Introducing: The Philosophy of CBT (2010)

Brief introduction to my book, The Philosophy of CBT (2010), with an excerpt from the start of the book.

Philosophy-of-CBT-Cover.jpgIt’s been a long time since I’ve written about my first book on Stoicism.  The Philosophy of Cognitive-Behavioural Therapy was published in 2010 by Karnac, a UK publisher specialising in psychotherapy.  It’s subtitle is Stoic Philosophy as Rational and Cognitive Psychotherapy because it’s mainly concerned with the historical relationship between cognitive therapy, particularly Rational-Emotive Behaviour Therapy (REBT), and ancient Stoic philosophy, although it also explains how early twentieth century “rational” psychotherapists, who preceded CBT by half a century, also explicitly drew upon concepts and practices derived from ancient Stoic philosophy.

After some discussion, Karnac invited me to submit a book proposal about philosophy and cognitive therapy.  My first degree was in philosophy and I’d recently finished a masters programme in philosophy and psychotherapy at the University of Sheffield’s multi-disciplinary Centre for Psychotherapeutic Studies.  I was a practising psychotherapist with a special interest in cognitive-behavioural therapy (CBT), self-help techniques, and psychological strategies such as meditation and self-hypnosis.  I was also studying the early history of psychotherapy, particularly the late 19th and early 20th century origins of the discipline.  I discovered Stoicism through the writings of the eminent French scholar Pierre Hadot.  Hadot did a superb job of describing a wide range of “spiritual exercises” to be found in classical philosophical literature.  These spanned all of the Hellenistic schools but were particularly associated with Stoicism.  I was also aware that Albert Ellis and Aaron T. Beck, the two founders of modern cognitive-behavioural therapy had both mentioned that Stoic philosophy was the inspiration for the approach they developed, in contrast to Freudian psychoanalysis.  I was, however, struck by the fact that nobody had written at length about what seemed to me to be the very obvious similarities between the psychological strategies Hadot identified in classical literature and those employed in modern CBT.  So that’s what I set about doing.  It seemed to me, at first, to be a very easy task because the parallels were so apparent.  However, this was one of my first books and a lot of effort went into writing it.

Looking back now, the only thing I’d really change is that I think I tried to cram in too much information, perhaps.  If I could revise it, I’d perhaps try to give it slightly more structure and trim back the content.  Because at that time a handful of the academics I spoke to were unconvinced that psychological or therapeutic strategies could even be found in the ancient literature.  I thought that had already been conclusively proven by Hadot’s research but I wanted to back it up by providing additional references.  Professor Stephen Palmer, one of the best-known CBT trainers and authors in the UK, wrote in the foreword:

[F]or many of us, something is missing from most of the literature.  What has been needed is a book that covers the underlying philosophy of the cognitive-behavioural therapies in much greater depth. […] This book […] includes some therapeutic techniques that seem to be modern, yet were developed and written about many years ago.

In other words, when psychologists  are actually presented with the a survey of the relevant quotations from ancient literature, it becomes pretty self-evident to them that philosophers such as the Stoics were indeed describing psychological strategies very similar to those we employ today in CBT.  Now, though, just a few years on, that argument seems to be pretty much settled and people no longer need to be convinced.  The debate has moved on.

Initially some people said they wanted to know more about how to actually apply these practices to daily life.  The Philosophy of CBT was never meant to be a self-help book.  It wasn’t a book on philosophy per se either.  It was conceived more as an academic text on the history of ideas, specifically the historical relationship between ancient Greek philosophy and 20th century psychotherapy.  (So it combined history of philosophy with history of science and medicine.)

Although, I’d studied academic philosophy for four years at Aberdeen and philosophy and psychotherapy for two years at Sheffield, I was still concerned that the scholarship would be of an adequate standard because I was writing as a psychotherapist rather than a professional academic.  However, I sought feedback from academics over the years and was reassured that they agreed with my work.  I was also heartened when positive reviews of the book appeared in professional journals, of both psychotherapy and philosophy.  In response to the request for more self-help style guidance, I subsequently wrote Teach Yourself Stoicism, published by Hodder.  (Hodder had previously invited me to write Teach Yourself Resilience, which combined modern third-wave behaviour therapy with Stoic philosophy.)

Around the same time, I was invited to become one of the founding members of Stoicism Today, a multi-disciplinary team of writers, academic philosophers, psychologists, cognitive therapists, and classicists, led by Prof. Christopher Gill of Exeter University.  Every Autumn since 2012, we’ve run an online event called Stoic Week, which encourages people to try following Stoic practices for seven days.  Stoic Week has been a huge success.  So much so that we launched a more rigorous, four-week long course called Stoic Mindfulness and Resilience Training (SMRT), which also runs each year. Over ten thousand people around the world have now participated in these courses and our work has been covered extensively in the media.

