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How should Christians think about CBT?
by Rev. Glen Scrivener

More on Christian Pastoral Care here

 

Cognitive Behavioural Therapy (CBT) is a

  • short-term,
  • practical,
  • client-based,
  • collaborative,
  • problem-solving,
  • life-skill learning

‘talking therapy’ which has had excellent and well documented success in alleviating certain emotional problems.[1]  These problems include depression, obsessive-compulsive disorders, anxiety disorders, panic attacks, phobias, post-traumatic stress disorders, eating disorders and, in the last 10 years the therapy has even been used on the hallucinations and delusions of schizophrenia sufferers.[2]  In general however the therapy works best on less severe emotional problems where the client desires relief, is relatively self-aware but is still not able to ‘cure’ themselves.[3]

 

The theory and practice of CBT can perhaps best be seen if we trace the history of its development.  We can discern three strands of thought feeding into what we now call CBT.  All three grew out of a dissatisfaction with traditional psychoanalytic therapies which located the problems in past traumas, family relations and an intangible, inaccessible sub-conscious.  First came the behaviourists.[4]  Their rejection of consciousness turned their attention to conditioning, education, the external environment.  B.F. Skinner, perhaps its most famous proponent, said:

 

“The picture which emerges from a scientific analysis is not of a body with a person inside, but of a body which is a person in the sense that it displays a complex repertoire of behaviour.”[5]

 

Since a person is, at every level, conceived of as a machine (though a very complex one),[6] personal problems are therefore problems of behaviour.[7]  The person, who is a function of his make up and environment, needs to behave in a manner better suited to smooth functioning.  In this system, the environment is the only variable we can alter and so conditioning through negative reinforcement of bad behaviour (‘stick’) and positive reinforcement of good behaviour (‘carrot’) is the path to personal change.

 

Such stark materialism cannot be accepted by the Christian counsellor either at the philosophical or practical level.[8]  However its methods proved very successful with problems such as bed-wetting and stuttering.  The behaviourists had demostrated that ‘the journey within’ is not always the route to change.  Thus the Christian can learn that, though we are more than bodily, it is not more spiritual to ignore the material, the environmental, the somatic, in the treatment of the person. 

 

The second strand contributing to modern day CBT came from another atheist, Albert Ellis, who developed Rational Emotive Therapy (RET) in the 1970s.  Again he did so as a reaction to the psychoanoalytic tradition in which he had been trained.  He came to see that most of the emotional problems that presented to him in counselling were not a function of either material cause and effect (as with behaviourism) or a sub-conscious, sub-rational struggle (e.g. between the id and the super-ego, as in Freud.).  Instead, emotional problems were the rational (or, more usually, irrational) reactions a person made to their situation.

 

A client may speak as though a situation (say, the break down of their marriage) caused their depression.  Antecedent event ‘A’ (the marriage break down) seems like it automatically produces Consequent emotional state ‘C’ (the depression).  Yet, in counselling, Ellis usually found that behind emotion ‘C’ is Belief ‘B’ (‘I must be a good spouse or I’m worthless’).  This belief assesses the event ‘A’ and assigns to it a significance which ‘A’ does not have in itself (marriage break down does not make me worthless, my belief is what assigns that meaning).  Thus the significance which has been assigned by belief ‘B’ is what causes the depressed emotion ‘C’.

 

            Antecedent => Belief  => Consequent emotion

 

The process of change becomes clear.  Once it has occurred, I cannot alter ‘A’ and emotions (C) are notoriously difficult to control, thus ‘B’ must be altered.  If ‘B’ does not produce an emotional state in which I can function properly, ‘B’ must be mal-adaptive.  The counsellor therefore seeks to un-earth, counter and replace faulty belief ‘B’, citing its empirical and pragmatic limitations (i.e. ‘it doesn’t fit the facts, and it doesn’t make you happy.’)[9]  Just as the behaviourist had sought to alter behavioural habits, the RET therapist views “human beliefs as mental habits that can be influenced in the same way.”[10]  The carrots and sticks of behaviourism are then used to condition our cognitive habits rather than physical.

 

Ellis listed many maladaptive beliefs a person could hold which would prove counter-productive in the world as we find it.[11]  Self-deification was one – the notion that I always ought to be held in high regard by others and that life always ought to go well for me.[12]  Yet Ellis warns us away from such a view, not so much because of its falsehood but because it will cause emotional problems in the world in which we live.  As to other maladaptive beliefs he writes in “The Case Against Religion” that “the concept of sin causes virtually all psychopathology.”[13] and that self-interest and self-direction are emotionally healthy, inferring from this that no Christian could be.[14]  All this warns us that the standards for rationality will be crucial in any cognition-based therapy. 

