Twice this week I have read the words of intelligent persons extolling the virtues of CBT. That is twice too many. These are not scientists, nor psychologists, but individuals who have been shown the therapy, found it useful and feel compelled to recommend it to others. It may appear to be altruistic, but it can be invalidating and damaging. For some it may be a trigger for self-alienation.
What is CBT? One way to understand is by considering each of the three words.
Cognitive: of, relating to, being, or involving conscious intellectual activity, such as thinking, reasoning, or remembering (Merriam-Webster Dictionary)
Behaviour: manner of conducting oneself; a specific response to a specific stimulus under normal or specified circumstances (Collins Dictionary)
Therapy: treatment that helps someone feel better, grow stronger, especially after an illness: (Cambridge Dictionary)
Put that all together and you arrive at a treatment to make you feel better, perhaps after illness, in which you consider and reconsider your responses to stimuli, and your manner of conducting yourself, using thinking and reasoning. What’s not to like?
Its provenance for starters. The key here is ‘behaviour’, tucked neatly between ‘cognitive’ and ‘therapy’ like a regular shit sandwich.
Behaviour therapy has its origins in the conditioning learning theory of Ivan Pavlov. Remember his dogs? John Watson used the same principle in researching whether behaviour could be ‘learned’ or ‘unlearned’. Then B.F. Skinner studied observable behaviour reinforcement, and rejected the idea of ‘inner causes’.
After Skinner came John Dollard and Neal Miller, Joseph Wolpe, and Albert Bandura. Bandura added the concept of modelling, learning behaviours by observing others.
Two of the earliest recognised forms of CBT were ‘Rational Emotive Behavior Therapy’ (REBT), developed by Albert Ellis in the 1950s, and ‘Cognitive Therapy’ developed by Aaron T. Beck in the 1960s. Modifying behaviour through conditioning, reinforcing, and finally modelling gained general acceptance when it was merged with cognitive therapy. CBT has been seen as a mental-health-cure-all for so long now that it’s become part of the furniture.
Standing proud alongside CBT on the shit sandwich shelf, are DBT and ABA.
DBT, or dialectical behaviour therapy, is based on CBT but also teaches you how to manage emotions and build relationships with others. Originally developed to help persons diagnosed with borderline personality disorder (BPD) to cope with ‘unstable emotions’, it has been reincarnated with an add-on of mindfulness and is offered as treatment for autism. I have been ‘referred’ for DBT for borderline and for autism. Through written exercises and mindfulness techniques the plan is that you will have better coping strategies and that ‘positive reinforcement’ will motivate you to turn away from ‘unhealthy thoughts and behaviours’. And as with CBT you get homework!
ABA, applied behaviour analysis, is straight from the behaviour analysis stable and is the gold standard treatment for autistic children. It studies behaviours, looks at the causes and consequences, and develops interventions. The interventions have maximum benefit when used with children for 30-40 hours per week. I’d be crushed to submission if I was subjected to such concentrated efforts to modify my behaviour.
Why do I feel so negative about these wonder treatments?
1 human behaviours do not need treatment simply because they fall outside the remit of ‘normal’
2 behaviours that have developed as a means of coping with fear and betrayal do not need modification, but understanding
3 these treatments are consistently theorised, developed, and controlled by people who have not ‘been there’. Walking the walk, talking the talk, but never thinking the thoughts. A need to control is qualification enough; to never look up from the manual and see the individual in front of them.
So, I beg those of you for whom CBT and DBT and even ABA have worked – please just enjoy your personal freedom, and accept that you are not at liberty to challenge the choices of others. They, and the people closest to them, are probably doing enough of that already.
Enjoy your own peace, and go quiet in our world.
Quite agree! x