Cognitive Behavioral Therapy:
The Good, The Bad, The Limitations

Richard D. Lewis
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6270

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.

 

 

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Richard D. Lewis
Addiction, Biological Psychiatry and the Disease Model: Richard D. Lewis, MEd, has worked with addictions for the past 19 years in New Bedford, MA. Richard discusses the relationship of addictions to severe psychological distress often labeled as a “disease” and/or a so-called “mental illness".

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121 COMMENTS

  1. Richard,

    And will we now have a post allowing equal time on the use of CBT for those folks involved with the Benghazi scandal (Watergate-like in terms of cover up); the use of the IRS to intimidate conservative groups (a tactic out of a banana republic; why not go back in time to Eric Holder’s gun-running?

    I doubt it.

    IMO, partisan politics, from the left or right, are going to take this group off-track. It will divide us. And that’s the *last* thing we need.

    My two thoughts.

    Duane

    • “in the reactionary cause of imperialist empire building,” Huh?

      “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.”

      Which tells me why you blinked on a previous thread by Ms. Grossberg rather than continue with your attempt to justify the ‘Dream’ of Socialism.

      Some truths, Mr Lewis, are timeless.

      “If you would abolish covetousness, you must abolish its mother, profusion.”
      Marcus Tullius Cicero.

      • Excerpts from ‘Learn to listen’

        Theo Stickley is a lecturer in mental health at the University of Nottingham
        24 February 2005 mentalhealth today

        “…Although presented as a psychological therapy, CBT is firmly wedded to the medical model. The analogy of the brain as hardware and thoughts as software is well established in the modern psyche. This way of thinking is present in the therapy world, as it is elsewhere…”

        “..CBT locates the client’s problems in their belief systems.Their beliefs about themselves and about the world are in some way wrong, inadequate,mal-adjusted. But while the focus is on a person’s ‘illness’, or ‘dysfunction’, the real problems that
        people with mental health problems (housing, poverty, social isolation, stigma, discrimination) are ignored. As Moloney and Kelly argue:4 ‘The overall outcome of CBT may be to contribute
        to the protection of those in positions of power in society by deflecting criticism from … social inequalities … and the abuse of power..”

        “..What about the enormous cultural differences often found between professionals and clients? If a therapist challenges different beliefs because of class, culture or religious differences, this is
        coercive practice. Besides which, while the therapist focuses on irrational beliefs they are completely missing the meaning that the person ascribes to these beliefs. CBT can be easily used to
        manipulate the client into social conformity and compliance to service driven regimes. Its principles are tried and tested, with positive results, among those who misbehave..”

        “Another component of CBT is psycho-education, based on a medical conception of distress. The therapist ‘educates’ the client about their illness”

        “CBT therapists may claim ‘scientific objectivity’. Foucault,however, would quickly observe that objectivity is meaningless when the therapist is in such a powerful position. Also, when in academic circles it has long been accepted that objective truth does not exist,how come CBT therapists act as if it does?”

        “…CBT has as much, if not more, to do with the personal relationship between the therapist and the client..”

        • The real problems that those with “mental health” issues experience can be external (poverty, etc.) or internal (low self-esteem, etc.). It’s best to avoid dogmatic commitment to simple-minded, one-sided “idealist” or “materialist” perspectives.

          The idea that there is no objective truth has been accepted in some academic circles, but it is increasingly rejected by academics and others as an artifact of a fading, once-popular “post-modernist” perspective, an ideological toy of “tenured radicals.” That is, it is scorned by many academics. Also, if there is no objective truth, then Theo Stickley’s analysis has no objective truth either, so why waste our time with it?

          Ron Unger notes below that many CBT practitioners are opposed to biopsychiatry.

          • I already knew that there are CBT practitioners such as British psychologist Richard Bentall who are opposed to biopsychiatry – it was you who said that you’d ‘never met a CBT practitioner who is opposed’.
            I had not distilled it solely to ‘idealist’ and ‘materialist’ perspectives, we can define anyone’s ideas we dislike as ‘dogmatic’.
            As for ‘wasting your time’, you don’t have to read what I say or talk to me, it’s your choice.

        • Joanna,

          I think your post here exposes some of the major problems with CBT and how it can be quite similar or part of the biomedical model used to drug or provide “therapy” to correct those faulty brains while brainwashing the victim that their bogus DSM stigma is a real illness that requires their toxic drugs forever and other self serving bunk.

          I think this is the point Richard is trying to make in that while he admits that CBT can be useful for some self destructive behaviors and negative thought patterns per the great book, FEELING GOOD by Dr. David Burns, it can’t change a victim’s poverty, fear of various abusers or bullies in power dominating their lives and other inequalities/oppression so prevalent in our crony capitalist country.

          I don’t know a real lot about CBT, but it seems to have limited value when dealing with the many injustices, oppression and violence that cause severe emotional distress because it doesn’t necessarily address the latter issues. Actually, the same could probably be said of any modern “mental health” treatment because unlike social workers of the past, they are not so inclined to fight for or advocate for the human rights violations harming their clients now. That’s probably because they are too busy fighting against such violations perpetrated against them and other workers/unions. Anyone who has evidence to the contrary, please let me know.

  2. THANKYOU – for raising the socio-economic-political lack of attention within most CBT, it’s bloody killing us here, and I too don’t want CBT to adjust my response to the material world.

    Here you would think that CBT had the power to make the flowers bloom in spring and bring about peace in the middle east, it’s hailed as a panacea for ANYTHING, and promoted to death. We even have a whole service set up here whose main goal is to get people back into work as though CBT can create jobs which are not available, change employers attitudes towards people with a label, or fix the fact that some people can’t do it as required but are not allowed the slightest flexibility to be enabled to do it their way.
    In reality, it’s time limited often just 6 sessions as a quick fix, with many excluded from even accessing it [diagnosis of psychosis or history of self-harm].
    Most things have a place and so does CBT, but I reckon it’s use has been seriously over estimated, but here it’s the main ‘psychological treatment’.

    CBT – Can’t Believe Therapist..

  3. CBT is not an “idealist” philosophy that denies the existence of a reality (“material” or otherwise) independent of our thoughts. It merely addresses the fact that our thoughts can shape and distort our emotional responses to reality. CBT labels “depression” an array of negative feelings rooted in distorted thoughts; it does not say that all painful emotions (such as all instances of sadness and remorse) are rooted in cognitive distortions. Bush and other evildoers feeling horrible about their crimes would not necessarily constitute “depression” (which is always irrational) under this definition.

        • “Ace,” really? Feel the need to be condescending & insulting today? I was responding to your comment that “all depression is irrational” (care to share how you came to that extremely broad and black/white conclusion?) and to the general current in our culture that says that good feelings are normal/acceptable/’healthy’ and bad ones are not.

          • It isn’t my conclusion; it’s a CBT tenet, which I tried to make clear (note my qualifier “under this definition”). Personally, I have nothing against “bad” feelings, and I consider suicide a viable life option. Yeah, I guess I was being snotty in calling you “ace.” Sorry, bro (or sis, whatever the case may be). Really.

          • I have experienced both depressed and non-depressed states in my life, and having analyzed them I can see quite clearly that the circumstances of my life directly produced the depressed or non-depressed responses that corresponded. My depressed states have been no more “distorted” or “irrational” than my happy states have been. This is one of the big lies of our culture, I think – that happiness is the only really rational response to life, and to be unhappy means that you personally are doing something wrong – and it certainly seems that this is what CBT in part implies.

