Stoic Philosophy as Psychotherapy (2005)

This article was first published in July 2005 in the journal of the British Association for Counselling and Psychotherapy (BACP). It outlines the relevance of Stoic philosophy for modern psychotherapy and contains material which was to form the basis of the book The Philosophy of CBT (2010).

Stoicism as Philosophical Psychotherapy

This article was first published in the July 2005 edition of the BACP magazine CPJ (now Therapy Today).

Republished with minor amendments.  Copyright © Donald Robertson, 2005.  All rights reserved.

The philosopher’s school is a doctor’s clinic. (Epictetus, 1995: 3.23.30)1

There is currently [2005] a growth of interest in the “practical” or psychotherapeutic aspects of classical philosophy. Academic experts have long perceived “Late” or “Roman” Stoicism (c. 1st – 2nd Century AD) as offering the most explicit system of therapeutic concepts and techniques to be found in classical literature.  This article seeks to introduce some of the basic principles of Stoic philosophy to an audience of psychotherapists and counsellors. We have found that therapists are often surprised at how relevant to their practice and strangely familiar Stoic ideas actually are.  Indeed, we hope to demonstrate that many modern theories of psychotherapy, counselling and personal development are ultimately indebted to this age-old but virtually forgotten therapeutic tradition.

The Origins & History of Stoicism

Stoicism is an ancient European school of philosophy, which incorporates a comprehensive system of therapeutic exercises. Zeno of Citium founded the school in Athens, as a “Socratic” sect, around 300 BC. However, Stoicism was more than just a “philosophy”, in the modern academic sense of the word, it was a far-reaching and long-standing cultural movement. 

 The historical boundaries are controversial, but it is safe to say that the Stoic school of philosophy can be situated within a broader philosophical tradition of “practical philosophy.”  That movement as a whole lasted from around the time of Pythagoras of Samos (c. 6th century BC) –who may be considered the original philosopher-therapist– to the superseding of pagan philosophy by Christian theology well over 1,000 years later. Following the closure of the great pagan academies by the Christian Emperor Justinian in 529 AD, the therapeutic practices of Stoicism and other philosophical systems survived only insofar as they were assimilated into orthodox Christian theology, i.e., barely at all.

 As a living tradition of philosophical practice Stoicism’s time was over. However, some of its concepts survived in literature and experienced various revivals, most notably the so-called “Neostoicism” of the Renaissance period, explaining the traces of Stoic thought in the work of such influential figures as Erasmus, John Calvin, Rene Descartes, William Shakespeare, John Milton, and Michel de Montaigne, to name but a few.  Even the royals, Queen Elizabeth I of England and King James I of England (VI of Scotland), were considered admirers of Stoic philosophy. More recently, Tom Wolfe, author of Bonfire of the Vanities (1987), published a novel called A Man in Full (1998) in which one of the lead characters adopts a philosophy of life based on the ancient Stoic Manual of Epictetus. Hollywood director Ridley Scott’s epic Gladiator (2000) depicts the last days of the Stoic emperor Marcus Aurelius (Richard Harris) and briefly alludes to the cardinal philosophical virtues and the Stoic notion of ‘contempt for death.’ 

It is worth noting, in this context, that the English language still retains evidence of the therapeutic dimension of philosophy. The adjective ‘philosophical’, among other things, still clearly alludes to the ancient ideal of emotional calm (ataraxia) and self-mastery (sophrosyne). This usage of ‘philosophical’ has also become virtually synonymous with the modern, popular meaning of ‘stoical.’

 philosophical. adj. 3. Calm in adversity.

 stoical. adj. Having or showing great self-control in adversity. (OUP, 1992: ‘philosophical’, ‘stoical’)2 

Indeed, Stoicism’s influence over our thought and language, usually unrecognised, endures right down to the present day, so much so that people are often surprised to find that many familiar clichés and proverbs are derived from Stoic philosophy – I call this its “déjà vu factor.”

Stoicism & Modern Psychotherapy/Counselling

Stoicism is fundamentally a philosophy of life independent of any political or religious dogmas. Some have seen it as comparable to a “European Buddhism” or “Western Yoga”, similar in appeal to Oriental systems of thought. Yet it is essentially agnostic, naturalistic, and European in character. Though we shall focus on the therapeutic dimension of Stoicism, it does encompass the possibility of certain metaphysical and spiritual themes, which provide the basis for a sophisticated kind of rational mysticism. Indeed, historically Stoicism evolved into the high mysticism of the last great pagan philosophical school, Neoplatonism, which was in turn assimilated into Christianity.