 

We now turn to the third strand contributing to CBT.  Aaron Beck was developing his Cognitive Therapy (CT) at about the same time as Ellis[15] and along similar lines.[16]  He again challenged the older psychoanalytic theories which held that negative thoughts and emotions “were symptomatic of other problems (low self-esteem, projection of un-acceptable impulses). [Such older theories saw] no benefit in directly changing the thoughts.  In Beck’s mind [however], the distorted thinking is not the symptom of the problem; it is the cause of the problem.”[17]

 

This seems to be Ellis’s insight repeated.  Yet we can discern three ways in which Beck and the CT school bring improvements to the actual process of change through cognitive restructuring:

 

Firstly, Beck identifies the specific cognitive content involved in emotional disorders:[18]

 

Cognitive Content,  which leads to…

Emotional Disorder

Devaluation/loss

Depression

Danger/threat

Anxiety

Situationally-specific dangers

Phobias

Unjustified intrustion

Paranoia

Transgression

Anger

 

Second, Beck and the CT fraternity have developed tailored techniques for uncovering both the negative automatic thoughts (NATs) and the underlying assumptions and core beliefs (or schemas).[19]  We will discuss these techniques below.

 

Thirdly, Beck puts a high degree of value on the client’s own abilities to uncover and diagnose faulty cognitions.  There is therefore an emphasis on homework outside counselling and, within it, what Beck calls ‘collaborative empiricism’. This refers to the joint efforts of counsellor and client in gathering information and looking for patterns.

 

Between these three strands – behaviourist, RET and CT – CBT has grown up as a practical method of handling emotional problems. 

 

It may be asked where behaviour fits back into this process.  It certainly does not occupy the prime place that it did for Skinner et al.  With Ellis and Beck we have a new confidence that factors within can be altered, not only the environment without. Yet behaviour remains important since the notion that ‘you feel the way you think’[20] is readily extended to the truth that you act the way you feel.  In general there will be a flow of causality from thoughts to feelings to behaviour.  Yet it also cannot be denied that causation often flows back in the other direction (think, for instance, of the emotional effects of alcoholism or self-starvation).  Thus behaviour has a deserved place in cognitive therapy (the B belongs to CBT).  This importance comes in two ways, firstly as new beliefs are acted upon in the counsellees environment (this itself will be a part of reinforcing the new beliefs).  Secondly, behavioural change is required to break out of Schema Maintenance,[21] Schema Avoidance[22] and Schema Compensation[23] where certain behavioural patterns are bound up with faulty cognitions. The same techniques applied to bad thought habits are applied to bad behavioural habits. In this way the counsellee is freed not only from the underlying beliefs that have dominated but also the behaviours which both flow from and re-inforce such beliefs. 

 

Thus CBT represents a small number of different counselling schools which understand the process of change to involve the re-habituation of thoughts and (secondarily) behaviours.  The underlying assumption is that faulty emotions and behaviours flow from faulty thinking.  It could be crudely diagrammed as follows:

 

 

Thoughts =>  Feelings => Behaviours[24]

 

 

These thoughts are themselves the result of faulty beliefs which underlie them and need to be confronted and changed. Sanders and Wills picture it as three concentric circles: Core Beliefs are at the centre, Underlying Assumptions are the middle layer and the outer layer represents Automatic Thoughts.[25]

 

The process of change for CBT happens in stages: (1) the rationale for therapy is explained, (2) precipitating events are discerned (3) automatic thoughts are examined then (4) underlying assumptions and beliefs (schemas) are uncovered, (5) challenged, (6) replaced and (7) the new beliefs maintained.

 

We will now assess what we see as the benefits of CBT before discussing some draw-backs which a Christian practitioner would have to bear in mind.

 

 

Benefits of CBT

 

1)            Beliefs are foundational

 

Our problems (those not a result of being victims of the curse) do indeed flow out of wrong beliefs. Romans 14:23 states “whatever does not proceed from faith is sin.”  Jesus defines sin as the fact that “men do not believe in me” (John 16:9).  Wrong beliefs are foundational, not only to wrong behaviour, but, more basically, wrong being.  To believe rightly is the fundamental issue of life. 

 

 

2)            Our emotional state is clearly affected by our thinking

 

Paul learns the secret of contentment in all circumstances.  (Phil 4:11)  He clearly frames his experience of life according to certain truths that give him comfort no matter the environment. 

 

Martin Luther has said:

 

“For the Holy Spirit knows that a thing has only such meaning and value for a man as he assigns to it in his thoughts.”[26]

 

Luther is often quoted as support for Christian CBT.  See here for many examples of preaching to yourself from his Galatians commentary.  See also Martin Lloyd Jones in his classic Spiritual Depression.

