13 - Social support processes and cognitive therapy

Summary

Therapeutic neglect of social resources and social support processes

It is asking a great deal of individual psychotherapists that they should be attuned to the potential resources in their patient's social network and alert to the implications of research on social support. To become skilful at working with one person intensively, using specific techniques within a specialised formal helping relationship, a therapist must spend many supervised hours with individuals, learning techniques of assessment and intervention. Therapists focus on the individual's development, learning, behaviour, emotional responses, perceptions and thoughts. They see people in the social vacuum of the consulting room, plucked from their usual social environment, building a picture of the patient's interpersonal processes and social world from self-report. This is not the perspective of the epidemiologist, the sociologist or even the community psychologist. Indeed, the patient's kith and kin are often seen by clinicians as part of the problem rather than a social resource (Heller, 1979).

Yet, perhaps increasingly, psychotherapeutic methods are being incorporated into community mental health services and care programmes (see Thornicroft et al., this volume), where there is a requirement both to deliver effective forms of specialist therapies and to ensure that these are ecologically valid, working synergistically with social and community approaches, increasing the willingness or ability of patients to access support from others. To use Pearson's (1990) comparison, this complements approaches which intervene directly within community networks to increase the willingness or ability of actual or potential supporters to offer social support to patients (Attneave, 1969; Gatti & Coleman, 1976; Rueveni, 1979; Jeger & Slotnick, 1982; Lewis & Lewis, 1983).