Cognitive Therapy’s Flawed Premise

Psychology needs to shine light on the source of distress and dysfunction.

Psychology needs to shine light on the source of distress and dysfunction.

People struggling to realize their potential or find inner peace often turn to psychotherapy. Yet they find themselves wandering without much guidance through a marketplace of mental-health offerings and claims, lacking the knowledge to distinguish good therapy from bad. More than 150 different psychotherapies are offered in the United States.

In this post, I present some insights concerning cognitive behavioral psychotherapy (CBT), which has become one of the most available forms of treatment. My intention here, as well, is to show important distinctions between CBT and the depth psychology that I practice, particularly as these distinctions apply to clinical depression. This post is twice the length I usually write, and it gets a bit “technical,” so be prepared for some heavy-lifting.

Cognitive therapy, which attempts to address “distorted thinking” by replacing it with rational thinking, originated more than 50 years ago. By the 1980’s, it was merged with the techniques of behavioral therapy to become CBT. This therapy now is widely offered, perhaps in part because it’s a simple, straightforward method for psychotherapists to learn and practice. It offers, as well, a limited, controlled expenditure for insurance companies. I look upon it as the fast food of mental health.

Cognitive therapy originated out of the work of Dr. Aaron Beck, a psychiatrist and psychoanalyst who became convinced in the late 1950’s that depression was not being effectively treated by psychoanalysis. Psychoanalysts believed that depression was caused by anger or hostility toward the self (self-aggression). Unfortunately, these practitioners were insufficiently effective in their treatment of depression because they were addressing only the aggressive side, not the passive side, of the primary inner conflict that produces the malady. [Read more…]

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Collapsing into Helplessness

A sense of helplessness. when emotionally embellished, makes things more difficult for us.

A sense of helplessness, when emotionally embellished, makes things a lot more difficult for us.

James E. Holmes’s spiral notebook helps us understand his descent into madness. Holmes, a neuroscience graduate student who killed 12 people in a 2012 mass murder spree in a Colorado movie theater, had covered page after page of his notebook with the single handwritten word Why?

In repeatedly writing Why? in his notebook (illustrated here), Holmes was desperately asking a question he couldn’t answer. Evidence suggests he was asking imponderable questions such as why do we exist, why does life exist, why should we matter in the great scheme of things. (His notebook brimmed with what his defense lawyers called “a whole lot of crazy”—delusions about death, human worth, and “negative infinity.”) Anyone who struggles relentlessly to come up with definitive answers to such questions faces the prospect of feeling painfully, profoundly helpless. (That’s why religions encourage people to deal with such questions on the basis of faith.)

Psychologically, we can make sense of what happened to Holmes. We can see clearly what he was doing to himself in the lead-up to his shooting spree. In a process of mental and emotional breakdown, he was falling into the passive side of his psyche and spiraling into a painful sense of utter helplessness. In doing so, the danger existed that he would flip to the other side and become manically aggressive.

This existence of inner passivity is not peculiar just to people with mental illness. We all have a passive side of our psyche, and it can lead us into emotional weakness and self-doubt, thereby creating serious behavioral difficulties. We benefit greatly by seeing and understanding this part of us. In the case of Holmes, meanwhile, we are able to study the role that this passivity plays in the development of mental illness. [Read more…]

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Answers to Questions from Readers (Part 4)

The road to inner freedom.

The path to inner freedom.

Readers often send me emails with their comments and questions. Here I answer three of them, edited to remove identifying details. My responses are in italics.

My life has been a struggle for many years. The negative emotions I experienced (mostly being viciously manipulated and disrespected by relatives and other people) are still present.

I always had the impression (even before reading your articles) that I was somehow choosing to be involved in those negative emotions and experiences. However, I did not have the proper understanding of the inner dynamics of this process. Certainly it is very difficult to accept the notion that I’m making inner choices in order to experience those bad emotions: this is extremely humiliating. I mean, it really is humiliating to recognize that I am choosing to hurt myself over and over again in this manner. What do you think about this? –DK

You are feeling what most people feel when presented with this knowledge. It’s very common to feel humiliated or offended when we first consider the possibility that we’re choosing unconsciously and repeatedly to indulge in certain negative emotions.

We experience this sense of humiliation mainly because our conscious ego is so offended at the revelations of this depth psychology. Our conscious ego, which operates rather like an old software program, is of course just one aspect of our total self. Yet a great many people identify with their ego and experience so much of their life through it. We can feel as if we are our ego. Absorbing depth psychology means, however, that we get access to some of the hidden operations, enabling a bigger self to emerge. Even though this benefits us greatly, we still experience resistance to the process. [Read more…]

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Breaking Free of Inner Passivity

Inner passivity keeps us locked up in misery and self-defeat.

