As I mentioned in my last post (See: A Primer on Cognitive-Behavioral Therapy), a lot of folks who say they have either administered or received Cognitive-Behavioral Therapy (CBT) have never actually engaged in a process that focuses heavily on the most crucial aspect of the paradigm: behavior. Affording attention to the thinking patterns and attitudes that predispose harmful behavior patterns is important to be sure, but when it comes to gaining the skills to empower oneself – and especially when it comes to overcoming character deficiencies – perhaps nothing is as important as confronting, correcting, and ultimately replacing dysfunctional behavior patterns.
In Character Disturbance, I present some vignettes that illustrate the very different nature of therapy that remains true to the cognitive-behavioral model. Disturbed characters readily display their problematic behavior patterns, even when they’re in the process of impression-management (i.e. doing their best to create a favorable impression and manipulate the opinions and judgment of the person evaluating them). and an astute clinician should be able to “spot” and label these behaviors when they occur. And what makes CBT so different from other forms of therapy is that because change always takes place in the here-and-now moment, therapists employing the paradigm have to be willing to call out the behaviors of concern at the very moment they occur, then artfully “invite” the person to correct these behaviors and replace them with more pro-social ones, providing them afterward with much needed reinforcement for the person’s willingness to conduct themselves in a healthier way.
When I was doing research for In Sheep’s Clothing, I encountered a man who had some level of genuine care and affection for his wife and who truly didn’t want to loose her as he feared was very possible but who was also prone to some casualness about his frequent “flirtations” with other women and the few times he’d “slipped” and had an affair. One would think he was “clueless” about the detriment his behaviors posed to his marriage. And at some level, I suppose you could say he was indeed clueless. But he was quite “aware” at least at an intellectual level that a marital bond that is both deep and mutually enriching is necessarily founded upon trust and fidelity. However, his habitual behaviors of minimizing the seriousness of his constant flirtations and episodic indiscretions, his persistent lying to himself about the consequences of his actions, his willingness to gaslight his wife whenever she suspected him of betrayal, and willingness to use a whole host of other behaviors (e.g., victim-blaming, feigning innocence, feigning ignorance) to manipulate her into sticking with him only “enabled” him to perpetuate the pattern. Something in this vicious cycle of abuse would have to be altered for the cycle to be broken, and that would necessarily mean some behavior would have to change. Now, I’d always been taught that a therapist should always set an atmosphere where the client would feel “safe” to sort through the “underlying feelings and dynamics” always presumed to be at the root of such problematic behaviors (e.g., “fear of intimacy, fear of commitment, unmet love needs, unmet needs for adulation or affection, etc.). And I’d especially been taught not to call out behaviors in a judgmental sense, lest I run off a client who’d not yet come to trust me and would likely become too “defensive.” But I quickly learned that unless destructive behavior is confronted and corrected, almost nothing really changes, despite all the possible flowery talk and promises a person might make. I also learned that there simply cannot ever be trust and respect between a disturbed character and a therapist (or anyone else for that matter) unless their tactics are both accurately labeled and confronted and a commitment to certain principles and values are firmly upheld (Over my career, I’ve seen far too many cases in which a disturbed character will “string along” both the therapist and an aggrieved relationship partner while all the time holding only both mistrust of and disdain for the person they were able to manipulate). And perhaps the most important thing I learned is that behavior always has to be confronted the very moment it occurs. So for awhile, I would confront this man every time he would minimize or trivialize, or when he would allow himself to distort the reality of circumstances. Only then did he come not only come to a fuller level of awareness of the destructive nature of what he had been doing but also become more amenable to changing the kinds of thinking patterns and attitudes that predisposed him to conduct himself in a way so hostile to the nurturing of a wholesome, healthy relationship. Just as the model predicted, changing behavior helped him reshape his attitudes, and as he changed his problematic ways of thinking, his behavior only improved all the more. Most importantly of all, he began to change. And as he became more willing to self-correct both his thinking and behavior without my prompting, I became even more reinforcing, until he was more consistently willing to engage in his own self-endorsement. Now, I’ve mentioned before that not all problem characters change their “internal stripes” as a result of outwardly changing their behavior. But many do indeed change. And it’s important to remember that for there to ever be any possibility of real and lasting change a person has to be willing to change behavior and thinking patterns in the here-and-now moment.
In next week’s post I’ll have some more detailed information about the actual mechanics of CBT (I have long made available to therapists and lay persons specially-designed worksheets for addressing and changing problematic thinking and behavior patterns).
Also, look for some more specific information about this fall’s upcoming webinar (we’re hoping to make it a fully interactive forum) in the next few weeks.
Sunday night’s Character Matters program will be a live broadcast, so I’m again happy to take your calls.