Don’t be so negative!
CBT challenges negative thinking, so that all your thoughts can be positive…or not. Am I allowed to write ‘not’? Perhaps I’m being too negative.
Negative thinking is a recurring theme in dumbed-down explanations of CBT. For example, a UK charity, The Mental Health Foundation, has just published a new booklet, Talking Therapies Explained, that attempts to describe psychological therapies for the public.
Sure enough, ‘for the public’ means dumbed-down, and dumbed down means negative thinking. This is the very first sentence in the booklet:
Talking therapies can help you work out how to deal with negative thoughts and feelings and make positive changes.
Why is this wrong?
This is not wrong, of course, and yet it’s completely wrong. It’s like saying “Going on holiday can help you to eat more fish.” Yes, people who go on holiday often go to the seaside, and while they’re at the seaside they might eat more fish than usual, but it’s rare for that to be the point of the holiday. And it begs the question, “Why eat more fish, anyway?”
In the same way, it’s rare for dealing with negative thoughts and feelings to be the point of psychotherapy, even though it’s common enough for it to play some part. And it begs the question, “Why make positive changes, anyway?”
The truth is that psychotherapy helps you to evaluate your thoughts and feelings, and to challenge them or change them if necessary. That sounds a lot more woolly, but real life is woolly, and psychotherapy reflects real life.
Take negative thoughts, for example. Suppose something very bad happened to you last year — on holiday, perhaps. It’s left you feeling bad about your whole life. You’re depressed. Your thoughts are certainly negative. Eventually you end up having psychotherapy.
In therapy you consider what actually happened to you, the very bad thing. You find out that it really was bad — it was terrible, it was appalling, it was a living nightmare, no one should ever have to go through that. So having negative thoughts is completely appropriate. In fact, the negative thoughts you have been having are mild in relation to the event. And that’s been the source your problem — your thoughts have not been negative enough.
With the help of your therapist you discover what’s blocking your negative thinking, and you remove the blocks so you can feel the full force of the strongly negative emotions that are an appropriate response to what happened.
This is what psychotherapy is really about. In therapy you explore your thoughts and feelings in order to make sense of them, to make them appropriate and effective. When negative thoughts make sense, “making positive changes” makes no sense.
Sometimes, it’s true, therapy might be about challenging negative thoughts. Sometimes it might be about reinforcing them. Sometimes it might be about reinforcing positive thoughts, sometimes about challenging them. You can’t pick only one of these to print in your booklet just because it sounds nice.
An odd mixture
Overall, I think the booklet contains an odd mixture of helpful and unhelpful information. Here’s some that I think is helpful (page 6):
The various terms used to describe talking therapies often mean different things to different people. Some people use them to describe the level of training of the professional delivering the therapy. But sometimes there is no link between a therapist’s training and the name of the therapy they offer.
Then it all goes wrong (page 12):
Several types of professionals may be qualified to offer talking therapies. Their job titles usually reflect how they trained or their way of working. They include:
- chartered psychologists – clinical psychologists, counselling psychologists, educational psychologists or health psychologists…
These are precisely the people whose training and job titles do not tell you anything about the kind of therapy they offer.
Here’s another helpful bit (page 9):
Talking therapies are not therapies that are ‘done’ to you by someone else. You play an active part in the therapy. That can be empowering at a time when you may feel you have lost control over part of your life.
But it’s followed immediately by this drivel:
Q: How many therapists does it take to change a light bulb?
A: Only one – but the light bulb has to really want to change!
If you are determined to get the most from the therapy, it is more likely to work…you get out what you put in.
No, sorry, psychotherapy does not rely on the patient to be good and work hard. The whole point going to see a therapist is that trying hard to overcome your difficulties doesn’t help.
And one more…first the good bit (page 19):
…even therapists who offer the same kind of therapy will have a slightly different way of working from each other because all therapists have a personal style as well. Some therapists train in more than one kind of therapy. They may decide to combine a few approaches if that will help you best.
But it’s followed by this about how cognitive behavioural therapies work (page 20):
…looking at how we can react differently to our thoughts and feelings (for example, challenging negative thoughts) and how changing the way we behave can help us feel better (for example trying new activities).
Is the idea that we can actually make sense of emotional difficulties really so difficult? Is it impossible to express in a dumbed-down booklet?
Why is this wrong, again?
What’s really wring with this is that it reinforces prejudices that are themselves damaging to people’s mental health.
Take the idea of challenging negative thoughts. Many people who have mental health problems know that they have negative thoughts, and they know that some, at least, of their negative thoughts are correct. They don’t want them challenged. Promoting the idea that therapy is all about challenging negative thoughts makes people say to themselves, “Therapy is not for me!”
Then there’s the idea that a person who has an impressive job title and lots of training is likely to be a good therapist. Many such people are ineffective therapists. Their patients know it, and word gets around. Ignoring the problem of ineffective therapists only makes people say to themselves, “Therapists can’t be trusted!”
And there’s the idea that the success of your therapy depends on your hard work and determination to be a good patient. People who seek therapy have usually tried and tried and it hasn’t worked. Telling them that they will only get out what they put in makes them say to themselves, “Therapy will do no good!”
Finally, there’s the way that this booklet suppresses the key concept of CBT, that emotional difficulties can be understood and made sense of. Hiding that remarkable discovery from people only makes them say to themselves, “Therapy is just a pretence!”
So it seems to me that this booklet will do its share of harm. Even though it has a sprinkling of useful insights, it contains misinformation that will discourage some of the people who could most benefit from psychotherapy.