Excerpt: The Philosophy of Cognitive-Behavioural Therapy (CBT)

The Philosophy of Cognitive-Behavioural Therapy (CBT)

Stoic Philosophy as Rational and Cognitive Psychotherapy 

Copyright (c) Donald Robertson, 2010.  All rights reserved. 

[F]or many of us something is missing from most of the [CBT] literature.  What has been needed is a book that covers the underlying philosophy of the cognitive behavioural therapies in much greater depth.  This book on the Philosophy of Cognitive-Behavioural Therapy by Donald Robertson provides us with the missing link between the theory and the philosophy.  [...] It is a fascinating read.  The Philosophy of Cognitive-Behavioural Therapy could be considered as either a prequel or a sequel to the standard textbook read by a trainee or experienced cognitive behavioural or rational emotive practitioner who wants to understand these approaches to therapy within an historical framework.
— From the Foreword by Professor Stephen Palmer PhD  FAREBT  FBACP, Director of the Centre for Stress Management, London, UK 


This is a brief excerpt from my new book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, published by Karnac and available for order online now.  You can also now order The Philosophy of Cognitive-Behavioural Therapy from Amazon, where you may preview a sample of the contents online free of charge.


Donald Robertson

Critics might say that it is actually a healthy sign that so little attention has been given to the historical and philosophical origins of CBT because it is inherently a forward-looking, scientific approach to psychotherapy.  Just because ideas are very old, it doesn’t necessarily mean that they are particularly valid or useful today.  However, there a number of legitimate reasons for exploring this matter in more detail.  As [US naval pilot vice-admiral James] Stockdale [who used his knowledge of Stoic philosophy to survive incarceration in a Vietnamese torture camp] wrote, 

Most of what Epictetus has to say to me is “right on” for modern times.  Will Durant [an American philosopher] says that human nature changes, if at all, with “geological leisureliness.”  According to me, not much has happened to it since the days of Homer.  Epictetus lived a tough life: born a slave, crippled by a cruel master, went from boy to man in the murderous violence of the household of a totally indulgent Emperor Nero.  And he read human nature across a spectrum like this, and by the standards of my spectrum it rings with authenticity.(Stockdale, 1995, p. 180) 

Indeed, a handful of cognitive-behavioural therapists have already attempted to make some headway in the direction of increasing dialogue concerning the relationship between Hellenistic philosophy and REBT or CBT(Still & Dryden, 1999; McGlinchey, 2004; Herbert, 2004; Reiss, 2003; Montgomery, 1993; Brookshire, 2007; Robertson, 2005).  

The Philosophy of CBT (Karnac)

Moreover, there are still therapeutic concepts and techniques to be found in classical literature that have good “face validity”, appear consistent with CBT, and may well deserve empirical investigation in their own right.  Nevertheless, in his recent article, Herbert, while defending the notion that comparisons between ancient philosophy and modern psychotherapy are interesting and valuable in their own right, has called into question the extent to which correlation in their respective ideas can be taken as evidence of causation, i.e., of a historical influence(Herbert, 2004).  While I agree that the question of influence is a complex one, and perhaps something of a diversion from the bigger issues, in the following chapters I will discuss the extent to which the founders of both REBT and cognitive therapy have explicitly stated, in some of their principal texts, that Stoicism and other ancient philosophical traditions were regarded by them as providing the “philosophical origins” of their approach, e.g., ‘The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers’(Beck, Rush, Shaw, & Emery, 1979, p. 8).  

Hence, some of the key points of the following text might be summarised as follows, for the benefit of readers requiring an overview of what may seem a complex and somewhat inter-disciplinary subject matter, 

