work is cognition / thought, which seeks to modify (restructure) through the observation of irrational beliefs and generalists that the patient may have, to later transform them into ideas that are more in line with reality.
In Gestalt therapy, the focus is on body sensation and emotion, so body posture and facial expressions are used to delve into something that may have been mentioned, so that the Gestalt psychologist accompanies the patient in the process to become aware of this postural or expression change and the relationship it has with the topic at hand.
Again in cognitive-behavioral intervention, one of the most common treatments for Obsessive-Compulsive Disorder (OCD) has a strong cognitive component when it comes to establishing a good psychoeducation about the disorder and a modification of the beliefs and attitudes that the patient can have, but it also includes good emotional management of anxiety linked to the ritual itself and to the perception that the patient may have of himself, and strategies directed directly at the behavior, such as slowing down or postponing the compulsion with the aim of eliminating it.
Confrontation is a psychological resource that works halfway between thought and emotion.
Referring to two widely known authors in our field, Ellis called it the "Socratic technique", as it focused on challenging the patient's beliefs, while Rogers knew it as a "feeling reflection", due to the search to find the linked emotions to the verbal expression of the person.
In other words, confrontation is a very useful tool in the therapeutic process because it helps the person to give another approach to the situation they are going through (in which they may have become “stuck”). When the person manages to position themselves in a different way with respect to their problem, they are usually much more capable of finding behavioral alternatives as well.
However, it is a technique that must be used very carefully, and each psychologist must calibrate how and with which patients he can make use of a confrontation.
This is because it not only generates an increase in awareness of the problem and a possible change at the cognitive level, but it can also generate an emotional impact for which the person may not be prepared and with which they do not know very well how to deal with..
For this reason, it is recommended that confrontational questions and statements are not given in the first sessions of psychological intervention, since the therapeutic alliance is not yet solid enough for the person, if they suffer an impact, to rely on the psychologist to talk about how the confrontation has affected you.
If we use it intensively from the beginning of the therapeutic relationship, it is very likely that we create a feeling of "attack" towards the patient and this causes him to reject the figure of the psychologist and, therefore, towards therapy.
Here are three examples of confrontational interventions based on my own experience.
These confrontations have been divided according to the level of impact they sought to cause and the degree of "subtlety" with which they were raised. It should be mentioned that this classification, in the present case, is completely subjective and is based on the personal criteria underlying the knowledge of the given patient and the therapeutic relationship created..
Any of these interventions, out of the context in which they occurred and with any other patient, could be classified differently:
Low impact level, subtle confrontation: Patient manifests a need for control in different situations and contexts. It refers to always looking for a location in those places where you go where you can visually "watch" everyone.
Confrontation: How would you like if we both continued the remainder of the session with our eyes closed?
Intermediate impact level, direct confrontation: Patient manifests (on several occasions) accusation from his environment about his hostile, aggressive, jealous and manipulative character. Shows an attitude slightly according to what is described, although he is always friendly in therapy.
Confrontation (after several sessions): Do you think there is something that you have usually told me about that corresponds to a hostile, aggressive, jealous or manipulative character??
High impact level, direct confrontation: Patient claims to be in a relationship with a man who tends to abandon his partners when he gets tired of them and fears the same thing will happen to him, although he refers to such a level of infatuation that it is unfeasible to end the relationship.
Confrontation (again, after several sessions): Could you tell me what differences you observe between your relationship with your partner and past relationships that he has told you about??
The objective of a confrontation is always to seek that the person can approach the situation, at least, from two points of view and that, therefore, with two alternatives they can choose.
It is essential to mention that it is not the competence of the psychologist to judge or argue (neither in favor nor against) based on our personal belief, since the psychologist should never push in any direction.
However, as professionals in the field of health we can consider that we are with the patient in a room with many doors. The patient may only be looking at one, so our task will be to illuminate the place a little more so that he can see if there are two, three or a hundred more..
In any case, it will be the patient who finally decides which door they want to open to continue moving forward.
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