Putting More We in CBT
A robust body of empirical research underscores the central role of interpersonal relationships in the development and maintenance of various psychological disorders. Yet, traditional cognitive-behavioral models of psychopathology have historically prioritized intrapersonal processes such as maladaptive cognitions, affect dysregulation, and behavioral patterns. There is growing recognition, however, that an individual’s relationships are not merely affected by psychological difficulties but also serve as causal and maintaining influences. Despite this, cognitive-behavioral therapy (CBT) training and practice often pay insufficient attention to assessing the broader relational context, integrating these dynamics into case conceptualizations, or directly targeting them in treatment.
Some CBT models do implicate interpersonal factors in the onset and maintenance of disorders. For instance, cognitive theories of psychopathology propose that maladaptive schemas typically emerge from early interpersonal experiences and are reinforced and reactivated within current relational contexts. These beliefs, in turn, shape how individuals interpret others’ behavior, regulate emotions, and behave interpersonally. Nevertheless, traditional cognitive interventions remain largely individual-centric—employing tools like Socratic Dialogue and cognitive restructuring to target internal thought patterns. Linehan’s biosocial theory posits that an invalidating interpersonal environment in childhood is a critical factor in the development of borderline personality disorder (BPD). Dialectical Behavior Therapy (DBT), a gold-standard treatment for BPD, includes interpersonal effectiveness skills as a core component. However, these skills are typically taught to individuals rather than practiced in therapy with significant others, limiting the extent to which relational dynamics are directly addressed.
Recent advancements in CBT have increasingly incorporated interpersonal dimensions into theory and practice. One such innovation is Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder (CBCT for PTSD), which I co-developed. Grounded in a cognitive-behavioral interpersonal theory of trauma recovery, CBCT for PTSD is designed to target both individual symptoms and dyadic functioning by involving intimate partners or close others in the therapeutic process. This model recognizes that trauma and PTSD reverberate through close relationships, and that improving communication and incorporating partners in cognitive processing of trauma can be powerful mechanisms of change. Randomized controlled trials have demonstrated CBCT for PTSD’s efficacy in reducing PTSD symptoms, enhancing relationship satisfaction, and improving partners’ own well-being. CBCT for PTSD belongs to a broader class of “disorder-specific” couple and family CBTs, developed for conditions such as depression, substance use, panic disorder, eating disorders, and bipolar disorder.
Even if you do not currently have the interest or training to provide couple or family CBT, there are meaningful ways to enhance your individual CBT practice by adopting an interpersonal lens. Conducting a thorough assessment of your client’s interpersonal relationships can reveal both champions and challengers of change, helping tailor your interventions. Collateral assessments may uncover important information your client is unaware of or hesitant to disclose—such as substance use or excessive reassurance seeking—and can deepen your case conceptualization. Providing psychoeducation to concerned others can also foster understanding and increase support for interventions that may seem counterintuitive (e.g., exposure exercises). This relational information can inform behavioral experiments, communication and assertiveness training, and cognitive interventions focused on interpersonal schemas. Research documents that improving interpersonal functioning not only reduces relational distress but also enhances treatment engagement and supports long-term outcomes.
The next generation of CBT models and practitioners are moving toward more relationally oriented approaches—bringing more “we” into traditionally “me”-focused models. As clinicians and researchers, we must continue to bridge the intrapersonal and interpersonal realms in order to better understand and effectively treat psychological problems. As social baseline theory reminds us, we are hard-wired for connection, and our interventions should reflect this.