However, Stoicism is also the forgotten ancestor of our own psychotherapeutic tradition.  The modern history of psychotherapy begins in the early Victorian era with the development of hypnotherapy as a medico-psychological treatment, from which Freud subsequently developed psychoanalysis. Yet thousands of years earlier, it was common parlance to refer to philosophy as a “physician of the psyche” and for philosophers to employ therapeutic aims, concepts, techniques, and styles of working. For example, it’s now known that Freud derived his concept of katharsis (psychical “purification”) from a superficial reading of Aristotle. However, as a classical scholar himself, he might have been aware that the word was more commonly used as a technical term to describe the separation of mind from emotional attachment to external, material things. This notion of the need to “separate” and “purify” the subjective (self) from the objective (other), so fundamental to Stoic practice, pre-empts the basic psychoanalytic concept of projection, which both Jung, and later Klein, inferred was among the most fundamental of all Freud’s so-called ‘defence mechanisms.’ 

More recently, existential and cognitive therapies have drawn explicitly upon similar themes from classical philosophy. When existential therapists, following Heidegger, discuss the importance of an “authentic being-toward-death”, e.g., they are perpetuating one of the central methods of ancient philosophical therapy, the melete thanatou or “meditation upon death”, dramatically portrayed in Plato’s dialogues on the last days of Socrates. The “here and now” philosophy of Gestalt therapy is a figure of speech translating the Latin “hic et nunc”, one of the key themes of Stoic psychotherapy: returning awareness to the present moment. Albert Ellis, the founder of REBT, openly acknowledges his debt to Epictetus, the author of the therapeutic Manual of Stoicism; hence many students of REBT are already partially apprised of its connection with Stoic philosophy. The “ABC model” widely used in cognitive therapy is simply another re-iteration of the perennial philosophical notion of philosophical katharsis, i.e., separating out our subjective judgements from the external events to which they give emotive meaning. In this regard, Cognitive therapists repeatedly cite the famous quotation from the Manual of Epictetus: ‘It is not things themselves that disturb people but their judgments about those things.’ (Epictetus, 1995: §5)1

Nowadays thinkers are freely developing personal development systems and eclectic psychotherapeutic techniques which, often unknowingly, re-introduce key concepts and techniques from classical Western philosophy. Indeed, the many ways in which modern therapists are indebted to ancient philosophy would fill a book by themselves. We only offer a few examples of this intellectual debt to emphasise the point that all therapists, for the most part unwittingly, operate in the shadow of a very ancient therapeutic model. We still speak the language and use the methods of an ancient therapeutics, whether we realise it or not. 

The Basic Concepts of Stoicism

The name “Stoic” simply refers to the stoa poekile, the “painted porch” within which Zeno of Citium, the school’s founder, delivered his lectures and training. However, Stoicism has a more descriptive name, it is also called the “Natural Life” or “Following Nature”, and many variations of this phrase are used to describe the basic orientation of the system. The ancient historian of philosophy Diogenes Laertius writes, ‘the end [of Stoicism] turns out to be living in agreement with nature, taken as living in accordance both with one’s own nature and with the nature of the whole [universe]’ (Diogenes Laertius: 1964, VII: 88).3  In this, Diogenes is alluding to the central Stoic distinction between (internal) human nature, and the (external) Nature of the universe.  In fact, this basic ideal was interpreted as applying at three levels, Diogenes could have added, ‘living in accord with the nature of all mankind,’ because the Stoics believed that the individual self can only be understand as one part, or rather a ‘limb’, of the community of all people. Hence, we have a system of coherence at three levels of ‘nature’:

  1.       Self.  Moral integrity, truthfulness, and personal authenticity
  2.       Mankind.  Empathic understanding, social justice, philadelphia (“brotherly love”)
  3.       Universe.  Being at one with life, with the All, with the totality of Nature

The Stoic Emperor, Marcus Aurelius, employs these three tiers of psychological relations in the therapy journal he kept, the famous Meditations, when he writes:  

Your own mind, the Mind of the universe, your neighbour’s mind –be prompt to explore them all.

Your own, so that you may shape it to justice [and authenticity]; the universe’s, that you may recollect what it is you are a part of; your neighbour’s, that you may understand whether it is informed by ignorance or knowledge, and also may recognise that it is kin to your own. (Marcus Aurelius: 1964, 9:22)4

Stoicism, therefore, is essentially a philosophy of being at one (homologoumenos), or in harmony with, the totality of life. As psychotherapy, it equates mental and emotional health with integration or a sense of “oneness” at these three levels of existence. This simple and intuitive threefold classification also provides the basic structure for applying Stoic psychotherapy, the ‘Threefold Rule of Life.’ 

The Threefold Rule of Life

Objective judgement, now, at this very moment [Logic].

Unselfish action, now, at this very moment [Ethics].

Willing acceptance –now, at this very moment– of all external events [Physics].

