[This is not the post I thought I would put up this weekend. That one is pretty much in the can, and will see the light of day before long. In the meantime, here’s the thing about trying to be Spirit-led: sometimes a topic will just grab hold and insist on jumping to the head of the line.]
First question: What’s the problem with Cognitive Therapy?
(Waves hand in air: Ooo ooo ooo, I know this one.)
The problem with Cognitive Therapy is that it doesn’t go far enough.
(Right. Here’s your gold star.)
What does that have to do with “The Problem with Thinking?” Keep reading.
When I was a young social worker, trying to do a good job with just a decent liberal arts education (a very good starting place BTW ; highly recommended), a smattering of psychology, and some native intuition, I sat down after a couple of years and tried to sum up what I’d learned. The result was an essay which described a new form of therapy, which I called Empirical Therapy. I discarded the essay later, when I found out that I was late to this party. It had been done, 10-15 years earlier, and a lot better. It was called Cognitive Therapy. (I went to a Master of Social Work program at around this time because I knew I was wasting time and effort every day, re-inventing the wheel. Boy, was I.) I encountered Cognitive Therapy in a counseling class, and recognized it for the mature expression of what I’d been groping for on my own. Aaron Beck had done stellar work in this area. So had Albert Ellis, who called his version Rational Emotive Therapy.
In 1994 I was introduced to Dr. David Burns’ work in this field, called Cognitive Behavioral Therapy (CBT). It was like putting on a tailored suit. I’ve been fortunate to have attended a 2-day seminar with Dr. Burns. I’ve been even more fortunate to have seen the results. I literally use CBT every day, in every professional interaction, in some way or another. It’s that good.
In 2006, I was lucky enough to be included in a pilot program run by the North Carolina Child Treatment Program, a joint venture of Duke University and UNC-Chapel Hill. 60 therapists in eastern NC were taught Trauma-Focused Cognitive Behavioral Therapy. This was a fantastic educational experience, led by a group of talented young clinicians. Representing pediatrics, psychology, and social work, most were young enough to be my children. I got over that pretty quickly, when I saw how much they had to offer. The thrust of the pilot program was this: TFCBT had proven its worth over years of research. Could it be taken off campus, and taught on a wide scale to active clinicians actually out in the trenches? Yes, it could. Working with survivors of sexual assault has been a specialty of mine ever since sort of accidentally getting involved with a case in 1980. With TFCBT, I’ve seen the time it takes for good treatment reduced from a year or so to around 4 months, with very good results. Once more, CBT has proven its worth, not just in its effectiveness but in its flexibility as well.
I’ve said for years that CBT is the most important development in psychotherapy in the last 50 years. I stand by that today. I’m not as disdainful of other forms of therapy as some CBT practitioners are. Psychodynamic psychotherapy is a powerful tool in the hands of a well-trained clinician. It’s a lot harder to produce well-trained clinicians in that mode, though. Good old B.F. Skinner-style behaviorism is being used with good results too. Ericksonian hypnosis and its many offspring are superb, the psychotherapeutic equivalent of laser and arthroscopic surgery. And nothing has ever superseded Carl Rogers’ insights into the nature and importance of the relationship between therapist and patient.
I dearly love a good dream analysis, and watching the ensuing changes in mood, thought and behavior as they unfold.
But if for some dire reason we were forced to select only one mode, I would have to pick CBT. You can teach more providers to be more effective with this one system than any other I have used. And, once patients have learned how to use CBT, they can use it themselves, for the rest of their lives, without a therapist. Slam dunk.
At the risk of over-simplification, here’s how it works: If you have negative thoughts, you will have negative feelings. Negative thoughts can be easily changed, with new information that either changes the thought itself, or calls the negativity into question. So if I think you are angry with me, and this makes me anxious, this can change either by finding out that you aren’t angry — new information — or learning that I can be calm even if you are angry at me — calling the negativity into question.
What, then, is the problem with CBT?
It doesn’t go far enough.
Why doesn’t it go far enough? Take, for instance, the problem of information. Computer folks have known from the dawn of time (computer time) that old saying, Garbage In, Garbage Out. CBT is like a computer program, software for the mind. The best program in the world cannot overcome bad data that is fed into it. As a grad student, I was introduced to a statistics program called SAS. SAS was marvelous. You could use it to slice and dice your data any way you chose. You could run all kinds of analyses, and turn out all kinds of charts and graphs. Here’s the thing: if your data collection was bad, SAS couldn’t point it out. It would give you wonderful stats and graphs that meant nothing, or were actually misleading.
Same with the mind. The information I have, from so many sources, affects my mood, outlook, ideas, opinions, etc. How can two people — patient and therapist — be certain that they are using the best information? They can’t. Neither can see past the blind spots they share. If I really think that women should never wear pants, and I am counseling a woman who is struggling with restrictions placed on her by a church that only allows dresses for women, where is the new information that she needs going to come from? Worse yet, if I only ever really talk to people who agree with me, will my basic fallacies ever be challenged?
