The most promising counseling theory

Being an LCSW of  Chinese decent, I have struggled with applicability of American social work theories in Asian cultures for over 30 years.  Below is my discovery about a most promising psychotherapy. I wrote this up as a critique submitted to a class on Biblical Counseling.

Cognitive Behavior Therapy                                  

Main selling points of CBT

1. CBT have been on of the “Evidence based Therapy” of the grant review committees.  It is seen as more measurable, therefore more justifiable to allocate precious mental health dollars.

2. It is often favored by mental health researchers because it is easier to measure for its short term nature. Its effectiveness should be visible external, and identifiable to the observer.

3. It is easily taught and manualized. 

4. CBT has another advantage over many traditional therapies in that its theoretical framework it allows for various cultures to continue its role in defining problems and shaping treatment goals rather than abstract, subjective concepts held by the clinician. It allows patients’ perceptions of themselves and others from what they have learned. For example for some people outside the Euro-American couture the concept of “unconscious”, inner drives and complexes may have no meaning at all. If it doesn’t exist then CBT does not need to invent it and imposed on clients. CBT allows people to conceptualize the desired outcome as long as it makes sense to them. Therefore it has the potential to be more applicable to more people groups.

Key points of CBT and Critique

In every psychotherapy there are inherent assumptions about

1. the nature of man,
2. what makes man happy, what is considered “sick” or “bad”, what are “problems”
3. where should the therapist lead the client to
4. The main strategies of getting there.

Strategy

The strategy of Cognitive Therapy is to correct errors and biases in information processing and at modifying the core beliefs that promote faulty conclusions. CBT believe that distress behavior is influenced by thoughts that is immediately aware and completely under controllable.  Through application of logic to dysfunctional ideas and use of behavioral testing they seek to invalidate maladaptive assumptions that lead to problem behaviors.  The focus of treatment goal is to create the “cognitive shift’” by addressing biased selection of information and distorted interpretations.

Many other psychotherapy also focus on cognition as the point of attack in the bio-psycho-social continuum. As in RET, the power for persuasion and the expertise of the therapist as a guide is key the effect change.  In a way it is similar to the “renewing of the mind” but instead of relying the Holy Spirit’s penetrating conviction and assistance in knowing the truth, it depends on the wisdom of fallible man.

CBT is supposed to be learning based. Pt is supposed to think their way out of their problems. It proposes the changes in thinking leads to changes in emotion. Changes in emotions result in changes in perspective and attitude. Attitudinal change leads to change in behavior (reactions and initiatives), which leads to more satisfaction and more effective thinking.

As an offshoot of Behavior therapy, everything is on the identifiable level, but the focus is not merely on external observable behavior or emotional level but in the “thinking/cognitive level. Like BT it is present centered and problem oriented, very detailed oriented about behavior and the situations in which behaviors occur, including consequences resulting from them.  CBT had developed extensive measurement tools for internal experiences: the thoughts, attitudes, and images.

View of man

Their assumption is that functional people always act rationally. The see people as having more control over their internal processes, in evaluating events, sensations, interpreting information, and choosing their responses. There is no “what I want to do I do not do, but what I don’t want to do I continue doing it” kind of dilemma. There is no rebuking of lies (what Satan whispers very convincingly by the ear) by claiming what the unchanging God (more believable) says.

 In rebuking accusation a believer can rely on the truth that “I an born again, thereby forgiven” but for the CBT patient even if he can to glean a kernel of truth  but soon  still drown in the  powerful torrent of blame and shame. The  approach is to override negate the powers of emotion that result in affecting out look on life by reasoning..

It makes no room for biological condition that lead to distorted reasoning.

There is no theory on power to change. The momentum of change is to come from patient agreeing with the therapist in thinking differently. They do not stress hope, or courage.

View of Health

By viewing behaviors as “mal-adaptive” it’s theory of man has evolutional connotations.

It avoids the word “irrational’ in favor of “dysfunctional”.

 It considers itself to be less philosophical than the Rational Emotive Therapy.  Whatever works is the considered good.

Without the philosophical foundation to provide guidance, Homosexuality  can be viewed as adaptive.

Hence it   holds no  notions of distress having any value. It does not allow for conviction of the Holy Spirit, because any uncomfortable feeling must be eradicated to qualify a person to be well adapted.

If man is product of evolution, then the highest goal for adaptation is survival.

Missionary will be considered highly irrational. They are nuts who take irresponsible risks.

Compulsive gambler who succeeded in evading police is functional.

There is no absolute right or wrong, no standard by which to determine desirability of any behavior.

 To summarize CBT believes man  to be in total control to his believe system, possessing all the power he needs to effect change.

Effectiveness and limitations

CBT is generally considered to be effective for mildly anxious or depressed patients. It is not effective with bi-polar patients, especially with in the manic phase. It is almost never provided alone with for patients having psychosis or Schizophrenia.  Severely depressed pts can be highly selective in picking up cues resulting in beliefs. Those who have a hard time changing their rigid thinking even after being shown its irrationality does not profit from CBT.

Patients who are too jumpy to sit around to concentrate also do not benefit from CBT unless they have been stabilized first with medication.

CBT is blind, too, about how general sense of well being, such joy, peace and love can change fundamentally the person’s temperament, risk tolerance and outlook (in processing the same information).

CBT may have limited success, like moving patients from one room to another, but not from 1^st to 2^nd floor.

CBT is an engine with no fuel. The tracks are there, the way is clear, but unless the person is loved and assured of that love the engine can slide backwards into a pit of unworthiness and hopelessness. All the gains learned from changing cognition can easily change back when a person’s cognitive powers are out matched by the stresses of next life event or the convincing whispers of Satan. Without the desire to please God as the source of motivation (the pull), the desire to get rid of problem behavior (the push) is not likely to take the counselee very far.