Over the years, as I mentioned earlier, the debate has shifted.  More recently, the main criticism we’ve encountered has probably been that by combining elements of Stoicism and CBT, and drawing parallels between them, we’re somehow equating these two things.  That surprised me, in a way, because it’s actually the opposite of what I wrote in The Philosophy of CBT.  I get asked about this frequently, though.  So having provided a little bit of context, I just wanted to clarify exactly what position it takes on this topic by quoting from the start of the book, which explains its orientation and provides a brief synopsis of the contents.  What I said was that the concepts of therapy and philosophy were not entirely distinct in the ancient world.  However, modern psychotherapy has become largely separated from philosophy, over the centuries.  For example, my summary of the main themes in the book below concludes with the following point:

Socratic philosophy has a broader scope than modern psychotherapy, and allows us the opportunity to place such therapy within the context of an overall “art of living”, or philosophy of life.

Ancient Stoicism and modern CBT are not “the same thing”, in other words.

Excerpt from The Philosophy of Cognitive-Behavioural Therapy

Philosophy & Psychotherapy

 Philosophy does not promise to secure anything external for man […] each individual’s own life is the material of the art of living.  (Epictetus, Discourses, 1.15.2)

Why should modern psychotherapists be interested in philosophy, especially ancient philosophy?  Why should philosophers be interested in psychotherapy?  There is a sense of mutual attraction between what are today two thoroughly distinct disciplines.  However, arguably it was not always the case that they were distinct.  Ancient philosophy was frequently concerned with what the French philosopher Michel Foucault, has called a technê tou biou, or an “art of living.”  As the Stoic philosopher Seneca, writes,

Philosophy teaches us to act, not to speak; it exacts of every man that he should live according to his own standards, that his life should not be out of harmony with his words, and that, further, his inner life should be of one hue and not out of harmony with all his activities.  This, I say, is the highest duty and the highest proof of wisdom –that deed and word should be in accord, that a man should be equal to himself under all conditions, and always the same.  (Seneca, Letters, 20)

Philosophy, to a large extent, has always been about transforming the life of the philosopher, in a manner resembling modern psychotherapy or self-help in many important respects.  As far back as Socrates, portrayed in Plato’s Gorgias, philosophy has been compared to the art of medicine applied to the mind or soul, i.e., what we now call “psychotherapy.”

By reconsidering the generally received wisdom concerning the history of these closely-related subjects, we can learn a great deal about both philosophy and psychotherapy, under which heading I include potentially solitary pursuits such as “self-help” and “personal development.”

  • Philosophers can gain insight into how modern evidence-based psychotherapy might provide ideas for the practical application of familiar philosophical wisdom.
  • Psychotherapists are likely to discover new practical techniques, strategies, and concepts, which may come as a surprise, as they are often consistent with modern therapy models, but relatively neglected by them.
  • Moreover, both therapists and philosophers may also discover the possibility of fitting the existing theory and practice of their profession into the framework of a vast philosophical vision of the universe and man’s place within it, and even find a whole way of life consistent with their professional activities.

The Origins of Philosophical Therapy

Many modern psychotherapists appear to think that Sigmund Freud, the founder of psychoanalysis, was the first psychotherapist.  Those who look a little further into the history of the subject will realise that Freud not only had contemporary rivals such as Pierre Janet and Paul Dubois, but had himself trained, albeit briefly, in hypnotic psychotherapy by visiting the two leading centres of his day, attending the Salpétrière lectures of Charcot and the “Nancy school” of Bernheim.  Modern psychotherapy first coalesced, in the latter half of the 19th Century, around the dominant schools of hypnotherapy.  Hypnotic psychotherapy itself originated over half a century prior to psychoanalysis, in 1841, when the Scottish physician and surgeon, James Braid, first attempted to take the therapeutic practices of Mesmerism and re-interpret them in the light of Scottish realist (“Common Sense”) philosophy of mind, substituting the psychological laws of association, habit, sympathy and suggestion, etc., for the occult theory of “animal magnetism.”  That is, broadly speaking, how I conceive of the origins of modern psychotherapy, as a branch of scientific medicine.