 

“…the ultimate cause of all spiritual depression is unbelief… What about treatment? … the first thing we have to learn is what the Psalmist learned [from Psalm 42-43] – we must learn to take ourselves in hand… we must talk to ourselves instead of allowing ‘ourselves’ to talk to us!… I suggest that the main trouble in this whole matter of spiritual depression in a sense is this, that we allow our self to talk to us instead of talking to our self… This is the very essence of wisdom in this matter.  Have you realized that most of your unhappiness in life is due to the fact that you are listening to yourself instead of talking to yourself?  … The main art in this matter of spiritual living is to know how to handle yourself.  You have to take yourself in hand, you have to address yourself, preach to yourself, question yourself.  You must say to your soul ‘Why art thou cast down’ – what business have you to be disquieted?  You must turn on yourself, upbraid yourself, condemn yourself, exhort yourself, and say to yourself, ‘Hope thou in God’ instead of muttering in this depressed and unhappy way.  And then you must go on to remind yourself of God, Who God is, and what God is and what God has done and what God has pledged Himself to do.” Martin Lloyd Jones, Spiritual Depression, Pickering & Ingliss, 1965, p20-21

 

It seems a Christian thing to reframe our thoughts on better grounded beliefs and in this way to address our feelings.

 

 

3)            Right behaviour must come from a right heart

 

A behaviourist model goes with Aristotle’s ethics rather than Christ’s. Aristotle believed act leads to being (I play the violin to become a violinist).  Jesus said the opposite, “A good tree produces good fruit.” (Matt 7:17).  This is to say: being leads to act (the one who is a violinist will play the violin).  This is crucial for understanding grace – the indicatives precede the imperatives.  Without such an understanding, a legalistic, earning, works mentality will pervade our pastoral care and the grace of Christ will be lost.

 

CBT fits well with this model of being-then-act.  The Christian counsellor can be true to the techniques of CBT when he/she says ‘understand the truth of who you are, conform your thinking to that reality and then act out of that centre.’

 

 

4)            CBT’s order of: beliefs => thinking => emotional state => action can be seen throughout the Scriptures.

 

Think of how Moses or Paul tried to encourage generosity.  (Ex 25:2; 35:4-29; Deut 15:7-11; 2 Cor 8-9).  Only those whose hearts had been changed by the Lord’s prior goodness were to give.  For those who were moved to give it is not difficult to recontruct the stages of their discipleship along the lines of: belief; changed thinking; a resultant (grateful, cheerful, generous) emotional state; followed by the behavioural change.

 

 

5)            Scripture exhorts us to challenge our thinking.

 

Deut 9:4-6: “Do not say in your heart… Know therefore… Remember and do not forget.”

 

Psalm 42:5,11; 43:5:  Why are you cast down, O my soul, and why are you in turmoil within me? Hope in God

 

Romans 12:2: Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.[27]

 

 

6)            Our discipleship should be marked by  such reformation of our minds

 

The New Testament word for repentance, ‘meta,noia’, is literally a word for changing of mind.  The word for discipleship ‘maqhth,j’ has clear cognitive overtones (it is the word from which we get mathematics).  Our repentance and discipleship is a matter of continual cognitive challenge and conformity to God’s word.

 

 

7)            We ought to be challenged to live consistently with our beliefs.

 

CBT works by drawing links between what we think, what we feel and what we do.  Any Christian will want to monitor their integrity in this. 

 

 

8)            The gospel of grace speaks into the very heart of our core beliefs.

 

McMinn notes this as a major reason why Christians ought to embrace much of CBT.[28] God’s unconditional love and acceptance in Christ addresses our deepest needs for security, worth, acceptance and love which CBT uncovers but cannot finally deal with.  

 

 

9)            There is a clear place for the use of Scripture

 

Since the heart of the therapy is challenging beliefs, the Bible can be used by the Christian CBT practitioner as an integral tool.[29]  In fact one could argue that Christian CBT can function more truly as CBT since the Bible provides an authoritative standard far superior to the empirical or pragmatic standards used in secular treatment.

 

 

10)         Feelings are given relative but (hopefully) not absolute importance.

 

Emotions are neither all powerful nor insignificant in CBT.  They are neither beyond all question nor beyond all control.  Instead feelings are acknowledged as reactions.  Christians can agree to this.  There is a story concerning Robert Murray McCheyne in which he counselled a woman who said she needed more joy.  McCheyne replied that she did not need more joy, she needed more Christ.  Joy will follow from the appreciation of Christ.  In this way feelings are addressed (and addressed in the strongest possible way) yet priority is given to gospel truth over subjective experience.

 

 

11)         CBT’s pragmatism makes it less wedded to anti-Christian world-views

 

Since it is not so interested in the deepest ‘why’s of emotional distress but rather the ‘how’ of recovery, there is far less humanistic baggage attached to CBT. (Of course the pragmatism itself expresses an anthropology etc which needs to be thought through).  It is much easier therefore to integrate CBT techniques into Christian counselling than, say, Rogerian or Gestalt therapies!