            Thanks to a a very lucky experience that happened to me, my eyes were finally opened to the fact that I and my thought processes had never been the problem/the reason I felt bad – it was the input I was receiving from my environment and the conditions put on my life which were more messed up than not, more often than not. When all of a sudden I received some great input/nurturing/life conditions (i.e. something that was provided in part by others, not just myself), my thinking clarified & my mood improved quickly & dramatically, with absolutely no more effort on my part than I was used to expending – in fact, I could put in even less effort than usual and still felt a lot better BECAUSE I HAD A GREAT SAFETY NET and others around me who genuinely liked & supported me. In the absence of those supportive relationships now, I have tried to talk or think myself into happiness/success, but have found that my own thoughts and cajoling are no substitute for the mental/emotional well-being produced by the genuine support & love of others.

            I came to see therefore that *I was not the problem*. So, I am not about to let CBT tell me that if I am depressed it must mean I have flawed/faulty/distorted/irrational/illogical thinking. I realize that my cognitive processes have always worked just fine. It is the input they have received from the outside world which has affected my ability to be happy or not, and I don’t see why all of us homo sapiens wouldn’t function more or less in the same way. So I wish our culture would stop pinning all the blame (really, this is what we do) and responsibility for how we feel and what we do on each individual person. As a highly interdependent social species we simply don’t work that way. We do not all function as little islands, though I believe our highly individualistic (and x, x, x) culture in the West has encouraged us to believe we do, can, should. This seems to have made us very ignorant, judgmental, and unrealistically demanding of our own and others’ emotional/”cognitive” functioning, clueless about some of our social & natural motivations, etc.

          • Well if it’s a CBT tenet then that explains why it’s so irritating & out of touch with reality. By the way, not to nitpick, but “under this definition” as you have it written above does not refer to your phrase about irrationality (since it is outside of the parentheses) but rather to the rest of your sentence about Bush, etc.

          • My depressed states have been no more “distorted” or “irrational” than my happy states have been. This is one of the big lies of our culture, I think – that happiness is the only really rational response to life, and to be unhappy means that you personally are doing something wrong – and it certainly seems that this is what CBT in part implies.

            oh god yes ssenerch, Barbara Ehrenreich smile or die:
            http://www.youtube.com/watch?v=u5um8QWWRvo

            This is the problem with CBT, it’s your fault, everything to do with how you react and behave, nothing to do with political systems, nothing to do with oppression. Taken to it’s political extreme the poor are blamed for being poor and the mad for their madness. Within the psych system, the people who suffer the most with this thinking are those labelled as PD, which is why I feel passionate about that area despite not having that diagnosis. I’ve seen women labelled as BPD effectively blamed for failing to cope with appalling life experiences. Those experiences are not the problem, their inability to cope with them is viewed as the problem as though the [verbal/physical/sexual/neglectful] abuse they’ve experienced is almost inconsequential – they need to get on with coping with it and stop being so ‘maladaptive’. The responses to those women are shocking and the most shocking are from therapists. Ruta Mazelis excellent publication ‘The Cutting Edge’which has been going for many years contains excellent survivors accounts, and Ruta’s work is very considered, worth checking out.

    • I’ll state it again: CBT does not view all unhappiness as irrational. You may label all unhappiness “depression”; CBT does not.

      “…under this definition” refers to “depression” in the CBT perspective. What’s unclear? My preceding words made clear that such “depression” is based on cognitive distortions (i. e., irrationality).

        • Ross it’s a choice to read and respond, no one’s suggesting you have to be the official or sole defender of CBT for the entire profession, and no blogger/poster is required to respond any more than they want to. I won’t be around for a while in a day or so, so I won’t be writing on MiA during that time, I won’t feel compelled to reach a computer to defend anything even though I could if I really wanted to. If it’s not helpful to you, then give yourself a break.

          • Joanna,

            My comment was humorously intended; I was a bit surprised at myself for devoting so much time to defending something–CBT–of which I’m often quite critical. And now here I am back on this thread again. F*ck.

          • LOL! sorry humour over the net can be harder to see, but as you say back again *tongue-in-cheek* do you need some therapy for this?! I’ve developed a few myself if you scroll down, plus I’m a fully qualified Star Trek Therapist

      • This is what you said: “Bush and other evildoers feeling horrible about their crimes would not necessarily constitute “depression” (which is always irrational) under this definition.”

        This is what that sentence means as written: “Bush and other evildoers feeling horrible about their crimes would not necessarily constitute “depression” under this definition. Depression is always irrational.”

        To say that depression is always irrational to me is very irrational indeed.

        • Yes, that’s what I intended the sentence to mean, bit it has to be read in context, as the closing sentence of that paragraph, which offered the CBT perspective. CBT does not define “depression” as broadly as you might. It acknowledges the soundness of “realistic sadness,” but distinguishes that from self-destructive forms of sadness and other downeresque feelings.

          I’m never getting off this thread, am I? (Shoots himself in the head.)

          • Ross,

            I still feel you are over the line in terms of determining for someone else which sadness is “realistic” or acceptable in your view and which or how much is unnecessary, “irrational,” excessive, “distorted,” in your opinion. Life conditions vary so broadly. Summing up my life from the outside you cannot necessarily see all the forces that are shaping my feelings & responses to the world. For example, I have never had any extreme trauma happen to me that would be recognizable by most people. (“Acceptably catastrophic” perhaps in your view). However, various conditions of my life combined to produce a rather difficult and unhappy situation for me for many years, and at one point I simply stopped being able to cope with it altogether. Depression is a logical answer when we simply can’t go on in a certain situation. Attempts to change the situation have been fruitless. Hopes seem to continually be dashed or dreams constantly deferred. Who are you to say that becoming depressed in these situations is “not rational”? Life is not all about cold hard “rationality” you know. Emotions are a big part of it and a big driver of our actions. If you condemn depression for being “irrational” you should condemn falling in love or loving anything, really, as similarly irrational and we should shame people who feel that emotion as “unrealistic,” “overly cheerfulesque,” etc. It makes just about as much sense and is just as valid as invalidating depression.

            How about some reading assignments for you now. Why don’t you leaf through “Depression: An Emotion not a Disease” by Corry/Tubridy and gain some insight into the logic and rationality of depression, an emotion which “has evolved over aeons of time stretching back to our ancient brain. We share this powerful emotional response with social animals who are bonded through relationship and attachment. Abandonment by their group can cause death. Lacking the required survival skills for life outside it, they experience overwhelming helplessness, and such animals become depressed, and surrender the will to live.

            Similarly in humans the moment exclusion and abandonment is experienced, these old evolutionary pathways and doorways are opened in the ancient architecture of the brain….” (in reference to bullying)

            “Depression is an emotional response, at the core of which are the feelings of helplessness, hopelessness and loss of control. Any life difficulty which we find insurmountable can cause depression. Being alive and human exposes us to risk and danger, placing us on a spectrum ranging from feeling effective and resourceful to powerless and paralysed. Life is fired at us point blank. From the moment we are parachuted into life’s soup, emotionally, behaviorally, and intellectually we are challenged to respond.

            From conception to death, traumatic and stressful events come our way: intrauterine stress, insufficient nurturing, family dysfunction, abuse and bullying, betrayal and ridicule, broken hearts, dependents with special needs, marital difficulties, accidents and life-threatening situations, financial burdens, drink and drug problems, job loss, peer group exclusion, chronic pain, disability and illness, ageing and finality of our own death.”

            “Like fingerprints, no two human beings are exactly the same. As such we do not respond to setbacks in the same way. Take a puncture [flat tire] for example. It’s the last thing you expect to find as you approach your car in the morning. As you take in what’s happened, a strategy begins to form. The meaning you ascribe to it, the action policy you decide on, and the intensity of your response is going to depend on a multitude of factors, both internal and external.

