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Christian thoughts on CBT

Here's excerpts from a longer paper from my website appraising Cognitive Behavioural Therapy:

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.

...

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.

Thoughts =>  Feelings => Behaviours

These thoughts are themselves the result of faulty beliefs which underlie them and need to be confronted and changed.

...

The chief benefit of CBT for the church  is perhaps the myriad tools that have been developed to uncover faulty thought patterns and beliefs.

Christians 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)

  • 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:

  • 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:

  • 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, 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…

  • ‘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.

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[Summary of intervening points]  In John 16:9 Jesus identified the criterion by which the Spirit would condemn the world for its sin - "in that people do not believe in Me."  Through loving Christian community, the tools listed above can be a means of the Spirit uncovering those false faiths.

A key verse in Christian counselling is Proverbs 20:5: "The purposes of a man's heart are deep waters but a man of understanding draws them out."  When I encounter a Spirit-filled 'man of understanding' in these circumstances I am exposed for my sinful beliefs and purposes - not simply my behaviours - and therefore may be brought to a broken and contrite heart.

I say may because it is always the Spirit's work to convict me of sin - never simply the work of logic.  More on this below...

...

Perhaps the chief criticism that could be levelled at CBT from a Christian perspective is this: It is not wise and persuasive words that are required but a demonstration of the Spirit’s power.

At the core of CBT is the challenging of irrational beliefs with logical standards.  However the deceitful and unfathomable heart 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.  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.  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

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The whole article, including a potted history of the development of CBT, can be found here.

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13 thoughts on “Christian thoughts on CBT

  1. Glen

    I think similar strengths and weaknesses to CBT. If the affirmations and images are Scriptural, if they affirm our weakness in ourselves but strength in Christ (which many NLP practitioners are loathe to do) and if they acknowledge that actually the word from *beyond* (rather than the word from within) is most helpful - all well and good. NLP is quite good at going for the gut more than CBT too which can be positive. To be honest *only* Christian NLP can lift it out of "power of positive thinking" stuff. Only the gospel can actually ground the positive affirmations in reality. But with the gospel I think it can be a useful tool. Do you have any thoughts yourself?

  2. Tim Vasby-Burnie

    I came across David Field's comments on NLP a few years ago. He thought it was a sharp knife - useful and dangerous at the same time!
    With both CBT and NLP it seems that there are some very good diagnostic tools (although Christians go further into the depths of sin/curse/fall/etc) and some good restoration tools.

    We know that we need the Word of Christ to change us, but perhaps our methods of engaging with the Word are limited? There is so much imagery / symbolism in the Bible but so much of our teaching is about the didactic communication of dangerously-abstract principles. E.g. maybe one way to use Psalm 23 is as an extended meditation, using our imagination to visualise green pastures and dark valleys, perhaps picturing difficult times carved into the rocks on those valleys, repenting of the false belief that we are alone in these times or somehow self-sufficient to cope with them, receiving the gospel that our Good Shepherd walks with us.

    Is that the power behind the Footprints in the sand poem?

    I guess that once I've said, "listen to a sermon, take communion in our usual rather meagre and individualistic way, or read a Christian book" then I feel like I've run out of options! I don't want to negate the way the Spirit could (and does) use these - not at all! I feel as if I have some blunderbuss tools but need some scalpels.

    I heard of a story at our diocese clergy conference of a woman with a very troubled past, and a big transformation. The secret? Looking in the mirror every morning and saying "I love you." I don't like the "if you are told to love your neighbour as yourself then we need to learn to love ourselves" stuff that was given, but neither do I want to dismiss the incident on the basis that I don't like the theology.

    Maybe she should have looked in the mirror every day and said, "Jesus loves you this I know, for the Bible tells me so." But when would an instruction like this become a new legalism - "Let me give you laws to obey / things to do, that will help you grow."?

  3. Glen

    Tim, yes indeed, I started writing a few meditations guiding people visually through Scriptures (like Psalm 23) ages ago. Can't find them now. But all that stuff that NLP is great at is *totally* biblical yet bible-people are afraid of it (in exactly the same way modern evangelicals are scared of "the real presence").

    I think the internal-legalism point is kept in check if it's done more in community. As Bonhoffer said, the Christ in the word of my brother is stronger than the Christ of my heart. Unfortunately (but predictably) CBT and NLP are self-help practices - we need to be surrounding ourselves with the *external* Word.

    Hi Barry, good Christian counsellors are like hen's teeth! Can't think of any proper BACP people (though I'm sure they're around) - but (and more of this on the full article which I link to) I'd say that Christians should be able to work with non-Christian CBT practitioners far more easily than with other psychological paradigms. It's very client led, adaptable and not wedded to Freud or Jung (actually a reaction against them). I'd be comfortable recommending non-Christian CBT but alongside talking and praying it through with wise Christian friends.

    Do you have thoughts on that?

    And does anyone else want to recommend gospel help for hurting people?