 

 

12)         The counsellor-client collaboration is healthy

 

This is especially important if a Christian sees a non-Christian CBT practitioner.  Unlike some other psychotherapies, the client is not submitting themselves wholesale to the counsellor’s world-view. Yet also in Christian settings a more collaborative style suits the mutuality of Christian life together and models that every Christian is ‘competent to instruct one another.’ (Rom 15:14). 

 

 

13)         The tools used to uncover faulty thought patterns and beliefs are excellent

 

This is perhaps the chief contribution which CBT makes to Christians offering pastoral care.  We have always known that beliefs and thought-patterns are life-altering, but three or four decades of clinical practice at ‘digging down’ into the beliefs of counsellees has produced very useful tools which can also be used by the Christian. 

 

            Identifying Negative Automatic Thoughts (NATs)[30]

 

·         Ask directly – What are you telling yourself when you feel X…

·         Guided discovery (ask around the issues, get them to unearth)

·         Note emotional change as they speak – these are ‘hot cognitions’

·         Worst consequence scenarios – What would be so bad if…?

·         Imagery (some NATs are images) – Do you have a picture of yourself or of your environment when this is happening?

·         Exposure exercises – go to uncomfortable situations either physically or in your mind. How are you now thinking?

·         Offer multiple suggestions of what the NATs may be

·         Offer suggestions opposite to client’s expected response. They will usually say ‘No, no, I’m telling myself X’

Question the assumptions underlying the NATs:[31]

·         What would be so terrible about X?

·         What would it be like for you not to do or feel X?

·         What does it say about you that you have done or felt X?

·         Are there verdicts being passed on you from God, the world and yourself associated with X?  What are they? Could you put them in words?

·         On what basis are these verdicts being passed?

·         On what basis are you believing them?

At this stage, CBT identifies the faultiness of such thinking as certain cognitive errors:[32]

·         Arbitrary inference: e.g. ‘I was much happier when I happened to be X, therefore I must regain X’

·         Selective abstraction: e.g. ‘X (and nothing else) is what makes me special.’

·         Over-generalisation: e.g. ‘Everyone who has X is happier and more successful.’

·         Magnification (of the bad) and minimisation (of the good): e.g. ‘I may have Y and Z, but that’s nothing.  X is everything.’

·         Personalisation: e.g. ‘My performance of X wasn’t bad, I was bad. Everyone must hate me.

·         Absolutist, dichotomous thinking: e.g. ‘It’s black and white, all or nothing.  Either I’m X or I’m nothing.’

  • Mind reading: e.g. ‘I know what they’re all thinking…’
  • Crystal ball: e.g. ‘I know what’s going to happen now…’
  • Catastrophizing: e.g. ‘It’s all over now. X is out of the bag, all hell will break loose.’
  • Emotional reasoning: e.g. ‘I feel X so strongly, therefore it must be a fact.’
  • Self-labelling / blame: e.g. ‘X makes me an idiot!’ ‘X makes me ugly!’

 

 

Beneath these faulty cognitions are the schemas or core beliefs that feed such thinking. CBT also offers helpful techniques in bringing these to the surface.

 

To identify core beliefs, look for…[33]

·         ‘If…, then…’ statements: ‘If I’m X, then I’m a failure.’

·         ‘Shoulds’ and ‘Musts’

·         Themes in the NATs

·         Family sayings, mottoes, memories

The CBT practitioner should then get the counsellee to put this core belief into words.  Make them identify it as a rule: e.g. “I need everyone in my environment to be ok with me or else I will be destroyed.”  Simply the process of articulating this rule – exposing it as the dominating force in a person’s every decision, act and feeling – is incredibly powerful.  In Christian contexts it should lead to heart-felt and deep confession. 

 

Yet it is precisely at this point that the Christian must part company with the non-Christian CBT counsellor.  For at this point the non-Christian CBT counsellor is committed to changing beliefs for the purpose of alleviating emotional distress.  The false belief is jettisoned largely because it is maladaptive for the person’s current environment. It would feel better for the counsellee to do away with it.  The Christian confronts this idolatrous commitment and sorrows over the unbelief.  A good outcome for the Christian undergoing CBT may well not be the glad heart but rather the broken and contrite heart. The Christian’s priority is not, primarily, the alleviation of distress, but the uncovering of unbelief of which the distress is a symptom. 

 

This moves us onto…

 

Draw-backs of CBT in a Christian context

1)            What is the motivation for change?

 

If the motivation for change is the relief of emotional discomfort or the cessation of behavioural compulsions, the entire process is set on a decidedly selfish footing.  So many of our core beliefs are self-centred strategies for minimizing the pain of vulnerable engagement with God and His people.  The question must be asked, ‘Will CBT simply substitute one selfish strategy for a smoother running selfish strategy?’ 

