Intertwined with the Internet discussion I wrote about yesterday in March Fool, another revealing discussion amongst therapists shows how some of them misunderstand the cognitive element of CBT, ending up in very strange territory.
The background to this is a distinction, fundamental to CBT, concerning the nature of thoughts (cognitions). Thoughts have a dual nature in CBT. For example, if you think about a daffodil, that daffodil is a thought. But the act of thinking about a daffodil is a behaviour. So is thinking about a daffodil a thought or a behaviour? It’s both.
This means that therapists can choose how to work with thoughts. They can work with them purely as thoughts, or they can work with them as behaviours. The dual nature of thoughts, and the resulting choice that therapists have, can lead to trouble.
Described by the originator of the discussion as “a bit of fun”, this experiment in thoughts and feelings was invented (as far as I can tell) by Prof. Jack Rachman, a well-known researcher of obsessive-compulsive disorder (OCD), or perhaps by one of his colleagues.
It is typical for patients with OCD to feel excessive responsibility for other people, and for them to employ magical ways to protect themselves and others against harm. By ‘magical’ I mean the mental techniques I described recently in Magic, by which symbols seem to acquire actual power to influence the real world.
So this experiment involves symbolism and protecting others from harm. It was performed in a training group for therapists, not patients, with the intention of leading to insight about the nature of OCD.
You can perform the experiment on yourself right now, although you might find it unpleasant. Here are the instructions:
To perform the experiment you have to actually do this, not just imagine it.
The result that prompted the discussion amongst therapists was that a member of the training group stormed out and later complained that the experiment was unethical. The consensus amongst therapists in the Internet discussion was that there is nothing wrong with the experiment, although other trainers have seen similar reactions to it.
To analyse this difference of opinion, let’s suppose the name on the sheet of paper was Vic (short for ‘victim’ — heh!). There are two questions to ask.
Q1: Will writing that on the sheet of paper cause Vic to die in a car accident today? Or will it increase the probability of a fatal accident?
A1: No, obviously. Writing words on a piece of paper is purely symbolic, and symbols do not have any power to influence the real world. There is no realistic chain of causation that could connect those words with an actual accident.
Q2: Will writing that on the sheet of paper cause distress to you and to anyone who is fond of Vic?
A2: Yes, obviously. Anyone who has normal emotions responds emotionally to symbolism, metaphor and stories.
The person who stormed out did not ‘phone to tell Vic to stay at home today, or cast a protective counter-spell, which is what he would have done if he really believed in magic. He allowed himself to respond emotionally to the tragic story that had been created. That person’s reaction is not very interesting — he got the right answers to both Q1 and Q2.
The interesting reaction is the reaction of seeveral therapists in the Internet discussion. Those therapists got Q1 right, but Q2 wrong.
Symbolism, metaphor and story
If you think that symbolism, metaphor and story should not evoke any emotional response, then all I can say is that you have a warped view of human nature. In therapists, this warping is associated with the dual nature of thoughts.
When you treat thoughts as an internal model of the real world, a model in which things can safely be imagined, scenarios can be tested, and stories can be played out, you are likely to answer Q2 correctly. You categorise the power of symbol, metaphor and story as a power that acts on the imagination, on people’s inner worlds.
But when you treat thoughts as behaviours — that is, as actions in the real world — then you are likely to answer Q2 wrongly. You wrongly categorise symbol, metaphor and story as acting in the real world because they act on thoughts (which you treat as being in the real world).
Those therapists who got Q2 wrong are behavioural therapists who do not really deal with cognitions in the proper sense. They claim to deal with cognitions, they advertise themselves as practising CBT, and the BABCP permits this, but the therapy that they do does not really have a cognitive component. They only deal with cognitions by classifying them as behaviours.
It’s ironic that the behavioural approach to this experiment is itself an example of magical thinking.
Magical thinking is when you wrongly categorise a symbolic representation as the real thing. The person who stormed out had an emotional response to the experiment. But he did not go and warn Vic.
The emotional response is an internal symbolic representation. While it’s true that he acted on his emotions by leaving the room, that’s not the same as warning Vic. Confusing the internal symbolic representation with real concern for Vic’s safety is a category error just like magical thinking.
A couple of special participants took part in the Internet discussion.
One is special because he is very well known, a top academic. Difficulty with the dual nature of thoughts and the behavioural approach extends right to the top of the profession. As I wrote yesterday, academic qualifications and professional status are no guarantee of good CBT.
Another is special because she told the story of when she was asked to perform this experiment herself on a training course. The way this psychotherapist dealt with it takes my breath away: She cast an antidote spell.