Thursday, September 1, 2011

Therapy and Traditional Belief

In my post, Absolutes, Relativism, Nihilism, I suggested that an evidence-based ethics could be developed based on Aristotle's Ethics; an ethics that takes the goal of life to be the flourishing of the human species and sees as a means to that goal reasoning well. In this post I want to further suggest that a leading method of psychotherapy, Cognitive Behavioral Therapy (CBT), can be seen as providing a framework for such an ethic, rather than as a neutral, therapeutic technique.

It's hardly surprising that psychotherapies necessarily incorporate the values of particular world views. Almost universally those world views reflect a secular, post-Enlightenment perspective that values the use of reason in individual and collective choices and opposes the influence of dogma and tradition. Freud's dictum' "Where id was, let ego be", reflects a belief in the heuristic value of reason over the unreasonable.

The initial rise in the practice of psychotherapy in the early Twentieth Century was accompanied by fierce opposition from most religions with the suspicion that psychotherapists were attempting to assume the role of priests; providing confession, absolution and guidance in the consulting room, rather than the confessional. In contemporary societies that are feudal in nature, those in which authoritarian rule and tradition predominate, psychotherapy is still seen either as a threat or as an irrelevant, incomprehensible import from Western culture.

Psychotherapy, or talk therapy, has become just one of the forms of intervention meant to promote mental health; the others being the use of psycho-tropic medications and direct forms of behaviour modification, neither of which need involve much in the form of conversation. Pharmaceutical and behavioural interventions have proven especially resilient in their ability to adapt themselves to the promotion of what is seen as desirable in societies as diverse as the authoritarian Soviet Union and the most liberal democracies of Western Europe. They could be equally adaptable to a theocracy, It would seem that talk therapy, involving a conversation in which the desires and values of individuals have a predominate role, is less adaptable to authoritarian cultures.

North America provides a striking example of adaptability in relation to all three modalities of intervention made in the name of mental health. Talk therapy or psychotherapy, to which I shall refer simply as "therapy", flourishes in the United States, even though the level of religious practice in that country rivals that of Islamic countries, polls indicate that the vast majority of its population believe in a personal God, who takes an active role in human affairs, and most believe in angels and miracles. It is curious that in a culture in which religious belief predominates, religions being world-views that purport to offer both directives for living life and solutions to human distress, so many people turn to secular, empirically based approaches for help in addressing their emotional problems.

It has been of interest to me in my own practice that clients sometimes present with concerns that are existential in nature, such as the meaning of life, the fear of death or loneliness, and are, at the same time, believers of a religious world-view that purports to address those very concerns. I usually ask how it is that they have chosen to speak with me, rather than a member of the clergy. It sometimes emerges that they are afraid to speak to another believer of the same religion from fear of encountering censure and rejection.

In those situations, not being a believer myself, I can sometimes assume a role similar to that of a cross-cultural therapist; those who practice in a different culture than their own and make use of traditional, indigenous beliefs that might prove helpful in alleviating the person's emotional distress; often working in collaboration with indigenous healers to accomplish that objective. While not, myself, believing there is a God who takes a personal interest in our lives, anymore than I believe in spirit possession or magic, if I am familiar enough with their particular faith, I can  sometimes suggest elements they might find in their religious tradition that respond to the issues provoking their distress. Ideally, I could do that while referring to resources within their own tradition that would be sympathetic with their concerns.

Most often, however, it emerges that their degree of commitment to their faith is not adequate for them to give credence to the solutions it offers. Indeed, it's my suspicion that someone who is a true believer would be very unlikely to consult me or any other secular psychotherapist. Research usually reflects a correlation between happiness, as identified by the individual himself, and religious belief, which is hardly surprising. Religions exist largely to provide answers to questions that are a source of emotional distress and an unquestioning belief in those answers can result in a high level of emotional comfort, no matter what the religion. For those of us who are not believers, that comfort comes along with baggage that we choose not to carry. A caution must also be made that, in most surveys of happiness, what is self reported is the feeling of being happy; someone can feel happy at any moment in time when from a more  detached perspective their life may be a mess; witness those in the grips of an addiction at their moments of being high.

