Cognitivisme et émotions selon Beck

Cognitivisme et émotions selon Beck

 

Compte rendu d’ouvrage avec applications pratiques au counseling de carrière

Par LOUIS COURNOYER, Ph.D., c.o., professeur-chercheur, UQAM

 

 

Si l’orientation et le développement de carrière ne tenaient qu’à l’établissement d’une mise en adéquation de caractéristiques personnelles et de possibilités professionnelles, alors notre travail serait d’une telle simplicité qu’il faudrait alors se reconnaître davantage technicien que professionnel. Mais voilà, bien que les demandes de certains clients puissent ne pas déborder le cadre de la transmission d’informations scolaires et professionnelles, plusieurs autres proviennent de personnes aux prises avec l’incapacité de traiter adéquatement l’information. Parfois, il peut s’agir d’une question d’apprentissage, soit de disposer d’une grille, d’une procédure ou d’une manière quelconque pour examiner les possibilités s’offrant à eux, parfois il s’agit plutôt d’une question d’organisation cognitive. Dans ce dernier cas, les personnes manifestent des pensées automatiques, des croyances irrationnelles ou encore des schémas d’adaptation qui les amènent à vivre des émotions et à adopter des attitudes et des comportements dysfonctionnels au plan de la capacité à s’orienter.

 

Pour Aaron Beck, les problèmes individuels « découlent en grande partie de certaines distorsions de la réalité fondées sur des hypothèses et des prémisses erronées. » (2010, p.9) Autrement dit, des problèmes tels que nous pouvons observer quotidiennement chez nos clients témoignent de la manière dont ils évaluent différentes situations et qu’ils y réagissent lorsqu’il s’agit, par exemple, de porter un jugement sur soi-même, de fonctionner avec les autres (notamment au sein de la relation d’accompagnement vécue avec nous), de donner sens au monde qui les entoure et aux possibilités qui s’offrent à eux. À de mêmes situations, chacun procède par une interprétation propre selon la réalité de vie construite au travers de son parcours de vie. Néanmoins, chacun « possède la clé pour comprendre et résoudre la perturbation psychologique située dans le champ de sa propre conscience. » (Beck, 2000, p.8) Ce texte traite du livre La thérapie cognitive et les troubles émotionnels d’Aaron Beck, une traduction française de 2010 d’un ouvrage de 1976 ayant marqué la discipline de la psychologie.

 

 

Qui est Aaron T. Beck ?

 

Aaron T. Beck est un psychiatre américain aujourd’hui professeur émérite de l’Université de la Pennsylvanie. Au début des années 1960, il développe les fondements de la thérapie cognitive. Intervenant alors à titre de psychiatre auprès de personnes dépressives, il constate rapidement chez ces derniers une propension particulière à l’entretien de pensées négatives récurrentes à propos d’eux-mêmes, des autres, du monde ou à l’égard de leur avenir. C’est alors qu’il développe des principes et des techniques d’accompagnement visant à faciliter l’identification et l’évaluation de pensées automatiques qui minent la qualité de vie des individus, afin de les amener vers l’adoption d’attitudes plus réalistes et constructives. Il approfondit également les enjeux d’une relation thérapeutique proactive où intervenant et client travaillent ensemble sur des objectifs communs. Les principes et les techniques de la thérapie cognitive sont aujourd’hui reconnus et répandus à travers le monde, à travers plusieurs modèles de psychothérapie et de counseling, ainsi qu’à travers plusieurs types de clientèles et de problématiques. Au travers de plus de 500 articles et de 22 ouvrages, Beck a contribué à l’avancement de connaissances scientifiques en psychothérapie, en psychopathologie et en psychométrie qui servent aujourd’hui de bases conceptuelles aux interventions quotidiennes d’un nombre important de professionnels des relations humaines, de l’éducation et de la santé mentale.

 

 

Compte-rendu commenté de l’ouvrage de Beck (2010)

 

Beck, A. T. (2010). La thérapie cognitive et les troubles émotionnels. Traduction de B. Pascal de ²Cognitive therapy and the emotional disorders² (1976). Bruxelles : de Boeck.