Inner passivity keeps us locked up in misery and self-defeat.

Inner passivity is an unconscious realm of our psyche that’s very much “in our face” emotionally. I write a great deal about inner passivity, and I keep trying to bring this psychological aspect into better focus.

My readers keep asking me how, exactly, can they eliminate inner passivity from their emotional life. “Okay, I can see that it’s a problem for me,” they say. “Now how do I get rid of it?”

This message from a reader in Australia is typical of this feedback:

The symptoms you describe in your book, The Phantom of the Psyche, were almost a carbon copy of what I’ve suffered from my whole life. I loved the book, yet I’m still not sure what to do in daily life at a more practical level. The exercises in the book make sense but they seem a tad trivial when juxtaposed with the scope of the problem. Perhaps I’m asking too much of your book and that psychotherapy is really the only way to change things. Any thoughts on this would be great.

Good psychotherapy can certainly bring inner passivity and its symptoms more quickly into focus. Yet very few psychotherapists are going to address inner passivity directly. Here, in this longer than usual post, I offer some further direction for doing this on one’s own. [Read more…]

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Deeper Reflections on Inner Passivity

Inner passivity is a hidden aspect of our psyche.

Inner passivity is a vitally important hidden aspect of our psyche.

A few years ago the actor and filmmaker Seth MacFarlane made a brave and honest observation about his inner life: “I wish I was better at taking in how great my life is, but that’s surprisingly elusive. I tend to be very hard on myself and insecure about failing no matter what happens.” Indeed, many successful people with confident personas are emotionally wobbly underneath.

Troublesome self-doubt of this kind is due in large part to inner passivity. This term refers to a hidden aspect of our psyche that can plague even the smartest people. Inner passivity blocks us from connecting emotionally with our authentic self and establishing inner harmony.

While inner passivity is a major source of our behavioral and emotional problems, it’s invisible to the naked eye or even to high-powered electron microscopes. If neuroscientists or physicists are unable to see it, how are everyday people supposed to get a bead on it?

We can often sense its presence in the chronic self-doubt and weakness of others, but we have a harder time seeing it in ourselves.

Inner passivity can be understood metaphorically as an undetected galaxy in the cosmos of the psyche. To grow psychologically, we need to discover this inner expanse so that we can claim it in the name of self-awareness and rationality. Inner passivity is located, according to classical psychoanalysis, in the unconscious part of the ego. [Read more…]

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Escape the Misery of Moodiness

Resolving inner conflict produces an expanded sense of freedom.

Resolving inner conflict produces an expanded sense of freedom.

“I drink and eat in moderation,” a client told me. “I go to bed at a reasonable hour. I love my wife and kids. The only thing I binge on is irritability and restlessness. I’m a bundle of blue moods.”

His blue moods, as he described them, were not agonizingly painful, yet he was weary of them and fed up with “the heaviness that rises and falls throughout my day.” Rarely did he experience a day completely free of the malady. It didn’t feel like depression, he said, but rather more like an intermittent gloominess, underlying angst, or, at worst, bouts of anxious distress.

Fortunately, his affliction didn’t qualify as a disruptive mood dysregulation disorder. This psychiatric term describes a condition in which a person has angry outbursts that occur, on average, three or more times a week, involving verbal rages and physical aggression. Rather, his moodiness indicates a less serious condition called generalized anxiety disorder. This disorder involves frequent experiences of three or more of the following symptoms: irritability, restlessness, muscle tension, sleep disturbances, tiredness, excessive worry, and difficulty concentrating or mind going blank.

In its diagnostic manual, American psychiatry doesn’t offer much in the way of an explanation for why and how a person develops or acquires this persistent moodiness. The manual does say in passing, however, that the disorder has been associated with “negative affectivity (neuroticism).” The depth psychology to which I subscribe attributes persistent moodiness to neurosis and explains how it arises.

All neurotics are subject to pronounced moodiness. Their psyche is an inner battleground between self-aggression (from the inner critic or superego) and inner passivity (located in the unconscious or subordinate ego). Moodiness is just one of many symptoms of this inner conflict. [Read more…]

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Answers to Questions from Readers (Part 3)

Inner work helps us to discover our authentic self.

Insight from inner work helps us to discover our authentic self.

Some of my readers send me emails with comments and questions about personal issues. Here I reply (in italics) to more of these emails. The topics here deal mostly with inner passivity.

Hello, I have enjoyed reading the posts on your website. I’m going through a really tough time. I’m beating myself up big time for purchasing a home that I truly don’t like. Somehow in my depression and obsessive search of a home, I made a huge mistake.

