Why I do not like CBT therapies

Report
MY DISLIKE OF CBT &
WHAT I PROPOSE INSTEAD
Originally given to my Counseling Class at Portland State University Summer
Term 2012.
This Power Point is organized as follows:
1. My historical dislike of Skinner and behaviorism
2. Advantages of CBTs.
3. What I, personally, do not like about CBTs – w/ which I encourage you
to argue and disagree during this presentation.
4. What I propose instead of CBTs.
PART 1:
THE STORY BEHIND
MY DISLIKE OF CBT
SKINNER & HARVARD
• When I went to Harvard in 1962 I took an aptitude test there:
• It showed that of all possible majors, my scores were most consistent with
those entering students who had gone on to graduate “with honors” in
psychology.
• I had been reading psychology books since junior high school.
• I took the only psychology class at Harvard that did not have the words
“rats and mazes” in the title of the class, and made a B+.
• At that time Skinner was head of the Psych Dept at Harvard.
• Skinner was a radical behaviorist and an outspoken atheist.
MY BELIEFS
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I believe in a beneficent God.
I belief in the soul.
I may be a fool, but I share these beliefs w/ 80 to 90% of the world –
And w/ 90 to 100% of my potential clients.
• How was I to include those believers in my approach to counseling?
• How would you?
SKINNER’S ATHEISTIC
RADICAL BEHAVIORISM
• Because of Skinner’s atheistic behaviorism, I did not become a happy
psychologist and psychotherapist in my youth.
• I became an unhappy lawyer who never fit in.
• I told myself that that was Ok: If I had become a psychologist or
psychotherapist then I would have thought I knew it all.
• I knew, and still know, that I do not know it all.
How was I to fit not-knowing into counseling?
NOT KNOWING IT ALL AT 67
• Now, at age 67, I think I have arrived at the perfect way to fit “not
knowing” into my approach to psychotherapy.
• I will present that approach in the final part of this presentation.
PART 2.
ADVANTAGES OF CBT THERAPIES
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Easy to use and apply.
Easy to teach to clients.
Quick.
Evidence based.
I know people who feel that some form of CBT has proved a life-safer for
them.
• Widely accepted.
• Can anyone think of any other advantages?
WIDELY ACCEPTED
• My bias is that they are widely accepted in part because they do not require
us to look deep inside or question what we find there.
• People do not want to come to counseling to have their inner quality
questioned.
• They want to be reassured that they are not such a bad fellow, as CBT
(Beck) and REBT (Ellis) do.
• They want to feel better.
• And fast.
PART 3:
WHY I DO NOT LIKE CBT THERAPIES
Despite their advantages.
I DO NOT LIKE THAT:
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They turn us into sales people with ourselves as customer.
Their exponents are all self-promoting salesmen.
They are comparatively shallow.
They are reductionistic.
They are amoral.
They ignore the shadow.
They ignore real problems with inner and outer growth in favor of a pat on the back.
They minimize the value of our pain, sadness, anger, and failure.
They value adjustment and compliance.
They hit us over the head with a hammer (see next slide).
If you are a hammer, every problem needs a nail (see examples on slide following next).
Does anyone have any other objections to CBT?
HITS US OVER THE
HEAD W/ A HAMMER
• Steven Hayes, developer of ACT, asks us to imagine a client who is hitting
himself over the head with a hammer.
• The client comes to you for “treatment.”
• He says he has a headache and asks you to give him an aspirin.
• You look behind the client and see that he is hitting himself on the back
of the head with a hammer.
• The hammer is the standard CBT approach to therapy.
IF YOU ARE A HAMMER
EVERY PROBLEM IS A NAIL.
• In a video of Beck with client Richard, Richard does not come to him
principally for depression but that is all Beck talks with him about.
• Beck tells him he is catastrophizing when he says he has no friends – but in
fact Richard appears to have zero female friends and only superficial
golfing and drinking buddies as male friends – nothing deep.
• In a video of Ellis w/ Gloria, Gloria does not come to him principally for
anxiety, but that is all Ellis talks about.
• In videos of the same clients w/ an object-relations therapist and a
person-centered therapist, we learn that there is a lot more to the clients’
concerns, especially relational problems (Richard with ex-wife and Gloria
with her daughter).
WHAT I DO NOT LIKE
ABOUT CBT -- CONTINUED:
I do not like that of all approaches it seems least likely to encourage:
1. Constructive revolution;
2. Living deeply in a superficial world;
3. Staying with our pain and learning from it;
4. Spiritual development.
Do you agree or disagree?