 

Le chapitre 1 s’intitule Du « bon sens » et au-delà. Pour Beck, de grandes distorsions cognitives, tant chez le client que chez l’intervenant, peuvent s’opérer au nom d’un gros bon sens populaire. Selon notre histoire personnelle, notre environnement de développement, ainsi que les événements façonnant notre vie, l’être humain construit son propre système de pensées, d’émotions et de comportements de manière à donner un (bon ?) sens à sa vie. Plusieurs problèmes d’orientation et de développement de carrière sont intiment liées à cette manière d’entrevoir et de réagir à des situations réelles ou anticipées. Les choix et les décisions de nos clients peuvent ainsi s’opérer par l’influence plus ou moins ajustée de croyances, d’interprétations, de généralisations de soi, des autres et du monde. Beck rappelle d’ailleurs que les intentions de suicide, le cheminement vers la dépression, les comportements obsessifs et compulsifs ou encore les troubles anxieux de différentes natures relèvent tous de conséquences faisant plein de « bon sens » pour les personnes qui les vivent – ce qui est tout le contraire pour celles vivant autour d’eux. À cet égard, il importe aux professionnels de l’éducation, des relations humaines et de la santé mentale à aider les personnes à mieux discriminer leurs erreurs d’interprétation  (pensées, émotions, comportements) en facilitant l’adoption de capacités discriminantes plus affinées et d’attitudes plus adaptées.

 

Le chapitre 2 s’intitule Vers l’exploitation du langage intérieur. Il y est question du phénomène d’idéation. La construction des idées s’appuie sur une organisation cognitive intimement liée à des émotions et des comportements opérant sous certaines conditions et certains contextes. De la même manière, l’anticipation de l’avenir repose sur des idées à l’égard de soi, des autres et du monde fondées par notre histoire d’apprentissage de la vie où nous a été communiqué des normes, des règles et des valeurs : si je fais ceci/si je ressens ceci …, alors je vais cela … Automatiquement, mais consciemment (distinction importante de la thérapie cognitive par rapport aux approches psychanalytiques), un langage intérieur se développe et s’opère par l’adoption interactive de pensées, d’émotions et de comportements lorsque nous devons agir ou réagir à des situations internes ou externes (ex. : il faut …, donc « je ressens … et   je fais … »).

 

Le chapitre 3 s’intitule significations et émotions. Lorsqu’un événement se produit, quelle en est la signification qui lui est accordée ? L’une des distinctions importantes à cet égard selon Beck porte sur la prise en compte de significations publiques et privées. La signification publique est celle partagée par un groupe d’une même culture, organisation ou société et qui se conventionne par une définition formelle. La signification privée est propre aux individus. Elle donne un sens, une connotation et une image unique à des événements partagés ou non avec les autres. Selon Beck, le récit de vie constitue la porte d’accès aux significations privées des personnes. En explorant les pensées, les sentiments, les envies conférées à des événements et les généralisations pouvant s’en dégager à l’égard de soi-même, des autres ou du  monde accède alors à des informations lui permettant tranquillement d’établir des liens afin de mieux comprendre l’organisation cognitive de la personne. Par exemple, quelle est la signification privée d’une perte d’emploi ? Quelle est la signification privée conférée à l’idée d’une carrière en informatique ou en travail social ? Quelle est la signification conférée par le client au travail même de counseling de carrière que vous réalisez avec lui ? Également, ce troisième chapitre aborde la question des transgressions que certains événements, certaines rencontres ou certaines situations engendrent (automatiquement) sur les pensées, les émotions et les comportements. Beck y distingue le rôle et la forme des transgressions intentionnelles (volontaires, délibérées, dirigé contre ou vers quelqu’un ou quelque chose), non intentionnelles (indirectes, construites subjectivement, dont l’impact procède par une série d’associations qui n’ont rien avoir avec l’action initiale) ou encore hypothétiques (qui se fondent sur des règles, des mœurs ou normes implicites de droits et de bonne conduite). Plusieurs pensées automatiques peuvent se manifester par l’expérience de telles transgressions et les intervenants peuvent, là aussi, y voir une occasion d’exploration et de compréhension intéressante de la manière dont l’individu construit sa réalité et y mènent des actions concrètement dirigées sur la construction de projets professionnels.

