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Four Drawbacks of Cognitive Therapy

Cognitive therapy is a generic term that refers to diverse cognitive approaches to modifying human experiences and activities. This critique focuses on cognitive therapy that focuses on altering negative self concepts. This approach is based on the theories developed by A. Beck and A. Ellis. Read More

weak

Those are weak critiques.

Cognitive therapy is highly affective at bringing awareness and changing behaviors in a realistic, tangible approach and it is one of the therapies that can help people with low self-esteem and depression change alter their schemas.

Please note that what I

Please note that
what I criticized was the self-focused cognitive therapy, not all types of cognitive therapy.

Feeling Good: The New Mood Therapy

I think you should read "Feeling Good: The New Mood
Therapy Revised and Updated" by Dr. Burns, about
Cognitive Therapy.

Your four concerns/criticisms of Cognitive Therapy have
been around for quite a while, and Dr. Burns specifically
and effectively addresses them in his book.

I don't think that Burns'

I don't think that Burns' book (1999) "Feeling Good..." has addressed the four weaknesses of the self-focused cognitive therapy I raised in my post. I appreciate that you can specify the page numbers where he discussed the issues.

That does not mean that the

That does not mean that the criticisms aren't valid.

My experience with a

My experience with a therapist who used cognitive-behavioral therapy with me, several years ago, seems to me to lend credence to at least one of your criticisms: the confusion of "negative" with "irrational".

As I recall, she asked me to list some of my self-perceptions as an exercise in revealing and fixing the ones that were bad. One of my items was, "I , but I can still be happy and have a good life." She responded to this with, "No, you can't believe , that's irrational." I was somewhat taken aback by this. Next session, I asked her, "How would you advise someone who actually does ?", to which her reply was, "I don't believe in people who ." Immediately thereafter I ended my sessions with her.

Regardless of whether I had, or have, "bad quality Y", it seemed to me that she was severely out of touch with reality and was quite possibly confusing "negative" with "irrational".

In any case, I thank you Dr. Sun for your well-written and thought-provoking article.

My experience with a

My experience with a therapist who used cognitive-behavioral therapy with me, several years ago, seems to me to lend credence to at least one of your criticisms: the confusion of "negative" with "irrational".

As I recall, she asked me to list some of my self-perceptions as an exercise in revealing and fixing the ones that were bad. One of my items was, "I 'have bad quality Y', but I can still be happy and have a good life." She responded to this with, "No, you can't believe 'you have bad quality Y', that's irrational." I was somewhat taken aback by this. Next session, I asked her, "How would you advise someone who actually does 'have bad quality Y'?", to which her reply was, "I don't believe in people who 'have bad quality Y'." Immediately thereafter I ended my sessions with her.

Regardless of whether I had, or have, "bad quality Y", it seemed to me that she was severely out of touch with reality and was quite possibly confusing "negative" with "irrational".

In any case, I thank you Dr. Sun for your well-written and thought-provoking article.

Thank you for sharing your experience

Thank you for your comments and for sharing your experience with CBT.

Possible points for discussion

An interesting article. I would venture to suggest some possible answers to your queriesfrom a cognitive standpoint. I am not a psychologist or therapist, myself, I just have an interest in the subject through my own self-treatment, so if I misunderstand any of your points, please excuse me.

Point 2. The suggestion that a situation is actually negative, and that reframing the thoughts to unrealistic, positive ones, would be a valid criticism if the therapist was merely trying to do this. However, David Burns suggests that a 'healthy' reaction to a negative event or events would be sadness, rather than depression, which he believes is always caused by a distorted cognition. To that end he might suggest that congitive therapy would be appropriate for the patient to assist with their depression and negative thoughts
about their past history, to enable them to cope, not to make them completely at peace with their past.

Point 3. Whereas a negative assessment of a situation may be realistic, if a positive or neutral thought replaces a negative one, and the situation doesn't put the patient in any physical danger, this could be a good thing.

Point 4. Aaron Beck states that how someone reacts to a situation would depend on their 'cognitive organisation' (their past experiences of similar situations), so perhaps this could suggest why an individual may default to a negative position in a given situation (and perhaps a positive one in another)?

On point 1 you seem to be asking a chicken and egg question: Do negative congnitions occur because of low self-esteem, or do they cause it? This is a good question, but perhaps, again, one's cognitive organisation and past experiences may determine whether one has low self-esteem, and this would influence one's current cognitions?

