Cognitive behavioral therapy and its problems, part 2
I wrote yesterday’s post on Cognitive Behavioral Therapy after reading one of its main creators — Aaron Beck’s — brief history from the Journal of Psychotherapy Practice and Research, “The Past and Future of Cognitive Therapy.”
The article begins with simple anecdotes observing patterns in people’s beliefs, thoughts, and behaviors that anybody could notice that led him to create what we now call Cognitive Behavioral Therapy.
But when he describes the theory and practice, as opposed to writing about it, he gets vague and jargon-y, and talking about problems instead of solutions. In particular, after general talk about patients he worked with, mainly things a layperson could have written, he starts a section “Defining the Cognitive Model.”
He starts with a colorful anecdote with a taxi driver.
Recently a taxi driver asked me what I was going to do at the conference he was taking me to, and I answered that I was going to discuss cognitive therapy. He asked, “What’s that?” and I said, “It has to do with the way people talk to themselves.” He said, “Oh, I thought that’s why they go to a psychiatrist in the first place.” I said, “Well, yes, but we teach them how to answer themselves.” That would be a simple definition of cognitive therapy.
So far I like how he’s going to define his field. He sounds like he’s going to define the field in a way a taxi driver — literally a man in the street — could understand. Just to say it teaches people how to answer themselves when they talk to themselves doesn’t describe it to me, but I was interested to read on.
How he continued undermined everything. He described the evolution of his definitions (I bolded part to highlight its irony)
I redefined cognitive therapy in terms of the cognitive model… What is the cognitive model? In very simplified terms, the cognitive model states that dysfunctional disorders, psychiatric disorders, and psychological or behavioral disorders are characterized by dysfunctional thinking, and that the dysfunctional thinking accounts for the affective and behavioral symptoms.
“Very simplified terms??” I don’t think so. How about “Your thinking affects your mood and behavior, and counterproductive thoughts create problems.”? (That paper came out in 1997. To his credit, his web page today says: “Cognitive behavior therapy is based on the cognitive model: the way we perceive situations influences how we feel emotionally.“)
Almost the whole paper to that point read simply and easily. The next paragraph goes back to simple, almost conversational language. This writing illustrates how practitioners don’t make it useful, despite claiming its simplicity and effectiveness. I agree with the simplicity and effectiveness, but I don’t see them putting that simplicity into practice.
He even described a conversation with a colleague talking about suicide based on CBT principles that cured the colleague. He wrote
This is what I call conversational technique, operating from the cognitive model. I think you can infer what I was thinking, what it was that had to be done with someone who didn’t want to have therapy. I didn’t give him therapy, I just asked some innocent questions to prim the more mature aspects of his personality. Once he discovered that he could indeed function, the psychological basis for his depression disappeared.
If you reread that paragraph you might see him imply that you don’t need therapy. You can help people from just knowing the model. I mean, someone talking suicide sounds nearly as serious as things get. Even if I’m exaggerating, it still begs the question: if it’s so great and helpful why don’t they teach the model so the average person can understand it? When I search the web on “CBT model” I find almost no sites and the sites I found didn’t teach the model so you could understand it.
I feel like CBT practitioners want to keep people coming back to them as much as they want to help the people. Am I jaded? If they made the model and techniques based on it more accessible, people could just use them and improve their lives.
That search also reminded me of my other big problem with how practitioners promote CBT: it focuses on problems. I know I wrote on that problem before, butÂ I wrote before about the value of looking for solutions over looking for problems. That search returned tons of problems, mostly serious ones. Well, what if you don’t have problems, especially serious ones? If the technique works, why only use it for, quoting the Beck Institute’s page on CBT Techniques
- Depression and Anxiety
- Personality Disorders
- Substance Abuse
- Children & Adolescents
- Weight Loss & Maintenance
That’s just the start. Nearly every page I find lists problem after problem. None puts the same effort to describing what to do beyond finding a therapist. I don’t question the value of therapists. I just think the average person — you! — could benefit from learning the principles of CBT and I think the average person can learn them.
A page called “Get Self Help CBT” — the self-help part sounded like what I hoped I’d find somewhere — listed anxiety, depression, low self-esteem, unstable relationships.
CBT publicity seems too much like these ads that promise to cure many problems.
I’m not suggesting CBT is snake oil. I believe it works. In fact, I believe it should work more in more cases than it does now. That is, I believe people should make it more accessible.
I point out the resemblance to snake oil marketing to call out its focus on problems instead of solutions, a focus I find counterproductive to helping the most number of people.
That’s why I wrote so many pages on the Model and the Method so anyone, including you, can learn and apply them.
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