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Cognitive Behavioral Therapy from a Christian Perspective

The following represents Arthur's opinions only and not necessarily those of Christie.

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Cognitive Behavioral Therapy

             Aaron Beck is the pioneering individual in cognitive therapy, which is the most influential and most often researched approach to psychotherapy.  Beck began with an attempt to further Freud’s theory of depression; however, the research led Beck away from Freud’s approach and towards one where errors in logic, coined “cognitive distortions” were deemed the basis of underlying pathology and depression.  The fundamental aspect of cognitive therapy, which later integrated components of behaviorism, was the continuation of negative beliefs that reflected the individual’s dysfunctional behavior.

            In addition to Beck, Albert Ellis contributed to the development of a cognitive based theory in his combination of humanism, philosophy, and behavior therapy when he formed rational – emotive behavior therapy (REBT).  Ellis continues to provide therapy and speaking engagements as a means of continuing his work and developing this form of psychotherapy.  He is said to be an abrasive, humorous, and a flamboyant individual who uses this energy to continue his productivity.

            The premise of cognitive-behavior therapy includes the reorganization of an individuals own statements and beliefs to develop congruence with his or her behavior.  A relationship exists between cognitions, emotions, and behaviors that create cause and effect in how the individual experiences events and situations.  Human nature, from a cognitive – behavioral perspective, defines individuals as having the potential for rational and irrational thinking.  This thinking result in the behavior that is often identified as the problem or issue when, in reality, it is the symptom of faulty thinking.

             Faulty thinking begins during childhood as children hear and adopt indoctrinated thoughts that are heard from their parents.  As they repeat these thoughts, dysfunctional attitudes and beliefs are kept alive and begin to affect how individuals behave.  In the REBT theory of cognitive – behavioral therapy, the A-B-C theory of personality exists.  First, an activating (A) event occurs; this triggers a belief (B), which is experienced as an emotional or behavioral consequence (C).  From here, therapy begins to disrupt the pattern by introducing a disputing intervention (D), which has an effect (E), and a new feeling (F).

            The intervention has a number of techniques however; the underlying therapeutic goal is to teach clients to separate the evaluation of their behavior from their evaluation of themselves.  Learning acceptance of self regardless of imperfections is the essence of therapy.  Therapists proceed with counseling attempting to identify faulty thinking of clients and assist them to abandon their irrational thinking and develop a rational groundwork for life. 

            Therapy sessions focus on the client’s experiences in the present with a specific role of learner and doer between counselor and client.  In addition, clients are expected to actively work outside the therapy session usually with homework assignments to continue the learning and development.  Therapists are open and often self-disclose their own beliefs and views with the client to provide modeling of healthy choices.

            Therapy with a cognitive – behavioral approach is an active and deliberate process with both the therapist and client working together to identify the client’s conclusions and form a hypothesis for the reason for the beliefs.  Active participation from the client is critical for success as the client needs to recognize the changes in thought that is required in order for changes in behavior to be realized.  CBT is used for treating depression and anxiety as well as for crisis intervention where individuals have beliefs that cause them to develop thoughts that are troubling and disabling for living a healthy life. 

            Beck developed the BDI (Beck Depression Inventory) as a standardized test for determining the depth of depression.  Through this inventory, specific areas of depression can be targeted for treatment.  In the use of families, core beliefs and family schemas provide the basis for families to re-identify what they stand for and develop healthy systems that guard against dysfunction.

            Criticisms and limitations of the CBT approach include the sense that it is a confrontational approach where clients are challenged with their faulty beliefs and directed to explore these towards healthy change.  This power can be misused by therapists who push clients to believe certain values limiting the neutrality of therapy.  Further, the focus on positive thinking may be viewed as being too superficial and overlooking the importance of a client’s past.  While symptoms are eliminated, the underlying causes of the problems are often ignored.  Finally, emotions also tend to be played down with the logical and thought oriented components overemphasized.

Personal Evaluation

            The notion that dysfunction originates with faulty beliefs is a very appealing theory to me as a Christian.  However, this can be a double-edged sword.  Cognitive-behavioral therapy begins with a client’s belief system and seeks to first change those beliefs.  This, of course, begs the unanswered question:  who or what defines a belief as faulty?  The therapist?  Or perhaps it’s the client, or maybe even society itself?  Two hundred years ago, the majority of society held the belief that blacks were only one-third human.  Imagine an individual who I will name Bob who grew up on a plantation where his father owned slaves.  As he grew up he learned how to devalue other humans because it was right and acceptable; after all they were slaves.  Later in life, he marries and finds himself constantly abusing his family.  Bob, on the verge of collapse at losing his wife and children, seeks help to control his rage.  He visits a cognitive-behavioral therapist who attempts to uncover his false beliefs.  At what point would his false belief that blacks are less than human be identified as irrational?  Since the greater whole of society held the same belief, and since that belief was also written into many legal ordinances, there would be no objective standard upon which to deem the belief as faulty.  The relativist CBT therapist would assume that belief as acceptable and instead look for another belief to explain the behavior, completely missing the actual one responsible.  And this is the overwhelming problem I have with this model:  it is based on the premise of “faulty beliefs” yet does not philosophically define what constitutes “faulty.” 

            In light of similar examples, I conclude that “faulty” in CBT is merely a subjective judgment made by therapist and/or client at real time during the session.  If this form of therapy is to have any value to me as a Christian, I would apply an absolute standard behind the concept of “false belief”.  Once a standard exists (that standard being God’s truth), only then does the phrase “faulty belief” have any real meaning.  Without an objective standard, this form of therapy, in my opinion, will simply result in returning an individual to “function” within his environment (and that environment could be local as in family, or macro as in society), regardless of whether or not that environment is corrupt or not.  And being able to function within a dysfunction may work for a time, maybe even for the rest of the individual’s life; but eventually it will crack and a much larger mess will have been made;  slavery being a case in point.