CBASP: A Tool for More Than Just Depression
Initially designed for the treatment of chronic, treatment-resistant depression, Cognitive Behavioural Analysis System of Psychotherapy (CBASP) includes techniques that are useful for everyone. CBASP involves therapists helping clients, at times by using self-disclosure, to see that it’s possible to positively influence outcomes if we think about what we want, rather than be swept along by others’ wishes or our own negative thoughts.
Through a process of reflection, CBASP helps us stop reactive, automatic behaviours and start engaging with life in a more thoughtful and goal-oriented way. At its heart, CBASP is about improving self-awareness and strategic thinking, helping solve personal and interpersonal difficulties more effectively. Importantly, CBASP’s approach is not about promoting selfishness but about ensuring fairness.
The Five Reflective Questions of CBASP
In CBASP, therapists review difficult situations with clients, asking a series of 5 questions. As an example, a client might describe their distress at having fallen out with their teenage son. The session would go:
What happened? I came home to a total mess that my teenage son had made.
What did you think? Everything gets left to me – no one ever respects me. I have to do everything in this house!
What did you do? I sighed and started to tidy up – then I finally lost my temper when my son just ignored what I was doing and didn’t offer to help.
What was the actual outcome? He got angry at me for yelling at him – then we had a full-on fight - and then he left the house.
What did you want to happen? I wanted him to tidy up and not just sit there!
The session would continue, reflecting on an alternative outcome, with the client’s wants considered first:
What do I want? I want my son to tidy up.
Is that reasonable? Yes, he’s 16.
What do I need to think? I can see he’s playing a game – but I need to ask him to tidy up.
What do I need to do? I need to say that I understand he’s playing a game but that he needs to tidy up. I’ll say that I’ll go and get a coffee while he does that and, when he’s finished, we can make dinner together.
What is the actual outcome? I don’t feel stressed or taken for granted.
One of the most impactful tools in CBASP is its set of guiding questions, which help individuals evaluate situations more clearly. These questions are particularly useful for those of us who struggle with chronic people-pleasing! So, the questions to remember are these:
What Do I Want?
This question increases clarity. It encourages us to identify our own desires and needs, a step often overlooked by those prone to prioritising others. By acknowledging what we truly want, we become better positioned to make choices that respect our own needs and wants.
Is That Fair?
Fairness in this context is about balancing our personal wants with a realistic assessment of what is fair. This question acts as a safeguard against self-centeredness and helps decision-making. It pushes us to consider whether being assertive is reasonable, whether others are happy with our views or not.
What Do I Need to Think?
Our thoughts drive both our emotions and our behaviour. This question prompts a conscious shift from automatic, often negative or anxious thoughts ,to more constructive, rational thoughts. It can help people-pleasers move away from catastrophic assumptions about disappointing others and refocus on what they want, based on what is fair.
What Do I Need to Do?
This question is about translating insight into action. Once we have identified what we want, assessed fairness, and are clear on what we think, it’s time to take steps. Whether it’s setting a boundary, expressing an opinion, or deciding not to take on a new task, this step is key to enacting change.
The Power of Knowing What You Want
One of the central themes of CBASP is the importance of being aware of what you want. This focus is not about fostering selfishness or disregard for others’ needs – it's about resisting the passive, reactive state that leaves people vulnerable to the whims of others. By learning to anchor ourselves around a clear understanding of our own desires, we are less likely to be swept up by others’ expectations or demands.
When people-pleasers practice CBASP, they learn that it’s possible to make choices that meet their own needs while still showing empathy and consideration for others. This prevents the cycle of frustration and resentment that often accompanies habitual people-pleasing.
Conclusion
CBASP therapy may have been designed for treatment-resistant depression, but it is a structured approach that can be beneficial for anyone looking to improve their mental health and interpersonal relationships. CBASP’s emphasis on fairness, self-reflection, and intentional action is particularly helpful for individuals who struggle to set boundaries or prioritise their own needs.
By consistently asking, “What do I want?” “Is that fair?” “What do I need to think?” and “What do I need to do?” we can create healthier patterns of thinking, behaving and interacting.