Cognitive Behavioral Therapy (CBT) has been a hot topic of late. In the recent MIA blog posting, “Colonization or Post Psychiatry,” multiple references were made about “system therapists” promoting CBT coming into the Hearing Voices Movement to possibly dilute or co-opt the essential revolutionary character of the movement, thus turning it into something more mainstream and less threatening to the status quo of Biological Psychiatry’s oppressive medical model.
In the discussion that followed several people stepped forward to defend CBT as a valuable therapeutic approach that in the right hands can be used to facilitate positive change. Some tended to exaggerate its importance and promote its use as almost some type of liberated way of thinking about the world; an approach able to solve all human emotional problems without referencing any type of moral evaluation of the material conditions of life giving rise to certain types of thoughts and behaviors in this world. So let’s take a cold hard look at what CBT really is, and what it is not.
To make this analysis, let’s imagine you are a therapist who is given the task of providing therapy for Ariel Castro (the recent accused kidnapper and rapist) to help him deal with suicidal thoughts over being universally hated and most likely condemned to a life sentence or the death penalty. Now think about the absurdity of doing CBT in this situation; that is, analyzing his negative thought patterns to help him deal with his one-sided thinking so he can better adjust himself to his (not so nice) life conditions.
Even better, imagine you’re given the task of providing therapy for Dr. Joseph Biederman (the key promoter of children’s Bipolar diagnoses) who perhaps is dealing with a severe depression related to negative public opinion regarding the enormous damage his work has done to tens of thousands of children (unfortunately his depression is a made-up scenario). Again you have the assigned responsibility to use CBT to help him see beyond the “negatives” in his thought patterns to find the “positives” in his career in order to help relieve his depression so he can get on with his work with great enthusiasm.
And even more controversial, let’s say you have the task of providing therapy using CBT for President George Bush several months after he launched the Iraq war; imagine for a moment that he has become quite depressed related to the growing mass demonstrations and the grief displayed by the parents of dead American soldiers coming home in coffins on a daily basis. Your job is to help him overcome his depression so he can get back to being The Commander In Chief.
Do you now get a clearer picture of the serious limitations and pragmatic and amoral nature of CBT? If you think like me, you would absolutely refuse the task of helping all three of these criminals attempt to solve their particular emotional problems. In my way of thinking if you had to choose, Ariel Foster would actually be the least difficult of the three to work with; after all he is in jail and can no longer harm anyone. In addition, his crimes against humanity (in my eyes), as horrible as they may be, actually fall short of his cohorts in this analogy.
As far as Biederman and Bush are concerned, I would actually hope they would become even MORE depressed NOT LESS. I would want this to become the outcome not because of hatred (although hatred is not wrong to feel towards these individuals) or revenge (I do understand why people might want these people to suffer, but I would struggle to resist those impulses) but instead for the morally justified reason that the MORE DEPRESSED they become hopefully the LESS EFFECTIVE they would be at performing their jobs, and thereby perhaps lessen the damage they can do to the masses of potential human victims. Whether or not they are nice to their own children or happen to be loving toward their dogs, this is of no relevance to my overall opinion of them or in any kind of objective analysis of their overall social role in the world at large.
Clearly I am responding from a position that Biederman’s social role as a major spokesperson for Biological Psychiatry is indeed causing great harm to thousands of children (and others) and he should be prosecuted and punished for the deaths and psychological damaged perpetrated against innocent children.
And in the case of George Bush, in the reactionary cause of imperialist empire building, he launched one of largest drive-by shootings in modern history, essentially almost killing a country by destroying its infrastructure, (including food distribution, medical services and electrical power etc.) creating the material conditions for the deaths of several hundred thousand Iraqi people (500 thousand may be an underestimate of human lives lost), and in addition, the lives of several thousand American soldiers.
It could be said that all three of these people have literally lost their humanity, but I don’t believe it is my job to spend one second attempting to restore it. My time would be much better spent exposing their crimes and organizing people to create the material conditions in the world where they (and others like them) can no longer have the ability to carry out further crimes against humanity; and in the long run help create a world where there is no longer the material or psychological basis for people to ever lose their humanity.
However, if you had a CBT therapist who was a believer in Biological Psychiatry’s Disease/Psych drug model of treatment (a completely different interpretation of the same material world that gave rise to my way of thinking) he/she might have no problem working with Biederman to help him overcome his “negative” thinking and thereby, not only justify his psychiatric work diagnosing and drugging children, but overcome his depression to rededicate himself to his “important” work “helping” his patients.
And if a backward thinking CBT therapist believed that it’s America’s moral destiny to police the world spreading “free market” capitalism and the Christian way of life throughout the entire planet by toppling any political leader standing in its way, and ultimately justifying the deaths of hundreds of thousands of innocent civilians for this cause, then he or she might jump at the chance to challenge the “negative” thought patterns of George Bush and help him overcome his depression and resurrect his “moral” courage to prosecute the war effort.