I’m past middle age, so I should have known better. Now I feel stuck. I so want to go back to the simple apartment we rented during our house search. My husband says we’ll have to stay in the home for at least a year, and he won’t discuss a time frame for putting it on the market. He adamantly does not want to go back to apartment living. We always had our own home, so I understand that.

I’ve had other depressive bouts. Most involved my helplessness over my first-born son’s serious mental illness. His life has been so very difficult. My heart will always break for him. I don’t know where to begin. Is there any hope for me?

Hi. I’m sorry for the difficulties you’re having. All of us need to be aware of our unconscious readiness to keep recycling negative emotions such as feeling helpless and trapped. If we don’t flush these emotions out of our system, they come back to haunt us. [Read more…]

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Follow Your Fantasies to Self-Awareness

Fantasies, like dreams, can give you vital knowledge about yourself.

Fantasies, like dreams, can give you vital knowledge about yourself.

“Fantasy is a necessary ingredient in living,” said Dr. Seuss, whose children’s books have sold in the hundreds of millions. “It’s a way of looking at life through the wrong end of a telescope … and that enables you to laugh at life’s realities.”

Yes, fantasy is a wonderful, enjoyable spinoff of our imagination, especially when a magical, mischievous Cat in the Hat comes by to visit. But sometimes the visitor from our imagination is a real villain, a remorseless Grinch who not only steals Christmas but happiness and peace of mind all through the year.

Fantasies come in all shapes and sizes, and they can stick around for hours at a time. People frequently have fantasies (or daydreams or reverie) about being famous or rich, aggressive or passive, triumphant or shamed, sexually active or impotent, and bonded to others or abandoned by them. People often imagine having magical or healing powers or fantasize being someone else. People with mental disorders, or even some neurotic people, sometimes can’t distinguish fantasy from reality.

If we’re willing to look deeper, we can analyze and interpret our fantasies for the purpose of overcoming inner conflict and all its attendant miseries. [Read more…]

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Answers to Questions from Readers (Part 2)

We become stronger by recognizing and resolving inner conflict.

We become stronger by recognizing and resolving inner conflict.

Readers often send me emails with comments and questions. I answer as many as I can. Sometimes I can only offer encouragement and a bit of advice. Here are some questions, edited to remove details that could identify the individuals, along with my responses (in italics).

Dear Sir, I came across your articles a while ago and found them profound and interesting. Although I know about the fact that inner voices are the source of our issues, and those voices have been absorbed by our mind during our journey of life, I still have not been able to control my perfectionistic qualities. The more I have witnessed and examined my feelings, the more I have realized that what some people see as perfectionism in me is in fact a combination of OCD, self-doubt, self-consciousness, and fear of people’s judgment.

I know that we can set ourselves free once we collect enough awareness of our issues, but I’m getting nowhere and feel like I really need help. I have been feeling a huge, horrible pressure in my abdomen, lower ribs, and chest. It feels like something wants to be released but fears won’t allow it. I’ve been suffering from this pressure for more than 18 months now. I would highly appreciate your advice.

Thanks for writing. You’re correct that your perfectionism is a fear of people’s judgment. But you want to understand that this fear serves as a psychological defense. The defense is employed to cover up your unconscious willingness to soak up criticism. [Read more…]

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The Art of Self-Regulation

Greater insight helps achieve improved self-regulation.

Greater insight helps achieve improved self-regulation.

Everyone knows the feeling of eating a bowl of ice-cream or having a glass of wine after pledging to stop. We say we’re going to eat and drink less, exercise more, stop smoking, be proactive, keep out of debt, get to bed at a decent hour—and then we fail completely to keep our word.

Sometimes we surrender to our impulses, cravings, or desires before the ink is even dry on our pledge to reform.

It’s time to learn a trick or two from the art of self-regulation. In keeping with this holiday season, I illustrate this method as it involves sweets and sugar consumption, but the practice can be applied to a wide variety of unwanted or unhealthy behaviors.

Take the case of Jamie. He’s overweight and a candidate for diabetes, yet he succumbs frequently to what he calls his “sugar addiction.” He needs to understand that his problem is not about sugar. His craving doesn’t stem from a physical addiction. We might say, instead, that his heavy consumption of sugar is due to a psychological addiction. That’s because the craving and his weakness in succumbing to it have to do with psychological conflict.

We’re all conflicted to some degree. We all want to feel strong and powerful, yet many of us find ourselves entangled in negative emotions involving helplessness, passivity, and feeling controlled. Life often feels like an everyday tussle between excess and moderation, and we find ourselves in various situations tottering back and forth between strength and weakness, resolve and indecision, and confidence and self-doubt. All the while, we want to feel we have some freedom to break the rules of moderation now and then. [Read more…]

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