Why?
WHAT CBT’S IGNORE,
CONTINUED:
• Most people are not interested in examining the ways in which they are at
fault in failed relationships.
• Examining those ways is the essence of inner and relational growth.
• I have developed a non-threatening, non-confrontational way of examining
these “failures” in individual & family therapy.
• I never use the word “failure:” of all words, it seems most calculated to
send people running –
• Yet we are all an assemblage of successes and failures – and we learn most
from our failures -- if we listen.
I DO NOT LIKE CBT BECAUSE
I AM A REVOLUTIONARY
• I do not value adjusting to a sick society.
• CBTs do: they are the darling of parole officers.
• I (like Erich Fromm and Robert Lindner – see References below) value
clients who are healthy revolutionaries.
• Unfortunately neither described a detailed approach to psychotherapy;
although Fromm referred to himself as a doctor of the soul.
• Below I describe an approach that nourishes healthy rebellion.
I DO NOT LIKE CBT BECAUSE
I BELIEVE IN THE SOUL
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Skinner and Ellis do not believe in the soul.
The soul carries what it has learned in this life into the next.
Therefore, one can continue to develop and learn right up until our death.
Below I describe an approach that values spiritual growth.
It is painful in part – and
In the process one will also learn to feel the pain of others.
CLASSES SUGGESTIONS
Class members pointed out that:
1. I make it seem that CBT and a believe in God or the soul are mutually
exclusive. They are not: one can use both CBT and an approach that is
sensitive to spirituality.
2. Many CBT practitioners combine it with other approaches for an
“integrative” approach.
PART 4
WHAT I PROPOSE INSTEAD
My Approach to Therapy
MY APPROACH
1.
2.
3.
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5.
6.
7.
8.
Recognizing the client’s inner drive to grow in healthy ways.
Incongruence.
12 areas of incongruence.
Reflecting all 12 aspects accurately.
Congruence.
My complete approach summarized.
My approach to couples and family counseling.
Definitions.
1.
INNER DRIVE TO GROW
• Carl Rogers found that all of his clients had an inborn motivation to
develop in healthy ways and to become “fully-functioning persons.”
• I agree.
• Each client is a unique soul and has a spirit of infinite capacity.
• Each client has it within them to figure out what they need to change, if
anything, and where they need to grow, if anywhere.
2.
INCONGRUENCE
• I begin counseling with sensing and reflecting the client’s feelings of
incongruence.
• What is incongruence?
• A full definition appears among the final, definition slides.
3.
12 AREAS OF INCONGRUENCE
• When a client comes to therapy s/he/they will be experiencing
incongruence in one or more of the following 12 areas of concern:
physical, mental, emotional, social/relational, spiritual, creative (the ways
we see and express the world differently), and revolutionary (the ways in
which we wish the world were different).
• When all 12 spheres are addressed, the total client is being cared for.
• In any of the 12 spheres, a client can be growing or stuck.
• These 12 spheres are interconnected and wellness in one affects the
wellness of all.
(The first 5 were suggested by Dr. David Elam of Southern Illinois
University’s Counseling Center.)
STUDENTS ADDED 10, 11, & 12
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2.
3.
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5.
6.
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11.
12.
Physical.
Mental.
Emotional.
Social/relational.
Spiritual.
Moral.
Attachment issues.
Creative (the ways we see and express the world differently).
Revolutionary (the ways in which we wish the world were different).
Maslow’s basic needs: physiological, safety, love and belonging, esteem.
Maslow’s higher needs: self-realization, self-transcendence.
Meaning and meaningful work.
4.
MY JOB
• My job is to spot and re-state the client’s concerns in words and tone that
make it clear that I do understand.
• The client will then re-state the concern again, and with each re-statement
on the client’s part (not on my part), the client will go deeper.
• Deeper in understanding what the problem means to him/her;
• Deeper in understanding how to react to the problem in ways that are selfsyntonic and oriented toward inner growth and growth in the quality of
relationships.
STILL FACE EXPERIMENT
• Each understanding restatement is like a smile in the still face experiment:
it reaffirms the client’s existence and value as a beloved unique human
being who is worth paying attention to.
• If I interpose some advice or suggestions or personal experience in this
relationship, the quality of the connection is compromised:
• It is no longer just about the client –
• It is about what a good counselor I am.
• It suggests that the client does not have the capacity to figure out what is
important to her/him and what needs to change in her/his life.
