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Below, I have posted an article which epitomizes all of the things I question about Cognitive Behavioural Therapy (CBT). I know I am going to get all kinds of flack about this, but it’s time someone stood up and questioned the efficacy of this approach, even though it is probably the most widely known and recommended of all current psychotherapeutic techniques.
The article is entitled, “6 Steps to Transform your Outlook“, and, while the author does not identify herself as a CBT therapist, her article has all the hallmarks of that approach. It contains six suggestions that, on the surface of it, seem to make perfect sense: 1) Stop Complaining, 2) Practice “Thought Stopping”, 3) End your “Yes, but…” attitude, 4) Beware the self-fulfilling prophecy, 5) Replace negative beliefs & 6) Take positive action.
All of these suggestions sound pretty good, right? But let’s just take one of them and try it out. Let’s take, “Thought Stopping”, for example. Right now, think about something that is bothering you. I’m sure you have something on your mind or you wouldn’t be reading this article. Now, stop thinking about it. Can you do it? Come on! Try harder! What is the matter with you?
The truth is that most of us are only vaguely aware of our negative thoughts (if we are aware of them at all), let alone how to stop them. And when we are anxious, depressed, grief-stricken or traumatized, we are absolutely incapable of addressing these negative cognitions because our feelings overwhelm everything else. It takes support, awareness and practice to be able to encounter and transform our destructive thoughts, but most importantly, we need to address our feelings first and come to a state of relative calm before we can even begin to address what we might be thinking.
We will come back to this later, but for now, let’s talk about the instruction to “Stop Complaining”. We all know there are those individuals who would rather complain than take any action to change their lives, but the majority of the people I see are very reluctant to complain. They tell me they have suffered silently for years because they don’t want to “bother anyone”, and besides, there are “other people who have suffered much more”. It is all I can do to get the average person to complain enough to even find out what is troubling them. And once they have an opportunity to “complain” (that is, talk about their loss, pain, trauma, anxiety and depression), they usually feel much better. Lighter. They feel supported and understood and it gives them courage to face whatever burdens they bear. It also helps them to sort out their thoughts and begin to process some of the pain and confusion that usually accompanies emotional distress. This is also known as the healing process.
Once the healing process has been initiated, we can then have a discussion about their negative cognitions. And not just a conversation, but a lengthy dialogue about how to go about understanding and transforming cognitions. It’s not enough to just say, “Practice thought-stopping”; people need to know how to do this. They need to understand tha nature of the inner dialogue which underpins human thought processes.
This is also related to point number Five in the article–the injunction to “Replace Negative Beliefs.”
Sigh. . .
If you don’t understand how you came to have these negative beliefs, if you have not mourned the circumstances under which you came to believe the confusing, debilitating, self-hating things you were taught about yourself, if you have not untied the knots of self-sabotage that have hindered you up till now, you are not going to be able to “replace” those beliefs. All you will be doing is adding another layer of self-recrimination to your repertoire of self-defeating inner dialogue.
I could go through the rest of the article in detail, but you get the point. If people could just “think” their unhappiness away, they would do it. If you are seriously suffering from grief, trauma, anxiety or depression, the advice in this article would fail you miserably; and the worst part is that then you would blame yourself for not being able to “fix” it.
I am not saying that Cognitive Behavioural Therapy does not have its place in the mental health firmament, but I do believe its usefulness is much narrower than we are led to believe. The biggest fallacy with CBT is its premise that we can control our emotions with our thoughts when research clearly indicates that, long before we are even capable of forming a thought, our emotions are already reacting to stimuli in our environment.
So this is where we must start, in most cases–with feelings, sensations, intuition, and experience. We need to be able recognize our own inner dialogue–that barely conscious discussion between an often unforgiving and disordered “Inner Critic” on the one hand, and the part of ourselves which the Critic shames, silences and depresses (often called the “Inner Child”, but it could also be our “Inner Woman, “Inner Homosexual”, “Inner Wimp” or whatever we have been taught to disparage). Furthermore, once we have recognized this inner dialogue, it takes time and practice to soften the Inner Critic, while at the same time learning to enlarge and esteem the part of us which has been vilified and oppressed.
And this is, to my way of thinking, the greatest problem with CBT. If we simply try to “stop our negative thoughts”, without first understanding and transforming our inner dialogue, we will of necessity be trying to manage our cognitions with the same disproportionately condemning Inner Critic that causes all the problems in the first place. Over the long term, this approach cannot work, and will likely make things worse. It is like trying to hammer in a nail with the very nail you are trying to hammer.
I am convinced that CBT is such a popular approach because it mirrors much of what society tells us about how to achieve success–“stop complaining”, “think positively”, “pull yourself up by your bootstraps”, “just change!”
My clients tell me that they have tried to do all these things, usually for years, with no success. They come to therapy feeling defeated and overwhelmed. But paradoxically, when we try the opposite approach–when we use empathy to help the person address the roots of their distress, then they are able to forgive themselves. The cycle of self-condemnation is broken because there is nothing to criticize, and our negative cognitions just stop.
At this point change happens of its own accord. We only need to get out of the way.