Effective CBT Requires Rational Thinking of the Therapist

Effective CBT Therapy Requires Therapist Rational Thinking

Dr. Aldo R. Puccci, President (writing on Effective CBT).

Dr. Aldo R. Pucci, CBT Therapist

As president of the NACBT, I am very motivated to encourage the practice of Effective CBT.  When I was in graduate school in the mid-1980s, Raymond Corsini claimed in his book, Current Psychotherapies, that at least 450 approaches to psychotherapy existed at that time.  That is at least 450 different options from which potential clients may choose.  Additionally, of course, there are many therapists whose practice does not resemble a recognized approach whatsoever.

The cognitive-behavioral therapies are well-known for being unique in a variety of ways.  CBT approaches:

Are based on the cognitive model of emotional response;
Are briefer and time-limited;
Emphasize that a sound therapeutic relationship is necessary for effective therapy, but not the focus;
Emphasize a collaborative effort between the therapist and the client;
Are based on aspects of Stoic philosophy;
Utilize the Socratic Method;
Are structured and directive;
Are based on an educational model;
Rely on the Inductive Method.;
Emphasizes the important role of homework.  (For more information, please visit: https://www.nacbt.org/whatiscbt-htm/

However, no approach to psychotherapy requires rational thinking on the therapist’s part more than the CBT approaches.  Effective CBT requires rational thinking on the therapist’s part, as well as a strong belief in its tenets.  This fact is problematic when we consider that therapists are human beings who both learn and are capable of developing their own irrational thoughts.  It is also problematic given the fact that the professional mental health field attracts people who possess various disturbances in the hopes of healing themselves through their studies.

After at least 30 years of training and supervising therapists (hundreds of thousands, that is), I can assure you that self-healing through the graduate study of counseling/psychotherapy usually does not work.  Some of the most disturbed people I have ever met have been therapists.

So how does irrational thinking on the therapist’s part interfere with effective CBT?

1. Therapists’ irrational thinking leads them to believe that the ABCs of Emotions apply to some emotional reactions, but not all.

For example, they believe that the ABC model applies to one’s angry reaction to being mistreated by one’s boss, but it does not apply to one’s reaction to having been raped.  I have found that a main reason for that assumption is that the therapist has a sensitivity to the issue of rape.  Perhaps they were raped themselves.  When therapists hold to this erroneous assumption, they will necessarily inhibit the client’s healing as they will either directly state, or indirectly imply, that since the rape itself is causing the client’s distress, they will always have difficulty with it to some degree.

However, rational therapists understand that the ABCs of Emotions apply to all learned emotions and behaviors.  In the case of rape, we seek to understand the meaning that the person has attached to the event.  Why does the client continue to make himself or herself miserable over the event?  It’s because of what they assume having been raped will mean for their present and future.  If they assumed that it would have no impact whatsoever on the rest of their life, they likely would compartmentalize it as a very unfortunate experience for which they are thankful it is over.

2. Therapists’ irrational thinking leads them to think that they must experience what the client has experienced to be helpful to the client.

Frankly, sometimes what comes out of the mouths of therapists is not much different than what is expressed by many clients.  During a recent training, when I taught about distress intolerance and the fact that panic is ONLY unpleasant and uncomfortable, NOT unbearable or life-threatening, a therapist asked me, “Have you ever had a panic attack?”  That led me to suspect that the trainee most likely tended to panic herself.  My suspicion was confirmed by her.

Rational therapists recognize that accurate empathy is NOT attempting to discover how the therapist would feel “in the client’s shoes.”  Accurate empathy is working to understand how the client feels in his or her shoes.  If the therapist has experienced something similar to the client’s experience, the therapist runs the risk of projecting his or her experience onto the client.

3. Therapists’ irrational thinking causes them to overlook the client’s irrational thoughts.

A client seeks therapy because they are painfully shy.  Their reluctance to be around people is based on the belief that they must have everyone’s approval, yet they doubt that others will view them favorably.  However, the therapist maintains the same irrational belief.  What is the therapist likely to do in this situation?  THE THERAPIST WILL AGREE WITH THE CLIENT!  As a result, one of the two people in that situation is useless, and it is not the client.

Therapists who strive to perform effective cognitive-behavioral therapy must learn how to recognize irrational thoughts and apply that knowledge to their own cognitions.  We need to work at eliminating our own irrational thoughts so that we may be in the best possible position to help the client recognize his or her own.

Rational therapists recognize that rational self-counseling is a life-long process and that we can always improve our ability to think and behave rationally.  But doing so, our clients will benefit from our increased ability to recognize their irrational thoughts and to help them correct them.

For more information on training opportunities in CBT, please visit: https://nacbt.americommerce.com/store/c/4-Home-Study-Trainings-for-Professionals.aspx.