What I want to propose is that the practice of some forms of psychotherapy is inconsistent with the structure of belief present in traditional religions. In particular, I want to indicate that the practice of Cognitive Behavioural Therapy (CBT), perhaps the most widely practiced in North American, is at odds with traditional religious faiths, especially those of the People of the Book. Its important to stress that in speaking of "traditional religious faiths" I'm referring to those which we would call fundamentalist, whether that be evangelical, Catholic and Orthodox Christian, Orthodox Jewish or fundamentalist Islam.

I appreciate that there are progressive, non-literalist understandings of all three faiths whose values and approaches are quite consistent with the practice of CBT; values and approaches which are, in fact, quite consonant with my own.

Cognitive Behavioural Therapists usually employ a list of what they consider to be cognitive distortions. This list of ten is one that I've culled from many other lists and has, at this point in time, the most utility for me.

1. All or Nothing: either-or and black/white thinking (as Oscar Wilde said, "The colour of truth is grey."); an example would be, "either you're for us or against us";
2. Over-generalization: characteristically employing terms such as "all", "always", "never", " everyone", "no one";
3. Mental Filter: dwelling on the negatives and
discounting positives; such as, "He only said he liked it because he felt sorry for me.";
4. Mind Reading: assuming people are reacting negatively to you without adequate evidence;
5. Fortune Telling: assuming/predicting things will turnout badly without adequate evidence;
6. Magnification/Catastrophizing: blowing things way out
of proportion; such as, "If I tell her that, it will kill her.";
7. Emotional Reasoning: assuming how you feel is how things are; as example, "I feel guilty or stupid, so I am guilty or stupid.";
8. Labeling/Rating: characterizing the the entire person or world instead of particular behaviours or events; as in, "I'm stupid" vs "I did something stupid" or "The world or life is cruel" vs "Some things that happen are cruel.";
9. Expressing Preferences as Demands: assuming how you want things to be is how they must or should be; as with, "You should always love your parents.";
10. Personalization and Blame: blaming yourself or someone else for something for which you or they are not entirely responsible.

Those distortions in thinking and speaking are regarded as a significant source of emotional distress; almost always present in the discourse of anxiety and depression. Phrases that reflect those distortions are most often, literally, wrong. Given that most people want to be reasonable, it is possible to help them identify distorted thinking and to correct distorted phrases with more accurate, balanced ones; phrases that are, also, less likely to elicit emotional discomfort.  CBT is to me an illustration of the Aristotelian notion that reasoning well contributes to flourishing both as an individual and species.

The thinking and discourse employed by traditional religious believers in the expression of their world-views can be analysed through the lens of cognitive distortion. Given that traditional religions form one of the most significant cultural sources of moral absolutes, their expressions of belief often constitute cognitive distortions. From more general statements, such as only members of a particular religion are saved, to more particular edicts, such as abortion and homosexual acts are always wrong, several of the above listed distortions are reflected. I've chosen not to analyze here and in detail the distortions often present in religious discourse; believing that you can readily undertake such an analysis yourself should it interest you. I think such an analysis would make clear the inconsistency in both believing in the heuristic value of CBT and being a traditional believer.

The traditional religious believer might reply that faith, not reason, is what they choose to follow in deciding how to live their lives. If that were the case, it would seem that it would be more appropriate to consult a clergyman for help in solving life's emotional problems, rather than a therapist. My point is simply that most ways of practicing psychotherapy are secular in nature and in varying degrees value the exercise of reason in resolving emotional discomfort. More particularly, CBT employs an understanding of reasonable, balanced thinking as an essential ingredient in emotional well-being. Far from being a value-neutral technique, it is a form or practice quite at odds with traditional religious belief. Given that fact, it is curious that CBT is so widely practiced in a society in which religious fundamentalism is as prevalent as it is in North America. I suspect that curiosity is sustained by many psychotherapists, whether themselves believers or not, tacitly drawing a cordon sanitaire around the religious beliefs of their clients; encouraging them to identify and correct cognitive distortions in their everyday life, while ignoring the fact the their religious discourse is rife with the same distortions.


  1. Thanks Bruce,
    I can't wait to get back home and reread this!
    I am American by the way....interesting read...were I closer, I may become a client if you have not retired.
    good day!

  2. Thanks, again, for the comment. I thought your English was very colloquial for you to be a native French speaker. No, I'm not retired, but I am, rather slowly (it could take years :), winding down my practice.