            It will make a difference if you don’t’ have a spare tire or a second car, you can’t change one by yourself, it’s pouring rain, a taxi isn’t an option, or you’re not a member of the Automobile Association. Time-urgency tips the balance too – if you’re rushing to catch a plane, hurrying to an important meeting, or rushing your child to the accident and emergency department. Cruising down the the local shop to buy the papers on a leisurely Sunday morning is a different experience.

            Other factors matter too. Such as whether you’re the boss or are further down the pecking order, and could lose your job because of your track record of turning up late. Your personality is in play too, you might be shy about asking a neighbour for a lift or for their help, guilty about letting others down, cringing at the idea of calling work to explain your late arrival, or still fuming from an argument with your partner over breakfast. The variables influencing our response to any setback are infinite, with resources defining whether it becomes overwhelming or manageable.

            The flat tire scenario is a trivial example. Many setbacks are of grave proportions, ranging from the loss of a loved one, to workplace bullying and life-threatening illness. The principle still remains however that resources are crucial…

            Resources or not, the continuous everyday grind can seem overwhelming in its own right. The treadmill, be it at school, college, or on the career ladder, can dampen the spirit and take its toll…..

            HOW A SETBACK IS PROCESSED EMOTIONALLY
            It is human nature to have desires and to want to satisfy them. To wish, want and hope that our future needs will be met. Isn’t every child’s game-plan to become successful, contented, loved and secure? From an early age we ‘look forward’; to santa coming, to being popular at school, to getting on a team, passing our exams, finding a job, falling in love, having a good lifestyle.

            This roadmap keeps us motivated, giving us the willpower and eagerness to continue. If our way is blocked, there is a sense of loss as our dream evaporates, as if something concrete has been taken away. In fact it is our illusion – that our future would turn out rosy – which has been removed. A sense of loss overwhelms us, and will and action become redundant.

            Now we are confronted by future scenarios which are painfully less desirable than those we’d planned on. Who anticipates rejection, sexual abuse, bullying, heartbreak, deaths, marital difficulties, failure to achieve, financial insecurity, problematic children, disability, chronic illness or lack of companionship? Unprepared and disillusioned, it can be impossible to find within us the desire or the will to remain engaged with such hardship. In shock, we wonder what happened to the game-plan. We can’t go back, nor can we yet see a way forward. Confused, lost and immobilized, the drive to go on dries up: we are depressed, and in grief.”

            “The scenario you’re confronted with may vary from sudden heartbreak, the daily anxiety of facing a workplace bully, or the dawning shock of finding that the life you’ve carefully constructed has come to look like a death sentence. Whatever the cause, your instinct is to recoil, disengage and have the bad dream cease.

            What can your average human being do in such circumstances? There are only so many ways out. Some run away – literally, by leaving a pile of clothes at the beach or by taking the next plane out. Others change their reality by swapping it for madness, mania being the ticket out. Many become physically ill, embarking on a road which absolves them from the same level of engagement. Those who can, make efforts to inject change into the situation, bringing control by whatever measures they can. Others heal with the passage of time.

            For most, although they may wish to curl up into a ball like a child, and turn their back on the problem, they can’t. Modern life demands that you go on. Working lives must be continued, the care of children not shirked, relationships maintained, bills paid. You must carry on regardless. Yet this requires that you engage, and you are in recoil mode. The unconscious compromise is depression. You’re still here, but really you’re not.

            This is a shadowy life, one where your body does one thing, goes through the motions, but your mind screams its dissent. It withholds its enthusiasm, supplying you with not a shred of motivation, rationing your energy so you have to get by on the slimmest budget. You’ve torn up your contract with life. But your ship at least must still stay ostensibly afloat, albeit in an agonizingly unsatisfactory state.”

            From the chapter “Fear, Panic, Post-Traumatic Stress Disorder, O.C.D – Battle Fatigue”

            Wave a wand, take away fear and helplessness and depression would virtually disappear. The fight or flight response is the most primitive and ancient of all survival responses, dealing as it does with the matter of life and death. The degree to which this is aroused is dictated by the threats we face, and their severity places us along a spectrum between fear at one extreme, and safety at the other. To spend extended periods of time at the fear end, teetering on the edge of panic, with no possibility of controlling it or disengaging from it, has to be one of the most disempowering and excruciating states a human being can experience…

            A PORTRAIT OF PANIC
            Picture this fictional scenario. Your home has been broken into and the intruder has assaulted you repeatedly over the last month, leaving you battered, bruised and exhausted. None of your familiar surroundings appear the same any more, the home you used to so enjoy is ruined. In spite of all your efforts, there seems to be nothing you can do to either predict or prevent the attacks. You think of nothing else now, vigilant all the time, waiting, expecting the worst. Sometimes the attack is during the night, taking you off guard, when you’re at your most alone. Of those you seek help from, some wonder whether you’re imagining it, since they see no intruder or sings of a struggle, suggest that your distress is an overreaction, tell you to ‘pull yourself together’, and then leave you to handle the attacks on your own.

            If this were really happening to you, do you suppose you might feel your zest for life ebbing away, since it would now all be sapped by having to be constantly watchful for the next onslaught, or recovering from the last one? Each morning on waking, might you not be likely to begin thinking ‘oh God, another day, maybe I’ll just stay in here under the covers”? It’s hard to believe you wouldn’t begin to lose faith in yourself, becoming ruthlessly self-critical over your inability to get your life back on track.

            Would you still be as keen to socialize, when that would mean hearing about the trouble-free lives others were living, when all that was on your mind was your hopeless situation? Might you lose interest in sex, in keeping the garden, in reading, while it seemed more urgent to keep checking the windows and odors, a permanent ear out for any sign of impending danger? Surely the future would begin to look bleak if all it held was more terror?”

            Etc. Etc. Etc.

            There is a description of animal depression towards the beginning of Paul Gilbert’s “Overcoming Depression” which helped crystallize for me the natural, valid nature of this emotion/response to life, which we share with other social animals, as well. (I’m not sure if this image I have in my mind comes from there or from somewhere else, but think of an animal trapped in the bottom of a ravine. It has tried and tried and cannot climb up the slippery slopes to escape. After x number of exhausting and futile attempts, it gives up hoping & trying, & lies down & essentially prepares to die. This to me seems a good analogy for depression. It’s like a state between life and death – we are not dead yet, but energetic/hopeful/full life, indeed sometimes survival at all, seems to be a futile endeavor.)

            Then there are Harry Harlow’s experiments on Rhesus monkeys from the ’60s in which he reliably created depressed states in monkeys subjected to social isolation, or other disturbed ‘mental’/emotional states in young monkeys deprived of their mother, etc. Harlow is quoted on his Wiki, “When initially removed from total social isolation… they usually go into a state of emotional shock, characterized by … autistic self-clutching and rocking. One of six monkeys isolated for 3 months refused to eat after release and died 5 days later. The autopsy report attributed death to emotional anorexia. …”

            Seems as if the monkey died from depression due to extreme social and environmental deprivation. I’m sure it would have helped if we left him in that situation but told him he was being irrational and catastrophizing, that his depression at that point was self-destructive – I’m sure that would have helped, when he was already past the point of caring about anything and had given up on life.

            Come on. There are tons of unbearable situations and, while positive thinking of course should be practiced as much as is possible and realistic, so much more is needed – and not just needed from the suffering party themselves, but from others. In the example of the monkey, someone should have come along and freed the monkeys and prevented Harlow and his team from ruining any more lives, and should have provided intensive care to the already-damaged monkeys to aid in their recovery as much as possible. All that, the monkey cannot do for itself. It takes outside help and real tangible changes in circumstance (often due to luck or conscious efforts on the part of others to help).