 

Le chapitre 4, intitulé Le contenu cognitif des troubles émotionnels  traite du rôle perturbateur des émotions sur les contrôles portés sur soi, sur les autres et sur le monde. Il aborde également le développement ou le maintien d’idées répétitives et de pensées automatiques à partir de la manifestation de certaines émotions. Ces émotions ressenties face à des événements ou des situations personnelle, interpersonnelle ou extra personnelles sont, selon une approche cognitive, simultanément la source et la résultante de pensées, de perceptions, de représentations, d’évaluation quant aux risques, aux anomalies, aux auto-injonctions de l’individu. Tel que le souligne Beck, il s’agit là de biais cognitifs pouvant influencer la direction de l’attention, la réduction de la conscience le traitement sélectif d’informations. Les phénomènes de distorsion par personnalisation de la réalité, de pensée polarisée ou rigide, de comportements évitant ou compensatoires en sont des exemples éloquents. Beck expose d’ailleurs des rapprochements entre ces biais cognitifs et le développement de tendances dépressives, d’hypomanie, d’angoisse, de phobie, de paranoïa, d’obsession, de compulsion, d’hystérie et de psychose.

 

Le chapitre 5 est le premier de quatre chapitres portant sur des applications possibles d’une approche cognitive de certains troubles de santé mentale. Celui porte spécifiquement sur Les paradoxes de la dépression. Beck considère la dépression sous l’angle d’un trouble émotionnel lié à un « sentiment de perte ». Tel semble, selon lui, le fil conducteur pouvant guider les intervenants œuvrant auprès de personnes dépressives : qu’est-ce qui rend la personne triste, quelles idées répétitives l’habitent, quels éléments marquants lui apparaissent les plus centraux et essentiels à son bonheur ?  Comment cette personne s’évalue-t-elle? Comment évalue-t-elle le monde autour d’elle ? Comment évalue-t-elle son avenir ? La dépression s’opère à la fois dans le temps (passé, présent, futur anticipé) et dans l’espace (vie familiale, relationnelle, amoureuse, parentale, conjugale, scolaire, professionnelle, etc.). L’intervenant est invité à s’intéresser aux impacts, aux répercussions et aux dommages associés au sentiment de perte de la personne au sein de différentes dimensions de l’existence. Beck propose de procéder tout d’abord à un examen minutieux de l’autocritique, de l’auto condamnation, de la sévérité du rejet portée sur soi, de la comparaison faite à l’égard des autres et du monde, et ce, tout en gardant le cap sur l’objet associé au  sentiment de perte, souvent quelque chose qui comptait beaucoup jadis pour la personne. Au fil des échanges et des rencontres, l’intervenant et le client pourront ainsi élaborer une conception circulaire des événements et des impacts vécus, ce que Beck qualifie de « réaction en chaîne ». Entre autres, il sera souvent question d’anticipation pessimiste chez la personne, ainsi que du rôle d’entraînement de certaines émotions, même lorsqu’il s’agit d’expériences de joie ou de réussite. Dans le cas de comportements suicidaires, Beck le qualifie d’ultime désir d’évitement de la souffrance pour soi, ainsi que pour les autres personnes autour, à qui l’on croit faire subir celle-ci. Le travail auprès de personnes dépressives ne peut s’opérer qu’à partir d’un minimum de motivation exprimée par la personne à l’égard d’une tâche ou d’une activité donnée, par une évaluation préalable de ses capacités afin de bien jauger le niveau d’efforts, ainsi qu’un sens clair au plan de la valeur du but et des attentes de réussite. En somme, toute programmation extérieure de l’aide offerte à la personne dépressive est vouée à l’échec et à la perpétuation du sentiment de perte chez la personne. Le changement motivationnel trouve sa source dans l’intention et le sens.

 

Le chapitre 6 a pour titre Quand l’alarme est pire que le feu : la névrose d’angoisse. Il y est plus particulièrement question d’anxiété, aussi bien flottante que chronique. Tel que le souligne le titre, l’anxiété consiste en la perception d’un événement effrayant appelé à se produire dans le futur. Les personnes anxieuses sont enclines à attribuer des risques de conséquences surévalués aux événements et aux personnes, de manière à ressentir des émotions et d’adopter des comportements tout aussi erronés. Bien qu’il y ait présence ou non d’un agent stresseur dans l’environnement immédiat de la personne, la personne anxieuse tend à en surévaluer les risques et les conséquences. Cela peut ainsi non seulement entraîner des émotions accrues de peur, mais aussi altérer ou paralyser son jugement, sa capacité d’évaluation, sa mémoire, son raisonnement, puis ultimement sa capacité à faire face aux événements (ex. : préparation aux examens; performance en entretien d’embauche; entrevoir une rencontre de négociation de salaire ou d’affirmation de ses besoins).

