Emotional Self-Management: The Art of Tranquility in the 21st Century

SECTION I: DISTINCTION BETWEEN COGNITIVE THERAPIES AND THE NON-COGNITIVE C-CTHERAPY®

A. What You Need to know About Cognitive, Medical-Model Therapies.

(1.) Supportive Psychotherapy, Advice-Giving and the Medical-Model Design

Webster’s dictionary defines “support”: “To hold up or in position; to bear the weight or stress of”. Supportive psychotherapy, by implication, takes on the image of the therapist bearing the weight of the patient’s mental distress. Inherent in this image is the requirement that the therapist’s presence enables the patient to tolerate his mental “pain”. The implication is that the patient cannot attain a state of mental relief without the supportive presence of the mental health practitioner. The patient’s well-being is dependent upon this equation.

In this sense, the therapist resembles more the kindly, learned and sensible person who guides the patient through his mental “mine-field”. This profile portrays more the picture of a Rabbi, Minister, Priest, or “Parent-person” than a clinician. The prevailing image here is one of “benevolent-benefactor”, a kindly “enabler”, the supportive psychotherapist.

Advice-givers abound. Longtime friends, relatives, even new acquaintances appear to know what is causing your problem and what you should do about it. They offer in an absolute manner how you should think and what you should consider. Every one of them is well meaning.

Advice-givers offer opinions on a multitude of issues, including human behaviour. They preach also about how people should think and behave. They present themselves as if they are experts, their commentary redolent with what they consider to be indisputable fact. They are serious about what they talk about. In the advice-giver’s mind his direction is not only right, but in fact it is the perfect solution to the listener’s dilemma.

Little does the patient realize that when he listens to their well-meaning opinions, he subjects himself to contradictory and conflicting advice. Choose any topic, important or frivolous, and you will find that for every professional or lay-person, queried on the matter, you will receive a differing viewpoint.

For instance, a group therapy patient asks the question, “Why don’t I get along with people?” That patient faces a personal dilemma: “Which of the many suggestions from this group makes sense and which should I listen to?” ; “Is it the right answer to my problem?”; “Can I trust that person’s advice?”

Whenever a patient tells me – as a therapist who does not practice supportive psychotherapy – about the “helpful” intentions of those “advice-givers”, I offer this observation:

“There are as many differing opinions as the billions of people to voice them. If you total-up this collection of opinions and add them to the collection from your next-door neighbor, your buddy, or, anybody else you care to name, you will only add to your mental confusion because you still face the problem: “Which of the many answers will work for me?”

I tell the patient also that when he seeks answers from another person about how to behave right, he has placed himself in jeopardy. He places himself right back into the group therapy dilemma, ‘What should I do?’ The seeker victimizes himself by conscientiously endeavouring to carry out their advice.

‘What should I do?’ is hostage to a fiction. The fiction is: There is an absolutely right way for any one person to behave. If you behave correctly, you will be protected from criticism. You will be safe. In his hurry to relieve himself of upset, he fails to recognize a demographic fact – there exists many billions of opinions. I also remind my patients that opinions, no matter their origin or how intelligent they sound or well intentioned the giver, are to be taken with the proverbial “grain of salt”.

(a.) Disease and the medical-model therapies

Opinions are different from pathogens. A pathogen is a necessary component of disease. The physical medicine doctor looks for the pathogen so that he can get rid of it. Supportive psychotherapy follows that approach, namely, find the pathogen – the cause – and get rid of it. Supportive psychotherapy, composed of advice giving and friendly suggestions, belong to the medical-model design.

While the disease, medical-model approach serves the treatment needs of physical medicine, its design, applied to mental health treatment, is inappropriate. “The notion that disordered thoughts are caused by disease of the brain remains a pure hypothesis.” (Friedberg, Pg., 103)

The sole preoccupation of the medical-model therapist in the treatment process is aimed at investigating for the truth. To do so, the cognitive therapist concentrates upon who said “what” to “whom”, in pursuit of a symptom. The medical-model, disease rationale, oriented around symptom detection absent a specific physical entity in mental health treatment, dictates that the cure resides in a change. In this case the culprit is wrong thinking. The theory is that it is wrong thinking which causes the patient to be crazy.

(b.) Cognitive and Supportive Psychotherapy’s Approach

“Cognitive therapists formulate the process of improvement in terms of the modification of conceptual systems, that is, changes in attitudes, beliefs, or modes of thinking. Most behavior therapists conceptualize the disorders of behavior and the procedures for their amelioration within a theoretical framework borrowed from the field of psychological learning theory, especially the concepts of classical and operant conditioning. Since these concepts are derived mainly from experiments with animals, they focus on the observable behavior of the organism.” (Beck, Pg. 322)

Cognitive therapies are designed around the premise that human behaviour yields to a logic and reason approach; convincing, preaching, explaining, figuring, analyzing, understanding. Consequently, all volitional, cognitive therapies are designed to appeal to logic and reason as their change agent. Their core treatment relies upon the patient responding to the logic and reason of ‘talk therapy’.

Cognitive therapies talk about the need for the patient to change his behaviour. For instance, the cognitive therapist tells the patient: “Change your attitude, look on the bright-side of matters, don’t be so negative!” Cognitive therapists urge their patients to change their attitude for their own and the public’s good. A social template is their means.

Dr. Allen Frances, chairman of the department of psychiatry at Duke University Medical Center in Durham North Carolina, counsels on the issue of difficult people: “Since you can’t avoid difficult people, you have to know how to cope with them, and the first step is understanding.” Their concern is towards making this person into a socially acceptable person. This correct social approach relies upon the theory that people change merely by changing their thinking. Their effort is to get difficult people to not think difficult things. The reason why the cognitive therapist promotes this vision of social correctness – which is the absence of difficult behaviour – is because it is supposed to provide the patient with a positive view of his surroundings. Getting rid of the patient’s socially unacceptable behaviour is the hallmark of the cognitive format.

Cognitive therapies employ relationships as the change agent. It is through relationships with his family, his boss, his peers and his therapist that change for the better is to occur. The term ‘Relationship Therapy’ is interchangeable with supportive psychotherapy. The attention to and the importance placed upon relationships is synonymous with supportive psychotherapy.

As is its style, cognitive, supportive/relationship therapy employs a volitional logic and reasoning treatment format. Peter Breggin in Toxic Psychiatry (Page 376) describes this approach with these words: “Understanding is an aspect of caring and love. To understand is to hear the other person’s viewpoint....”

Breggin’s concentration is on how his patient gets along with other people -- his sociability. Spiritual love and sympathizing with the needs of your neighbour are emphasized. The patient comes to the cognitive therapist seeking how to be a good person, as if he were talking to his cleric. Breggin as the cognitive therapist is supplanting the traditional role of the clergy in the patient’s life.

Understanding the patient assumes that the cognitive therapist’s advice possesses a curative imprint. The curative imprint implies that the origin of mental turmoil is pathogenic.

Just as the physical medicine doctor establishes, through his face-to-face contact, a relationship with his patient so too does the cognitive therapist. This face-to-face contact allows the physician to acquire a full history of the patient and physically examine the patient. These steps enable the doctor to arrive at a diagnosis and a treatment plan. This is the picture of the medical doctor, his white coat, his examining room, his nurse in a white uniform and the whole hospital scene with its disease connection.

Transposing this scene to the mental health setting, we find the supportive, relationship therapist understanding the patient’s history and empathizing with his mental anguish. The supportive psychotherapist, just as does the physical medicine doctor, uncovers the patient’s current complaint, takes a history of the patient which includes a possible commentary on the...