8) Cognitive Ordeal - In a cognitive ordeal, rather than trying to convince a client to change rigid thinking and perceptions, the clinician takes the unexpected position of ‘joining’ the client’s reasoning. In paradoxical style, a ‘cognitive ordeal’ goes against the grain of what one might logically expect. Particularly for CBT practitioners it may seem ‘a slippery slope’ to agree with erroneous client perceptions!
This intervention is effective when a client has a certain ‘world view’ or thinking pattern that defines his identity. In so doing he blocks out the clinician’s rational reasoning, which he believes has no relevance to his life or situation.
The client’s investment in his own perceptions will not change through rational logic. The client is quite willing to enter this ‘power struggle’ over logic because in the end the client has ‘no doubt that he is right!’ The clinician should understand that when entering a struggle between his ‘rational reasoning’ and the client’s ‘world view’, - the client’s perception will always win!
In surprising fashion, the intent of the intervention does not target the client’s ‘thinking process’: rather the intent is to dismantle the client’s underlying identity of feeling alone and isolated. For the most part, the client with ‘rigid thinking’ is aware that others disagree with him, and he is accustomed to being alone in his ‘world view’. However, from a clinical perspective the client will feel discomfort if the clinician ‘steps into his box’ and agrees with his skewed perception.
So for example, Joey, a young ‘inner-city teen’ that has grown up on the streets and seen violence first hand, may have come to the conclusion that bullying, fighting, and intimidation is not only important to ‘get respect’, but in his ‘world view’ being “top-dog” is the only way to survive. Any attempts to convince Joey that ‘life has so much more to offer’ will fall on deaf ears, as his life experience has shown him otherwise! Through creating a ‘cognitive ordeal’, the clinician’s intent is to disrupt Joey’s unquestioned experience of being alone-in-the-world. In this process, the clinician might advise that he ‘must always be top-dog’ – of which Joey will readily agree. Once he has agreed, the clinician then ‘hooks on and doesn’t let go’. At that point, the clinician goes ‘overboard in joining’ Joey’s thought process and makes it into a ‘broken record’ ordeal. By ‘overly agreeing’, the clinician turns behavior and thoughts that Joey had considered a ‘free will choice’ into a monotonous chore. In regimented fashion the clinician will hammer Joey’s perception by making an ordeal of: ‘who it is best to bully, where to instigate the next confrontation, and how to best intimidate. In the process of the intervention the clinician may note that although he himself does not live in this manner, given Joey’s ‘world view’ he can understand that Joey really has no choice to act or think differently.
When done correctly, a ‘cognitive ordeal’ not only bypasses the expected ‘power struggle’, it leaves the client with the uncomfortable awareness that his ‘world view’ is a burden. Rather than needing to be convinced, the client comes to his own conclusion that to live by his ‘world view’ is boring and tiresome. As a result, without instruction, planning, or forethought, the client simply takes a permanent vacation from previous disruptive and intimidating behaviors.
9) Achievement Awards and Mementoes – In this intervention, the client’s ‘achievements’ are honored through a physical award, trophy, memento, or card. Examples of a framed award or plaque might be: “Slip-slider of the Week”; “Manipulator of the Month”; “World’s Best Truth Stretcher”. Such ‘awards’ are presented for ‘excellence and distinction’. The intent here is to use humor to address an obvious ongoing pattern.
Since the therapeutic alliance is always primary to the treatment process, the intent of such interventions is not to embarrass or shame the client. The idea here is to let the client know that you and other staff members are aware of the client’s expertise in his specialty area. As such it is therefore due to the client’s skill and adeptness that he is deserving of receiving an award or memento.
Other examples would be: a) an inappropriate or destructive relationship that the client continues to engage in. Here the client might be presented with a ‘Wedding’ or ‘Anniversary’ card; A client who has maintained his status on ‘Red Level’ for a series of months might get a T-shirt saying, ‘Better Red Than Dead!” Such mementos serve as a reminder that not only is the primary clinician aware of his behavior and patterns, but other staff throughout the agency are aware of such patterns as well.