Cognitive therapy's emphasis on distorted thinking is itself distorted.
(image by Michaelson/bigstockphoto)
Recently I came across a best-selling psychology textbook, and I believe the sections of it dealing with the essentials of self-awareness are not accessing a deep enough level of understanding.
The widely used textbook, written by three Harvard University professors of psychology, is titled simply Psycholog y (Worth Publishers, New York, 2009). Students pay $152.48 for the latest edition of this textbook. They're not getting their money's worth, and I'll tell you why.
In this textbook, the authors express their preference for cognitive therapy. (They subtly--and not so subtly--disparage psychodynamic therapy which is based on depth psychology.) Cognitive therapy, they say, "focuses on helping a client identify and correct any distorted thinking about self, others, or the world." The key term here is "distorted thinking." Who decides what constitutes distorted thinking? Sure, if you're thinking about murdering someone or jumping off a cliff, that's obviously wrong-headed. But most people who go to psychotherapists don't need someone telling them what or how to think. Rather, they need help in discovering their inner truth and developing their authentic self.
The best psychotherapists don't mess with this notion of distorted thinking. We don't deal in "cognitive restructuring," to use one of the textbook authors' favored terms. Instead, we trace the client's difficulties back to the source, using as clues the memories and occurrences associated with the client's anxiety, stress, painful emotions, and self-defeating behaviors. We're guides for the exploration of their unconscious mind. We don't tell them what to believe or what to think, although we do introduce basic principles and knowledge for them to consider.
Let's compare the two approaches, cognitive therapy and psychodynamic therapy, using an example from the textbook. The cognitive approach, excerpted below (on page 551 of the first edition), is then followed by my analysis.
[From the textbook] For example, a depressed client may believe that she is stupid and will never pass her college courses--all on the basis of one poor grade. In this situation, the therapist would work with the client to examine the validity of this belief. The therapist would consider relevant evidence such as grades on previous exams, performance on other coursework, and examples of intelligence outside of school. It may be that the client has never failed a course before and has achieved good grades in this particular course in the past. In this case, the therapist would encourage the client to consider all this information in determining whether she is truly "stupid." . . . [the therapist may] help the client decide whether doing poorly in one course constitutes being "stupid'' and whether there is anything the client can do to better prepare for future exams.
As I see it, this cognitive approach does the woman a disservice. She is indeed feeling stupid, but that painful feeling is likely a symptom of (as well as a defense against recognition of) a deeper problem. As her therapist, I would listen to her to get a sense of what that deeper problem might be, and I would guide her, if she were willing to be guided, towards her own inner truth, whatever that truth might be.
So, what might be that truth? It's possible that she's feeling overwhelmed by college life and the rigors of her academic program. These circumstances aren't necessarily overwhelming in themselves, but she experiences them that way because the challenges of college life have triggered within her an old unresolved emotion from childhood having to do with lingering helplessness and powerlessness. All of us are reluctant to see our lingering entanglements in old unresolved emotions. The entanglements mean that one or more negative emotions (refusal, helplessness, criticism, or rejection, for instance) are still unresolved within us. As a result, we're still unconsciously inclined, even determined or programmed, to experience the negative emotion, even though it's painful and self-defeating to do so.
This woman hasn't achieved inner freedom. She wants to feel strong and competent, but she still remains an emotional prisoner of lingering helplessness. She has to expose this emotional "default position" and understand that she has been making an unconscious choice to continue to experience it. Such insight produces inner freedom.
This woman is likely using the idea of being stupid as a defense. The unconscious defense makes this claim: "I'm not willing to experience the challenges of college academics through old unresolved feelings of weakness or helplessness. The problem is I'm stupid." This is a defense called "pleading guilty to the lesser crime." According to the irrational terms imposed by our unconscious mind, the lesser crime is being stupid, the more serious crime is being emotionally attached to helplessness and being unconsciously prone to replaying and recycling that unresolved negative emotion.
This analysis of mine might be wrong. The woman's plight could be due to something else, and she and her psychodynamic therapist would pursue other possibilities. She could, for instance, be entangled emotionally in being a disappointment to herself and others. Her father might have felt this way about himself, and then projected this negative expectation on to her. The woman consciously wants to do well, but unconsciously she expects to be a disappointment. She could be exceedingly smart, yet still be determined unconsciously to act out this unresolved conflict. The defense now reads: "I don't want to be a disappointment or to be seen in a negative light. The problem is that I'm stupid." Again, in the unconscious mind's irrational reckoning, being stupid is the lesser crime, being emotionally attached to the feeling of being a disappointment is the more serious crime.
Though the defense "works" in hiding the inner facts, she pays a painful price in feeling herself to be stupid. That painful defense, when not exposed for what it is, would also cause her to lose confidence and could lead to failure in her academic program.
If either of the above analyses were true (and other possibilities can be explored), then obviously that self-knowledge is of much greater value to her than what the cognitive approach offers. While the cognitive method does have value in certain situations, its use with this woman is like talking to a university student at a fifth-grader's level. ( Here's a report from The Journal of the American Medical Association on the superior effectiveness of psychodynamic therapy.)
Knowing her deeper truth, she provides vital knowledge to her conscious mind and thereby to her intelligence. Knowing what's true, she's greatly empowered. It's not "cognitive restructuring" that frees her from her plight. Rather, it's her intelligence, now enhanced by vital insight, which does so. This process doesn't require years of therapy. With skilled psychodynamic therapists, some people can begin to assimilate the inner facts and have that knowledge begin quite quickly to benefit them, sometimes within a month or two of beginning weekly therapy. Many people decline to do the deeper work, yet they should at least be presented with that option.
Cognitive therapists claim that clinical studies have proven the benefits of their method. (Possible flaws in the methodology of psychological studies are noted here , here , and here .) How are these benefits ascertained? Researchers ask the clients how they're feeling and doing after experiencing cognitive therapy. Yes, some clients do feel better and they express satisfaction with the therapy. However, because they sincerely want to do well, they unconsciously can renounce, on a temporary basis, some of the lesser symptoms of their dysfunction. But their inner conflicts remain unresolved, and different symptoms relating to those conflicts can soon emerge in ever more painful and self-defeating ways. Moreover, these individuals are initially grateful to their cognitive therapists and will praise their effectiveness because, through this superficial form of therapy, they (the clients) have avoided the often fear-inducing challenge of deeper introspection and self-examination.
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