The following has been informed by Cognitive Behavioral Tsunami: Managerialism, Politics and the Corruptions of Science by Farhad Dalal. It’s a brutal takedown of this therapeutic modality.
I’ve been to lots of therapists in my life. Some have been good, some not so much. Ultimately, it’s just the done thing when you’re in emotional distress.
When I was a child I didn’t really understand what it meant to be involved in talk therapy. I didn’t have any experiential baseline to compare my own internal life to, and no one ever brought me up to speed on the idea that I was somehow abnormal. Nor did I have an understanding of the behavioral benchmarks that indicate abnormality. So I sat around with various adult professionals without understanding the goal of that sitting around.
In adulthood I’ve been more aware of the goal in these settings. There’s a problem and the goal is to make that problem less onerous. It hasn’t worked much of the time, but this might be me, or it might be the world.
Generally, the difficulty has been in the exclusion of material conditions from the discussion, and a failure to evaluate my ability to bring myself into line with the ideal resolution of the problems identified. A lot of it is grey, but moments stand out.
There’s a man from early adolescence who had age appropriate and interesting book recommendations. Awesome. A+.
Then there’s a person who insisted that I take psychiatric medications or she wouldn’t treat me. I left the session.
A therapist once grazed the surface of a larger issue: I needed to want something. But I didn’t want anything, except maybe to feel better.
An elderly therapist made me take the Briggs-Meyer personality test. No thanks.
Two years ago I was ruined. I was just flailing around, sinking. I was enrolled as a patient in an anxiety focused clinic with a sliding scale payment policy. I filled out an endless evaluation form and was then receiving therapy.
The person administering my sessions was a young woman who was a postdoctoral fellow in neuroscience, which is not a field of expertise that normally deals with human thoughts or feelings out in the world of subjective experience. They look at brains. This might or might not bear upon human suffering.
She explained the paradigm that we’d be working within, that being Mindfulness Based Cognitive Behavioral Therapy (MBCBT). This isn’t something I knew much about. It was explained to me that MBCBT was a data-driven, research informed therapeutic model supported by the innovative thinking of a dickhead stepfather: Your thoughts impact your feelings and you’re in control of your thoughts. The process doesn’t waste time on past events- there’s no point. Nor is it concerned with material conditions. The right mindset is either impervious to, or perhaps able to overcome, almost any life circumstances.
There are obvious deficits in this understanding. Or, perhaps, deliberately harmful myths that are perpetuated.
A case study: A thirteen year old is beaten. What comes first in this event? I think it depends on the staging.
Let us say the beating is unexpected (which seems highly unlikely, but I guess we’re dealing with abstractions). What comes first?
A fist hurtles towards a face. Is the brain behind the face aware of what’s coming? I guess the fist could be coming towards the back of the head, but if it’s head-on, then yeah, the victim is aware.
So, if there’s an awareness, is that a thought or a feeling? I don’t know. In my experience there’s a moment of terror, which is definitely a feeling, coupled with a reflexive urge to avoid this theoretical fist, and I guess a thought, which might be “Oh fuck. Anthony is punching me in the face (again).”
I don’t know how to pull these things apart. I’m no thought scientist (and you don’t have to be to practice CBT) but experience tells me that there’s no parsing out chickens and eggs here. Human consciousness isn’t an assembly line.
In the straw man argument above, how would thinking inform the feeling? Maybe if one were able to alter the automatic thought from “Oh shit, a fist,” to “This is an opportunity to learn to endure pain,” the sufferer could have a more enriching experience, as long as they subdue their urge to get out of the way. Any anxiety one might have about such an event happening again is to be dealt with by recognizing that just because you got punched today it isn’t necessarily going to happen tomorrow.
This is the institutional model of therapy practiced in the modern psychotherapeutic context, and its prominence coincides with the rise of the nonprofit sector and the psychiatrization of society, against the backdrop of neoliberal austerity. This makes quite a bit of sense.
“Non-profit organization” is a misnomer. It is true that there are no shareholders in such an organization (instead there’s a board comprised of wealthy people and professional administrators), but they still operate according to the mandates of accumulation: The organization that can provide more services for less money receives funding, and the entire sector is based upon a low wage/high turnover business model. It’s an outsourcing of the management of human misery. Non-profit executives make six figure salaries while the grunts get $13 an hour and a consolation prize: They’re doing good work that helps people (which probably isn’t true).
Therefore, CBT is perfect for this sector. It is brief- instead of years of psychotherapy, CBT generally terminates after a given number of sessions. Also, it doesn’t require intensive training. In my brief experience in social work education, this is the only therapy we would be trained in, and the training wouldn’t be extensive.
And it’s ideologically convenient. As it is concerned with thoughts rather than material conditions or personal history the distress of the client is a personal failing rather than a systemic problem. Good news though: You can change your negative thoughts. And if you don’t, well, you’re two times a failure.
I’ve tried to imagine bringing this therapeutic approach to bear on someone in an abusive domestic arrangement with no familial assistance, and I immediately revert to the ‘getting punched in the face’ example. It doesn’t work. It doesn’t help. It’s actually profoundly harmful.
During my time receiving this therapy, before every single session, I used a Macbook to fill out a questionnaire of approximately 60 questions that pried into the myriad ways that I hadn’t measured up to being a functional person. After this endless reminder of my disappointment the therapist would sit me down and show me a graph charting my responses. Occasionally there would be a spike- progress! Most of the time it was a straight line.
I always left these sessions with worksheets. Yup. Fucking dittos about how to reframe life problems. Or I’d receive a recommendation for an app that would allow me to journal about my spontaneous negative thoughts. I didn’t know what to say. That app would be open all day, every day.
Perhaps most egregious was a focus on mindfulness. I’m not knocking the practice of meditation. But there is a profound disconnect between MBCBT and mindfulness, a breach that is healed by simply not talking about it. My baseline understanding of the various iterations of mindfulness meditation is that thoughts are inherently out of control. I recall a statement by Jon Kabat-Zinn (and I’m paraphrasing) that one can’t think their way out of depression, and I agree. But CBT, as a fundamental principle, asserts that thoughts can and should be controlled.
But whatever, branding is what matters when you’re obviously failing to help people and getting paid for it. I hope someday we awaken to a society that has made the “helping professions” obsolete, and proceeds to remove their taint from whatever world comes next.