GROWTH IS PAINFUL
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In my experience growth is painful and frightening.
Do you agree?
There are some people who believe growth does not have to be either.
I think they are making excuses for their own safe choices.
WHY NOT ALONE
• If all I am doing is re-stating the client’s concerns, why am I even needed?
• Why can’t I, or anyone, just talk to a mirror, or to a tape recorder and get
the same benefits?
BECAUSE IT TAKES TWO
As we know from existentialism, it takes two to grow.
Any other reasons?
5.
CONGRUENCE
• Rogers defined “congruence” to mean an “accurate matching of
experiencing and awareness” and it may be “further extended to cover a
matching of experience, awareness, and communication” (Rogers, 1961, p.
339).
• Brothers (1991) said “‘Congruence’ is no more, and no less, than being all
of who we are at a given point in time with another human being.
Congruent communication is a committed, active pursuit of clarity of
meaning with another person.”
• One goal of counseling is to become more congruent, more honest with
oneself and more honest with others.
6.
MY APPROACH SUMMARIZED
MY APPROACH TO WORKING WITH
ALL OF THESE CONCERNS EXCEPT
THE PHYSICAL
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Psychological contact (the client wants to be there and I want to be there for
this client).
Incongruence (may include incongruence between a client’s spiritual ideals
and material ambitions; or, as in AA, incongruence between one’s will and the
will, or wish, of a higher power; or it may include moral incongruence).
Genuineness, authenticity, and congruence.
Unconditional positive regard and acceptance (non-possessory love/agape).
Empathy.
Perception by the client of the counselor’s empathy and acceptance.
Understanding (of the client’s emotional, intellectual, spiritual, and moral
concerns, and ability to restate those accurately).
Privacy and Confidentiality.
Patience and Optimism.
7.
MARRIAGE & FAMILY THERAPY:
If the client wishes to include some or all of those with whom s/he is having
relational difficulties, I make the following assumptions:
MARRIAGE & FAMILY THERAPY:
ASSUMPTIONS:
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The family comes to counseling because it is experiencing “incongruence” between the family’s idealized
picture of itself and its actual experience.
That incongruence may involve any of the five areas – but is most likely to include relational, especially
attachment issues (see below).
A communication within the family and within therapy is congruent if it honestly matches the member’s
experience and awareness.
Increased congruent communication within a family leads to mutually accurate understanding of
communications and improved psychological adjustment and satisfaction among all family members.
Each member of the family is seen as having the potential and yearning to become a fully functioning
individual in a fully functioning family.
Fully functioning persons are those who can meet their need for positive regard from others and have
positive regard for themselves.
Fully functioning persons can meet their need for intimacy within the family and meet their need for
individual development outside the family.
Fully functioning persons allow others to express intimacy within the family and to grow outside the
family.
In family counseling each member needs to learn to feel and show positive regard for the other members,
and each member needs to be seen to show that regard.
MARRIGE & FAMILY THERAPY
INVENTIONNS:
To help the family achieve the above, the counselor will:
1.
Listen attentively.
2.
Show empathy.
3.
Show understanding by making kind-hearted restatements of each client’s individual
concerns.
4.
The counselor must demonstrate unconditional positive regard, and acceptance for each
member and for the family as a whole.
5.
The family therapist must draw out member’s strengths and validate those strengths; and
6.
The therapist must be felt by the family members to be genuine, empathic, and fair.
7.
In order to do his job effectively, I will value each member of the family and each member’s
point of view equally.
8.
DEFINITIONS
INCONGRUENCE
Incongruence describes feelings of depression and unhappiness caused by not living the life we really want to.
Rogers felt that individuals could have a good job, marriage and children but still feel unhappy, a key element of
incongruence.
Rogers believed that these feelings of unhappiness are important because they serve to remind us that we aren’t on the
path we would really like to be. He felt that we often take a direction in life based on society’s values and principles
rather than our own. These are programmed into us during childhood by our parents and other authority figures which
we accept without question, and which stay with us throughout adulthood. An example could be a career path we are
encouraged to pursue, or a marriage we are encouraged to stay in rather than risk societal and family rejection or
disapproval.
The key is to follow our own personal value system, which Rogers called the ‘organismic valuing process’, or risk
feelings of Incongruence. How can counselling help us get in touch with our true value system?