 

This is an issue in any counselling situation yet one that is a particular temptation with CBT’s problem-solving focus.  Christian counsellors must repent of seeking such small goals with their counsellees as ‘a smoother running emotional and behavioural life.’  Our goals must be to create a deeper thirst for Jesus Christ, a deeper confession of sin and weakness, a firmer trust in His blood and grace, a closer walk with Him day by day.  To focus on short-term, practical relief from certain behaviours and feelings could simply produce a white-washed tomb. 

 

The pastor using CBT must ask, Is the goal of therapy relief from certain feelings and compulsions or is the goal a deeper repentance of idols, a firmer trust in the true and living God, a heightened longing for Christ’s return and a greater freedom for service.[34]  CBT by itself is inherently selfish and pragmatic. CBT will not push Christian counselling in the direction of other-centred submission to God and His people. The pastor will need to be very clear that this is the priority.

 

 

2)            What are the grounds used for assessing beliefs as rational/irrational, valid/invalid?

 

The rationality of a person’s thinking is generally judged on empirical and pragmatic grounds.[35]  That is to say ‘Does it fit the facts?’ and ‘Does it work?’  On the first we must ask, What counts as ‘the facts’, and how is a person to weigh the relative importance of differing standards?  (More on this below).  As to the second, the Christian simply must not decide his/her beliefs according to ‘what works for them’.

 

 

3)            If empirical testing is used, how do the ‘facts’ of the Bible inter-relate with the ‘facts’ of experience (even if scientifically derived).

 

It might be that the process of empirical testing (using the judgements of the world) work against the belief-level repentance required by the word of God.

 

Imagine a person who presents with a performance anxiety and whose NATs are along the line of ‘Everyone at work thinks I’m incompetent.’  A CBT counsellor may prescribe a long list of homework exercises examining the counsellee’s past performance appraisals and interviewing co-workers about their abilities.  However it is quite conceivable that the counsellee’s problem is itself this obsession with the approval of others and the homework simply feeds this obsession.  In the end, the CBT counsellor might well diagnose this underlying obsession as the problem. Yet the route towards diagnosis has largely modelled a dependence on the opinion of others.  The testing process could well foster an initial sense of walking by sight and fearing men, before (under Christian direction) it eventually resolves into walking by faith and fearing only the Lord.

 

The counsellor will have to use judgement as to when the testing may exacerbate the problem. 

 

 

4)            In Christian CBT the Bible can be used out of context and against its intention.

 

The clear place for an empirical standard against which to judge faulty cognition gives the Bible a prominent place in Christian CBT.  However, if this is the only way the Bible is used (to ‘bash’ faulty thinking and behaviour) its intention as testimony to Christ is twisted into a simple behavioural manual.[36]  The Bible ought to have a prominent place in heralding the new identity of the Christian who is clothed in Christ.  It is this prior indicative, known only by faith and not by sight, which the word proclaims and which ought to shape our core beliefs.  The Christian CBT practitioner must therefore ensure that the bible is not simply employed as law but, far more, as gospel.

 

 

5)            On what grounds can the counsellor or client determine that a particular emotion must be relieved (thus necessitating a belief-change)? 

 

Could there not  be a case when an unpleasant emotion ought to be endured precisely because it is produced by a true and unalterable belief?  Does CBT provide reliable guidance on when emotions are truly problematic.

 

One wonders what a CBT counsellor would have made of Luther’s Anfechtung (deep sense of sin).  Stanton and Jones wonder if the question would come: “What evidence is there that God exists or that he cares for your behaviour?”  “The goal would be to eradicate the thought because it bothers the client.”[37]

 

CBT itself cannot tell you what levels of emotional distress are right and healthy.  Again, the Christian sitting under the word must use judgement.

 

 

 

6)            It is not wise and persuasive words that are required but a demonstration of the Spirit’s power.[38]

 

At the core of CBT is the challenging of irrational beliefs with logical standards.  However the deceitful and unfathomable heart[39] will take more than good reasoning to shake it from its madness.  The truth of God’s gospel must be driven home to the counsellee with living power by the Spirit.  Faith does not come by reasoning but by hearing and hearing through the word of Christ.[40]  Therefore there ought to be a healthy dose of proclamation to pastoral counselling, a worshipping community to surround it and the regular table fellowship of the Lord’s Supper. All the means of grace ought to be employed by the Christian counsellor.  This goes far beyond pointing out faulty cognitions!

 

It is not our intellects that need changing but our hearts.  The heart is the centre of a person according to Jesus and the source of our thoughts and actions.[41] Our true hope is in the change of hearts.  This means:

a)                  we will not look for non-rational means (the heart is not an anti-intellectual concept in the Bible)

b)                  we will employ emotional, artistic, sensory means also

c)                   true change is ultimately the work of God.[42]

 

 

7)            Mental rehabituation can be every bit as legalistic as behavioural rehabituation

 

An internal rather than external focus does not equate to a grace-based rather than works-based focus.  That is to say, CBT does not save itself from the works charge of behaviourism simply because it focusses on mental rather than behavioural habits. It is entirely possible to perform behaviours which are faith-based and equally possible to change mental habits on a works basis.[43]  A counsellee’s desire for a righteousness of their own could well drive their mental re-habituation (especially if they know that their pastor will hear all about their mental habits the following week).