            I really don’t know how you (or CBT) can continue to claim that anything more than a passing sadness is uncalled for in life… Depression is a natural emotion just like all our other ones and provides us feedback on our environment and situation… It should be viewed as such and not invalidated

    • CBT identifies a number of common cognitive distortions. (You can easily reference them and decide for yourself whether you consider them irrational and destructive.) One can agree or disagree that these constitute “distortions”; that doesn’t change the points I’ve made about the philosophy and principles of CBT. I’m just trying to clarify that CBT is not what Richard Lewis represents it as being.

    • Amen, Joanna. Wouldn’t it be great if we could all trade places, walk in other people’s shoes, and then see if we still consider their feelings and responses to be “irrational” when we don’t have our safe, healthy distance to be judging from. Or if we wouldn’t come to understand, empathize with, and validate them much more once we have been put through what they’ve been through…

      I wish….

      • yes ssenrch and this becomes ever more pertinent when people carry out the one action which psychiatry AND therapists struggle with the most – self-harm [the type without suicidal intent]. Many struggle when that can be a life saving act for some people and can miss the context in which it occurs. Put an animal in a cage and if biting the fingers put through the bars doesn’t achieve anything other than a slap then ultimately the animal will chew it’s own tail. Vivisection animals in cages, people in cages [hospitals, or virtual in the community or by environment/circumstances]. they look the same.
        This is why people with any history of self-harm [past or present] can be refused CBT

  4. Let me add that I seldom use CBT in my work as an MFT intern; instead, I tend to favor humanistic approaches (especially the Rogerian, person-centered approach). But I don’t like to see CBT misrepresented.

    Also, a philosophical note: though there may be a reality independent of our minds, we can only experience this hypothetical reality through our minds.

    • I feel it does ignore the material because it disregards the social and political reality of people’s lives by decontextualising and focusing on the individual.
      Your feelings and thinking are not ‘right’ and if you just ignore your feelings and think about things in the ‘rational’ way then you will realise that you don’t really have problems, you are the problem.
      To me giving that ethos to people that there is something ‘wrong’ with them and the way they deal with things, and that the person is so obviously wrong but it can be changed in a few sessions. I dislike brief therapies for that reason, because it invalidates the depth of people’s experiences and treats them as faulty automatons.
      Problems are real and people’s emotional responses to them are not just valid but also natural human responses to wounding experiences. I think that paying attention to feelings, listening to the messages in them and developing intuition and a deep emotional relationship with ourselves are more constructive and empowering tools than simply being told how to retrain our thinking about things.
      It’s not a mere ‘emotional response’ to feel bad and negative and for that to have an ongoing ‘ripple out’ effect, it’s justifiable traumatic distress

      • You haven’t taken the time to educate yourself about CBT. CBT does not deny the existence of harsh realities such as economic deprivation, and it does not view all painful emotional responses as irrational. Do you seriously view all emotional responses as “valid” in all ways? If a student fails an exam and concludes that he is a moron who can never succeeed academically and falls into a depressive funk, do you consider that a sound, logically-based response? I hope not. This is the kind of “cognitive distortion” that CBT addresses and (hopefully) corrects.

        I’m not saying that CBT is the only approach to changing people’s experience of themselves and the world; as I noted in an earlier comment, I definitely prefer (like you, it seems) the Rogerian approach; but CBT (unless it’s being abused by the practitioner) is not what you say it is. If nothing else, read David D. Burns’s popular book on CBT, FEELING GOOD. It’s a handy introduction.

        • try being at an event where psychiatrists insist that the CBT they will be offering to people as per IAPT’s main aim and the fact that people are not able or facilitated practically to meet the aim has NOTHING to do with them. That IS ignoring reality. Just like Jobcentres attempting ‘psychometric testing’ when they know it doesn’t matter how many tests they do to locate a persons “strengths” when they have no jobs to offer that person.

          • CBT [and problem solving] can be used to get people to accept the unacceptable, and it can be used to suggest ‘better’ belief systems which may or may not work regarding perceptual differences – I know that’s not it’s original intention.

          • Of course there are instances (many instances, I would think) in which purveyors of CBT ignore certain realities. But, as I mentioned earlier, that is not a problem limited to CBT practitioners. It pervades psychotherapy and our society generally.

            Meanwhile, look into CBT more thoroughly; you may even find it useful in some respects. Or don’t look into it. The choice is yours.

            Joanna, I love this conversation, but I have to check out for now. Things to do.

        • CBT often seems incredibly condescending and invalidating. If that student fails an exam and concludes he is a failure and becomes depressed, there are likely multiple strong reasons he has come to feel that way. For example he could be receiving excessive harsh criticism from his parents, being teased about how stupid he is, etc. From all that feedback he is receiving, it is perfectly LOGICAL and RATIONAL for him to come to agree with them and conclude he really is an academic failure. This is where CBT is incredibly invalidating. Maybe that student has had multiple failures before and needs special help which has not been available to him. Maybe he has many other worries which get in the way of his learning. From that person’s experiences in life, what he is concluding can seem PERFECTLY logical and rational, to conclude otherwise one would have to be ignoring a lot of feedback from the environment, which intelligent people are not wont to do. To focus on the person with any ‘negative’ or painful thoughts and feelings as the problem, to say they are ‘faulty’ (which saying they have faulty thoughts implies), to ignore the context of their lives and act like they’re silly and sabotaging themselves for no reason, that is where, to me, CBT as an approach is totally arrogant, ignorant, and out of line.

          • ssenerch, I must empathise with your feelings about it having potential to be arrogant given I’ve been referred to as uneducated, simple-minded and time wasting without consideration of; stigmatising behavioural therapy language [maladaptive], violent group control through peer pressure behavioural regimes [eating disorder units], the social control use of it by governments [as a cheap alternative to real help with employment and with claims of “cure” for ‘mental illness’] and its dominance and limitations as a psychological intervention which is promoted, researched and funded to the exclusion of most other psychological and survivor defined approaches within mental health services.

          • Joanna – stigmatizing behavioral therapy language, peer pressure/shaming (if you feel bad it means you’re not working hard enough at correcting your bad, faulty thoughts), lazy cop-out approach to social control, and people fawning over it – I agree with all.

          • ssenrch – stigmatizing behavioral therapy language, peer pressure/shaming (if you feel bad it means you’re not working hard enough at correcting your bad, faulty thoughts), lazy cop-out approach to social control, and people fawning over it

            This is what I struggle with, when CBT and other BT’s don’t produce the desired results it’s because you’re not trying hard enough rather than it simply not being suitable.How is this different to taking meds, this not producing the desired results and it meaning you’re ‘treatment resistant’?

  5. this article starts off as bitter humour (therapy to help nasty people feel better). I approve.

    I recently met someone who is giving training to Job Centre employees in the UK to help them be more effective in getting claimants to jump through impossible hoops to get their benefits. The staff don’t approve of the policies they have to impliment, it’s all part of austerity politics and vilifying the unemployed, which kind of lets the bankers and the politicians off the hook for the credit cruch. So this person I know is training the staff to do things that the staff find unethical and which will be damaging to clients.

    It aint CBT but it’s using psychology based training techniques to aid the oppressive state in grinding down the poor.

  6. Me too Ross, thanks for going there!

    Of course there are instances (many instances, I would think) in which purveyors of CBT ignore certain realities. But, as I mentioned earlier, that is not a problem limited to CBT practitioners. It pervades psychotherapy and our society generally.

    Then we’re firmly agreed on two counts Ross!

    I also don’t write it off, I think it can be useful for less life limiting difficulties, but I don’t think it scratches the surface of some difficulties because it doesn’t view them enough within the context of the persons whole life.

    DBT is the other popular psychological intervention here, and I’d levy much greater criticism of that because it purports to be one thing whilst being another..

