Cognitive Behavioral Therapy

In twenty years of pastoral ministry, it is rare that I come across someone who has benefited from counseling/therapy. Which is odd considering how many people have tried it. This might be anecdotal to me, but when I ask the struggler who has approached me to describe their previous counseling experience, I usually get something like “At first it felt really good to talk to someone, but then it just sort of fizzled out and nothing ever changed.” This leads me to believe that the majority of secular counselors could be replaced by a good and wise friend. Good Will Hunting moments are unicorns.

a person drowns underwater

So when I encounter someone who has benefited from counseling, I tend to notice. In The Coddling of the American Mind, which is essentially a critique of the fragility incarnated in higher education, Greg Lukianoff, one of the authors, overcame (or perhaps learned to cope with) depression using Cognitive Behavior Therapy. The authors of this books are not Christians but are also clearly intelligent, thoughtful, and well intentioned. They go so far as to recommend simple forms of CBT be taught to children as a way of helping them become anti-fragile. I find it interesting to see CBT recommended heartily by two self described liberals who are concerned about the fragility of the up and coming generation, so I thought I would do some exploring. (For an introduction to CBT try The Beck Institute).

I am struck by 2 reasons CBT might be successful, and these are shared traits of the Biblical Counseling that I practice. First, CBT treats the client as an active agent in the change process. This may seem like a no-brainer, but the reality is that for many of the common causes for which therapy is sought, the client is treated like a victim of a disease. The term “mental illness” captures this approach. For example, the practical result for many seeking help for depression, anxiety, and bi-polar disorder is a prescription. The CDC reports that in the years 2015-2018, 13.2% of Americans age 18 and over had taken an anti-depressant in the last 30 days. Since the overwrought response to the pandemic, anti-anxiety prescription use has dramatically increased. This medical model of therapy, whether intentionally or not, minimizes the agency of the individual.

But there are other reasons why counselors may refrain from challenging their clients in all but meaningless ways. In our increasingly Woke culture, a mental health worker at a university might expect a lawsuit or the loss of employment if they challenged the narrative of a client who belonged to an “oppressed” demographic. But it sounds to me like in CBT, a counselor can say “What are you thinking?” and “Does that actually reflect reality?” Like Biblical Counselors, those who practice CBT are willing to challenge their clients views, claims, perspectives, values, and conclusions.

Secondly, as implied in the name, CBT focuses on the thoughts. It’s reasonable to say that a lot of people seek counseling for conditions that are emotional in nature. How do we access the emotions? The short answer is that we have no idea. But we can address the thoughts. Scripture actually uses phrases like “the thoughts of the heart”, or “As a man thinketh in his heart, so is he.” Emotions are tied to our physical bodies, but they are also tied to our thoughts and behaviors. CBT enters the process of counseling through the thoughts as well, “Dr. Beck began helping patients identify and evaluate these automatic thoughts. He found that by doing so, patients were able to think more realistically. As a result, they felt better emotionally and were able to behave more functionally.” There is an echo of noutheteo in this statement, is there not?

But what does it mean to “think more realistically”? Here the paths between CBT and Biblical Counseling begin to diverge in (at least) two distinct ways. The first is that CBT contains no body of universal knowledge from which to define “realistically”. Biblical counselors have the Bible: an unalterable exposition of humanity’s origin and destiny, a unified narrative of redemption assembled across centuries and cultures, and a complete and sufficient body of Truth. Compared to this incomparable resource, CBT is quite limited. Human beings can be ruthlessly honest with ourselves and endeavor to be objective regarding the world around us. But even then – especially then! – the human soul seeks Transcendent Truth that must be revealed by God before it can be discovered by man.

Secondly, I find it difficult in secular therapy to determine the telos of the counseling because I cannot discern within that counseling paradigm what they think is the telos of the individual. What is the goal? Is CBT’s goal to make people happier or more productive? Do those terms differ from client to client? What if those goals are achieved and yet the counselor knows that the client is still not thinking realistically? Contrast this with Biblical Counseling which knows from our catechism that the chief end of man is to know God and enjoy Him forever. The purpose of man is not to be happy or productive, but to know God and in knowing God, become someone in whom the image of God shines forth. In so doing, a man often finds deep joy and accomplishes great things. But the order can never be reversed or the whole enterprise collapses. When my foster son was a teenager he took to sneaking out of the house at night and running away, which eventually led to the Department of Family Services taking custody over him. In one of the conversations I had with the team (consisting of three or four people) we had an argument that ended with me saying something like, “There’s a lot worse things for ______ than winding up in jail” to shocked faces. Their goal was to cajole him into obeying the rules long enough for him to age out while my goal was for him to learn that actions had consequences, which I considered a step towards some change in his character. Telos makes a difference.

After some research and some pondering, I get how CBT was helpful in Greg’s life. There is enough light in this world to tell the difference between imaginary and reality. There are enough God given faculties within the human soul to do the hard work of challenging our own conclusions and improving our mental processes. What it is missing in CBT is transcendental truth, a clear vision of humanity as made in the image of God with all the moral responsibilities that entails, and we could add to that the Biblical Counselor’s confidences in the redeeming work of Christ, the community of believers, etc… I also wonder how long CBT can endure without being co-opted by the medical model or the politics of progressivism. Still, I can say I am honestly happy for Greg and honestly happy that even little “T” truth is being utilized in counseling. Once the door of truth is cracked open, we can only hope Who might come walking through.

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