  • The origins of modern cognitive-behavioural therapy can be traced, through early twentieth century rational psychotherapists, back to the ancient therapeutic practices of Socratic philosophy, especially Roman Stoicism.
  • The notion of Stoicism as a kind of “intellectualism” opposed to emotion is a popular misconception.  Stoicism has traditionally attempted to accommodate emotion, especially the primary philosophical emotion of rational love toward existence as a whole.
  • Ancient philosophy offers a clear analogy with modern CBT and provides many concepts, strategies, and techniques of practical value in self-help and psychotherapy.
  • The contemplation of universal determinism, of the transience or impermanence of things, including our own mortality, and the meditative vision of the world seen from above, or the cosmos conceived of as a whole, constitute specific meditative and visualisation practices within the field of ancient Hellenistic psychotherapy.
  • Contemplation of the good qualities (“virtues”) found in those we admire and in our ideal conception of philosophical enlightenment and moral strength (the “Sage”) provides us with a means of role-modelling excellence and deriving precepts or maxims to help guide our own actions.
  • The rehearsal, memorisation, and recall of short verbal formulae, precepts, dogmas, sayings, or maxims resembles the modern practice of autosuggestion, affirmation, or the use of coping statements in CBT.
  • The objective analysis of our experience into its value-free components, by suspending emotive judgements and rhetoric, constitutes a means of cognitive restructuring involving the disputation of faulty thinking, or cognitive distortion.  By sticking to the facts, we counter the emotional disturbance caused by our own “internal rhetoric.”
  • Mindfulness of our own faculty of judgement, and internal dialogue, in the “here and now”, can be seen as analogous to the use of mindfulness meditation imported into modern CBT from Buddhist meditation practices, but has the advantage of being native to Stoicism, the philosophical precursor of CBT, and to European culture and language.
  • The enormous literary value, the sheer beauty, of many of the classics with which we are concerned marks them out as being of special interest to many therapists and clients, just as it has marked them out for many thousands of previous readers throughout the intervening centuries.
  • Socratic philosophy has a broader scope than modern psychotherapy, it looks at the bigger picture, and allows us the opportunity to place such therapy within the context of an overall “art of living”, or philosophy of life.

The modern industrialisation of psychotherapy, the division of the therapist’s labour, has compartmentalised it in a manner that is bound to cause certain contradictions.  What was once a lifestyle and calling, a vocation in the true sense of the word, has now been degraded into a mere “job”.  By nature, however, we do not merely study the cure of human suffering in order to alleviate it, but also to understand and transform ourselves and our relationship with life itself.  Perhaps, as the ancients seemed to believe, the philosopher-therapist must first transform his own way of life, making it a living example of his views, in order to be able to help others.  By contrast, if the goal of the “rational” or “philosophical” therapist is merely to do his job and leave it all behind him at the weekend, to treat what we call “psychotherapy” as just another profession then perhaps that’s not a very rational or philosophical goal. 

Philosophers and psychotherapists have a great deal to talk about, and a better common ground is required on which the two traditions can meet each other and exchange ideas.  I hope that this study of the philosophical precursors of modern cognitive-behavioural therapy will help to clarify and strengthen the basis for further dialogue between philosophers and therapists in the future.


This is a brief excerpt from my new book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy, published by Karnac and available for order online now.  You can also now order The Philosophy of Cognitive-Behavioural Therapy from Amazon, where you may preview a sample of the contents online free of charge.


Comments

Excerpt: The Philosophy of Cognitive-Behavioural Therapy (CBT) — 12 Comments

  1. Hi Donald,

    Thanks for posting the excerpt – when is it going to be released? I recently picked up a book on Stoic philosophy (The Stoics by Sandbach) as I found your references to it in the CBH course manual fascinating.

    It seems to me – with my albeit limited knowledge of the subject – that stoic philosophy really had a practical, therapeutic function. The same I think can be said of Zen Buddhism, which has always struck me as being far more similar to psychotherapy than religion, and a lot of the highly regarded zen texts of the last century reveal some pretty striking overlaps with cognitive and behaviour approaches. Anyway I digress; I can’t wait for the book!

    -Jon

  2. Hi Jon,

    The book should be out very soon, perhaps within the next couple of months. It’s available for pre-order online. Stoicism was, basically, the most explicitly therapeutic of the ancient Graeco-Roman philosophical sects. In other words, it’s the closest thing to genuine, major psychotherapeutic discipline we have in European culture, prior to Freud. Modern CBT draws quite explicitly on Buddhist practices, especially in the treatment of depression. The literature of the Stoics is more integral to European languages and traditions, though, and has permeated our culture for over two thousand years, giving it a familiarity that Oriental traditions will never attain within our lifetimes.

