Over the years, I’ve had the opportunity to visit various treatment programs and to consult with many therapists, all of whom purported to employ a cognitive-behavioral approach to treatment. And I’ve also heard from hundreds of individuals who have purportedly participated in cognitive-behavioral therapy (CBT). But what I have frequently found is that while both the clinicians and their clients were quite fairly well-versed in the theory behind CBT, the treatment actually provided fell far short of genuine CBT, focusing primarily if not exclusively on the cognitive component of the paradigm (i.e. on the clients’ thinking patterns, core beliefs and attitudes, etc.,) and affording little to no attention to the most critical component: the problematic behavior patterns that so often both flow from and reinforce unhealthy ways of thinking. As a result, the treatment recipients did not derive the level of benefit the research indicates is so possible with CBT.
As readers of my book Character Disturbance already know, I’m a proponent of CBT, especially when it comes to the treatment of individuals with some modicum of character impairment. And I have long asserted that change – genuine, meaningful change – always takes place in the here-and-now moment, which one of the bigger reasons why I favor the CBT model. All of us face pivotal moments of choice. And only when we seize the moment and make the choice to take a different course from our more habitual ways of dealing with things can we truly acquire new ways of coping. CBT, properly employed, provides an excellent means for achieving those ends. Now, to be sure, some disturbed characters are really good at “going through the motions” of change (i.e. giving assent to demands placed on them) while still harboring much resentment and defiance in their hearts. And a few of these folks know how to stage some pretty convincing performances while inwardly resisting any modification of their preferred modus operandi. But at the core of the cognitive-behavioral therapy perspective and paradigm is the notion that just as our beliefs, attitudes, and ways of thinking influence our behavior, the consequences we incur as a result of our actions also shape our beliefs and attitudes. And any heart open to lasting changes in the long run must at least be willing to a few things differently in the short-run. Because we both learn and grow from our experiences, making even the smallest of changes in our behavior can eventually lead some big changes of heart.
CBT isn’t just for folks with character disturbances. Research indicates it’s the treatment of choice for a wide variety of human concerns. Still, I’ve gotten many complaints over the years from folks who claim to have participated in CBT only to have derived little benefit. But in almost every case, when I examined carefully the model of therapy in which they participated it became clear that they had received something far more akin to cognitive therapy (CT) than CBT. CT came into vogue several decades ago when the connection between depression and the altered perceptions and thinking patterns (i.e. depressive cognitions) that accompany depression became more fully understood. That’s what made us realize what a powerful a therapeutic tool it could be to challenge depression-fostering cognitions and replace them with beliefs that might foster a more positive outlook. CT quickly became popular with clinicians because of its ease of application and because of its compatibility with a lot of other “talk therapy” approaches. Behavior therapy, on the other hand, has never enjoyed the same level of popularity or support, despite the ample research attesting to its superior clinical efficacy. Incorporating the cognitive component has been demonstrated to enhance behavior therapy’s effectiveness. Still, the crucial core of CBT is the behavioral component. Because most clinicians know how powerful a treatment approach it is, when asked, they’ll frequently tell you they’re both knowledgeable about and employ CBT, even if in practice what they really do is mostly CT or their own unique blend of CT and other traditional insight-oriented techniques. Very few have the desire or deliberately make the effort to confront maladaptive behaviors at the very moment they occur and encourage their clients to replace those behaviors with more appropriate ones, which is what the behavioral aspect of CBT is all about. And that’s a shame because that’s where the real efficacy of treatment lies. As I’ve advocated in other articles (see, for example: Putting the “B” Back into Cognitive-Behavioral Therapy), if they’re really going to make a difference in people’s lives, helping professionals need to put the “B” back into CBT.
Over the next few weeks I’ll be providing some examples of how the CBT approach can be used successfully to address a wide range of problems (e.g., ameliorating post-traumatic stress after a relationship with a character disturbed individual, overcoming anxiety disorders and depression, modifying personality patterns, etc.) and how therapists who properly employ the approach can not only help their clients make meaningful changes in their lives but also help them acquire a greater sense of personal empowerment (i.e. increased self-efficacy) in the process.
This Sunday night’s Character Matters program will be a rebroadcast of an earlier show, so no phone calls can be taken.