Of course, there may also be a vague recognition that psychotherapeutic practices resemble in some way the much older religious notions of pastoral counselling and confession.  However, what many non-Christians may inevitably perceive as the scriptural and doctrinaire orientation of Christian theology somewhat restricts the value of any analogy with modern psychotherapy.  Some therapists are aware that seemingly very ancient Oriental practices such as chanting or meditation may serve a kind of therapeutic purpose but these are often shrouded in exotic symbolism, and religious ideas alien, and often inscrutable, to our culture.  There may even, among some therapists, be a sense that throughout European history various authors may have hinted at obscure self-help techniques or contemplative exercises, fragmentary and fleeting, which they appear to have stumbled across in seeking a balm for their own troubled minds.  In the literature of theology, secular self-help, philosophy, biography, fiction, and poetry, nuggets of therapeutic advice, concepts, and even psychological exercises can be found, for instance, in the Remedies for Love of Ovid, the Spiritual Exercises of St. Ignatius of Loyola, the Consolations of Boethius, in Montaigne and Bacon’s Essays, Spinoza’s Ethica, Bertrand Russell’s The Conquest of Happiness, Tom Wolfe’s novel A Man in Full, to pick just a handful of the most relevant examples.

However, there is an important sense in which psychotherapy, even as we know it today, can trace its roots much farther back, perhaps all the way back into prehistory, before such ideas were committed to writing.  Modern psychotherapy, especially in the form of cognitive-behavioural therapy (CBT), the most “modern” of our contemporary schools, can also be viewed as part of an ancient therapeutic tradition derived from the informal philosophical circle surrounding Socrates (470-399 B.C.), and therefore stretching back to Athens in the fifth century B.C.  Of the various schools of Socratic philosophy the one which bears the strongest therapeutic orientation is undoubtedly Stoicism especially that of the later Roman schools.  According to Galen, physician to the Stoic emperor Marcus Aurelius, Chrysippus, one of the founders of Stoicism, emphasised the role of philosopher as that of “physician of the soul”, someone whom we would now refer to as a psychotherapist.

Socratic philosophy in general and the Stoic school in particular definitely bear the strongest similarity to cognitive-behavioural therapy (CBT), out of the various contemporary schools of psychotherapy.  Narrowing our focus down even further, the Stoicism of Epictetus and the Rational-Emotive Behaviour Therapy (REBT) of Albert Ellis, a major precursor of CBT, are perhaps the two schools of thought through which the ancient and modern traditions of psychotherapy may come closest to meeting, and between them a bridge may perhaps be built which can allow a commerce of ideas to flow between ancient and modern traditions, and a fruitful dialogue to develop.

To return to the questions with which we began: why, then, should philosophers and psychotherapists be concerned with one another?  First of all, the difference between what the ancients did and what modern therapy does lies largely, but not exclusively, in its scope.  Philosophy answers a craving for something more expansive; it embraces the totality of things through their essence.  It has the capacity to raise the head of modern psychotherapy and tilt its gaze upwards toward the vastness around us, perhaps even the whole of time and space, as Socrates and the Stoics, literally, recommended.

It is precisely this “bigger” philosophical picture which, I think, the psychotherapist-qua-psychotherapist must wrestle with at some point in his or her career.  When the therapist goes home from work, leaving his clients behind, when he lies in bed at night, he must wonder about certain things.  He must ask himself what therapy means.  What role it plays in life.  Whether its truths must stay locked up in the consulting room when the lights are switched off, and the doors locked shut overnight, or whether they spread and grow, touching other areas of life, colouring things as a whole.  How does a therapist relate to God?  How does he relate to the absence of God?  What does he make of life itself?  What happens when, in quiet contemplation, he puts himself on the treatment couch, or when he attempts to think of his relationship with the universe itself, in its totality, using the intellectual tools of his trade?  These are the philosophical questions which must surely stir in the minds of many professional psychotherapists, and which philosophical therapy can at least strive to answer.

Recent decades, likewise, have seen the growth of interest in “philosophical practice” (Marinoff, 2002) and other movements which seek to promote philosophy outside of the academic institutions, as something that “ordinary people” do in cafés, or apply to their own life problems in the form of individual counselling or group sessions with a quasi-therapeutic style.  Even many academic philosophers appear to crave, quite understandably, a return to the days when philosophical discourse was meant to be rooted in corresponding behavioural and emotional transformation and not merely an “academic” pursuit abstracted from any practical application.  The ancients conceived of the ideal philosopher as a veritable warrior of the mind, a spiritual hero akin to Hercules himself, but since the demise of the Hellenistic schools he has become something else, perhaps something more like a librarian of the mind.

 

[…]

Summary

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 unusual inter-disciplinary subject,

  • The origins of modern cognitive-behavioural therapy can be clearly 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, and allows us the opportunity to place such therapy within the context of an overall “art of living”, or philosophy of life.

The division of labour, the industrialisation of psychotherapy, has compartmentalised it in a manner which is bound to cause contradiction, and tension.  What once was 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.  Philosophers and psychotherapists have a great deal to talk about, and a clearing is required in which the two traditions can shake hands and exchange ideas.

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…  Well, perhaps that’s not a very rational or philosophical goal.

 

 

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