Clarifying Identity and the Self in a CBT Context

Two important psychological frameworks, self psychology and cognitive behavioural theory, are brought together in this chapter as one way of advancing our understanding of the role that identity and ‘the self’ play in psychological disturbance and its treatment. Numerous definitions of the self have been discussed across multiple disciplines, and these are referred to either implicitly or explicitly in cognitive behavioural formulations of psychopathology. Researchers have consistently emphasised the complex transactional associations between psychological disturbance and ruptures in self-structures or self-processes such as self- identity, esteem, regulation, stability, cohesion, complexity, incongruence, discrepancy, schemas and ambivalence. Furthermore, early developmental influences are known to impact on the emergence of both the self and a range of psychological disorders, which could also impact on aspects of psychological treatment. Moreover, while cognitive behavioural therapy (CBT) is considered the gold standard treatment for many psychological disorders, efficacy and targets of treatment vary widely from disorder to disorder, with the emergence of the Third Wave of psychological therapies focusing attention on the need to target a broader range of factors in CBT to improve outcomes, inclusive of the self. For instance, the emergence of successful strategies targeting dysfunctional self-processing in disorders such as social anxiety and borderline personality has seen greater interest specifically in evidence-based self-related interventions. Such considerations are important in evolving CBT, inclusive of advancing personalised approaches to psychological treatment, as well as preventative mental health, education and even public mental health policies.