  7. Richard, I respect you and have enjoyed your previous posts here at MIA. In this case, I think you’ve exposed serious ignorance by lampooning an approach you clearly do not understand. I do not even know where to begin to highlight the poor logic and mischaracterizations of CBT evident in your post. I am on vacation at the moment and do not presently have time for a detailed response, but I feel compelled to post this brief reply. I don’t see how it helps us at MIA for you to select one school of psychotherapy, create a poorly understood straw man from it, and bash it. “CBT therapists are so stupid they would try to make George W. Bush feel better by thinking positive thoughts, instead of holding him accountable for his crimes!” Give me a break.

  8. “CBT therapists are so stupid they would try to make George W. Bush feel better by thinking positive thoughts, instead of holding him accountable for his crimes!”

    Maybe not so ignorant I can offer a more ordinary example regarding Exposure and response prevention which is offered by CBT therapists.
    My friend who is defined as having OCD was told she would get ERP and she said great what do I when can we start. The therapist said to her right now. The she told my friend ‘next time you feel compelled to clean – don’t’. That was it, that was the sum total of her therapy.
    It doesn’t inspire much faith,

    • Joanna, as an expert in exposure therapy, I can tell you that what your friend received (assuming that really was the sum total of the therapy) is not exposure and response prevention. The problem there is the therapist, not the therapy, which is a fact I suspect you recognize. There are incompetent practitioners of all therapies.

  9. Speed, E. and Taggart, D. (2012) It’s your problem but you need us to help you fix it: the paradox at the heart of the IAPT agenda, Asylum Magazine for Democratic Psychiatry

    This is a really good article looking at the political use of CBT cloaking social issues, I can’t locate an electronic version and it’s too much to type from my paper copy, I don’t know whether Asylum or the authors could offer a copy, but it’s well worth reading because they explain it better than what I can.

    Also Theodore Stickely [Nottinham Uni] wrote a great paper critiquing CBT and likening it to Daleks [you have to watch Dr Who to know what that means], again, I don’t have an electronic copy but I’m sure if contacted he would offer an electronic copy

  10. Hi Richard, many thanks. I share your bug bear, that CBT can be viewed as the antidote to biological psychiatry because there is no single antidote but that’s what’s promoted/funded within services.

    Ross, I do grasp the basic premise of CBT to address vicious cycles in a person’s life by looking at their thoughts and what feelings and bodily sensations these trigger and resulting behaviour, I’ve critiqued problem solving therapy for a study and instigated amendments. Nurses/psychologists get sick of being expected to offer CBT irrespective of whether that’s what a person wants to the exclusion of anything else – they say so.
    If it doesn’t ‘work’ then you can just as easily be viewed as ‘treatment resistant’ as with any physical intervention, rather than it simply didn’t suit you.
    Most things have a place, and CBT does yes, but I resent it’s elevation to the exclusion of little else in terms of psychological interventions in my country, and I resent any intervention being used for the purposes of social arm wrestling [IATP] and that’s a critical difference with other sorts of psychological interventions, they are not being used for those purposes by the state.
    You said on Colonization or Postpsychiatry about changing the relationship with voices and relating to them to in the right way, my concern is if there are attempts to replace beliefs about them which are not of the voice hearer’s choosing, I know you would say that’s down to poor competence, nevertheless…

    Regarding DBT- it’s promoted as a “treatment of choice” in the UK for people who self-harm, but how is it a choice if that’s all the person is offered? DBT frames a person’s difficulties as “dysregulation” and the [often denied] goal of the intervention is cessation of self-harm. You might think that cessation is of course the best aim but not if your self-harm represents a life saving action and for some people it can be just that, therefore if it’s prised away by force it can up the risks not lessen them. You might think DBT can’t be forced but if a person is faced with the take this or sod off line is not what I’d define as ‘choice’.
    So the self-harm is framed as ‘maladaptive’ with abstinence as the goal but self-harm is not an ‘addiction’ to everyone. There is the “24 hour rule” where if the person self-harms they are not allowed to contact their therapist for said time, that could be construed as punitive, and imagine if A&E took that line – which they can’t both medically and psychiatrically, most service users are forced to undergo psychosocial “assessment” in A&E as a condition of receiving surgical repair and even physically restrained from leaving the department before this happens [assessment typically consists of 3-4 questions over 5-10 mins].
    I have seen survivors on the surface of it present an amended self to their therapist in order to keep their support but how they feel hasn’t changed one iota, or even worse they can show their unharmed arms but the therapist doesn’t realise the legs are bandaged instead.
    Attempting harm-minimisation of the self-harm [I can expand on that further if anyone would like me to], taking better care of oneself, or feeling a bit better in oneself is not good enough for some therapists when cessation is their goal. I know you could say that’s bad DBT, and as with CBT it comes down to a competent practitioner and of course I accept that any intervention can be badly applied, nevertheless..

    Ultimately, I’m of the view that human relationships trump any physical or psychological intervention. When most people refer to a ‘good’ therapist/health or social care professional, they’re not typically referring to an intervention but to the human qualities and attitude of that person, and connection with that person.

    On a lighter note – I’ve developed Rabid Verbal Abuse Therapy [RVAT], I use this with my medical contact lens and computer when it breaks. So here’s how it works;
    Blue screen – scream – tell computer it’s doing this to me quite deliberately and has it in for me – get hammer – threaten it with hammer – walk away – call friend who lets me know when it’s time to panic.
    Medical lens hurts/eye streaming – hurl rabid verbal abuse too obscene to write here – run to disabled toilet [more space for bottles/towel] – take lens out – tell lens it’s doing this to me quite deliberately and has it in for me – emerge from toilet appearing sane and reasonable [even though people have walked past it hearing me shout ‘Get in you bastard’].
    There is also a ‘by proxy’ version of this – computer

    • Lol, Joanna, I LOVE RVAT, in fact I often make use of it myself.

      Totally agree that the RELATIONSHIPS are often what really matter. (It’s the relationship, stupid!) Contrary to mechanistic views of psychology we are not really machines that one can easily perform a “technique” on & have us back up & running in no time (much of the time). At least, I’m not! Don’t know about the rest of y’all. I mean, I have been ‘turned back on to life’ as easily as flipping a switch but it hasn’t been by people who have no real genuine interest in/love or concern for me.

    • RVAT…I have another therapy ssnerch…making up different explanations for existing acronyms;

      Cognitive Response Action Plan [CRAP]

      Wellness Affective Neuro Knowledge [WANK]

      Transient Intermittent Therapy [TiT]

      Behavioural Appropriate Limited Liaison Sessions [BALLS]

      Doing Bollocks Therapy and Diabolical Behaviour Therapy [DBT]

      2 friends came up with;

      Dialectical Insight with Cognitive Kneecapping [DICK]

      Professionals Really Into Cognitive Kneecapping [PRICK]

      And of course Can’t be Tossed and Can’t Believe Therapist [CBT].

      *Humour Alert*
      I’m sorry if this offends anyone doing therapy either as a service user or as a therapist, but we do need to have some humour about the issues sometimes to lighten the load. Survivors can have very dark humour here, I’ll tell you more about that sometime, it helps us to survive, just as medics have renowned dark humour to help them get through stressful work.

  11. I myself didn’t find CBT to be very helpful at all. I felt that it was very simplistic but maybe that was the fault of the person doing the therapy with me. I’m not against it and support other people in their use of it, but I don’t think much of it and went back to my mindfulness practice. The thing that bothers me is that so much of the time it’s touted as the end all and be all of therapies these days. I don’t think any one therapy is the end all and be all for anything since people are so diverse and require many different kinds of therapies to choose from. When I took myself out of the less than helpful care of the community mental health clinic that I went to for assistance CBT was the great god in that place and if you wanted therapy (which you had to fight for tooth and nail to even get) it was going to be CBT or nothing at all. I don’t think this is helpful to anyone but the people who click well with CBT.