In summary, most psychopathologies seem to create almost as many questions as they answer, and cognitive/rational emotive therapy aren't any different. However they are useful tools with a strong theoretical background, and treatment can be fairly rapid.

Thank you for your comments

About your comments on Points 2 and 3, What I suggest is that there is a major problem with conceptualizing the client's issues in the current CBT. As I stated, the therapy views "negative self concept" and "inaccurate self concept" as the same, when they indicate two separate issues.

I welcome and appreciate all relevant comments

I welcome and appreciate all relevant comments and examples.

Your critiques are valid for

Your critiques are valid for a bad cognitive therapist, but a competent therapist knows the difference between negative and biased or inaccurate. A competent therapist does not try to swap negative thoughts with positive thoughts, but rather balanced thoughts that take into account the postivie and negative aspects, as well as the neutral. Your critique is basically a strawman.

I appreciate your comments

About the conceptual inconsistencies and ambiguities (e.g., among the terms "negative, biased, inaccurate, irrational") I pointed out in the post, I found those in the writings by Beck and A. Ellis and others.

Hi, I have tried CBT for

Hi, I have tried CBT for about 6 months in the last year and in my experience you really nailed it with the last part of your point two and your point 3

Quote:
In many cases, clients' appraisals and reports of their negative or distressful experiences are quite rational, realistic, and accurate. For example, their experiences of sexual or physical abuse at the hands of another or the tragedies of their loved ones have left enormous scars in their life. In such circumstances, cognitive-restructuring exercises, with their emphasis on reframing reality and not on changing it, do not deal with the true problem.

Third, research has shown that positive self-evaluations may be dysfunctional and maladaptive. It is the positive, rather than the negative self-assessment that is characterized by inaccuracy and bias in the fields of health, education and the workplace.

keeping in mind the recent "straw man" argument - if bad therapists are the real problem I don't think bad therapists are that unusual. I only had one therapist, who seemed quite sharp and into her job, but she seemed to put way to much faith into the CBT system. Like a previous poster I had issues where the therapist was quick to interpet any negative toward myself as something misguided that needs fixing, and she seemed to ignore that I tend to look at things from different angles constantly. In fact I was very clear that I really think I am a decent person, just I feel awkward in social situations. for instance in a get together with family and family friends where the all the kids, well not kids we are all 25-42, all of the kids have degrees and good jobs and I have either been on welfare on doing menial labour. Is it really irrational to feel awkward there?

on a side note it now seems likely my problems finding meaningful employment may be due to undiagnosed adhad-pi I even had teachers accuse me of coming to their class "stoned out of my mind" every day when I had never been to their class stoned. And the 0% in math 10 is kind of suspect. Anyway I am seeing a psychologist tomorrow to get this checked out

I guess my point is that I am likely feeling down because of what ADD did to me, or on the other hand I may be feeling down because I an an extremely lazy underachiever and can't seem to change.

The only positive thing I can think of for CBT is that it is my fault I didn't see its shortcomings for me sooner and bring them up with my therapist. Hardly a great review

ps

same poster here again, also interesting is that I didn't really notice CBT was not doing me and good for the longest time, and I didn't notice how the therapist was grasping at straws till it was over. For instance she complained that I would follow a positive self thought with a negative one on the same topic. Is being thorough and balanced in your self examination something that requires therapeutic help?

I dont know if I didn't see this problem sooner because I was being open and modest, or if I just lacked the balls to challenge it, or maybe a combo of both

I appreciate your two comments, thank you for sharing your observations

Because I am unfamiliar with the details of your situation, I cannot make any specific suggestions. You may have read my recent related post "understanding depression from a different cognitive perspective." That post may shed light on the issues you raised.

Best, KS

A timely read for me

I just had two frustrating sessions with a PhD who uses CBT. My real therapist (psychoanalytic) suddenly became very ill with cancer and has been unavailable for a few months now. I held out as long as I could, but finally made an appt with a new therapist (they are all CBT here). After the first session I had such an intense negative transference to this new therapist I wondered what in the world was going on.

I went to a second session mainly to make sure I wasn't just being defensive, missing my therapist etc.

I went yesterday and wow, it threw me for a loop again! I have been in analysis for years with two different people and I never had such a strong negative reaction that I couldn't interpret.

