F .

C i m o c i d

o g n i v e f o u l a t n u s i n o g n i v e m o e l f o

t r i g t r

C B T w i t h o l d e r p e o p l e

anyone else with their problems. In a sense, she identified with a cohort belief that to be depressed is

evidence of a wea ness of character, and that peopleought to stand on their own two feet. !rs " also had

a disturbed relationship#neg ative intergeneration al lin ages$ with her family and would oftenovercomp

ensate for any difficulties in their relationships by entirelysub%ugat ing her needs to them. &he

appeared to endorse the view that herneeds were secondary to those of other people. This was evidenced by

the factthat she would often 'lend( money to her great)niece, despite the fact that themoney was never returned. !rs "

would state 'her needs are greater thanmine(.The cognitive formulation seen in Figure 3.1 was derived

and discussedwith !rs ". It ta es into account precipitating factors , predisposing

factors and maintaining factors . The formulation also ta es account of age)related

factorsand cohort beliefs. The formulation is descriptive of the nature of her currentdifficulti es and also predictive in

the sense that from the hypothesi*edco nditional beliefs one might predict that she will characteri*e her difficultiesas

wea ness and might therefore be more li ely to see these as unchangeable.! rs " might also present other challenges to the

therapist, as she appears tohold the view that getting old is synonymous with developing dementia. Froma previous

interaction with !rs " it became clear that she would over) reactwhenever she made any mista es #note the e+treme

reaction in her charitywor $ and often assumed that she was starting to develop a dementia. It is notunusual for

people with direct dementia caregiving e+periences to developfears about dementia and to become concerned over

what they perceive astheir poor memory performance #Bar er et al., 1,,-$.Core beliefs are described that

highlight the global, stable and internalnature of her attributions #see .ehm, 1,//$. !rs "

has always set highe+pectation s for herself and her e+pectations regarding the e+tent of changeand the pace of change

in therapy need to be e+plored. &he is also verycompliant and in therapy the therapist might predict that she will

find itdifficult at first to ta e a full part in therapy, as she may go along with whatthe therapist suggests in

terms topics in sessions. Challenging interpersonalcor e beliefs #&afran 0 &egal, 1,,1$ is discussed in more detail in

Chapter /.2ver) compliance by !rs " re3uires the therapist to wor hard to ensure !rs"(s active participation in

therapy and in ensuring that her needs #apart fromthe need to please$ are being met in therapy. In the early stage of

therapy thetherapist may ma e this one of the goals for treatment.4lso of note in this formulation is the delineation

of compensatory strategiesthat !rs " uses to cope with dysfunctional attitudes and core beliefs.Behavio

ural e+periments can be developed to challenge the utility of !rs "(scompensator y strategies. The compensatory

strategies ought to be consideredas more malleable than core beliefs, but less malleable than negative

automaticthough ts, and consideration needs to be given to the correct time to challengethese coping

strategies.
35
C267ITI89 B9:48I2;. T:9.4<= >IT:2?@9. <92<?9

The therapist can use all the insights from this formulation

when planninginterve ntions and can decide to apply some simple behavioural e+perimentsiniti ally to increase

!rs "(s confidence in her abilities. The sub%ugation of herneeds reflects an important core belief that she

developed from herunderstandin gs of her mother. In addition, she faces stresses in intergenera)

tional relationships that reinforce her belief that in order to gain the approvalof others she needs to do

whatever they wish. In a discussion of thisformulation, !rs " found it interesting to draw parallels between herself

andher ideali*ation of her mother. &he could see that this was unhelpful to herwhen she was dealing

with depression as she was labelling herself as wea and inade3uateAa view not shared by her closest friends.

C27C?;&I27& 47@ &;!!4.=

Formulations are a relative newcomer in terms of cognitive therapy.Formul

ations that ta e account of the challenges facing older adults hold thepromise of providing an improved

treatment outcome. Formulations alsoprovide therapists with a chance to avoid feeling overwhelmed by

the wealthof clinical data they may be dealing with when wor ing with older adults.:owever, formulations are

beneficial to therapeutic outcome in the sense thatthey aid the important process of understanding

between patient andtherapist. 6iven that older adults may at times feel devalued and unwanted by the value placed

upon youth in our societies, this e+perience can be a verypowerful agent for change. The new cognitive

model developed here will bediscussed in detail and applied throughout the rest of this boo