In chapter 3 of Integrative Psychotherapy, McMinn and Campbell provide a nice overview of a significant portion of their theoretical foundation–Cognitive therapy. They begin by discussing the so-called cognitive revolution in the 1960s (over against mechanistic behaviorism and the prior king, psychoanalysis). They remind us how this revolution continues to shape the landscape of mental health (empirically-validated treatments, short-term therapy, self-help books, etc.).
Going into more detail, McMinn and Campbell divide Cognitive therapies into 2 broad categories: Semantic Cognitive Therapy (SCT) and Constructivist Cognitive Therapy (CCT). What is the main difference between the two? SCT’s premise is that people attribute feelings to the events/circumstances in their life, but only simplistically–overlooking their interpretive thoughts about the situation. The authors provide this common diagram: Events -> Thoughts -> Feelings. SCT is designed to help folks critique their thought patterns and evaluate their rationality. Once this happens, it is supposed that individuals will then have more control over their feelings. They mention Albert Ellis’ REBT model: Activiating event -> Belief -> Consequential emotion. This leads to his treatment: Disputing irrational beliefs -> revised cognitive Effect. They also mention Aaron Beck’s additions to SCT in his description of Core Beliefs that color one’s view of the world and self and are highly resistant to change. While there are some benefits to SCT (revealing our tendencies to assume the worst, making mountains out of molehills) McMinn and Campbell find this model to oversimplify “the complexities of human change.” (p. 85).
CCT began to develop in the later 80s and 90s, per the authors, to address the problem of linearity in SCT. Instead of merely assuming that we react to events, CCT recognizes that how we shape events and feelings can also shape interpretations. “Our beliefs do not simply reflect a passive understanding or misunderstanding of reality; they actually change reality…” (p. 86). From this point, the authors go into a sidebar apology on constructivist philosophy, but not radical constructionism. “One can still believe in external authority and truth while acknowledging that human processes influence the actual events of everyday life.” Also, “Christians can and should accept the premise that personal values and perceptions of reality end up changing reality itself.” (p. 87) Unfortunately, CCT sputters and fades because of a new focus on Empirically Validated Therapies which are based on SCT models.
The remaining 20 pages of the chapter provide the authors’ critique of the the CT foundations and model. On the plus side, they see how CT has a lot of commonsense to it, has clear goals/objectives in focus, is time-limited, and supported by scientific research. As a model it does not have a deterministic mindset. Rather, CT believes in at least partial human agency–you can change how you think, see, feel, etc. You are not merely robotically determined by your past. On the negative side, they acknowledge that CT is rather disconnected from well thought out foundations. They call it a practical response to the frustration of analytic models. CT is, in their words, free-floating interventions without the foundation of a good theory. Further, they point out several false premises within CT and support with examples to the contrary: healthy people think rationally, cognitive errors are usually negative, healthy, rational people eliminate negative emotion, thoughts come before feelings, and we are motivated to be more rational. Finally, they charge CT with being “pragmatic rationalism” (I’d call it pragmatic modernistic rationalism) and point out the problem that it doesn’t deal well (at least as originally designed) with the importance of feelings, relationships, culture, fallen human condition, values, etc. in the process of change. They also point out that some of the Christian versions of CT fall into some of these false premises as well. “The Christian narrative is not primarily about correcting sloppy or ineffectual thinking. We are not taught in Scripture that the path to wholeness is found in better thinking. The bible is a narrative about humans being created for relationship with God and one another, struggling because those relationships are now tainted by the devastating effects of sin, and living with the hope of creation restored.” (p. 109).
My thoughts: I’m glad to see they critiqued the problems in CT. In fact, they did it so well, I’m surprised they didn’t do much more to defend why they keep it rather than looking for an entirely new model. Maybe that will get explained in the next chapters. They avoid the simplistic view that CT is similar to the put off/put on message of the bible. I’m glad they presented the material in the SCT vs. CCT description. I did wonder why CCT didn’t take off given its affinity with postmodern philosophies of science. I would quibble with their bible passages used to defend a chastened constructivism. I have no problems defending a form of social constructionism. But, the passages picked from 1 Peter have more to do about the fact that we influence others than about whether our assumptions about the world construct a portion of reality. I would have liked to see them build a more christian or theological model for CCT and relating it to emotions and narratival therapies. I understand the chapter was already getting long but I would have also like to see them connect the dots in other therapies that have cognitive features (e.g., emotion-focused therapy, Mindfulness, etc.).