 

Again it must be clear that being leads to act.  The Christian does not ‘change the tape’ in order to think their way to a new mind-set.  The Christian is new and now thinks out of their new centre in Jesus. 

 

It is significant that Paul’s two great mind renewal verses (Rom 12:2 and Eph 4:23) both have ‘renewal’ in the passive.  We cannot think our way to renewal but are renewed as our minds are acted on by a truth beyond us.  For this reason, the words we say to ourselves may be important, but the words said to us are crucial.  That is our next point…

 

 

8)            Truth spoken to ourselves is important, but truth spoken from beyond ourselves is even more vital.

 

The alien word of an alien righteousness comes best from another.  As important as it is to ‘change the tape’ on your automatic thoughts and ensure your self-talk is godly and true, God has ordained that our beliefs are shaped from outside ourselves.  Faith comes by hearing and God gives us communities and preachers within them to proclaim a truth from beyond.  It is often said that the gospel is not in us – it is above and beyond us in Christ.  Putting ourselves in the way of gospel preaching and speaking the word to one another in community ought to be our primary means of ‘changing the tape.’

 

 

 

 

9)            CBT is in danger of defining the problem so that the solution is within my grasp

 

This is not simply a problem for CBT but for all reactive counselling.  However CBT is more problem-solving focussed than most and so seems to promise easier answers than most. 

 

Whenever the problem is defined as less than the curse of all creation, my desperately fallen flesh, the power and policy of hell and my wrath-deserving sin, then the solution will be something less than Christ – His life, death, resurrection and return.  Instead the solution will be thought of as some power of change within me and the gospel of redemption will be turned into a religion of repentance. 

 

The Christian using CBT ought to linger long at the diagnosis stage.  We must face the awfulness of our wretched core beliefs and wonder at our own faithlessness and idolatry.  As we seek to challenge and replace these ‘schemas’ we must realize that such repentance does not atone for them – only the blood of God is sufficient for our wicked unbelief.  We rejoice at the change that God may choose to grant as we examine our thinking, feeling and acting, but we continually confess that it is entirely beyond us.  If CBT simply revealed our inability to change it would have served a wonderful gospel purpose.  Yet the Christian counsellor must watch that the solution-oriented drive of CBT does not then proclaim a hope outside of Christ.[44]

 

 

Conclusion

 

With the 9 caveats expressed above, the Christian pastor can use CBT techniques to great effect in pastoral ministry.  In 1-1 contexts presenting issues can be used as a starting point for discussing deeper issues of the heart.  Through these lines of questioning, idolatrous commitments are uncovered and seen more clearly.  As Proverbs 20:5 says, “The purpose in a man’s heart is like deep water, but a man of understanding will draw it out.”  CBT techniques can assist in this ‘drawing out’ process. 

 

In the wider context of the congregation, the questions generated by the CBT fraternity can be used by all who are seeking to ‘confess [their] sins to one another’[45] and to ‘speak the truth in love.’[46]  In going beneath surface issues, these techniques allow a deeper sharing of life and a more profound revelation of the depths of our sin and thus the depths of Christ’s covering.

 

CBT should never be seen as the solution but as one tool which, when guided by Scripture, can help diagnose the problem.  The success of CBT ought not to send us back to the secular therapist but back to our Bibles where we will see again the tremendous importance of our beliefs and thinking. Cognitive restructuring was first God’s idea and while non-Christian practitioners may have refined some few techniques in the area, they must be deployed in the context in which God intends such mind renewal.  That context is in the prior indicatives of the gospel, in the community of believers, alongside the preaching of the word, in dependence on the Spirit’s power, in recognition of our own impotence and in waiting for Christ’s return which is the only true salvation from our fallen state.

 

 


BIBLIOGRAPHY

 

Martin Lloyd Jones, Spiritual Depression, Pickering & Ingliss, 1965

 

Richard Gross, Psychology: the Science of Mind and Behaviour, Third Edition, Hodder & Stoughton, 1996

 

Stanton L. Jones & Richard E. Butman, Modern Psychotherapies: A Comprehensive Christian Appraisal, IVP, 1991

 

Mark McMinn, Cognitive Therapy Techniques in Christian Counseling, Word Publishing, 1991

 

Roger Hurding, Roots and Shoots: A Guide to Counselling and Psychotherapy, Hodder & Stoughton, 1986

 

Roger Hurding, The Bible and Counselling, Hodder & Stoughton, 1992

 

Neil T. Anderson, Terry E. Zuehlke, Julianne Zuelke, Christ Centred Therapy, Zondervan Publishing House, 2000

