CBT or not CBT?

In Saturday’s Times, psychotherapist Benjamin Fry laments the way the NHS handles mental health issues.  In his experience the UK treatment model is a “CBT monoculture that has invalidated and decimated…other talking therapies.”  He explains:

“CBT starts with the idea that our thoughts create our emotions and, therefore, our behaviour…the worst thing about CBT is that it relies on the idea that you are ill because you have the wrong thoughts; so if it doesn’t work, it’s your fault.”

There are a number of issues here:

First, is it true that thoughts cause emotions which determine our behaviour?

Second, are our thoughts the root of our troubles?

Thirdly, could it be that sometimes our illnesses are our own ‘fault’?

Here’s some of my (flawed!) thoughts…

That the heart (which is not the same thing as the “emotions”) shapes human personality.

That whilst there may be some problems we can rationalise, our minds are as fallen and fallible as the rest of us.

That we are both sinners and slaves.   Whilst we can be sinned against,  we’re also perpetrators of the sin.  We make choices and mistakes that can have physical and mental consequences. And we can’t just think our way out.

What do you think?  Where does CBT get it right?  Where does it get things wrong?

6 thoughts on “CBT or not CBT?

  1. Hi

    I agree that CBT is not the answer-or at least not totally the answer-to quote an illustration from Paul David Tripp-unless the heart changes then changing thoughts alone is like nailing apples onto an apple tree which is not producing apples-it just covers the problem rather than dealing with the root problem.

    However although the Bible tells us that our main problem is our hearts (cf Jeremiah 17v9) it also tells us to take every thought captive to Christ and to be self controlled. So I think that CBT is a good technique but it should be seen as a tool to help patients deal with the illness not a solution to the problem-which sadly is how it is being sold. There is a more in-depth therapy called cognitive analytical therapy which delves more into the causes of whatever the illness might be-CBT merely looks at the symptoms.

    As a Christian GP I feel that all the current models of therapy are flawed and no 1 has the solution. I think from a Christian perspective the best model of Christian counselling and thinking on these things (from a starting with the Bible point of view rather than tacking the Bible onto a theory view) is the CCEF stuff-a good starter if you haven’t already read it is “Instruments in the Redeemers Hands-People in need of change helping people in need of change” by Paul David Tripp, but I’ve found most of their stuff really helpful in thinking these issues through- also “When people are big and God is Small” by Ed Welsh is very helpful.

    Thanks for the post has made me think again about this stuff.

  2. Hi Emma

    Thanks for your comment – really, really helpful, especially as in your job you must have to engage with both the theory and practice of these issues every day.

    CAT sounds very interesting. I agree too, that CBT can be useful when we see it as a tool rather than a complete solution. And thank you for the book recommendations – as you say, it’s vital that we start with the Bible instead of simply tacking it on to current theories.

  3. I have done some CBT as part of dealing with depression. Whereas it can be really helpful to identify negative thought behaviours, once you know that is wrong what do you replace it with? I was referred by my G P somy psycho wasn’t a Christian. I was encouraged to look for areas of myself and gifts and parts of my personality that I felt OK about and to build on them. I had mixed feelings about this. Yes, we should replace our wrong thinking, but only with our identification in Christ. (which is what I struggle with re last time I commented !). E bible tells us that we should be renewed by the transforming of our minds. That is what CBT does, but unless you are putting God stuff in there it feels a bit hopeless. A little while ago my vicar came to pray with me. She asked me to imagine that I was taking my hand out of the depression and eating issues and placing it firmly I Jesus’ hand instead. I am learning that I have to consciously do this EVERY morning at the moment. Once was not enough. And that is what I think Paul means by the true transforming of our minds.

    Sorry for the ramble… Hope it makes sense to some of you!

  4. Hi Jojo

    That’s a great point. Once you know what is wrong, what do you replace it with?

    I suspect that as Christians, we’ve been using CBT for years before it was formally labelled as such. Scripture reminds us that we are to ‘renew our minds’, to think on what is pure and noble and lovely – and to live out what we believe. What we put in instead isn’t a new or better set of morals, but rather we look to Jesus and are captivated and transformed by Him. As Thomas Chalmers writes, it’s the ‘expulsive power of a new affection’. In other words, we can’t just chuck out the old stuff unless something or someone bigger and more glorious takes its place.

  5. Hi Emma,I’ve been having CBT for a while now.It is important to remember that it isn’t a solution. I did the ‘Freedom in Christ’ course at my previous Church and that was so great. 1 focus of it was identifying the lies we believe and replacing them with God’s truth about us. That was a lot more eye opening and transforming than I have experienced from CBT. Sometimes CBT opens my eyes to new thoughts I’ve not considered before but I definately think it’s important to keep my eyes fixed on Jesus and his thoughts about me, also his power to change me, as I know there’s little strength in myself to change my mindset or myself!

  6. Hi Han

    Thanks for commenting! (and for the pointer to the Freedom in Christ course).

    It sounds like CBT can be a helpful starting point as long as it’s not the whole story and we’re not just cutting out lies but putting in truth as well.

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