    There are many parallels between Oriental and Graeco-Roman thought, though, and there were several points of contact between the two hemispheres in ancient times. The Buddhists have a scripture called the Questions of King Milinda, which records a dialogue between a Greek colonial ruler and a Buddhist sage, supposed to be dated around 100 BCE. However, it may surprise many people to know that because Buddhism was primarily an oral tradition, we have more certainty about Greek philosophical doctrines which may well predate “Buddhism” as we know it today, and could potentially have been assimilated into Oriental culture from Western sources. Buddhism is founded on the doctrine of impermanence (anicca vada), which fundamentally distinguishes it from most Hindu doctrine. However, whereas the earliest Buddhist scriptures only date from around the first century BCE, we know for certain that Heraclitus introduced the doctrine of impermanence (ta panta rhei = “everything flows”) to Greek metaphysics about four hundred years earlier, and this idea became central to the whole Platonic tradition.

    Regards,

    Donald Robertson

  3. I would really like to understand more about the techniques used in CBT. I am a hypnosis instructor and would like to talk more about what CBT is, what CBT is applied to (issue wise), how long it takes to resolve issues in most cases, and how many people finish the “work” positively changed by it.

    My question is, can you direct me to an easy read that covers these sorts of topics? Is this the book I seek? Thank you!
    Celeste Hackett

  4. Hi Celeste,

    Well, this is an academic text that presupposes some basic knowledge of CBT so it’s maybe not ideal as the very first book to read, unless you’re also quite interested in philosophy. If you’re looking for a quick and very basic overview of CBT you might as well start with the Wikipedia article. CBT is used to treat a very wide range of issues but is particularly favoured in the treatment of clinical depression and most anxiety disorders, where it generally has a stronger evidence-base than other psychotherapy modalities. The average number of sessions varies depending on the particular treatment protocol being used and the problem treated. However, cognitive therapy for clinical depression was traditionally 16-20 sessions, including relapse prevention.

    How many people benefit? That’s a bit of a “how long’s a piece of string?” question. Some types of problem generally have much higher mean success rates than others, across the board, regardless of the treatment offered. On average, most people are “positively changed” by most therapies. However, more stringent criteria are normally used in research to test the clinical significance of treatment outcomes. About half the patients with clinical depression, on average, tend to exhibit clinically-significant improvement in clinical trials using cognitive therapy for depression. To answer your question, though, you really need to compare like-with-like by looking at specific studies. Assen Alladin recently published a well-received randomised-controlled trial (RCT) comparing hypnotherapy head-to-head against cognitive therapy for depression, and found they achieved very similar results.

    If you’re really looking for a very “easy read” then try CBT for Dummies by Wilson and Branch, which is actually a reasonably good starting point. I don’t think it will go into treatment outcome research in much detail, though. If you do want something a bit more technical then try Dobson & Dobson’s recent Evidence-Based Practice of Cognitive-Behavioural Therapy.

    Hope that helps!

    Regards,

    Donald Robertson

  5. I have pre-ordered the Philosophy of Cognitive-Behavioral Therapy from Amazon US but it does not appear to have been released here yet and I have not gotten any response from the publisher yet as to when it will be. It has been my experience that publishers often ignore this type of query. Do you have any idea as to when a US release will occur?

  6. Sorry about the wait. It was published last week by Karnac and is now in stock on Amazon UK. I don’t know when it will be in stock at Amazon US but it probably won’t be very long. Only Amazon or the publisher would be able to give a more specific date, unfortunately. It should be soon but send them an email if you want to pin down the date.

    Donald Robertson

  7. Just to say thanks, I am training at level 4 on a counselling with CBT course. I have been finding it a tad difficult in relation to all the assignments we have to complete in such a short space. I am very interested in the roots of where it all began and I have found your work extremely helpful as the qusetion I am on is all about the historical developement of the model and its basic philosophy. I am very interested in your book and I intend to buy it. Karen Dunton

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  11. Hi
    Really interesting topic area.
    I am a Senior Lecturer at the University of Wolverhampton.
    Myself and two colleagues (David Bell – Dean Holyoake) run workshops for each mental health cohort around CBT and SFBT.
    We discuss as a key theme in each workshop the underpinning philosophies of both approaches. Feedback from students is excellent. It is something they really enjoy.

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