Constructivist cognitive therapy

Domain II · Behavioural & cognitive · Michael J. Mahoney · 1991

What it is

Constructive psychotherapy is not a manualised protocol. It is a framework: a set of assumptions about how people organise experience, plus a relational stance and a flexible repertoire of experiential, embodied and reflective exercises. Mahoney began in cognitive-behaviour modification and moved…

Format

• Mahoney does not give a fixed sequence of numbered phases or session counts. The format is individual and open-ended, usually weekly at first and spaced out later, and length is set by the client's process. The 2003 book is organised as: constructivism (ch. 1); an overview of practice (ch. 2);…
• Stage A: Beginnings (roughly sessions 1–4, but flexible)

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Sustained presence and curiosity in sessions, and fewer signs of burnout.
• The client becomes curious about their own hesitations, and pace and engagement improve.
• Impulses to send letters in anger or to abusers; slow those down and review safety first.
• Imposing your own spiritual framework; meditation triggering distress in trauma or psychosis.
• Nightmares tied to trauma may need trauma-focused methods (see Section 5). Working: the client finds personally resonant meaning.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.