 

Michael Neenan & Windy Dryden, Cognitive Therapy: 100 Key Points & Techniques, Brunner-Routledge, 2004

 

Michael Neenan & Windy Dryden, Cognitive Therapy in a Nutshell, SAGE Publications, 2006

 

 Zindel V. Segal, J. Mark. G. Williams, John D. Teasdae, Mindfulness-Based Cognitive Therapy for Depression, The Guildford Press, 2002

 

Diana Sanders & Frank Wills, Cognitive Therapy: An Introduction, SAGE Publications, 2005

 

Ruth Williams, Making Sense of Cognitive Behavioural Therapy, Mind Publications, 2001

 

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Copyright 2007 Christ the Truth

 



[1]CBT has a good evidence base in terms of its effectiveness in reducing symptoms and preventing relapse. It has been clinically demonstrated in over 400 studies to be effective for many psychiatric disorders and medical problems for both children and adolescents. It has been recommended in the UK by the National Institute for Health and Clinical Excellence as a treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, OCD, bulimia nervosa and clinical depression.”  Wikipaedia Entry for CBT: http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy

last checked 19/04/07

[2] See web article: Cognitive Behavioural Therapy by Debbie M. Warman and Aaron T. Beck, June 2003:

http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&template=/ContentManagement/ContentDisplay.cfm&ContentID=7952

last checked 19/04/07

[3] Sanders and Wills list the characteristics of the client who will benefit from CBT:

CT is useful if the client:

is able to access automatic thoughts

is able to distinguish different emotions

accepts responsibility for change

understands rationale of CT

can make sense of a formulation approach

the methods make sense to the person

is able to form a good enough relationship with the therapist

is able to concentrate enough to focus on issues

the person’s problems are not too severe or chronic

the person’s safety behaviours, such as avoidance or excessive intellectualizing, are not going to get in the way of engaging in therapy

the client has some optimism regarding therapy

From Diana Sanders & Frank Wills, Cognitive Therapy: An Introduction, SAGE Publications, 2005, p81

[4] John Broadus Watson, who Hurding calls the ‘founding father’ of behaviourism said this in 1913: “The time seems to have come when psychology must discard all reference to consciousness.” Quoted from Roger Hurding, Roots and Shoots: A Guide to Counselling and Psychotherapy, Hodder & Stoughton, 1986, p44.

[5] Ibid. p48

[6] “Man is a machine in the sense that he isa complex system behaving in lawful ways, but the complexity is extraordinary.” Quoted in ibid. p49

[7] “[For Skinner] all behaviour is essentially a product of operant conditioning.” Ibid. p46

[8] W.H. Auden said: “Of course Behaviourism ‘works’ .  So does torture.  Give me a no-nonsense, down-to-earth behaviourist, a few drugs, and simple electrical appliances, and in six months I will have him reciting the Athanasian creed in public.” Quoted in ibid. p40

[9] Stanton L. Jones & Richard E. Butman, Modern Psychotherapies: A Comprehensive Christian Appraisal, IVP, 1991, p178

[10] Stanton L. Jones & Richard E. Butman, Modern Psychotherapies: A Comprehensive Christian Appraisal, IVP, 1991, p182

[11] This list of 11 beliefs includes number 8: ‘The idea that one should be dependent on others and needs someone stronger  than oneself in whom to rely.’ Stanton L. Jones & Richard E. Butman, Modern Psychotherapies: A Comprehensive Christian Appraisal, IVP, 1991, p178

[12] Stanton L. Jones & Richard E. Butman, Modern Psychotherapies: A Comprehensive Christian Appraisal, IVP, 1991, p188

[13] Mark McMinn, Cognitive Therapy Techniques in Christian Counseling, Word Publishing, 1991, p39

[14] Mark McMinn, Cognitive Therapy Techniques in Christian Counseling, Word Publishing, 1991, p49

[15] Actually Beck had begun developing his ideas at University of Pennsylvania from the early 60s yet was not as quick to publish or popularize as Ellis.

[16] [Beck] “The thesis that the special meaning of an event determines the emotional response forms the core of the cognitive model of emotions and emotional disorders: the meaning is encased in a cognition – a thought or an image.” Quoted from Mark McMinn, Cognitive Therapy Techniques in Christian Counseling, Word Publishing, 1991, p23.

[17] Stanton L. Jones & Richard E. Butman, Modern Psychotherapies: A Comprehensive Christian Appraisal, IVP, 1991, p204-5

[18] Michael Neenan & Windy Dryden, Cognitive Therapy in a Nutshell, SAGE Publications, 2006, p6

[19] “A schema is a relatively enduring, deep, cognitive structure that organizes the principles of giving appraisal and meaning to experiences, especially in relation to rule of living, with regard to self, others and the world.” (Diana Sanders & Frank Wills, Cognitive Therapy: An Introduction, SAGE Publications, 2005, p147)

[20] From D.D. Burns quoted in Michael Neenan & Windy Dryden, Cognitive Therapy in a Nutshell, SAGE Publications, 2006, p1

[21] Here the schema is upheld by the counsellee’s living up to old cognitions.  E.g. “I’m not very good at Hebrew, therefore I won’t try very hard, therefore my grades will suffer which will justify my original belief that I am not good at Hebrew.”  A behavioural change of trying harder at Hebrew will be required to break out of this cycle.