So I looked up CBT and I found this statement... "CBT is a non-humanistic approach". Exactly. Basically for me that means that the comfort I should have received in sharing the possible death of someone who means so much to me (my therapist) was not there. She made sounds with her mouth "That's sad" for example. But I never, ever, got the sense that she was with me in my experience — one of the traits my current therapist excels at...holding.

Secondly, this new therapist was challenging everything I said and I didn't realize why, but it was making me angry. We are the same age and I have a world of hurt compared to her from which to assess life and its meaning and she's making statements designed to make me question my appraisal of the situation? I felt insulted not assisted.

I feel like I should give an example. I said "I feel like everybody leaves me". She said "You know, at our age it's natural that some friends and family would move away and even die." Uhm. Duh. I'm 58 years old. Do I look stupid? I'm talking about low self-esteem. This is how she handles it? By suggesting I am taking it too personally? Of course I'm taking it too personally! It's ludicrous to think that by reframing this current traumatic event that I can overcome debilitating anxiety issues stemming from childhood and neurological abnormalities.

My final thoughts? She was too perky with someone who came in facing such tremendous grief, again, having lost my mom at a young age. I was very distraught. I wanted safety, sympathy even, before I could trust her. She seemed robotic, safe behind boundaries. She laughed several times and told me three times about the book she is writing, all in the first visit when I'm pouring out my grief. The second session, she wanted me to read from the ACoA red book. She said "Read this. It's the problem and the solution." I felt like she had pulled out the Bible. I am no stranger to ACoA and the literature on codependence. She never took the time to know who she was ministering to. I felt labeled and boxed in. I left in a daze. I canceled my next session after looking up CBT.

NO "real" empathy. NO idea of who she was treating. Smug. Robotic. Simplistic. Dangerously simplistic.

I appreciate hearing about your personal experience with CBT

Unfortunately, many therapists using CBT have not recognized its limitations.

You gave a good summary of her demeanor and approach: "NO "real" empathy. NO idea of who she was treating. Smug. Robotic. Simplistic. Dangerously simplistic"

I'm really sorry to hear

I'm really sorry to hear about your experience. It is sad that CBT has been given this exalted status in our society - it is a political agenda, as usual related to the search for a quick and cheap fix for the soul. There is a broad spectrum of human experience, including loss, sadness, hurt, as well as joy and happiness. Why shouldn't we hurt when we lose someone we love? Why shouldn't the experience of tragedy and trauma move us? CBT is a dangerous epidemic for us.

Everyone in the world is

Everyone in the world is nice!!

CBT

Just as CBT hopes for us all to perceive.
How unrealistic. Certainly most people do not intentionally want to hurt another individual.
But many are too caught up in themselves to notice their harmful behaviour towards others.

The shortcomings of an unwise culture.

The current preodominance of CBT in community mental health and in private practices which bill third-party payers is evidence of an unwise society hooked on a hedonic based definition of psychological well-being. Rather, eudiamonic well-being sees positive and negative affect and thinking as part of a whole experience and process. While an over-abundance of negative experiences such as patterns of poor self-appraisals are problematic, they are not something to be re-programmed or reset as if they are the only issue of concern. Rather, they are information which informs the client and practitioner about the nature of an individual's deep pain and woundedness. Mindfulness-based therapist Tara Brach recommends that instead of eradicating pain, it is more healing to turn toward pain and allow it to inform us about what is true in the moment, what is asking for attention, and to learn to hold pain rather than resist it. The net result is to develop more than distress tolerance and short-circuiting automatic defensive responses, but to actually integrate painful experiences into new experiences as client's experiences are validated, appreciated, affirmed, and accepted. For example, negative self-talk is re-experienced as making sense given one's context, and this validation forms a basis of positive self-appraisal, ie, "I am not defective for having thought this way." If client's are taught to develop mindfulness and then loving kindness toward the unwanted aspects of experience, they begin the process of healing and integration. recent developments in interpersonal neurobiology (Daniel Siegel, Richard Davis)involving mindfulness and the possible link to social brain development is supporting this approach to therapy. In time, CBT will likely have a place in identifying distorted cognitions and to offer some reality testing and behavioral work; however, its preeminence in mainstream therapy may change. I predict that attachment based, acceptance-oriented, mindfulness, and IPNB informed therapy will increase.

Great article thanks

I am so glad that I found this article. It has been 15 hours since my second appointment with my CBT therapist. Wow, I cannot agree more with Dr. Sun's critism of the CBT, and I am also grateful for other commenters sharing their personal experiences with the CBT in the above posts.