 

Le chapitre 7 porte sur La peur incompréhensible : les phobies et les obsessions. Souvent identifiées à titre de troubles anxieux ciblés, les phobies s’associent à une idéation altérée des objets. Les types de phobies sont incalculables : peur des espaces vides (agoraphobie); peur des endroits élevés (acrophobie); peur des ascenseurs; peur des tunnels; peur des voyages en avion, etc. En matière d’orientation et de développement de carrière, celles les plus fréquentes sont les phobies sociales. Il n’y a ici qu’à penser à la peur de l’échec qui peut engendrer des émotions intenses qui peuvent prendre contrôle de facultés intellectuelles (compréhension, mémoire, pensée) ou motrices. La prise de parole en public constitue une autre manifestation des phobies sociales. Face à un groupe d’individus, parfois même des collègues de travail que l’on fréquente tous les jours, la situation constitue un agent stresseur tel qu’il engendre un état de détresse et de tension chez la personne qui bloque ses capacités de concentration. Pour Beck, l’impact des phobies sociales chez la personne relève de l’importance des réactions émotives relativement à la perte de contrôle et au jugement des autres envers soi. Une des raisons pour lesquelles il peut s’avérer difficile de traiter les phobies est que dans une certaine mesure (réaliste), le danger objectif n’est jamais dénué de risque réel (Beck, 2010).

 

Le chapitre 8 conclut quatre chapitres abordant des troubles spécifiques au plan cognitif et émotionnel. Celui-ci s’intitule L’esprit plutôt que le corps : les troubles psychosomatiques et l’hystérie. Depuis toujours, les problèmes du corps et de l’esprit se croisent sur la frontière de la médecine organique et de la psychologie. Prenant implicitement position, Beck constate que la notion de réel chez la personne relève non seulement de constructions psychologiques, mais également de certaines prédispositions physiques. Beck définit les troubles psychosomatiques en termes d’« anomalies démontrables dans le fonctionnement ou la structure d’un organe ou d’un système physiologique du corps : la peau, le système gastro-intestinal, le système cardiovasculaire ou le système respiratoire » (p.154) Au cœur des troubles psychosomatiques se trouve les émotions. Celles-ci témoignent de la pression exercée par un stresseur interne (ex. : concevoir le bonheur comme résultante d’une réalisation de soi dans toutes les dimensions de sa vie, entretenir des exigences élevées, envisager toutes les situations comme une question d’évaluation de sa valeur à l’égard des autres et socialement) entraînant un état de tension continuelle, auto-imposé et exagéré. Il est ici possible de penser à un employé qui ressent un mal de tête à chaque fois qu’il doit assumer des fonctions d’autorité ou d’un étudiant présentant des ulcères lorsqu’il doit rencontrer un client dans le cadre d’un cours de counseling de carrière, alors que ces deux personnes n’ont jamais véritablement échoué ou vécu de difficultés notables par rapport à ces activités. Tel que le mentionne Beck, le cycle psychophysiologique comprend un événement externe, qui entraîne une expérience de stress important, l’adoption de croyances quant aux dangers associés à celle-ci, puis à des manifestations physiologiques. Ce débordement psychologique se manifeste généralement par une souffrance disproportionnée et une anticipation exagérée des conséquences. Toutefois, il arrive aussi que la souffrance psychologique soit tellement importante qu’elle entraîne l’apparition de réels problèmes de santé physique. C’est pourquoi les approches cognitives préconisent l’accès conscient à cette double souffrance par les personnes en difficulté. Beck fait entre autres référence aux techniques d’imagerie somatique telles que des exercices de représentation du soi somatique et de son influence sur les émotions, puis sur les pensées qui orientent les comportements; les procédures de stimulation visuelle où une expérience sur mode vidéo présente une gamme de situations potentiellement porteuses de sensations physiques plus ou moins intenses chez la personne; les analyses de rêves centrées sur les sensations corporelles associées à certaines images, souvent répétitives lors des périodes de sommeil.  En terminant, Beck distingue les troubles psychosomatiques des troubles hystériques. Ces derniers présentent également une distorsion cognitive qui entraîne l’expérience d’une sensation de dysfonctionnement physique, mais sans qu’il n’y ait pour autant de maladie ou d’anomalie apparente.