That’s all you need. (Marcus Aurelius: 2003, 9.6)5

The Stoics divided their philosophy into three branches: Logic, Ethics and Physics. It is important to realise that these words have now changed their meaning; indeed we will substitute “Metaphysics” for “Physics.” Greek philosophy in general also recognised four ‘cardinal virtues’: Truth, Justice, Temperance, and Fortitude.  These may correlate with the Threefold Rule, the disciplines of Judgement, Action, and of Fear and Desire, and with what we might term the three ‘Core Qualities’ of Stoicism: ‘Objectivity’, ‘Integrity’, and ‘Acceptance.’  Fortunately, for ham-fisted scholars trying to translate these ideas into plain English, we possess a beautifully concise and poetic expression of the Threefold Rule,

“The Serenity Prayer”

God,

Grant me the Serenity

to accept the things I cannot change;

Courage to change the things I can;

and Wisdom to know the difference.

This is the so-called “Serenity Prayer” of the Twelve Step Programme of Alcoholics Anonymous. Although the earliest records attribute it to the late Victorian era, it is so obviously consistent with Stoic philosophy that it is tempting to speculate whether it originates in a much earlier source. In fact, some writers claim that it is based upon the work of the early medieval philosopher Boethius, author of The Consolations of Philosophy, though I have been unable to verify this. 

This, in a nutshell, is the essence of Stoic philosophy; though precisely because of its simplicity it does not give full expression to the enormous breadth of ideas which that system contains. It expresses one of the most fundamental principles of Stoicism: ‘to know the difference between what depends upon me and what does not.’ The Stoics mean by this precisely the distinction we have made between that which is internal and directly subject to my will, and that which I must accept as external and beyond my immediate control, i.e., wholly, or even partially, contingent upon external events.

What, then, should we have at hand upon [challenging] situations? Why, what else than to know what is mine, and what is not mine, what is within my power, and what is not. (Epictetus: 1995, 1.1.21)1

The Threefold Rule of Life

The previous section considered the Stoicism’s history and its relation to modern psychotherapy and counselling. We explained that the grand maxim of Stoic therapy is ‘To follow Nature.’  The first logical step on this path being to distinguish between our own internal nature, the field of Stoic Ethics, and the external Nature of the universe as a whole, the domain of (Meta-) Physics; Stoic Logic aims to make this distinction objectively. This is the Threefold Rule of Life, the basic psychotherapeutic structure presupposed in classical Stoic literature.  Marcus, e.g., exhorts himself to: “Apply them constantly, to everything that happens: Physics, Ethics, Logic” (Marcus Aurelius: 2003, 8:13) 5  We now proceed to examine each of these therapeutic disciplines in turn.

Logic: The Discipline of Judgement

And progress for a rational mind means not accepting falsehood or uncertainty in its perceptions […]. (Marcus Aurelius: 2003, 8:7)5

We can equate the supreme classical virtue of ‘Truth’ with the core quality which I call ‘Stoic Objectivity’, the ability to separate internal from external nature.  In one sense, the heart of Stoic Logic is ‘know thyself’, the legendary maxim inscribed at the Oracle of Apollo in Delphi. However, such knowledge takes on a special character in Stoicism; true knowledge is seen as precisely this ability to clarify the boundaries of the inner self. That is, to continually distinguish, in the present moment, between internal and external nature, i.e., between mind and matter.  As Epictetus says, ‘And to become educated [trained in philosophy] means just this, to learn what things are our, and what are not.’ (Epictetus: 1995, 4.5.7). We can picture this demarcation as the drawing of an imaginary boundary, a circle around the limits of the true self. Indeed, the Stoics described the perfectly circumscribed mind of the ideal Sage as ‘fencing itself off’, an unassailable ‘inner citadel’, and a ‘sphere in perfect equilibrium.’

The ancients generally defined the psyche in terms of activity, as ‘that which moves itself.’ Hence, for Stoicism, the essence of the self is the autonomous action of our freewill: our intentions, thoughts, and decisions. This is a deeply existential view of the self; man is essentially freewill in action, everything else is extraneous to the self. The attitude we call ‘Stoic Mindfulness’ (prosoche), then, means constant self-awareness of the movements of the mind, assuming full responsibility for our own judgements, actions, fears and desires. 

Mindfulness also entails owning our thoughts, re-owning our projections, and suspending all value-laden or emotive judgements. Our thoughts project meaning and form onto our perceptions, by separating the two we attain Truth and Objectivity.  Moreover, the key therapeutic slogan of Stoic Logic is: ‘It is not things that disturb people but their judgements about things.’ (Epictetus: 1995, §5)1  Hence, John Milton’s Satan boasts, ‘The mind is its own place, and in itself can make a heaven of hell, a hell of heaven.’ (Milton, :I, 254)6 As Shakespeare’s Hamlet exclaims: ‘There’s nothing good or bad but thinking makes it so!’ (Shakespeare, 1994, Act 2, Scene 2)7 Marcus Aurelius provides many practical examples of this principle in his therapeutic journal: 