Also, neither of us knows that there is needed information that we don’t know. It seems this goes without saying — you don’t know what you don’t know, duh — and yet it is seldom taken into account. As Thomas Kuhn pointed out in his landmark work “The Structure of Scientific Revolutions”, science advances when it becomes apparent that what we think we know is wrong. Scientific advance is held back by people who are certain that they know what isn’t so.
I see this all the time. It is a major factor in our public life. Liberals who only talk to liberals. Conservatives who only talk to conservatives. Religious people who only talk to other religious people, and atheists who only talk to other atheists. People who get angry and bitter when confronted with different beliefs than their own. People only read books and magazines, or watch TV shows, that support their own favored views. Things seem evidently correct, because “everyone agrees.” It reminds me of the Chicago socialite who couldn’t believe Eisenhower beat Stevenson, because “no one voted for Eisenhower.” No one she knew, that is.
Try it yourself. Take any random politically oriented post on Facebook. Say something that disagrees with it. Watch the fireworks.
Many people who are the most convinced that they have an open mind, have very closed minds. As A.A. Milne put it, “The third-rate mind is only happy when it is thinking with the majority. The second-rate mind is only happy when it is thinking with the minority. The first-rate mind is only happy when it is thinking.” There are so few first-rate minds. The other two are not really thinking at all. They are massaging their biases.
Which brings us to the second way in which CBT does not go far enough. The first is that it can’t guarantee that you will get better information than you have. The second is that it doesn’t really teach how to think. It does a very good job of pointing out some of the most common fallacies — perfectionism, taking things personally, etc. — but learning what constitutes the wrong way to think does not equal learning how to think.
For that matter, there are many ways to think poorly that are not covered in CBT. For these, you might need to take a basic course in logic. There, you would find out about the ad hominem fallacy, circular reasoning, “post hoc ergo propter hoc,” the straw man, and others.
It’s not a matter of intelligence. Not entirely. I know some people of average intelligence who are better thinkers than those of vastly greater intelligence. They are, however, limited in what they can think about; the ability to reason abstractly does not show up until somewhere around an IQ of 120. But having a big brain is no guarantee of being a good thinker; some of the poorest thinkers I know have very high IQs. They’ve learned how to use it in some ways, but not in this important way.
What does it take to be a good thinker?
1. High quality information, from a variety of sources. For instance, when a major world political crisis takes place — say, the fall of the Berlin Wall — don’t just watch your favorite news programs. Get a shortwave radio and tune in to news shows from around the world, such as Deutsche Welle, the BBC, Radio Canada International, Voice of Japan, Voice of China, and one of my favorites, Radio Prague. Shortwave radio listening is fun, too — check out all that different music. (If for some silly reason you don’t want to fool with a radio, many stations also livestream over the Internet. But this is cheating.) If you like Fox News, listen to NPR. If you hate Fox news, find one of the more reasonable conservative bloggers such as Victor Davis Hansen. Do whatever it takes to stay out of the “echo chamber.”
2. Be aware of the signal-to-noise ratio. Signal is useful information. Everything else is noise. Most of what you get in daily conversation and via the mainstream media is noise. With just enough signal to make it seem worthwhile. This is a tough one! Recognizing good information from bad takes work.
3. Learn about the obstacles to clear thinking. CBT is very good at identifying the most common cognitive distortions — ways we let our emotions affect our thinking. And there are many websites, such as the Wikepedia article on logical fallacies, that describe ways in which we fail to keep our thinking straight in a more formal sense. Learn them. Learn to spot them when other people are under their sway. Your favorite commentator might look very different.
4. Learn to trust the limits of knowledge. Get comfortable with the idea that no one knows all there is to know about anything. We have to make decisions, even though there is never sufficient high-quality data for complete assurance. That person you dislike so much just might know something you don’t — and it’s just as likely you know something he doesn’t. Live and let live.
5. In a special application of #4, but worthy of a spot all its own because it is so dang important, learn to accept the legitimate difference of opinion. Everyone who disagrees with you is not a fascist, or a communist, or whatever your bete noir may be. I’ve written a whole essay on this and posted it on this blog. It is the least-read of any essay I’ve posted. Many, many people just don’t really want to know how to think.
6. Practice, practice, practice. If you want to learn how to think, you have to read the works of great thinkers. Not novelists (although some of them were great thinkers), not poets, not biographers, not cookbooks. You can’t become a great musician without listening to great music, and practicing your scales over and over and over. You can’t become a good thinker without the company of other good thinkers.
7. Honesty. You have to be able to take an honest account of who you are, what you do, which distortions you allow into your thinking, what poisons do you allow into your data stream, and so forth.
As always, I know I will get comments that will add a lot to this. Good data stream!