 

Les quatre derniers chapitres du livre (9, 10, 11 et 12) constituent une forme de retour synthétisée sur les approches cognitives. Le chapitre 9 présente Les principes de la thérapie cognitive. Tout d’abord, Beck porte la souffrance psychologique au cœur des approches cognitives. À cet égard, le travail d’intervention auprès des personnes en souffrance doit miser sur l’utilisation de techniques efficaces afin d’identifier, d’évaluer et de corriger les conceptions et les autosignaux erronés qui maintiennent les personnes en état de fragilité, de confusion, de déception à l’égard d’eux-mêmes, des autres, du monde et de la perspective d’un avenir heureux. Toujours selon Beck, les réactions émotionnelles constituent la clé donnant accès aux souffrances de la personne. De son coté, les cognitions révèlent la manière dont cette souffrance est construite et les zones d’intervention spécifiques afin d’en atténuer ou d’en modifier les effets, que ce soit en termes d’attitudes ou de comportements. Trois types d’approches peuvent guider l’intervenant de la thérapie cognitive. Tout d’abord,  Beck nomme l’approche dite  intellectuelle. Celle-ci porte sur l’identification d’erreurs de conception chez la personne, puis d’une discussion visant à tester leur validité, afin de favoriser une compréhension de l’interaction entre ses émotions, ses pensées et ses comportements lors de l’expérience de certains contextes, puis l’adoption d’attitudes plus appropriées. Une autre approche est dite expérientielle. Celle-ci mise sur l’exposition de la personne à des situations d’expériences suffisamment puissantes émotionnellement de manière à confronter les cognitions erronées de la personne et de soustraire les erreurs de conceptions associées. Enfin, l’approche comportementale, de nature plutôt pédagogique, mise sur l’apprentissage de nouvelles conceptions de soi et de la réalité environnante en parallèle à des essais comportementaux en conséquence. Pour être efficaces, les personnes cibles visées par les approches cognitives doivent être minimalement aptes à l’introspection et à la réflexion sur ses pensées. Conséquemment, l’intervenant faisant appel à une telle approche tiendra compte du niveau de développement intellectuel et de formation du langage de la personne (dénomination d’objets et de situations; élaboration et vérification d’hypothèses). Sur le plan de la relation de travail avec son client, l’intervenant s’assure d’une collaboration authentique, ce que Beck qualifie d’entente claire et formelle entre l’aidant et l’aidé à propos d’un problème à régler, le but de la démarche, les moyens à utiliser, la nature et la durée de l’intervention, la participation active essentielle du client pour alimenter le travail commun. L’intervenant devra également se montrer souple face à l’émergence de nouvelles préoccupations soulevées par le client au fil des rencontres. L’alliance collaborative nécessaire à l’efficacité de la démarche devra permettre au client d’exprimer ses pensées et ses sentiments, sans risque de honte, d’infériorité ou d’imperfection, notamment lors des rétroactions fréquentes et nécessaires de la part de l’aidant.  En fait, l’intervention ne porte pas tant sur la personne en problème que sur le problème de la personne. Une méthode de résolution de problème permet une distanciation suffisante entre la personne et son problème, ce qui permet une meilleure conscience des impacts d’actions portées sur le développement de nouvelles façons de pensées, de ressentir et de vivre … et transférables à d’autres dimensions de vie. La crédibilité constitue également un enjeu important pour Beck. Pour ce dernier, l’intervenant doit afficher une position neutre, ni trop optimiste, ni défiante, qui encourage l’expression de pensées automatiques et de croyances irrationnelles, qui porte une écoute attentive à la capacité de s’ouvrir du client selon les méthodes employées. Celui-ci doit faire attention de tomber dans une dynamique d’intervenant-surhomme (client attribuant au conseiller l’autorité et la responsabilité de la démarche, abandonnant du coup sa capacité d’autocritique), ni celle d’intervenant-menace (qui affronte, plus que ne confronte les résistances du système de croyances du client). De même, il doit éviter de devenir un intervenant trop optimiste tellement centré sur la dynamisation positive que la cliente peut y percevoir un manque de considération à la gravité de ses difficultés. En terminant, Beck décrit les phases d’un travail de résolution de problème par  reconstruction d’une séquence causale. Ainsi, l’intervenant cherchera tout d’abord à identifier le dénominateur commun aux multiples difficultés et symptômes du client. Ensuite, il tente d’élaborer une chaîne de symptômes relatifs aux problèmes vécus par le passé et actuellement. Enfin, il articule un modèle conceptuel de l’expérience subjective de la personne en le partageant et le corrigeant au travers d’un travail ensemble.