[22] This happens when a person’s behaviour is designed to distract them from unpleasant core beliefs. “I drink to drown my sorrows, but my drinking makes me more withdrawn and sorrowful.”  Again new behaviour will be required to break out of the cycle.

[23] Here I go out of my way to compensate for a dominating belief (e.g. that I am unloveable if people get to know me). I may then throw myself into relationships in a desperate way which repels others further.  The rejection at this point becomes doubly hard.  Again, a change of behaviour is required, this time a refraining from certain compensating behaviours.

[24] Having said this, CBT practitioners realize there are complex relationships for instance between feelings and behaviours and that causation can flow back in the other direction (think for instance of the way faulty beliefs may lead to negative thoughts, to depression, to the beginning of a drinking problem and then from those behaviours the emotional problems are compounded and reflect back on the thinking.

[25] Diagram from Diana Sanders & Frank Wills, Cognitive Therapy: An Introduction, SAGE Publications, 2005

[26] Quoted in Stanton L. Jones & Richard E. Butman, Modern Psychotherapies: A Comprehensive Christian Appraisal, IVP, 1991, p180

[27] See also Eph 4:17-24; Phil 4:8; 1 Pet 1:13

[28] Mark McMinn, Cognitive Therapy Techniques in Christian Counseling, Word Publishing, 1991, p12ff

[29] See for instance how McMinn uses the Scriptures to counter various NATs:

“I can’t stand this any longer” => 1 Cor 10:13

“What I’ve done makes me unworthy and filthy” => 1 John 1:9

“I am a wretched sinner” => 1 Cor 6:11

“No one loves me” => Rom 5:8

“I can’t trust anyone” => 1 Chron. 16:34

From Mark McMinn, Cognitive Therapy Techniques in Christian Counseling, Word Publishing, 1991, p103-4.

[30] These are taken from a very helpful practical introduction: Michael Neenan & Windy Dryden, Cognitive Therapy in a Nutshell, SAGE Publications, 2006. p35-44.

[31] These are taken from ibid p11ff and my own personal reflections and experience.

[32] These are taken from Beck in James Moorey, Living with Anorexia and Bulimia, Manchester University Press, 1991, p36-37; from Michael Neenan & Windy Dryden, Cognitive Therapy in a Nutshell, SAGE Publications, 2006, p3ff and from Diana Sanders & Frank Wills, Cognitive Therapy: An Introduction, SAGE Publications, 2005, p7.

[33] Michael Neenan & Windy Dryden, Cognitive Therapy in a Nutshell, SAGE Publications, 2006, p77ff

[34] 1 Thes 1:9-10

[35] Stanton L. Jones & Richard E. Butman, Modern Psychotherapies: A Comprehensive Christian Appraisal, IVP, 1991, p178

[36] Hurding’s warning is well-balanced: “There is a danger in cognitive-behavioural approaches, with their prophetic stance and prescriptive use of Scripture, that people in need can be badly damaged by insensitive or overzealous handling of the word of God… [But] When prophetic counsellors, emphasising the need to change patterns of thinking and behaviour according to biblical guidelines, do so with compassion and sensitivity, guided and empowered by the Holy Spirit, then God’s word can most readily exercise its challenging and restorative work.”  Roger Hurding, The Bible and Counselling, Hodder & Stoughton, 1992, p155

[37] ibid. p213

[38] 1 Cor. 2:4

[39] Jer. 17:9

[40] Rom 10:17

[41] Mark 7:20-23

[42] Ps 86:11; Jer. 24:7; 31:33; Ezek. 11:19; 36:26;

[43] Think for instance of the Israelites in Numbers 13 and 14.  Having heard the report of Joshua and Caleb, the faith-based response would have been to charge into enemy territory – a quite impressive external behaviour-change.  The faithless response was to be inactive.  Alternatively, once the LORD had pronounced his opposition to ‘going up’ the faithless response was to charge and the faithful to do nothing.  Works versus faith is not the same as action (external) verses inaction (internal).  Again we stress, an internal mental focus does not necessarily mean a grace focus.

[44] “To suppose that whatever God requireth of us that we have power of ourselves to do, is to make the cross and grace of Jesus Christ of none effect.” (John Owen, The Death of Death in the Death of Christ, quoted on www.monegism.com. Last accessed 26/04/07)

[45] James 5:16

[46] Eph 4:15