The Evolution of Psychotherapy

Cognitive Behavioural Therapy is based on the model that it is not events themselves that upset us, but the meanings and values we assign to them; so negative thoughts are seen as indicators of unaddressed feelings and wounds that interfere with our lives.

Many people see psychotherapy as a fairly static experience with which little has evolved or is happening in terms of research or development of different approaches to the discipline. While psychotherapy has a stereotypical image based on the early days of psychoanalysis, the perception and stereotype don’t do justice to the evolving world of psychotherapy.

I would like to introduce you to a newer psychotherapy modality. While it may not be brand spanking new, it is growing rapidly in its use and applications world-wide. It is called Cognitive Behavioural Therapy or CBT for short. Although only about 50 years old, it is one of the most researched modalities in psychotherapy and is very adaptable in terms of the conditions and issues it is used for. Originally used for treatment of depression, it is being tested and proven to be of significant value in many disorders and mental conditions.

What makes CBT exciting is that it recognizes the triad of the human experience. That triad would be our thoughts, our feelings and our actions or behaviour. It asserts that all three are present with one feeding the other in this triangle. CBT is the result of different streams of therapeutic approaches coming together – the cognitive stream looks at how and what we think which activates our feelings, and combined they determine our attitudes and perceptions of how we experience our world. The behavioural stream works with the interplay of feelings and thoughts which results in feeding our behaviour which may or may not be in our or others’ best interest.

An example would be our thoughts: how and what we think causes us to experience feelings, and in turn how those feelings feed our behaviour. It recognizes the importance of our thought process, usually ignored in many modalities, and also recognizes that our thoughts are inclusive of our beliefs, attitudes and expectations that together produce an endless flow of phrases and ideas which may not always be correct. In other words, what we believe to be true from our thoughts may be erroneous and won’t pass the reality test when it is applied. These distortions in our thinking are referred to as cognitive distortions or biases and we all have them.

Simply put, a bias is our mind’s way of working with lots of information, and it convinces us it is true. These thoughts mostly are used to reinforce our negative thinking and feelings – they may sound rational but they are only working to make us feel bad about ourselves.

Cognitive Distortions

Cognitive distortions have a way of playing havoc with our lives. This kind of “stinkin’ thinkin” can be ‘undone’ but it takes daily time and work, however it allows us to experience our lives in a more honest and realistic way. Below are a few examples of common distortions, this is far from a comprehensive list:

1) Filtering – We take negative details and amplify them while filtering out all positive aspects of a situation. Example: A person may take an unpleasant detail and dwell on it exclusively so that their reality becomes distorted.

2) Polarized Thinking – Things are either ‘black or white’ – there is no middle ground. Everything is placed in an ‘either/or’ column.

3) Jumping to Conclusions – Without any individual saying so, we know what they are feeling and why they act the way they do and specifically we are able to determine how people feel towards us.

4) Control Fallacies – If we feel externally controlled, we see ourselves as helpless and as victims. The other fallacy of internal control has us assuming responsibility for others. Example: ‘You look sad, is it something I said?’

5) Blaming – We hold other people responsible for our pain and discomfort.

6) Emotional Reasoning – We believe that what we feel must be true automatically. We assume our unhealthy emotions reflect the way things are: “I feel therefore it must be true.”

7) Always Being Right – We are feeling continually on trial to prove that our opinions and actions are correct. Being wrong is not an option and we will go to any length to prove we are right. Being right becomes more important than the feelings of the people around us who we may be hurting, even loved ones.

8) Entitlement beliefs – Believing that the same rules that apply to others should not apply to you. Example: Believing you shouldn’t have to do an internship even though an internship is the norm in your career path.

9) Confirmation Bias – we tend to look for things that confirm our own beliefs, which is precisely what gets us mired in our current beliefs. Our mind seeks out what it knows, making it difficult to adopt new thoughts and beliefs.

Cognitive Behavioural Therapy is based on the model that it is not events themselves that upset us but the meanings and values we assign to them. Negative thoughts are important in CBT as they provide a map of our psyche where, underlying our negative thoughts and attitudes, are the unaddressed feelings and wounds that interfere with our lives, our decisions, and relationships. Left unaddressed, the very essence of our inner world, our thinking, feelings, and behaviours can slowly descend into a downward spiral.

What makes CBT different? It is very now-oriented; time is not spent going over our earlier life story unless it is having a direct impact on our world today. It recognizes that our thoughts are a combination of our beliefs, and attitudes and they colour our perception by impacting how we feel and therefore our actions. Eastern philosophies have been teaching the impact of our thoughts for millennia.

Sometimes referred to as Brief Therapy, almost all CBT work is for a finite period of time, usually 8 to 12 sessions, and defined as problem-focused and goal-oriented. It is evidence-based and has shown to be an excellent treatment for mild to moderate depression, anxiety disorders, substance disorders, and more. The client and therapist work as a collaborative team to establish goals and results. CBT begins with helping to identify, up front, why you are seeking counselling and then uses those findings in establishing goals for you to work through during sessions. It encourages the client to do daily work with changing and moving towards the goals established at the first meeting.

CBT is considered as the first wave of cognitive therapies. There are many other modalities for treatment based on CBT. The therapies are now considered to be in the third wave with the advent of new variations to treatment. Give it a try; it is organic, and certainly holistic as it treats the whole you – body, mind and spirit.

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