 

Le chapitre 10 aborde Les techniques de la thérapie cognitive. Plusieurs de ces techniques sont proposées par Beck et la plupart peuvent être utilisées au sein de mêmes stratégies d’intervention. D’abord, il propose la méthode expérimentale où des hypothèses sont identifiées, puis vérifiées par une expérience plus ou moins contrôlée. La technique de reconnaissance d’idéations inadaptées ou de pensées automatiques vise de son côté à entraîner la personne à relever progressivement les manifestations de certaines cognitions dysfonctionnelles à partir de l’émergence d’émotions récurrentes. Dans le cas de pensées automatiques moins facilement accessibles, Beck propose la technique de remplissage des « blancs », laquelle implique un travail d’approfondissement et d’observation de la succession de pensées, d’émotions et comportements par rapport à différents événements externes. La technique de distanciation et de décentration relève davantage d’une attitude. La distanciation facilite la soustraction de la personne par rapport à une dynamique situationnelle par l’essai d’une nouvelle perspective. La décentration porte plus particulièrement à éviter le piège de la personnalisation des composantes d’un événement par rapport à d’autres possibilités dépassant sa seule expérience subjective. Parmi les autres techniques nommées par Beck, il y a aussi celle d’authentification des conclusions où les conclusions automatiques et potentiellement erronées des personnes sont soumises à des épreuves d’argumentation logique. La technique du changement de règle consiste quant à elle à explorer et identifier des situations de risque, d’insécurité, de souffrance où sont autosuggérées des obligations (il faut que …! je n’ai pas le choix …; c’est la vie …) et des règles de fonctionnement (ex. : si (mon conjoint, mon père ou ma mère, mon enfant) ne m’aime pas, je ne vaux rien; si un collègue n’est pas d’accord avec moi, c’est qu’il veut me rabaisser ; si je refuse une demande de mon patron, je vais perdre de l’importance dans l’entreprise). De façon générale, les stratégies d’interventions proposées par ce type d’approche cognitive ont pour objet d’aider la personne à corriger un problème par une démarche systématisée afin d’éviter les essais-erreurs, l’errance parmi des méthodes disparates, la perte de direction.

 

Le chapitre 11 aborde La thérapie cognitive de la dépression. Ce type de problématique rejoint plus particulièrement les intérêts de recherche d’Aaron Beck. Dans son ouvrage, il propose d’ailleurs un tableau (p.216-217) – très pertinent pour les praticiens – traitant d’interventions spécifiques à certains types de problème ciblés avec la personne : inertie, évitement, fatigabilité, intentions suicidaires,  désespoir, manque de gratification, autocritique et haine de soi, douleurs émotionnelles, surévaluation des exigences, des problèmes et des pressions externes. Bien que le symptôme d’un problème puisse apparaître sous la forme d’émotions ou de comportements, l’efficacité de toutes interventions porte sur la modification de l’organisation cognitive de la personne. Pour ce faire, les stratégies d’intervention sont multiples : activités de structuration des pensées du client; prescription de tâches avec niveau progressif de difficulté ; relativisation consciente de situations de vie tout aussi plaisantes que déplaisantes; réévaluation cognitive séquentielle (symptômes, cognitions, motivations, généralisations, inférences arbitraires, pensées dichotomiques, théories personnelles implicites, tests de validation d’hypothèses et de prémisses). D’autres stratégies d’intervention porteront davantage sur l’essai de nouvelles attitudes et de nouveaux comportements suivis d’un travail d’analyse rétrospective et de la mise en place de solutions d’alternative aux problèmes psychologiques.  De plus, les stratégies pourront également porter sur la visualisation et l’entraînement à l’imagination de situations problématiques et de formulation d’alternatives éclairées (but, étapes de réalisation, obstacles et conflits potentiels, ajustements possibles).  De plus, ces tâches peuvent aussi bien se réaliser en contexte d’entretien avec l’intervenant que par assignation de tâches à domicile décidé, puis revisité (retour sur l’expérience) lors de ces rencontres.