[Remember that] this noble vintage is grape juice, and the purple robes [of imperial office] are sheep wool dyed with shellfish blood. […] Perceptions like that –latching onto things and piercing through them, so we see what they really are. That’s what we need to do all the time –all through our lives when things lay claim to our trust– to lay them bare and see how pointless they are, to strip away the legend that encrusts them. (Marcus Aurelius: 2003, 6:13)5

[Assent to] nothing but what you get from first impressions. That someone has insulted you, for instance. That –but not that it’s done you any harm. The fact that my son is sick –that I can see. But “that he might die of it,” no. Stick with first impressions. Don’t extrapolate. And nothing can happen to you. (Marcus Aurelius: 2004, 8:49)5

We ascertain the truth when we acknowledge and suspend our own prejudices and let the facts speak for themselves. This technique of stripping things down to their essence, phrased in a few words, is known by scholars as ‘essential analysis.’ Its goal is called ‘objective representation’ (phantasia kataleptike), to this alone the Sage’s judgement assents. 

At a practical level, the Discipline of Judgement was achieved by a variety of therapeutic methods. For instance, sophisticated rhetorical techniques and verbal formulae –i.e., language patterns– were used to reframe perceptions. Visualisation was employed, e.g., in imagining the presence of an ideal Sage, accompanying the student as a mentor and observer. Moreover, the therapy was conducted in three modes which happen to correspond to the main surviving examples of Roman Stoic literature.

Mode  Format  Example
Solitary Therapeutic journal The Meditations of Marcus Aurelius
One-to-one Mentor and student The Letters of Seneca to his student
Group Dialectical debate The dialogues in Epictetus’ Discourses and Manual.

Although the Discipline of Judgement was the logical cornerstone of the whole therapeutic system, practical training began with the two disciplines to which we now turn. 

Ethics: The Discipline of Action

[Follow] your own nature, through your actions. Everything has to do what it was made for. […] Now, the main thing we were made for is to work with others. (Marcus Aurelius, 2003: 7:55)5 

Stoic Integrity means to act at one with one’s own innermost nature and the nature of all mankind. The cardinal virtue of ‘Dikaiosyne’ has a dual meaning, it translates as either ‘personal authenticity’ or ‘social justice.’ Likewise, the Discipline of Action involves taking responsibility for all of our actions and directing them toward the solitary goal of reconciling personal moral integrity with love for all mankind.  Our sense of identity determines self-interest and therefore Ethics, because ‘wherever “I” and “mine” are placed, to there the creature inevitably inclines.’ (Epictetus: 1995, 2.22.18)1 For the Sage, therefore, there is no conflict between self-interest and social-interest because he identifies his own nature with the nature of all mankind. This sense of existential kinship is exercised by deliberately practising ‘brotherly love’ (philadelphia) and ‘exploring the minds of others.’ The striking parallel with the core counselling qualities of ‘congruence’, ‘unconditional positive regard’, and ’empathic understanding’ espoused by Carl Rogers will be obvious to any counsellor.  Motivation comes by making an affirmation of the first principle of Stoic moral psychology: ‘The good man is always happy.’ They distinguish sharply between sensory ‘pleasure’ (hedone) which is superficial insofar as it depends upon external factors, and ‘happiness’ (eudaimonia) which comes purely from doing the right thing, i.e., Integrity.  

Your integrity is your own; who can take it from you? Who but yourself will prevent you from using it? When you are eager for what is not your own, you lose that very thing. (Epictetus: 1995, 1.25.3)1

Epictetus elaborates, ‘nothing is of concern to us except our volition.’ The Sage, therefore, renounces attachment to material possessions and invests happiness solely in what is always within his grasp, moral integrity.  However, the Stoics recognised this was an idealistic vision. For practical purposes they distinguish between the absolute value of internal acts and the relative value of external goods. For example, physical health is considered a natural thing to desire and worth having, however, its value is secondary and derivative. That is, physical health is worth having only insofar as it contributes to moral integrity. Yet the Stoics believed that in extreme circumstances even death could be a rational choice. The archetypal example being Socrates, who famously accepted forced suicide rather than accept the trumped-up charges made against him in court – choosing Stoic Integrity over life. This solitary existential decision made him a legendary martyr, and effectively guaranteed philosophy a place at the heart of Western civilisation for posterity.

Some of the Stoics’ ethical views may seem challenging, even radical. However, their “Ethics” was not about moralising, in the modern sense, but something more akin to a system of personal development. Classical philosophy in general predicated its ethics on a notion of enlightened self-interest, which aims for a state of personal fulfilment and happiness. Hence, Aristotle refers to ethics as ethike arete, the science of ‘character excellence.’ Our moral character (ethos) is constituted by the principles of action which we develop into habits.