    • I attempted to read David Burns’s book a few years back but was pretty turned off by it. His “Feeling Good” approach does not make me feel good. Instead, I would get much more validation & motivation from, for example, critiquing & attacking biopsych than from listening to some guy who doesn’t know me simplistically tell me why I’m doing everything wrong and stupidly thinking maladaptive wrong thoughts. I guess I’m just one of those who doesn’t ‘click’ 🙂

      Seriously? This is from a review I just saw of Burns’s book – “your negative mood results from your own thoughts. Not from external events – those are just triggers for the thoughts. Only your thoughts decide whether you’re cheerful or sad.” This is the line of thinking that I absolutely cannot stand. Try saying that to someone who’s been raped, traumatized, tortured, abandoned, any one of a million terrible things that can happen to people and animals in this world. Are you seriously going to come in here and say it’s their own thoughts about the event that is the problem? How simplistic and out of touch can you be? I’m guessing people who hold this line of thinking are secure and comfortable with all their basic needs met and no big traumas. How invalidating, how dehumanizing.

      • ssenerch – you’d find people who work with rape and domestic violence victims have little truck with CBT.
        People who have been medically tortured – sutured and stapled with no local anaesthetic, have these experiences ‘reframed’ for them, or silenced with ‘that was then this is now’ as though being deliberately put in pain is something people can just brush under the carpet.

          • The truth is that life is not at all as pretty as it is made out to many of us to be from the time we are little. It is full of some pretty horrific, gruesome, awful, tragic things. Because of that, it can cause immense pain and often even more so when one is an open, sensitive, loving individual exposed to some of these horrible things. If one is really paying attention to what goes on in the world then to be honest, depression is the only rational response. We all constantly have to play little mind games or just shut off awareness of what’s going on if we want to maintain some sanity and cheerfulness. I probably do “CBT” on myself intuitively a hundred times per day. The negative, bad thoughts are not irrational or distorted at all, in fact some of the cheerfulness I try to replace them with is the more distorted and contrived of the two. I would very much like my intelligence and awareness not to be insulted by ‘mental health professionals’ who think they know so much more than I do. More than 1,000 innocent, poverty-stricken, hard-working Bangladeshis were crushed to death a couple of weeks ago in a factory making our super cheap clothes that we all have way too many of and throw away without a second thought. Sickeningly wealthy individuals are profiting off of the exploitation of these extremely unfortunate other individuals whose lives matter just as much as the wealthy ones. No one (not enough people) cares. This is the way our world works. The inequality, injustice, waste, wrongness of this world is mind-boggling if you truly think about it. Don’t come telling me that my cognitive processes are distorted. I went to the best schools and trained for x number of years to have fully functioning cognitive processes. It’s what those cognitive processes have to deal with more often than not that is the problem. If we focused less on trying to make people dis-believe what’s right in front of their eyes and in their hearts, and put more effort into truly transforming our world for the better, as Richard is saying, we would have much less need to play CBT mindgames and we could actually just feel our natural feelings as we were meant to and not have to try to constantly convince our mind and body that everything they are telling us is wrong.

      • That’s what a review of Burns’s book said. Burns himself makes a distinction between realistic negative feelings (such as negative feelings about traumatic events of the kind you’ve mentioned) and unrealistic negative feelings (“depression,” as he defines it). You can’t meaningfully review a book based on what a reviewer said about it.

  12. Joanna wrote, “Ultimately, I’m of the view that human relationships trump any physical or psychological intervention.” This, as I understand it is what the research shows. That it is the relationship between the therapist and client, as assessed by the client, that is the most important thing.

    The same can be said for friendships, or teacher/student relationships, or many other situations. Therapistas are people, so are clients. So whatever underlying reasons for therapy being helpful should also be found in other areas of life. otherwise we are trying to create some kind of rarified mumbo jumbo.

    • That’s right John research shows that – however it needs restating because some mental health workers will still insist that is not enough and argue against listening/being there etc and insist that is not enough because they feel they must ‘do something’ and in a more systematic manner

      • Listening/being there/a trusting an empathic relationship is important, and I don’t know ay therapist who would say otherwise. But the notion that this is all that is necessary is not valid across all mental health problems. Simply listening is unlikely to be sufficient to help a person overcome, say, anorexia or obsessive-compulsive disorder. Context matters.

          • You mention anorexia – the most oppressive and humiliating individual and peer pressure behavioural regimes happen in EDU’s
            I guess the question is how structured and goal orientated do we need to be in how we help, when being there is not enough?
            Can we please expand the range of non-physical approaches beyond thought restructuring and behavioural based ones.
            Can we stop using such stigmatising and judgemental language within the CBT/DBT therapies [maladaptive]
            Can we stop using CBT and psychology training techniques to aid oppressive state practises.

        • Context matters, exactly, and does a therapist usually help much with that from within their inert little office disconnected from the client’s life? Not from my experience. This is why I have experienced ‘psychotherapy’ (rarified mumbo-jumbo, yes John) as extremely limited and impotent as compared to having an actual supportive relationship out in the real world

          • I question therapy tenets ssenrch but there are decent mental health workers out there from all disciplines, and it can be useful to speak with someone who isn’t close to your life. Maybe the most helpful approach people with less ‘intervention’?
            If I were given a of sum of money to set up a non-medical community resource for people in distress, both residential and drop-in I’d not exclude any therapist/psychiatrist/nurse/social worker/psychologist from applying just as not everyone who has been through the system is automatically someone I’d want supporting me in distress. It comes down to human qualities, attitude, and ability to work with someone within their beliefs.
            I take your point about therapy-life context disconnect, that’s often the case, just as it is with psychiatrists.

          • Joanna, replying to your comment from 8:44 am, I quite agree. There are some psychologists that I really like and respect, I just think that where our society gets in trouble is by depending on them too much, depending on professionals to take the place of healthy communities where people look out for and care about each other, there is no adequate substitute for that. An outside helper can be a helpful adjunct but we cannot outsource all our emotional caring to paid professionals. Our social fabric will quickly fall apart as it seems to be doing now.

            I like Paula Caplan’s project involving having “normal people” hear out and empathize with returning war vets’ stories, not relegating them to (I feel, sometimes) inert, sterile therapists’ offices, where no one actually involved in the person’s life has to hear about what they’re dealing with. This is what we do more and more as a society, we say, if you have a problem, find someone whom you can pay to listen to you, because no one else has the time or interest or can bear to hear you out or offer concern or advice. (a lot of therapists don’t even offer advice. They are into being as neutral and risk-free – on their parts – as possible… how helpful is that really?) Then well if you don’t have money or insurance to pay anyone to care about you and you are really in need of attention and support, well you are pretty badly screwed. Honestly I don’t know why everyone’s so surprised when we have these terrible situations with people shooting up schools and workplaces and committing suicide. We give them absolutely no outlets and nowhere to turn, we make caring and attention into a commodity that they have to purchase with their nonexistent funds, then when they spiral out of control from all of the burdens put on them which absolutely no one has stepped up to help them with, we complain and condemn them and talk about how we just can’t understand it. Of course you can’t understand it if your life is relatively easy, sweet, and provided for. Trade places with them and see if you start understanding it more.