So let’s get real about CBT. At the beginning and end of the day CBT is nothing more than a pragmatic and sometimes useful tool that has serious limitations due to its’ fundamentally “idealist” philosophical origins in understanding the world. CBT comes out of the school of thought that says we are what we think we are, or if we take it a step further, “I think therefore I am.” This way of thinking implies that there is no material reality independent of our thoughts; so there can be multiple realities based on any one person’s interpretation of the world. This is in direct opposition to a “materialist” philosophical perspective that says “I am therefore I think.” The latter view postulates that thoughts, ideas, and theories come from one’s interaction with the material world. If that world is, in fact, oppressive to the humans interacting with it, this will be directly reflected in the thinking and behavior of those human beings. Of course when ideas (emerging from interaction with the material world) are subsequently put into action they can influence and change the material world in an ongoing dialectic or spiral development of change.
CBT, being part of the “idealist” school of thought, tends to sever the relationship between the specific nature of the material conditions in the environment that gives rise to a person’s thoughts, and leaves it up to the interpretation of the listener (often a therapist) to determine whether or not the environmental source of those thoughts was actually traumatic or oppressive or more positive and humane.
So in reality the pragmatic value of CBT as a therapeutic method (in the short run) can be achieved without any type of moral compass or historical barometer to determine if the end result actually advances the cause of humanity, or if it only meets the immediate selfish needs of its user in the moment. In other words, we need to ask the important question: for whom is the CBT method being used, and for what purpose?
Yes, CBT can be defined as a pragmatic tool. However, should we somehow imply that it is a liberating program and ideology? Definitely not. In the right hands, in the right circumstances, and in a micro sense, CBT can help people overcome specific problems; in the wrong hands it can actually do great harm.
We could apply the same morality that condemned psychologists who helped train and evaluate the CIA’s water boarding interrogation methods to those that would help people on the wrong side of history feel better about themselves and function better in the world by using CBT. In a macro sense, the only way this can ultimately be evaluated is by making an historical examination regarding what political and social movements (and the ideologies and ways of thinking arising out of and promoting them) are truly advancing the cause (conditions of life) for all of humanity and therefore should be supported; and those that are moving things in the opposite direction and therefore should be opposed. This is not an easy task, but one that CAN and MUST be done.
Twenty two years ago I was trained as a therapist with a specialty in addictions. I was exposed to multiple theoretical and practical approaches to helping people overcome problems. This training included Rogerian, Psychoanalytic, Object Relations, Reality Therapy, Twelve Step, Rational Emotive Behavior Therapy, Family Systems and Cognitive Behavioral Therapy, to name a few.
In my work I probably have used bits and pieces of all of these methods and theories, but it would be absolutely foolish to think that one therapy approach provides even close to all the answers to the human condition. There are clearly other liberation ideologies that have led to major advances in human social organization and morality that have more potential revolutionary content than those necessarily coming out of the field of psychology.
In fact it was my preceding 20 years of experience as a radical political activist (coming out of the late 1960’s) that actually prepared me in the best ways to be a “coach” or a so-called counselor to people experiencing problems in life. These experiences trying to change the world certainly made me want to pay very close attention to a person’s narrative and truly understand the conditions of life that gave rise to their thinking and behavior.
The critical thinking skills promoted among radical activists allowed me to very quickly migrate to the critics of the medical model and determine that Biological Psychiatry was an oppressive paradigm of treatment. In 1991 I even wrote my Masters’ thesis on the dangers of psychiatric drugs after encountering the work of Peter Breggin. However, I must say that it has been my recent exposure to the survivor movement through MIA that has taken my critique of Biological Psychiatry to a whole new level and renewed my activism and desire to radically change the world.
Working as a therapist in community mental health for 20 years I have sat with people who have experienced so much trauma and negative experiences in life that I felt as though I had absolutely nothing to offer them, other than to act as a witness to their personal horror and express my sorrow that they had to go through those terrible experiences. In those moments I have even thought to myself “if that was my life I would absolutely find it unbearable and most certainly consider ending it all.” Their resilience to survive and go on another day would literally astound my own sensibilities.
In those situations if I had somehow attempted to apply CBT to help get that person to focus on evaluating their “negative” thought patterns and look for and reframe the “positives” in their thinking, this would have been totally absurd and perhaps even harmful to that person at that moment.
In another example, I have worked several years with a woman who has experienced trauma, depression, multiple losses, and a series of dysfunctional relationships. She told me a year ago that the most profound moment in all our therapy together, after more than 6 years of work, was when she saw me shedding tears as she described the time when she had to put down her 13 year old beloved dog.
A final example might be those people I’ve seen in counseling who say that in the throes of some deep emotional crisis they actually hear my own words reverberating in their head guiding their actions. I often don’t even remember exactly what I said at that particular moment in therapy, and have to recheck the content of those words to be reminded of the power of my position in helping people in extremely vulnerable moments in their life.
It is these types of experiences in counseling that should truly humble us as we have been so privileged to share a window into the lives of people experiencing deep emotional suffering, and who are bravely attempting to solve the problems of life we ALL face on this planet, each of us learning from the other as we go. It should also force us to go through some type of continuous self-interrogation of our own beliefs and values and how they may be influencing the beliefs and actions of others. This all reminds us of our tremendous responsibility doing this kind of work.
I gladly look forward to a time in history when this type of counseling or “coaching” type of relationship between human beings will literally wither away and no longer be needed. We all have much work to do to radically transform the material world, and in the process transform ourselves and our ways of thinking, as part of the achieving true liberation.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.