[Philosophy is] doing what human nature requires. […] Through first principles. Which should govern your intentions and your actions.’ (Marcus Aurelius: 2003, 8:1)5 

The process of ‘essential analysis’ central to Stoic Logic also creates the pithy slogans typical of their Ethics, e.g., “Seize the day”, “Indifference to indifferent things”, etc.  Contemplation, repetition, and memorisation of such principles of action (dogmata) was a key psychotherapeutic technique, as can be seen from the journal of Marcus Aurelius. Hence, these statements were used as autosuggestions, or affirmations, composing a ‘principle-centred’ and inherently therapeutic Ethics.

Metaphysics: The Discipline of Fear & Desire

Reasonable nature is indeed following its proper path if […] it has desire and aversion only for that which depends on us; while it joyfully greets all that which is granted to it by universal Nature. (Marcus Aurelius: 2003, 8:7)5 

Stoic Acceptance means living at one with the external Nature of the universe. The cardinal virtue of ‘Temperance’ means mastering our desire for sensory pleasure, that of ‘Fortitude’ the conquest of our fear of pain and death. Hence, this discipline is about controlling pathos, or emotion. The Stoics believed that both fear (or emotional ‘aversion’) and desire result from excessive emotional attachment; the attitude of the Sage toward external things, therefore, is one of serene non-attachment. The primal and underlying fear which the Stoic seeks to conquer is that of death. ‘The breast from which you have banished the dread of death’, counsels Seneca, ‘no fear will dare to enter.’ (Seneca: 1997, 19)8. Contemplating the transience of life was a standard therapeutic technique of classical philosophy in general.  Indeed, Socrates famously insisted that all philosophy is preparation for death. In the wake of military victory, ancient Roman generals were followed by assistants whispering “memento mori” in their ears: “Remember you must die!” (cf. Discourses 3.24.84-8). Traditionally, many clocks and watches carried Latin inscriptions meant for the same purpose, typically the tempus fugit (‘time flies’), of the Roman poets.

This philosophical theme spawned a vast genre of the same name in the history of art. Examples of memento mori are countless, from the human skulls and wilting flowers of classical Vanitas painting to the animal cadavers of Damien Hirst, all confront us with coolly dispassionate reminders of our own mortality. That most iconic of all Shakespearean images, black-clad Hamlet contemplating the skull of his jester Yorick, affectionately parodies the philosophical practice of meditation on death. The practice of non-attachment and conquering death-anxiety is basically the application of Metaphysics. The original Stoic Metaphysics was wedded to pagan theology, however, belief in God is not essential to Stoicism. As a system of psychotherapy it stands apart from any particular religion or set of spiritual beliefs, and is easily adapted to modern agnostic or even atheistic perspectives. Nevertheless, the early Stoics were mainly pantheists who believed that the totality of the physical universe is simply the Body of God, and the object of His eternal meditation. The aim of their mysticism is simply union with the Mind of God (‘the One’). Hence, it was natural for them, like many earlier philosophers, to infer that by visualising the universe (‘the All’) they attained a Godlike point-of-view. From this God’s-eye perspective, the key concepts of Stoic Metaphysics became more apparent; namely, the unity, transience, and interdependence of all material things. 

The world as a living being –one nature, one soul. Keep that in mind. And how everything feeds into that single experience, moves with a single motion. And how everything helps produce everything else. Spun and woven together. […] Time is a river, a violent current of events, glimpsed once and already carried past us, and another follows and is gone. (Marcus Aurelius: 2003, 4:40-43)5 

For the Stoic, the universe viewed in its entirety is objective reality. Our normal, embodied and earthbound perspective necessarily distorts reality because it is confined to a tiny corner of the universe. Hence, ‘the All is One’, and the totality is the only authentic reality.

Modern scholars call this meditation exercise the ‘View from Above’, and variations of it abound in ancient literature. Sometimes it entails contemplation of the entire universe as though contained in a sphere. Typically though, philosophers attempted to visualise the Earth seen from outer space, a technique which created profound emotional detachment and tranquillity.  Support for this ancient therapeutic intuition comes from the numerous observations of astronauts, who describe the actual experience of seeing the world from space in remarkably similar terms. General Thomas Stafford, commander of the NASA Apollo 10 project, reports:

[From space] you have an almost dispassionate platform -remote, Olympian- and yet [seeing the Earth from up there is] so moving that you can hardly believe how emotionally attached you are to those rough patterns shifting steadily below. (Kevin W. Kelley (ed.), 1988)9 

Marcus Aurelius writes of the ideal Stoic attitude in identical terms: ‘To be free of passion and yet full of love.’ (Marcus Aurelius, 7.9)5 Coincidentally, this meditation exercise may well have evolved out of attempts to visualise the same perspective, of Zeus looking down from Mount Olympus, that General Stafford metaphorically alludes to.  This attitude of serene affection is the goal of the Discipline of Fear and Desire. It is for this reason that Stoicism viewed the practice of pre-scientific, or ‘phenomenological’ physics as a therapy of ‘fear and desire’ in its own right.