    • John,

      ‘Psychotherapy,’ much of the field of psychology, and let’s not even mention biopsych HAVE been made into rarified mumbo jumbo. Simple and elemental concepts common to all of us down to the last uneducated little baby have been put through the academic mumbo-jumbo machine to the point where you need a PhD to decipher it all. And even if you do decipher it more often than not you’ve lost the connection of all this mumbo jumbo to the basic, intuitive, felt concepts that it refers to – concepts like love, hurt, violation, shame, abandonment etc., which, yes, the last little baby intuitively feels. Secondly, aren’t relationships often the main ‘meat’ of therapy work, since relationship problems are so often central to people’s psychological problems? So the quality of relationship between therapist/therapee is even more important than say that of a student-teacher relationship – it’s central. In fact, I have received more helpful, more life-changing ‘psychotherapy’ from several people lacking high school diplomas (or certainly no formal training in psychology) than from all the degree-holding psychological professionals I’ve seen put together, because it was the relationship and real genuine connection that mattered, which the non-educated non-professionals were more disposed to form. I.e., they were willing to be there in ways the professionals were not, which is what made all the difference. I don’t doubt that some professionals do great work, but in my experience the whole ‘professional therapy’ model has seemed very limited and certainly rarified. It’s attentive, loving, supportive relationships. Not, sorry for the cliche, rocket science.

      • ssenrch – You remind me that often survivors will say that the best conversations they have are with domestic staff.
        I sometimes feel that the more ‘qualified’ people become the greater the disconnect, unless they are able to transcend some of that training. I think of a friend who trained as a psychologist who readily admits to junking most of her training in her head. Nurses and psychologists are required to do CBT now, need those qualifications to progress in clinical practise, but wouldn’t it great if they could choose not to, or get ‘qualified’ in survivor defined approaches

  13. Low self-esteem does not begin internally. It is also a product of our interactions with the external world.

    Yes ssenerch I’d agree with that.

    Many years ago Jeffrey Masson author of ‘Against Therapy’ visited the UK and I’ll never forget hearing him speak because the reaction to him from therapists was more angry and explosive than anything I’d ever seen before [even with staunchly medical model psychiatrists].
    At one of our ‘premier’ therapy institutes I’ve seen conference/training fliers with truly unpleasant titles to describe diagnostic groups which are as bad as any psychiatric descriptions, and on asking known ‘critical thinking’ therapists at events as to whether they would be prepared to work within their clients belief systems the answer was often NO.
    I’m not against the use of therapy or CBT, nor of anyone seeking it, everything has a place, but I do think the professions need to reflect alongside psychiatry, it all too often falls into psychiatry – bad, therapy – good, and it’s only not good if it’s poor practitioner competence. I don’t think debate should ever be shut down, even if we think we already know the conclusions for ourselves

    • Of course low self-esteem is the product of interaction with the external world, but that’s the key term: interaction. Said interaction involves the encounter of a particular human subject with the external world. We’re not talking simple material-mechanical causation here, but the dynamic interplay of intrapsychic and environmental factors. Subjective interpretation (involving perceptual, affective, and cognitive factors) is important.

      Joanna, referring to an earlier comment of yours, I never called YOU “simple-minded”; I was referring to the implications of Stickley’s analysis as I read it. And I never called you “uneducated” in some general sense; I said I thought you had not taken the time to educate yourself thoroughly about CBT. I may have been right, I may have been wrong, but that’s all I said. Also, you took too personally my comment about “wasting our time” with Stickley’s analysis. My point was that when thinkers deny the existence of objective reality, they undercut themselves. If Stickley’s viewpoint is as subjective, partial, and biased as, say, Rupert Murdoch’s, then why should we bother with it? I apologize for any bad feelings generated.

      • I demonstrated clearly enough that I understand the premise of CBT and other behavioural approaches,I referred to more than the material-mechanical, little of which you commented upon. As for simple-minded views wasting your time, I accept your apology for your poor communication. I don’t take it personally I’m a psych survivor, I’ve listened to far worse. In my experience at events medical model psychiatrists are more direct when they patronise and therapists more insidious [generalisation not characterisation]. Former hostage Brian Keenan once described leaving a therapists conference he once attended because he couldn’t understand what the hell they were talking about. At least with biopsychiatrists it’s a more direct argument.
        Therapists often don’t wish to explore power because compared to psychiatric power it seems so benign but it isn’t. Being head fucked isn’t much better than being body fucked. “Therapeutic communities” are an example of this, as are behaviour modification regimes using peer pressure [EDU’s]. Now you can say that’s not CBT but the roots of BT’s are in conditioning, and rarely are there opportunities to further discuss therapeutic power.TC’s like CBT and other types of BT are supposed to be some of the nice alternatives to biopsychiatry and whilst I’d defend any survivor’s right to access them, [everything does have a place] it’s remains reasonable to question the profession and it’s practises. TC’s use peer pressure to cajol people into behaving differently, I’d describe some of their work as little more than organised dog fighting.

  14. I have never worked with a therapist on CBT. I wouldn’t have the money to pay for it and I don’t take part in the circuits that offer the free therapy you get when you take their drugs. So, I don’t have experience with that.

    But I have read a book about CBT and done the exercises, which I found helpful at the time, although there was too much emphasis, as is pointed out here, on being positive, which to me for the most part means getting excited about being part of the grind. and perhaps formulating politically correct goals rather than seeing what life brings you all by itself.

    But CBT’s basic concepts that we bring fear into our lives and allow this to create unrealistic images, which is called catastrophising, I think this is truly insightful. It’s basically those unrealistic images that run the whole illusion. This is how George Bush and his administration ran a whole war that anyone thought was necessary; this is how George Bush himself fails to see what he’s doing and sees some great loss would he get out of such a cult; this is how all wars are fought with people filling their heads with fear of what might happen if they didn’t resort to violence, while they never truly find out what’s going on with the other side enough to relate to them non-violently; this is how whole multitudes under fear of going to hell, believe that they know what’s good and that homosexual love when allowed brings natural disasters God inflicts on those not rigidly against it; and this is how whole institutions, having been brainwashed as to what kind of horrors would supposedly happen, believe that pills are magic and don’t even see what the pills are really doing; and when you have a society which dehumanizes people into objects that shall be controlled by accepted (and pretty much arbitrary fears, fears that don’t have to be realistic just there to control people), then you get these criminals and heinous acts, all which are supposed to be controlled by more of the fear that caused them.

    That part of CBT is a really helpful concept, if applied in a way that people let go of fears, of brainwashing.

    And when such fears are dealt with this changes the whole matrix of society which uses guilt to control people rather than allowing them to let go of the cause of the behaviors everyone is trying to eradicate by contributing to it through the back door of condemnation rather than letting go of fear.

    There are further materials like A Course in Miracles, Anita Moorjani’s teachings, Boddha’s teachings, Mindfulness, The Mutant Message books, The teachings of Lao Tzu, Music, Art, Philosophy, Gardening, Taking walks, Looking at sunsets etc. etc…..

    Anita Moorjani who healed of the worst kind of cancer in less than a month after having a spiritual experience, she says that what remains of us when we die, it sheds all of these programming we take on of fear; and all the judgments we have of others fall away. That ANYONE’S life becomes a logical accumulation of what they’ve been through, and we can see that, experience it, become it and know it is part of the human experience (and know it could have happened to anyone, to all of us); and thus we can relate to it and bring the light, the understanding that’s possible. Shame, Condemnation, Judgment, Punishment aimed at coercion and all of the high standing justice that goes along with all of these will never create such understanding, will never restore the humanity that’s missing…..

    • Anita Moorjani who healed of the worst kind of cancer in less than a month after having a spiritual experience, she says that what healed her and what remains of us when we die, it sheds all of these programmings we take on of fear; and all the judgments we have of others fall away. Those judgments just don’t exist in that creative realm. ANYONE’S life becomes a logical accumulation of what they’ve been through, and we can see that, experience it, become it and know it as part of the human experience (and know it could have happened to anyone, to all of us); and thus we can relate to it and bring the light, the understanding that’s possible. Shame, Condemnation, Judgment, Punishment aimed at coercion and all of the high standing justice that goes along with all of these will never create such understanding, will never restore the humanity that’s missing…..

