Mind matters: When I returned to Ireland in 1982 after completing a fellowship in cognitive therapy with its founder, Tim Beck, in Philadelphia, I thought his approach would never wash with the Irish.
Beck's emphasis on adaptive clear thinking would be an affront to our poetic, semi-mystical imagination. The sheer practicality of his therapy model would be regarded as simplistic and antagonistic to our cherished complex psychological conundrums.
To cap it all, this was an approach that was brazen enough to propose solutions to intractable emotional pain. Who needed that? We were a people who boasted a proud history of tragedy and misery, one that was deeply interwoven with our cultural identity and religious faith.
I was wrong. Cognitive therapy, more commonly known as cognitive behavioural therapy (CBT) - reflecting its incorporation of fundamental behaviour therapy principles - has become a household name. People may not understand exactly what the term means, but they perceive CBT to be a sensible "talk therapy" that combines insight with action.
At a very basic level, people see cognitive therapy as a means of breaking free from the grip of destructive self-defeating ways of thinking and acting in their lives. An approach that calls on their capacity for clear and compassionate thinking to help with painful emotions.
In cognitive therapy's view, a great deal of our distress results from the way we think. Whether we're depressed, anxious, angry or confused, the key factor that keeps us stuck is how we think about our predicament. Take a moment to check this for yourself next time you feel things are getting too much for you: notice how negative, self-attacking and catastrophic your thinking becomes when you start feeling upset.
These negative thinking patterns reflect how frightened you feel and they represent your current best effort to quickly restore some feeling of safety in the world. But they rarely succeed - they simply dig you into a hole deeper than the one you're trying to escape from.
No need to panic, however. You don't need to be crippled by these thoughts over and over again. It's possible to (literally) change your mind, to think about difficult parts of your life in a more liberating way, to break old habits and try a new approach to solving familiar problems. CBT is a structured collaborative approach with some tried and tested ideas for achieving this.
CBT is not without its critics. A recent comment by a leading mental health practitioner, which seriously dismissed its value to people in distress, prompted me to write this column.
For some critics, CBT is a technique-driven impersonal approach that takes little account of the importance of establishing a trustworthy relationship with the client. Undoubtedly, this can be true if the therapy is delivered by an untrained or insensitive clinician.
For other critics, it is an approach with limited appreciation of the deeper roots of some psychological problems, neglecting the extent to which some problems are buried in the unconscious mind or frozen into the tissues of the body. This criticism may sometimes have validity in the case of people with painful early traumas that do not easily heal. But it gives no credit to the considerable innovations within CBT that address deep-seated personality difficulties.
The great strength of the CBT approach has been its honesty in respect to its own limitations. Through carefully controlled research, it has always demonstrated a commitment to evaluating its own effectiveness and reporting transparently on both its achievements and its failures. Acknowledged failures with particular problems have typically led to a deepening and a refinement of the approach.
For example, reported findings in respect to the high incidence of relapse in depression have spurned the development of mindfulness-based cognitive therapy to equip this vulnerable group with different kinds of coping skills; earlier reports of failure to help people with social phobia gave rise to an entirely unique approach to this particular anxiety disorder.
Very few other models in psychotherapy have been so accountable to their users or so agile in adapting to new insights based on real-world clinical experience.
CBT is a practical, rather than simplistic, psychotherapy. The problems that continually beset us are rarely amenable to simple solutions. If they were, we would have discovered the solutions ourselves, or we would heal our mental cuts and grazes as naturally and as effortlessly as we heal the cuts and grazes our skins have suffered since toddlerhood.
Competently trained therapists, equipped with a broad understanding of the complexity of psychological problems and the wisdom to see where even small changes can make the world of difference, are required to deliver effective CBT.
Worldwide, CBT is now the most practised model of psychotherapy, and regarded by mental health systems as the best practice psychotherapy intervention for a wide range of complex psychological problems. Cognitive therapy will always have its critics, but hopefully its most rigorous critics will continue to be its most competent exponents.
Tony Bates is a clinical psychologist and director of the Msc, Cognitive Psychotherapy at TCD.