Conclusion

[After training in Freudian analysis] I gradually turned more and more to accumulated wisdom in the fields of philosophy. After all, philosophers have been thinking of some of the same issues that we have for the past 2,000 years and I’ve drawn a lot from philosophical insights. (Dr. Irvin Yalom, interviewed in the CPJ, July 2004: 8)

Why does this philosophy stuff matter so much to so many therapists and counsellors?  First, many people simply prefer the stylistic beauty and philosophical depth of classical literature over modern alternatives. Stoicism has demonstrated a perennial appeal enduring more than two millennia. For example, former US President Bill Clinton recently named the Meditations of Marcus Aurelius as his most treasured read. 

Second, many therapists feel the need for a broader philosophical framework. Psychoanalysis, perhaps Marxism, and to some degree religions such as Buddhism and Christianity offer an established ideological basis for therapy practice. Stoicism, on the other hand, offers a viable philosophy of psychotherapy which is not inherently wedded to religious or political dogmas. Ironically, in relation to modern, brief psychotherapy Stoic philosophy proves significantly more relevant than traditional Freudian theory.

Third, the Stoic system contains basic therapeutic principles and techniques not found in modern therapy, which are still relevant and applicable today. Indeed, we have only scraped the surface of Stoic psychotherapy in this article. In particular there are a number of rhetorical strategies and therapeutic interventions –visualisation techniques, etc.– which are not discussed here but which we have found of considerable use in working with clients and workshop participants.  Hence, we would encourage those with an interest in this area to research the primary texts themselves. There is still a great deal to be learned from the ancient forebears of psychotherapy. 

References

1 Epictetus The discourses, the handbook, fragments. London: Everyman, 1995.

2 Oxford University Press The Oxford Dictionary of Current English. Oxford: OUP, 1992.

3 Laertius, Diogenes Lives of the philosophers. H.S. Long (ed.) Oxford: OUP, 1964.

4 Aurelius, Marcus Meditations. London: Penguin, 1964.

5 Aurelius, Marcus Meditations: living, dying and the good life. London: Phoenix, 2003.

6 Milton, John Paradise Lost. Oxford: OUP, 2004.

7 Shakespeare, William Hamlet. London: Penguin:, 1994.

8 Seneca, Lucius Annaeus Consolation to Helvia, in Dialogues and letters. London: Penguin, 1997.

9 Kevin W. Kelley (ed.) The Home Planet. Boston: Addison-Wesley 1988

 

Introducing The Philosophy of CBT (Karnac Blog)

Short blog article introducing the book The Philosophy of CBT (2010) by Donald Robertson, written for Karnac, the publisher.

The Philosophy of Cognitive-Behavioural Therapy

Stoic Philosophy as Rational & Cognitive Psychotherapy

The Philosophy of CBT CoverBlog article for Karnac.  Copyright © Donald Robertson, 2010.  All rights reserved.  This article includes adapted material from The Philosophy of Cognitive-Behavioural Therapy.

The Philosophy of Cognitive-Behavioural Therapy (CBT) is a new book about ancient philosophy and modern psychotherapy.  Professor Stephen Palmer, author of Brief Cognitive Behavior Therapy and several other books on CBT, has kindly contributed a foreword in which he observes that a thorough discussion of the historical roots of modern cognitive-behavioural therapy (CBT) has been lacking.  He adds,

This book takes us on a historical journey through millennia, and highlights the relevant philosophies and the ideas of the individual philosophers that can inform modern cognitive-behavioural therapies.  This book also contains some therapeutic techniques that seem to be modern, yet were developed and written about many years ago. (Ibid.)

This is the essence of The Philosophy of CBT.  It’s a book about the practical relevance of ancient philosophy to modern psychotherapy, most especially the relevance of Stoicism to modern CBT.  

Stoicism had more of a psychotherapeutic orientation than most modern psychotherapists are probably aware of – it was essentially a psychological and philosophical therapy in its own right.  CBT is also more indebted to it than is widely recognised.  Epictetus, one of the most important Stoic philosophers, went so far as to say that the philosopher’s school is a doctor’s (or therapist’s) clinic (Discourses, 3.23.30).  In 1979, Aaron T. Beck and his colleagues wrote in the first major CBT treatment manual, Cognitive Therapy of Depression, ‘The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers’ (Beck, Rush, Shaw, & Emery, 1979, p. 8).  These comments echo earlier remarks made by Albert Ellis, the founder of Rational-Emotive Behaviour Therapy (REBT).  Most CBT practitioners will be familiar with the famous maxim of Epictetus, from the Stoic Enchiridion (Handbook), that states,

It is not the things themselves that disturb people but their judgements about those things. (Enchiridion, 5)

This ancient philosophical precept is widely-quoted in introductory texts on CBT and in the writings of Beck, Ellis, and other leading authors in the field.  It serves to highlight the fundamental link between ancient Stoic therapeutics and modern cognitive therapies.  However, this link is never explored – at least not in much detail.

