Here's excerpts from a longer paper on my website appraising Cognitive Behavioural Therapy:
Cognitive Behavioural Therapy (CBT) is a
- 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, 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…
- ‘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.
[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
The whole article, including a potted history of the development of CBT, can be found here.