The film watched in class, which portrays a case study of how cognitive therapy is utilized in borderline personality disorder, demonstrates not only the techniques with which the cognitive therapist works, but also the broader theoretical framework which shapes cognitive therapy as a whole. In other words, the techniques of cognitive therapy are consistent with the notion that such disorders can be overcome through the implementation of proper techniques, in so far as a given patient, “judgments and behavior in areas of experience beyond the boundaries of his specific vulnerability often reflect a high level of functioning.” (p. 213)

This entails that the disorder is a type of localized neurosis, which has a precise cause and effect structure. However, one of the key points in the film is that this cause and effect structure is not reduced to a historical cause and effect, for example, in terms of psychoanalysis and some type of trauma. Rather, the aim is to identify the localized neurosis and then change the thinking patterns and approaches that lead to the problematic reactions. Key in this sense is that the patient’s cognitive abilities are not afflicted entirely by neurosis, which means that the patient can come to understand the cause and effect relationship of the particular neurosis and thereby alter behavior.

This is exactly what is demonstrated in the film in question. The methodology employed by the therapist, in consistency with the techniques and conceptual framework of cognitive therapy, intends to isolate the particular thoughts in the patient which generate the given problematic course of action. In the film, the patient becomes irritated, even using physical violence, when a co-worker does not accept her work. The techniques used by the cognitive therapist are largely interrogative, asking the client questions about her emotional state, what she thinks and feels, at the time of such incidents. Because the neurosis only appears under the specific set of preconditions in the film, the techniques function, since the patient is able to rationally reflect on the course of events which constitute the particular neurosis. This allows for the potential to correct or alter the causal sequence which is clearly demonstrated in the disorder itself.

The client, in the film, associated her actions with a feeling of vulnerability, whereby she viewed the rejection of her work as a personal attack, both in terms of her co-workers devaluing her as an individual (for example, thinking that she is “stupid”) and even a fear that her co-workers may use physical violence against her. This is therefore a type of defensive strategy, whereby the reaction intends to preempt the physical violence against her person, or this fear takes the form of physical reaction against those who the patient feels are demeaning her.

Whereas in the film one of the techniques used by the therapist is to locate historical sources of this trauma, for example, the patient notes that her father used to demean her and this may be the reason for her particular reactions, the therapist’s aim is to relegate this incident to the past and see the neurosis as something that can be controlled from the viewpoint of the present, as a localized cause and effect sequence. One of the key techniques to developing this new perspective is that of role-reversal, whereby the patient is encouraged in the film to look for positive relationships from her past and then overcome a particular traumatic incident by looking at her current relationships from the perspective of this positive relationship, in the film a personal riding instructor that had a good influence on the patient.

What is most compelling about the techniques explained in the film is the sense in which cognitive therapy provides a very pragmatic approach to disorders. Arguably, this is accomplished by emphasizing the fact that the patient is not overcome by neurosis, but rather experiences a disorder in a particular situation. With this approach, the therapist is able to communicate to the patient his or her overall health, and then use this foundation to counteract a particular problem in his or life.