We outline our understanding of collaborative empiricism (CE) as used in cognitive therapy (CT) for psychosis. We discuss how CE can be thought of as a technique for facilitating cognitive change in the service of a client's goals, but also as an expression of respect for client autonomy, recognizing the ethical imperative to empower clients by involving them in decisions about their care. Taking a CE approach is therefore consistent with user-led conceptualizations of recovery, and the related movements of “shared decision-making” and “evidence-based patient choice.” We discuss how CE can aid with engagement, assessment, formulation, and intervention in CT, illustrating this with case material. We focus on how CE can help with distressing intrusive experiences and beliefs, and also consider its role in helping clients achieve wider life goals. Adaptations to CE for working with people with problems with learning, attention, and memory are discussed, as are considerations for working with high conviction and conceptual disorganization.
Collaborative empiricism (CE) has been a defining feature of cognitive therapy (CT) ever since the latter was invented (Beck, 1967). It forms a particularly important part of CT for people with psychosis, where CE is the general approach taken when helping clients evaluate the validity, reliability, and usefulness of their appraisals, behavior, and wider belief systems (Chadwick et al., 1996, Fowler et al., 1995, Gumley and Schwannauer, 2006, Kingdon and Turkington, 2005 and Morrison et al., 2004c). According to Beck and Dozois, “Collaborative empiricism means that the patient and the therapist become coinvestigators both in ascertaining the goals for treatment and investigating the patient's thoughts. Methods of guided discovery are used to help patients to test their own thinking through personal observations and experiments rather than via cajoling or persuasion” (Beck & Dozois, 2011).
CE is particularly important for case conceptualization in CT. According to Kuyken and colleagues, collaboration between therapist and client here involves “bringing their respective expertise together in the joint endeavour of describing, explaining and helping resolve the client's presenting issues,” while empiricism involves a synthesis of theory, research, and observation, and a hypothesis-testing approach to clinical decision-making (Kuyken, Padesky, & Dudley, 2008).
However, Tee and Kazantzis have drawn attention to some uncertainty over the definition, noting that the term “collaborative empiricism” now means different things to different theorists (Tee & Kazantzis, 2011). These authors offer a fresh perspective on how CE leads to belief change, using the framework of self-determination theory. They note the lack of scrutiny of CE, and make a call for empirical work to examine, among other things, the components of CE, the relationship of CE to other constructs and variables, and the effectiveness of CE in CT.
CE may be therapeutically valuable in two important and complementary ways. First, it may be an aid to achieving the overall goal of helping a client reduce their suffering and emotional distress. Clients with psychosis have reported finding it inherently engaging to be treated as an equal partner (Kilbride et al., 2012), and they may be more likely to consider the full range of evidence before them when they have taken at least an equal role in discovering it (Tee & Kazantzis, 2011). Second, helping clients form views or make decisions based on evidence (and reason) may help them make more reliable and informed decisions, now and in the future (Stacey et al., 2011). Thus, CE might be viewed as a process that helps to build and protect decision-making capacity which, in turn, may promote autonomy (Owen, Freyenhagen, Richardson, & Hotopf, 2009).
Our aim in this paper is to discuss the use of CE in CT with people who have received a diagnosis of a psychotic illness. We first discuss why CE is a particularly important feature of CT with this group, focusing on how CE can help clients achieve cognitive change. We then outline examples of CE in CT, illustrated using anonymized case material.