Moreover, there are many practical therapeutic strategies and techniques to be found in the literature of classical philosophy that have good “face validity”, appear consistent with CBT, and may well deserve empirical investigation in their own right.  Hence, some of the key points of The Philosophy of CBT might be summarised as follows,

  • 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.

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. 

The book is divided into two parts.  The first explores the historical and theoretical relationship between Stoicism and CBT.  However, the discussion extends to other schools of ancient philosophy, such as Pythagoreanism and Epicureanism, and other 20th century schools of psychotherapy, precursors of modern CBT, such as the rational persuasion school of Paul Dubois, etc.  The second part of the book focuses upon the practical strategies and techniques of Stoic therapeutics in relation to modern CBT.  For example, the role of specific mindfulness, visualisation, autosuggestion, and semantic techniques in ancient Stoicism are explored in some detail.  Appendices provide examples of a possible Stoic daily routine and a complete script for modern practitioners to employ in groups or with individuals, based on the Socratic meditation termed “The View from Above” by modern scholars.

Table of Contents

  • Foreword by Prof. Stephen Palmer
  • Introduction: Philosophy & Psychotherapy
  • Contented with Little

Part I: Philosophy & Cognitive-Behavioural Therapy (CBT)

  • The “Philosophical Origins” of CBT
  • The Beginning of Modern Cognitive Therapy
  • A Brief History of Philosophical Therapy
  • Stoic Philosophy & Psychology
  • Rational Emotion in Stoicism & CBT
  • Stoicism & Ellis’ Rational Therapy (REBT)

Part II: The Stoic Armamentarium

  • Contemplation of the Ideal Sage
  • Stoic Mindfulness of the “Here & Now”
  • Self-Analysis & Disputation
  • Autosuggestion, Premeditation, & Retrospection
  • Premeditatio Malorum & Mental Rehearsal
  • Stoic Fatalism, Determinism & Acceptance
  • The View from Above & Stoic Metaphysics
  • Conclusion: Fate Guides the Willing
  • Appendix: An Example Stoic Therapeutic Regime
  • Appendix: The View from Above Script

More information on the book can be found on the blog,

www.philosophy-of-cbt.com

Introducing The Philosophy of CBT

The Philosophy of Cognitive-Behavioural Therapy (CBT), Stoic Philosophy as Rational and Cognitive Psychotheray, by Donald Robertson, published by Karnac Books, 2010.

The Philosophy of CBT

Stoic Philosophy as Rational & Cognitive Psychotherapy

The Philosophy of CBT Cover“The philosopher’s school”, said Epictetus, “is a doctor’s clinic.”  The Philosophy of CBT is the first comprehensive review of the relationship between modern cognitive-behavioural therapies and classical philosophy.  The founders of cognitive therapy and REBT, Aaron Beck and Albert Ellis, both refer to Stoicism in particular as the main precursor of the modern cognitive approach.  This book elaborates in detail upon the historical relationship between different schools of ancient philosophy and modern psychotherapy.  It places particular emphasis on the specific therapeutic strategies and techniques employed in Stoicism and other Hellenistic philosophies and explores the potential for integrating them within modern psychological therapies. 

For example, the central principle of Stoicism was that emotional disturbance is linked to placing excessive value upon things outside of our direct control while neglecting things we can more easily change, especially our cognitions and behaviour.  Visualisation techniques such as “The View from Above” and Stoic mindfulness practices are explained as part of a “forgotten” armamentarium of therapeutic methods.  The author argues that certain aspects of these ancient schools of philosophical psychotherapy may well deserve to be rehabilitated within the modern psychotherapeutic framework.  This book opens up a new forum for dialogue between philosophers and psychotherapists, focusing on the practical dimension of Socratic philosophy and its relationship with the cognitive-behavioural tradition.

Excerpt: Shame-Attacking Exercises

This is a brief excerpt from the new book The Philosophy of CBT by Donald Robertson, discussing the similarities between “shame-attacking” exercises in modern REBT/CBT and ancient philosophical training in “shamelessness.”

Shame-Attacking Exercises in Ancient Philosophy

Diogenes-the-Cynic-Billboard_thumb.jpgThis is a brief excerpt from my book, The Philosophy of Cognitive-Behavioural Therapy: Stoic Philosophy as Rational and Cognitive Psychotherapy.

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

In certain concrete practical respects, REBT also contains therapy interventions that resemble techniques familiar within ancient philosophical therapy. Ellis was known for what he described as REBT’s “trademark” use of various “shame-attacking exercises”. In order to help clients overcome self-consciousness, social embarrassment and inhibition, Ellis would prescribe changes in behaviour which were designed to forcefully and directly challenge their sense of shame. For example, he refers to the technique of asking clients to repeatedly stop a bus without getting off, or asking strangers in the street to give them money, etc.