  4. Si Hollett

    Tim, that you bring up the "you need to learn to love yourself" stuff, is interesting - I've been wrestling with these ideas (and more nuanced arguments for a Biblical call to love yourself) this past year. There's different types of loving yourself, Bernard of Clairvaux distinguished between stages 1 and 4 (and 2 and 3):
    1) When Man Loves Himself for His Own Sake
    2) When Man Loves God for His Own Good
    3) When Man Loves God for God’s Sake
    4) When Man Loves Himself for the Sake of God

    I'm not sure I agree with his views here (his argument is one of the ones I've been exposed to), but I would agree that there are different ways to love yourself. I would, however, certainly split loving-you and loving-you-in-Christ, being selfishly curved in and loving yourself because you are loved (which could fit in with phase 4).

    Loving yourself because you are loved is certainly a good thing - it's surely dishonouring the one who loves you if you don't agree with them that you are lovely - like not being able to take a compliment.

  5. Glen

    Hey Barry, I dunno, I just point people to Emma's blog and let her handle it :)

    Si - that's very interesting, I'd heard of the first 3 stages of Bernard - interesting that there's a fourth.

    I was thinking only yesterday how evangelicals often have an allergic reaction to 'positive thinking' psychology but will let all sorts of negative thinking slide. i.e. We're comfortable with pseudo-law but outraged by pseudo-grace.

  6. Chris E

    "Perhaps the chief criticism that could be levelled at CBT from a Christian perspective is this: It is not wise and persuasive words that are required but a demonstration of the Spirit’s power."

    The problem is in the real world it's hard to actually detect 'real change caused a demonstration of the Spirit's power'.

    As long as we don't assume that what CBT is doing is redemptive, then I'm not sure what the issue is. CBT can 'work' in the common grace sense, just as often 'Spritual change' fails to 'work' in the common grace sense while working in the redemptive sphere.

  7. Glen

    Hi Chris,

    Yes, I'm all for saying that Christians still struggle in significant ways with all manner of problems. (In fact becoming a Christian can really screw you up in all sorts of psychological ways! Certainly to begin with). And I'm all for saying that CBT etc can help regardless of a person's faith.

    But don't we believe that 'Spiritual change' shows up in conquering fears, bringing peace and joy? We don't want to make the "spiritual realm" into something that has no bearing on "real change" in my personal life. Surely it's the heart and soul of it?

    If someone wants to overcome certain phobias or a speech-impediment or the like with a dose of CBT, then no-one needs to put much thought into how these spheres interact. But when "souls are downcast", the "redemptive" and the "real world" are, I agree, distinguishable - but they are not separate matters.

  8. Chris E

    Hi Glen -

    "But don’t we believe that ‘Spiritual change’ shows up in conquering fears, bringing peace and joy? We don’t want to make the “spiritual realm” into something that has no bearing on “real change” in my personal life. Surely it’s the heart and soul of it?"

    So how do we detect this in other people? How much change is enough? What else can we rely on that a professed belief in the efficacy of the means of grace?

    "If someone wants to overcome certain phobias or a speech-impediment or the like with a dose of CBT, then no-one needs to put much thought into how these spheres interact. But when “souls are downcast”, the “redemptive” and the “real world” are, I agree, distinguishable – but they are not separate matters."

    Well, on a practical level how do we diagnose between a 'downcast soul' and a dopamine imbalance? The biblical counselling folk would surely take exception to your first example also, after all a speech-impediment could be the result of idolatry via a faithless anxiety. It seems to me that such explanations could become so universal as to be practically useless, and they themselves are generating their fair share of car crashes.

    Finally, whether CBT 'works' or not is completely orthogonal to the question of whether redemption is needed. It seems that a lot of the writing about it in Christian circles is driven by the situations in which it seemed to 'work' whilst some method based on supposedly Christian pre-suppositions didn't 'work'. I don't see this as something to particularly worry about.

  9. Glen

    Just to address your questions....

    "how do we detect [real change] in other people..."

    The situations I'm thinking of aren't about us detecting change in others. It's about hurting people detecting that change is needed for themselves. And seeking not only to figure out their NAT's and any possibly chemical imbalances but also whether there's unbelief going on too.

    "how do we diagnose between a 'downcast soul' and a dopamine imbalance."

    It could easily be both, and we shouldn't rule out the former underlying the latter. It might be entirely the latter too, I'm not advising that anyone casts out the evil spirits of depression from poor counselees. But such 'car crashes' don't, in my view, come from a theology which sees that spiritual factors (unbelief etc) may be affecting dopamine levels, etc. You don't avoid car crashes by denying that potential link. 'Car crashes' come from what counsellors *do* with a potential spiritual problem. As you mention - it's the means of grace to which we point ourselves and each other - not any systems of penance.

    Given that Jesus links sin and sickness so profoundly (e.g. Mark 2:17) I'm not sure we need to be certain what is sin and what is sickness. Whatever it is, this sin-sickness is bigger than us anyway and it's not an occasion to beat ourselves up or "pull ourselves together" (as though we could cure ourselves), but to seek the Doctor.

  10. Chris E

    "Given that Jesus links sin and sickness so profoundly (e.g. Mark 2:17) I’m not sure we need to be certain what is sin and what is sickness. "

    I'd agree with you there to an extent, both are an effect of the fallen-ness of this world. I think though that both approaches ('psychological' and 'spiritual') can exist side by side - after all, nothing negates the need for redemption. I guess though that there is a tendency in Christian circles to see things like CBT as intrinsically more problematic because psychological problems are often inherently more mysterious.

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