Rogers believed the role of the counsellor is to interpret what is being said to them by their client, and not try to
analyse their unconscious as recommended by Freud. The counsellor needs to reflect back to the client so that they
can become more aware of their feelings and the situation they are in. The client can then think about what is making
them unhappy in their present situation and discover the path they would like to take.
From http://counsellingcentral.com/ 7-16-12
FULLY FUNCTIONING PERSON
(1) As they mature, people tend to move away from façades. Pretense, defensiveness, putting up a front are
negatively valued. They move away from "oughts." The feeling of "I ought to do or be thus and so" is
negatively valued.
(2) They no longer seek to meet the expectations of others. Pleasing others, as a goal in itself, is negatively
valued. Being real is positively valued. The client tends to move toward being himself, being his real feelings,
being what he is.
(3) Self-direction is positively valued. They discover increasing pride and confidence in making their own
choices, guiding their own lives. One's self, one's own feelings, come to be positively valued. From a point of
view where they look upon themselves with contempt and despair, they come to value themselves and their
reactions as being of worth.
(4) Being a process is positively valued. From desiring some fixed goal, clients come to prefer the excitement
of being a process of potentialities being born.
(5) They come to value an openness to all of their inner and outer experience. To be open to and sensitive to
their own inner reactions and feelings, the reactions and feelings of others, and the realities of the objective
world -- this is a direction which they clearly prefer. This openness becomes their most valued resource.
(6) Sensitivity to others and acceptance of others is positively valued. They come to appreciate others for
what they are, just as they come to appreciate themselves for what they are.
(7) Deep relationships are positively valued. To achieve a close, intimate, real, fully communicative relationship
with another person seems to meet a deep need in every individual, and is highly valued. (Paraphrased from
Rogers, 1964, p. 182).
FULLY FUNCTIONING
PERSON CONTINUED
Rogers wrote: “My experience is that he is a basically trustworthy member of
the human species, whose deepest characteristics tend toward development,
differentiation, cooperative relationships; whose life tends fundamentally to
move from dependence to independence; whose impulses tend naturally to
harmonize into a complex and changing pattern of self-regulation; whose
total character is such as to tend to preserve and enhance himself and his
species, and perhaps to move it toward its further evolution. . . . [M]an appears
to be an awesomely complex creature who can go terribly awry, but whose
deepest tendencies make for his own enhancement and that of other members
of his species. I find that he can be trusted to move in this constructive
direction when he lives, even briefly, in a nonthreatening climate where he is
free to choose any direction" (Rogers, 1989, pp. 404 – 405, 408).
FULLY FUNCTIONING PERSON
ALSO CREATIVE
A fully functioning person is also creative.
“I believe it will be clear that a person who is involved in this process is a
creative person (Rogers, 1961, p. 191.)”
MY EXPERIENCE
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I was a Deputy DA for 7 years.
I was a criminal defense attorney for 13 years.
I was a divorce attorney for 10 years.
I worked with adolescents with drug and alcohol issues for 4 years.
I have worked with mental health clients since returning to graduate school
in 2004.
• In all that time, I have personally encountered 3 people and heard of 1
who did not live up to this positive view of human nature: who did not
want to be better, did not want to grow.
REFERENCES
Brothers, B. J. (1991). Methods for connectedness: Virginia Satir’s
contribution to the process of human communication. In B.J.
Brothers (Ed.), Virginia Satir: Foundational ideas (pp. 11 - 20). New
York: The Haworth Press.
Counseling Central website.
Fromm, E. (1994). The Erich Fromm reader, Rainer Funk, ed. Atlantic
Highlands, NJ: Humanities Press International.
Fromm, E. (1963). The dogma of Christ and other essays on religion, psychology and
culture. New York: Holt, Rinehard and Winston.
Fromm, E. (1950). Psychoanalysis and religion. New Haven: Yale University
Press.
REFERENCES, CONTINUED
Lindner, R. (1944). Rebel without a cause: The hypnoanalysis of a criminal psychopath.
New York: Grune & Statton.
Lindner, R. (1952). Prescription for rebellion. New York: Rinehart.
Lindner, R. (1956). Must you conform? New York: Grove Press.
Rogers, C. R. (1951). Client-centered therapy: Its current practice, implications, and
theory. Boston: Houghton Mifflin.
Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy.
Boston: Houghton Mifflin.
Rogers, C. (1989). Reinhold Niebuhr. In H. Kirschenbaum & V. L.
Henderson (Eds.) Carl Rogers: Dialogues (pp. 208 – 228). Boston:
Houghton Mifflin.
THE END

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