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.
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