 

En guise de douzième et dernier chapitre, Beck aborde Le statut de la thérapie cognitive. Il énonce une posture personnelle à l’égard de l’importance de l’exhaustivité, de la fiabilité et de la validité de modèles théoriques d’intervention auprès des personnes. Parmi les critères permettant une juste évaluation de la qualité des approches et modèles théoriques d’intervention, Beck nomme d’abord l’importance de pouvoir s’appuyer sur une théorie ou un modèle théorique exhaustif sur le plan de la cohérence interne (opérationnalisation des concepts), des principes logiques qui lient la théorie à la pratique,  à l’explicitation de ses particularités, de ses avantages et de ses limites par rapport à d’autres théories ou modèles, à la souplesse lui permettant le favoriser le développement de la recherche et de nouvelles techniques, ainsi qu’à la vérification par la preuve empirique de ses hypothèses, de ses axiomes et de ses postulats. Une autre dimension importante de la qualité d’une théorie ou d’un modèle théorique d’intervention est de décrire de manière détaillée les différentes techniques permettant son utilisation en contexte pratique : définitions et descriptions claires, exhaustives et applicables; argumentation empirique favorable, fiable; à leur efficacité en situation d’intervention similaire par des essais conduits avec des mesures , des groupes témoins, des évaluations par juges indépendants et par un suivi à long terme. Par la suite, Beck se livre à un examen comparatif des approches cognitives avec celles d’allégeances psychanalytiques ou comportementales au plan de certaines variables telles le statut de la conscience, le rôle d’accompagnement, la nature du changement, les mécanismes sur lesquels se réalisent l’intervention, le transfert de connaissances à des fins de formation et de recherche.

 

 

Pertinence pratique

 

L’ouvrage de Beck expose les fondements de la thérapie cognitive. Les professionnels de l’orientation et du développement de carrière qui souhaiterait faire l’usage d’une telle approche devraient 1) prendre en compte la dimension du fonctionnement psychologique de la personne lors de leurs interventions; 2) accorder une place prépondérante à l’organisation et l’opérationnalisation des mécanismes cognitifs de la personne ; 3) considérer les émotions et les comportements de la personne à titre de symptômes significatifs de l’expérience de certains événements, de certaines rencontres ou de certains contextes. En contexte d’intervention individuelle ou de groupe, de formation ou d’enseignement, d’encadrement ou de gestion de personnel, une approche cognitive de l’orientation et du développement de carrière peut enrichir la pratique de professionnels sensibles aux pensées automatiques, aux croyances irrationnelles, aux idéations, aux généralisations ou encore aux interprétations des personnes par rapport à elles-mêmes, aux autres, au monde, ainsi qu’à l’égard de leur vision de l’avenir.

Une intervention réalisée sous une approche cognitive peut ainsi bénéficier d’une entrée en relation de travail par l’analyse de récits de vie. En se racontant, la personne est ainsi invitée par son conseiller à un travail d’approfondissement et d’exploration certains enjeux problématiques. Progressivement, une telle approche pourra faciliter l’identification de liens possibles entre différents événements présentant des similitudes quant aux cognitions, émotions et comportements s’y associant. Après quelques rencontres, ces différents liens établis pourront permettre une meilleure articulation d’ensemble du fonctionnement psychologique de la personne. Au travers de toutes ces actions précédentes et à partir de ce moment, les interventions peuvent alors permettre l’identification de mécanismes cognitifs spécifiques sur lesquels mettre en place des méthodes menant vers des attitudes et des comportements plus éclairés à l’égard de leur orientation et de leur carrière.

Parmi les avantages d’une telle approche, notons 1) la considération de la dynamique d’interdépendance entre cognitions, émotions et comportements; 2) la possibilité de mesurer et d’observer les effets de l’intervention; 3) l’accent sur le problème de la personne plutôt que de la personne en tant que problème, ce qui évacue de possibles conséquences culpabilisantes pour le client; 4) sur une plus grande responsabilisation du client en raison d’interventions centrées sur les mécanismes psychologiques accessibles à la conscience; 5) sur la possibilité du conseiller à jouer plus aisément un rôle actif au sein de la démarche et de faire valoir aisément au client la participation active essentielle dont il doit faire preuve pour être aidé à s’aider.

 

A propos de Louis Cournoyer 216 Articles
Professeur-chercheur (Counseling de carrière) / Directeur de la Clinique Carrière / Directeur des programmes de premier cycle en développement de carrière / Conseiller d'orientation et superviseur clinique Université du Québec à Montréal

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