I realised, soon after I started REBT in 1955, that what we call “shame” is the essence of a great deal of our emotional disturbance. […] Seeing this, I created my now famous shame-attacking exercise in 1968; and perhaps millions of people, especially psychotherapy clients, have done this exercise and trained themselves to feel shamed or sorry about what they did, and about the public disapproval that often went with it, but not to put themselves down and not to feel humiliated about their personhood. (Ellis & MacLaren, 2005, p. 95)

Ellis further explains the exercise as follows,

Here clients deliberately seek to act “shamefully” in public in order to accept themselves and to tolerate the ensuing discomfort. Since clients do best to harm neither themselves nor other people, minor infractions of social rules often serve as suitable shame-attacking exercises (e.g., calling out the time in a crowded department store, wearing bizarre clothes designed to attract public attention, and going into a hardware store and asking the clerks whether they sell tobacco). (Dryden & Ellis, 2001, p. 329)

This aspect of Ellis’ work is strikingly reminiscent of the practices of the ancient Cynic philosophers who appear to have adopted, albeit in a more extreme manner, controversial lifestyles and behaviours in order to liberate themselves from social conventions.

The Cynics break with the world […] was radical. They rejected what most people considered the elementary rules and indispensible conditions for life in society: cleanliness, pleasant appearance, and courtesy. They practiced deliberate shamelessness – masturbating in public, like Diogenes, or making love in public, like Crates and Hipparchia. The Cynics were absolutely unconcerned with social proprieties and opinion; they despised money, did not hesitate to beg, and avoided seeking stable positions within the city. […] They did not fear the powerful, and always expressed themselves with provocative freedom of speech (parrhesia). (Hadot, 2002, p. 109)

Ellis seems unaware of this precursor to his “shame-attacking” exercises. However, the Cynics themselves specifically refer to the deliberate practice of “shamelessness” (anaideia) as a psychotherapeutic exercise. In the case of Diogenes, this was referred to metaphorically as his “defacing the coinage” of social conventions, which inevitably shocked others. So notorious were the shameless acts of Diogenes that Plato allegedly called him “Socrates gone mad”.

According to the Greek biographer Diogenes Laertius, the famous Cynic, Crates, who trained Zeno the founder of the Stoic school, was nicknamed “Door-opener” because of his habit of inviting himself into people’s houses to lecture them somewhat abrasively on philosophy(Laertius, 1853, p. 250). He also mentions another practice of Crates which sounds like an even more provocative version of Ellis’ shame attacking exercises, ‘He used to abuse prostitutes designedly, for the purpose of practising himself in enduring reproaches’(Laertius, 1853, p. 251). Epictetus seems to imply that Diogenes and the other Cynics, whom he greatly admired, deliberately broke wind in front of people, presumably also as part of their practice of shamelessness (Discourses, 3.22.80). Indeed, I am indebted to Still and Dryden for the following illustration drawn from Montaigne’s account of a quite surprising Stoic anecdote,

In the midst of a discussion, and in the presence of his followers, Metrocles let off a fart. To hide his embarrassment he stayed at home until, eventually, Crates came to pay him a visit; to his consolations and arguments Crates added the example of his own licence: he began a farting match with him, thereby removing his scruples and, into the bargain, converting him to the freer stoic school from the more socially oriented Peripatetics whom he had formerly followed. (Montaigne, in Still & Dryden, 1999, p. 157)

Crates’ exercises in shamelessness, or the overcoming of social anxiety and inhibition, can be seen as a practical training in his maxim, ‘That a man ought to study philosophy, up to the point of looking on generals and donkey-drivers in the same light’ (Laertius, 1853, p. 252). Zeno appears to have assimilated some aspects of his mentor’s philosophy into Stoic therapeutics, although moderated by a greater respect for society than the Cynics allegedly displayed.

Like Crates, Diogenes the Cynic, who was revered as a Sage by some Stoics, reputedly tested prospective students by instructing them to follow him around carrying a salted fish, or a piece of cheese, in their hands. When some refused, out of embarrassment, he would chide them: “See how a piece of salted fish was enough to dissolve our friendship!” (Laertius, 1853, p. 230). Notoriously insolent and iconoclastic, he once asked the Athenians to erect a statue to him, and when asked why he had done so, replied, “I am practising disappointment.” (Laertius, 1853, p. 235). These and many similar popular philosophical anecdotes illustrate the striking parallel between the ancient Cynics’ psychotherapeutic technique of anaideia, or shamelessness, and the “shame-attacking” exercises made famous by Albert Ellis within REBT, precursors of certain more modest “behavioural experiments” used to challenge social anxiety and inhibition in modern CBT. Beck and his colleagues also refer to “anti-shame exercises” and observe that cognitive therapy provides opportunities for clients to deliberately expose themselves to feelings of shame in order to conquer them (Beck, Emery, & Greenberg, 2005, p. 282). Indeed, there are many more parallels which can be drawn between the principles of REBT and those of Stoicism.


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 to 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.