Cognitive therapy's emphasis on distorted thinking is itself distorted.
(image by Michaelson/bigstockphoto)

Recently I came
across a best-selling psychology textbook, and I believe the sections of it
dealing with the essentials of self-awareness are not accessing a deep enough
level of understanding.

The widely
used textbook, written by three Harvard University professors of psychology, is
titled simply Psycholog y (Worth
Publishers, New York, 2009). Students pay $152.48 for the latest edition of this textbook. They're not
getting their money's worth, and I'll tell you why.

In this
textbook, the authors express their preference for cognitive therapy. (They
subtly--and not so subtly--disparage psychodynamic therapy which is based on
depth psychology.) Cognitive therapy, they say, "focuses on helping a client
identify and correct any distorted thinking about self, others, or the world." The
key term here is "distorted thinking." Who decides what constitutes distorted
thinking? Sure, if you're thinking about murdering someone or jumping off a
cliff, that's obviously wrong-headed. But most people who go to
psychotherapists don't need someone telling them what or how to think. Rather,
they need help in discovering their inner truth and developing their authentic
self.

The best psychotherapists
don't mess with this notion of distorted thinking. We don't deal in "cognitive
restructuring," to use one of the textbook authors' favored terms. Instead, we trace
the client's difficulties back to the source, using as clues the memories and
occurrences associated with the client's anxiety, stress, painful emotions, and
self-defeating behaviors. We're guides for the exploration of their unconscious
mind. We don't tell them what to believe or what to think, although we do
introduce basic principles and knowledge for them to consider.

Let's
compare the two approaches, cognitive therapy and psychodynamic therapy, using
an example from the textbook. The cognitive approach, excerpted below (on page
551 of the first edition), is then followed by my analysis.

[From the textbook]
For example, a depressed client may believe that she is stupid and will never
pass her college courses--all on the basis of one poor grade. In this situation,
the therapist would work with the client to examine the validity of this
belief. The therapist would consider relevant evidence such as grades on
previous exams, performance on other coursework, and examples of intelligence
outside of school. It may be that the client has never failed a course before
and has achieved good grades in this particular course in the past. In this
case, the therapist would encourage the client to consider all this information
in determining whether she is truly "stupid." . . . [the therapist may] help the
client decide whether doing poorly in one course constitutes being "stupid''
and whether there is anything the client can do to better prepare for future
exams.

As I see it,
this cognitive approach does the woman a disservice. She is indeed feeling stupid,
but that painful feeling is likely a symptom of (as well as a defense against
recognition of) a deeper problem. As her therapist, I would listen to her to
get a sense of what that deeper problem might be, and I would guide her, if she
were willing to be guided, towards her own inner truth, whatever that truth
might be.

So, what
might be that truth? It's possible that she's feeling overwhelmed by college
life and the rigors of her academic program. These circumstances aren't
necessarily overwhelming in themselves, but she experiences them that way
because the challenges of college life have triggered within her an old
unresolved emotion from childhood having to do with lingering helplessness and
powerlessness. All of us are reluctant to see our lingering entanglements in
old unresolved emotions. The entanglements mean that one or more negative
emotions (refusal, helplessness, criticism, or rejection, for instance) are
still unresolved within us. As a result, we're still unconsciously inclined,
even determined or programmed, to experience the negative emotion, even though
it's painful and self-defeating to do so.

This woman
hasn't achieved inner freedom. She wants to feel strong and competent, but she
still remains an emotional prisoner of lingering helplessness. She has to
expose this emotional "default position" and understand that she has been
making an unconscious choice to continue to experience it. Such insight produces
inner freedom.     

This woman
is likely using the idea of being stupid as a defense. The unconscious defense
makes this claim: "I'm not willing to experience the challenges of college
academics through old unresolved feelings of weakness or helplessness. The
problem is I'm stupid." This is a defense called "pleading guilty to the lesser
crime." According to the irrational terms imposed by our unconscious mind, the
lesser crime is being stupid, the more serious crime is being emotionally
attached to helplessness and being unconsciously prone to replaying and
recycling that unresolved negative emotion.

This analysis
of mine might be wrong. The woman's plight could be due to something else, and
she and her psychodynamic therapist would pursue other possibilities. She could,
for instance, be entangled emotionally in being a disappointment to herself and
others. Her father might have felt this way about himself, and then projected
this negative expectation on to her. The woman consciously wants to do well,
but unconsciously she expects to be a disappointment. She could be exceedingly
smart, yet still be determined unconsciously to act out this unresolved
conflict. The defense now reads: "I don't want to be a disappointment or to be
seen in a negative light. The problem is that I'm stupid." Again, in the
unconscious mind's irrational reckoning, being stupid is the lesser crime,
being emotionally attached to the feeling of being a disappointment is the more
serious crime.

Though the
defense "works" in hiding the inner facts, she pays a painful price in feeling
herself to be stupid. That painful defense, when not exposed for what it is,
would also cause her to lose confidence and could lead to failure in her academic
program.

If either of
the above analyses were true (and other possibilities can be explored), then
obviously that self-knowledge is of much greater value to her than what the
cognitive approach offers. While the cognitive method does have value in
certain situations, its use with this woman is like talking to a university
student at a fifth-grader's level. ( Here's a report from The Journal of the American Medical Association on the superior
effectiveness of psychodynamic therapy.)

Knowing her
deeper truth, she provides vital knowledge to her conscious mind and thereby to
her intelligence. Knowing what's true, she's greatly empowered. It's not "cognitive
restructuring" that frees her from her plight. Rather, it's her intelligence,
now enhanced by vital insight, which does so. This process doesn't require
years of therapy. With skilled psychodynamic therapists, some people can begin
to assimilate the inner facts and have that knowledge begin quite quickly to
benefit them, sometimes within a month or two of beginning weekly therapy. Many
people decline to do the deeper work, yet they should at least be presented
with that option.

Cognitive
therapists claim that clinical studies have proven the benefits of their
method. (Possible flaws in the methodology of psychological studies are noted here , here , and here .) How are these benefits
ascertained? Researchers ask the clients how they're feeling and doing after
experiencing cognitive therapy. Yes, some clients do feel better and they
express satisfaction with the therapy. However, because they sincerely want to
do well, they unconsciously can renounce, on a temporary basis, some of the
lesser symptoms of their dysfunction. But their inner conflicts remain
unresolved, and different symptoms relating to those conflicts can soon emerge
in ever more painful and self-defeating ways. Moreover, these individuals are
initially grateful to their cognitive therapists and will praise their
effectiveness because, through this superficial form of therapy, they (the
clients) have avoided the often fear-inducing challenge of deeper introspection
and self-examination.

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