      And there is a state where you can let go of all these fears rather than letting the catastrophes they NEED (whether real or unreal) rule your life. You can avoid the whole phenomenon.

      I felt I needed to edit this last paragraph of my original post here, which I have done.

      I’ll also be leaving my responses to this, since it’s about what helps with the idea of CBT and how this touches upon universal concepts that have always helped. For the rest I’m sure it’s like trying to argue with what the Christian Church does, when you are upholding Jesus’ true teachings which never needed such institutionalization.

    • Of course it’s a choice. It’s a very understandable choice in light of imminent tragedy, but it’s still a choice (and not one I’m interested in condemning). Many people face such catastrophes and don’t commit suicide. Saying suicide is not a free choice plays right into the hands of biopsychiatrists, who also proclaim that suicide is not really a choice, and thereby justify confining the suicidal against their will.

      Also, CBT does not deny the occurrence of real catastrophes. “Catastrophizing” in CBT terminology means magnifying commonplace disappointments into catastrophes.

  15. I like the sound of Paula Caplan’s project and agree with pretty much everything you’re saying here. In fact before you posted this I was about to thank you. I’m so grateful to have read your words, I feel much common ground with you. I wish we lived in the same continent, I’d offer my email to you if there was a way of doing so

  16. Well Ross, for people who are ‘in the closet’ about being a trekkie I help them to ‘come out’ and be proud as many Brits can be embarrassed about such things. Otherwise Trek therapy for non-trekkers involves a bit of Klingon, Borg-stropping, Romulan Ale, being checked out with a tricorder with flashing lights and sounds effects [appreciate that’s hard to do online]

  17. “Catastrophizing” in CBT terminology means magnifying commonplace disappointments into catastrophes.

    er I think when people are experiencing things like loss of income, home, rape,etc they’re not exactly everyday little disappointments. I’ve never condemned anyone for wanting to kill themselves. No saying that preventable social events leading to someone’s suicide can be a most unwilling suicide is not saying please hand over to psychiatrists for some drugging. When someone feels they have no option and don’t want to do it for want of a welfare payment it’s a preventable tragedy.

  18. I appreciate CBT helped you and it’s uncomfortable for it to be slated but I’m not ‘anti-CBT’ as in not wanting anyone to seek it or practise it, it’s anyone choice, myself and others have questioned it’s tenets, application and limitations

  19. “I still feel you are over the line in terms of determining for someone else which sadness is “realistic” or acceptable in your view and which or how much is unnecessary, “irrational,” excessive, “distorted,” in your opinion. Life conditions vary so broadly..”

    A great piece of writing and one which I’ll reference, ssenrch please writing for publication

  20. I’d like to quote a dear friend,a survivor who trained in psychology who read this blog;

    “I really enjoyed reading the debate about CBT, it made me think a lot about positioning theory and why people get stuck in absolute positions which prevent acknowledgement of difference. I like your point about cognitivism privileging thinking over the meaning of emotions. Academia and therapies justifying themselves within scientific discourses has meant a complete blindness to the art and power of humanity. The philosophy of therapy is often not attended to, nor it’s political origins. CBT still depends on the ideas of Descartes even though the traditional sciences having moved away from this decades ago! I think all therapists should not be allowed to train without understanding the tenets of their practice and the philosophy of ethics”

  21. Jean-François Lyotard said it best when he wrote that he was “generally skeptical of grand narratives.” The major problem with CBT are adherants who see it as a dogma, as a magic bullet for all situations, who know of no other way to provide support and who impose it on consumers instead of listening to consumers and responding to their own sense of what their needs may be. One size does not fit all. Context does matter.

    It was my great fortune to work with a therapist who was sensitive to context. A trauma and abuse survivor I was in some extreme distress in my late 20s. When I finally found my way to a therapist that would work with me without having any income, she began by suggesting a very standard and in-favor CBT approach. I was not unwilling to try her suggestions for homework and reframing. But I knew that everything in my heart felt wrong about this – somehow I knew it wasn’t what I needed.

    I was very afraid to say anything, because just the act of coming to a therapist was difficult for me at that time. But right before I was about to leave the office, I summoned the courage to tell her what I felt. I expressed my willingness to give this a try if she felt it was best, but I told her how and why it felt wrong. I was able to explain to her that for some reason, it felt like my healing lay in understanding how and why I arrived at who I was in that moment, rather than doing tasks to help me change my present thinking and experiences.

    The miracle of healing was this: instead of arguing with me, or labeling me non-compliant, or refering me to someone else, she really listened to me. In that vary meeting she asking me some more questions and we had a lengthy discussion. The session went an extra hour. At the end of it, she suggested things that really felt right to me.

    What did we end up doing? I’m going to use a word that has fallen completely out of favor, so brace yourself: psychotherapy. Thank god she was not so pigeon holed in one approach that she couldn’t adapt to my needs. By the end of our work together, I had experience powerful trans-formative understanding of myself and my history such that my present thinking and behaviors CHANGED ON THEIR OWN. There was powerful healing and transformation in coming to place of “This is how I got to be where I am” without doing what direct thing to change who I was. Simply the arrival at awareness was transformation in itself.

    What was right for me will not be right for others. That’s why we need practitioners who are not dogmatic, and don’t fall into the trap of believing that they have found the special singular one “best” way to do therapy. I don’t believe there are ANY shortcuts do clinicians who are versed in a diversity of approaches, willing to genuinely listen to their clients, and willing to adapt to the specific needs of specific people in unique situations.

    That’s what we lack in the present day. We keep moving more and more toward therapy-by-numbers without critical thought or emotional empathy. That must change.

  22. this is the best thing i have read on CBT. particularly near the end where it talks about people that have had traumatic experiences and doing CBT. That is what happened to me. No one asked about the abuse I was facing. just about how i had to change my thoughts. i had to get with the program. accept the status quo. The status quo was a sexually abusive scout leader. A friend of my father. They called me treatment resistant when I got mad. it brought out rage. Sometimes I can’t contain it. Meds and cbt for so long. even though my body couldn’t handle the meds, and the cbt was so infuriating. All the private hospitals do CBT, and won’t take me because I won’t participate in CBT programs. The public hospitals don’t take you unless you are dead. I have no where to go. At least I finally got some victims compensation, and can finally afford (for a while) psychotherapy. It feels better then anything else has at least. Thankyou for this article.

    • It is never helpful to invalidate the perspective of the client! CBT can be used to support a client’s goals, or it can be used to impose the clinician’s perspective on their client. It sounds like you got a lot of the latter. It makes no sense to even use a CBT approach if someone is in an unsafe situation or being currently traumatized. It’s also quite an invalidation to have such experiences in your past and have someone say, “You only feel bad because of your own thoughts about the events.” While such a statement may be technically true, it makes it sound as if a) feeling bad about being abused is abnormal, and b) changing one’s thoughts about an incident of abuse is a simple matter, like repeating a positive affirmation ten times and you’re OK. And that crap about being “treatment resistant” always sends me around the bend! You don’t keep taking your car to a mechanic who says your car is “repair resistant!” “Treatment resistant” should be replaced with “I have failed to be of help to you” or “I guess we have not found the right approach yet.” “Treatment resistant” is just another way to blame the victim of the clinician’s failure to help.

      To me, any formulaic approach to helping someone in distress is bound to create problems. I think I agree most with Milton Erickson, who said “you have to re-invent therapy for each client.” It’s about being human and connecting and observing honestly if you’re actually helping and changing your approach if things aren’t improving. There is no magic school of thinking that leads to good results. It requires being a good communicator and being willing to BE with a person in their pain, no matter where that person may be.

      —- Steve