CBT (Cognitive-Behavioural Therapy) – a critique

bullet waves 5 blue grey crosslines aa-img029CBT (cognitive-behavioural therapy): what it is and what it isn’t

[Postscript added Jan 2016. This essay in The Guardian: “Therapy wars – the revenge of Freud” is relevant. It is artificial in that in compares CBT and psychoanalysis though CBT is not in fact any longer the best of the “brief” therapies, nor is analysis the best or only “depth” therapy. But it is good to see the shallowness of CBT being plainly named. ]

Cognitive-behavioural therapy (CBT) is a form of brief therapy much favoured by the NHS and clients sometimes ask me how it compares with what I do.

CBT has many plusses compared to therapies such as traditional counselling: it is action-oriented, here-and-now, incorporates basic psycho-education, and it leverages what people say to themselves to change how they feel. But it has shortcomings. In my view it in no way deserves its growing reputation in the media as “THE evidence-based therapy”, especially when compared to such inspiring brief therapies as Solution-Triented Therapy (SOBT). (The myth of CBT – why cognitive-behavioural therapy isn’t the uniquely “best” therapy.)

Cognitive-behavioural therapy (CBT) was invented by American psychoanalyst Aaron Beck in the 1960s. Beck decided that psychoanalysis, in the form of endless talking and self-reflection, simply didn’t work. He took the bold step of sweeping away all the processing and found his patients did much better when he instead said to them (in my words, dramatising just the tiniest bit) “Stop telling yourself worrying thoughts and step by step, get on with life.”

It is true that therapy which focusses only on looking inwards can take forever to get nowhere. But what makes for real, deep personal change is a flexible, balanced mixture of action and inner process, a balance of thought and emotion. In my view Beck threw out the baby with the bathwater. CBT, even when useful, is shallow.

That’s not just my opinion. It’s what my clients who’ve previously had CBT repeatedly tell me. (What my clients in Bristol say about counselling, psychotherapy and CBT.)

The spirit of CBT is to choose to think rationally about a problem (“cognitive”) and take active common-sense steps (“behavioural”) to challenge fears and insecurities. For example: do cats really bite if you stroke them? – try it and find out; wise advice! In particular CBT changes what we say to ourselves about things. For example, you might change “I must succeed, or there will be unbearable consequences” to “I prefer to succeed. If not, there may be consequences, and if so I can cope with those.”

But CBT has crucial omissions: feelings, emotions and the all-important subconscious mind. In the CBT view, emotions arise from thoughts. And for some feelings and emotions, this is true. But most certainly not the deepest core feelings. Core emotions arise from a profound place inside us, far deeper than words. CBT is often appears to be just ignorant of these human depths. What more, when emotions are connected to thoughts, the thoughts are often buried in the subconscious mind.

What’s missing from CBT – joy, emotions and the subconscious

Human life is about joy, discovery, courage, truth, risk, adventure, compassion, love, spirituality, finding and following the inner voice, commitment, sex, passion, joy and fun. To me, so is therapy. With its one-dimensional academic emphasis on rational thinking, it is virtually impossible to find anything of these in any CBT manual I have ever seen. Yet it is not difficult for a highly effective, highly research-supported psychotherapy to be alive, empowering and human and reflect all these qualities. Solution Oriented Therapy does so magnificently.

Life is also about deep unconscious and superconscious forces. Again, it is impossible discover anything of these in CBT.

Here is a very simple example, a client of mine who had previously had CBT. [All case vignettes are real but anonymised.] Her issue was that she’d get so far into a relationship, and then when things were going well, she’d create an excuse to throw a fit of hysterics, and leave. This had happened several times. The CBT therapist had said that this was a learned behaviour pattern which she could re-learn, and taught her “thought-stopping” techniques. And she was striving and straining to stop those thoughts of leaving. She just couldn’t.

Within five minutes it was obvious that the problem was nothing to do with her leaving her boyfriends. Rather, she was terrified that they would leave her. She left pre-emptively in order to avoid the pain of them leaving her, a common pattern. She had an “A-ha!” moment as she linked this to her father walking out on her mother. In one session we made more progress than several months of CBT, and in only a few sessions saved her relationship.

Although CBT has over time been forced to recognise the value of the client-therapist relationship, if you look at CBT books you will find them drier and more lifeless than a dry, lifeless thing. By contrast, solution-oriented therapy textbooks are inspiring and full of respect and appreciation for human beings and their capacity to overcome problems, with just a little help. CBT lacks a loving or expansive vision of human potential. It is incomplete or more often simply wrong in its academic understanding of feelings and emotions. It is highly structured (“manualised” or “protocolised”) with little room for the creativity of the moment. All in all, CBT is a very useful therapy. But its self-belief that it is the best or only therapy, is plain crazy. See here for a thoughtful critique of CBT in The Guardian by psychoanalyst and author Darian Leader.

CBT with heart and soul

My own approach could be termed “CBT with heart and soul.” It includes those principles of CBT that I feel have enduring value – the emphasis on living life now, on taking action, on changing from destructive to constructive patterns of thinking. These are not original to CBT, they are basic to all the ancient wisdoms:

“Our life is shaped by our mind; we become what we think. Suffering follows an evil thought as the wheels of a cart follow the oxen that draws it.”
Gautam Buddha

But my approach also includes the things that CBT so woefully excludes: feelings, emotions, unconscious forces – the depths that are so painful and the heights that are so joyful, the things that make life alive.

If you would like to explore how that expanded way of therapy can help you, just give me a ring: the permanent number is 0845 3510604, currently the same as dialling 0117 955 0490. You can call any time at all; leave a message and I’ll get back to you.

 

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