During my first session 4 weeks ago, I was shunned by my therapist for feeling upset when a stranger knocked me over carelessly and refused to apologize. Yesterday, I was told that the reason I am feeling upset is because of my 'distorted perception'. I seriously doubt who is really guilty of 'distorted perception', me or my therapist? I guess if the best CBT can do to ease clients' pain is to tell them that it is wrong to feel pain, then it must has reduced psychology into a mere pain-killer. Worse its overly-simplistic approach can turn their clients into thinking/feeling zombies. And for the UK government to fund so much money into this highly ineffective practice, I can only feel sorry for the UK taxpayers who are being massively ripped-off. Look, I am not discounting the function of a pain-killer, it has its place, though I believe that most sufferrers sought for professional help are NOT just after a pain-killer, AND they don't want to be turned into a thinking/feeling zomby.

Often the pains that people suffer mentally in our societies are caused by things that are going wrong in the society, hence I believe instead of denying people's pain, good therapy can help sufferers to learn to deal with their pain and direct it into a more positive resolution, perhaps even social awareness of abuses that caused the mental sufferrings in the first place, that I believe is the the REAL cause of most of our sufferrings. As I read the comment above by Michael Honk, it gives me relief and hope to see some different perspectives on the the matter, which I believe is more useful for people who are serious about healing themselves. May everyone be healed and be happy. :-)

Thank you for your comments

Thank you for your comments and sharing your experience with CBT.

CBT

can you please give me some points on why CBT wont work, just intrested in CBT, im student and wanting to know some basics around it and why it wont work, much appreciated.

To answer your question, you

To answer your question, you need to give me your definition of "work." Can CBT make depressed people feel better? Yes. Is it the best model to treat depression. No.

CBT

Thank you also for these comments. I too had an unsuccessfull CBT session. I have been trying to work out why my therapist's comments did not make sense to me and what problem did I have to be misinterpreting his adamant questioning of something I found to be unambiguous? Much like OzChinese eg. it is as though nothing should be interrpreted as rude or offensive behaviour. If so it appears to my therapist that it is my fault in having this perecption. How niave and disempowering is it to be challenged in this way. Effectually being told that my perceptions are inaccurate. It's like taking part in 'thought police' exercises. Are not individual perceptions valid for themselves and should not the patient identify the best resolution to their personal problem with the therapist's encouragement, rather than being dicated to on how to think (and supposedly feel) about one's personal circumstance. My therapist and I ened up raising our voices at each other, as he kept questioning my interpertation of a conversation with a family member. I told him that his questioning "does not make sense to me", I am often able to see alternative interpretations to senarios, but not in this case. The therapist also failed to offer one. The yelling I initally thought was positive in one way, (breaking down barriers of resistance) but I have now lost confidence to return to therapy with this individual. I don't respect his position and do not believe he is flexible in offerring the assurance I require to develop my own positive thoughts by his minimal inference as I work toward developing my own personal solutions. Instead I was branded as 'victimising' myself and to have ' my own agenda', all in the third session. And I am now supposed to have the confidence and trust to confide in him next week? No thank you.

Nothing is perfect and

Nothing is perfect and nothing works for everybody. As with any therapy, if you let it, it will work. The relationship between therapist and client is key. And at the end of the day, in any therapy, the client makes the changes - the therapist facilitates it.

So if you are aginst CBT, person-centred counselling or psychoanalytical, it won't work and you'll find flaws because it's easier to blame someone else for not fixing you rather than admit your own faults.

And we are all different, with different ways of working and different ways of fixing.

CBT is definitely not perfect

It may be true that nothing is perfect, and nothing works for everyone. I did not found CBT effective, not because I am against CBT, person-centred counselling or psychoanalytical, but because the therapy and the therapist were ineffective. I found CBT lacks the theraputic empathy necessary for the healing trust to be established between the therapist and the client. Therefore I found the logic of the above comment flawed and irresponsible. Then again if it must take such twisting to defend CBT, I am less convinced of its merits in promoting psychological wellbeing.

Criticism of cognitive therapy is justified

Key Sun is right to point out these drawbacks. Another criticism of cognitive therapy, titled "Cognitive Therapy's Distorted Thinking," has just been published at www.WhyWeSuffer.com.

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Key Sun  is a psychologist and social worker. He has taught at Central Washington University and Bastyr University.

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