We’re looking forward to new contributions coming soon from James Pretzer, Bill Reid, Dan Short, and other contributors this month. Check back here to see their new articles, front and center!

Personally, I’d argue that a therapist who emphasizes skill-building at the expense of the therapeutic relationship is doing CBT badly and is likely to be much less effective than he or she could be.  I can think of quite a few CBT texts that emphasize the importance of the therapeutic relationship.  For example, in Beck’s venerable Cognitive Therapy of Depression (1979), Chapter 3 is on the therapeutic relationship in Cognitive Therapy.  It discusses the importance of warmth, accurate empathy, genuineness, trust, rapport, the importance of a collaborative relationship, and briefly discusses transference and counter-transference.  I can’t think of any texts on CBT that say that the therapeutic relationship is unimportant.

In a recent discussion of myths about CBT in the Huffington Post, Judy Beck says “CBT requires a good therapeutic relationship. Therapists do many things to build a strong alliance. For example, they work collaboratively with clients (making joint decisions such as how to spend the therapy hour), ask for feedback (“What did you think of the session? Anything you want to do differently next time?”), and conduct themselves as genuine, warm, empathic, interested, caring human beings. They also work hard to reduce patients’ suffering as quickly as possible. Interestingly, research shows that the alliance becomes significantly strengthened when clients see that their therapist is helpful, that is, when clients see themselves solving their problems and feeling better (http://www.huffingtonpost.com/judith-s-beck-phd/cognitive-behavior-therap_b_638396.html).”

If it is true that CBT emphasizes the importance of the therapeutic relationship, where does the idea that it doesn’t emphasize or value the therapeutic relationship come from?  There are several possibilities:

1. Sometimes this assertion is made by critics who actually know little about CBT and who are basing this comment on their preconceptions about CBT.
2. Some presentations on CBT focus solely on what is different about CBT and spend little or no time on “common factors” such as the therapeutic relationship (often because the presenter assumes that the importance of the therapeutic relationship self-evident).  This results in the presenter focusing on techniques and strategies that are unique to CBT and unfortunately the audience may get the impression that these strategies and techniques are all there is to CBT.
3. Not everyone who claims to practice CBT actually has learned CBT.  There are plenty of therapists who have read a CBT-based self-help book and now claim to do CBT.  This is equivalent to someone reading Freud’s Interpretation of Dreams and declaring that they’re now psychoanalysts.  Therapists who have simply read a manual or two may do therapy “by the book” with little attention to the therapeutic relationship.  However, this isn’t because CBT doesn’t value the therapeutic relationship, it is because those therapists don’t know how to do CBT well.
4. Not everyone who teaches CBT teaches CBT well.  Arnold Lazarus has suggested in the March 2013 edition to the Behavior Therapist that some grad schools are currently teaching structured treatment protocols without teaching the concepts, theory, and principles that are needed to practice CBT well.  Again, this isn’t a shortcoming of CBT, it is poor teaching.
5. Many works about CBT focus on how to treat one particular problem and the therapeutic relationship is one small part of the discussion.  Unfortunately, some readers overlook the importance of the therapeutic relationship as a foundation for effective intervention.

Quite a bit has been written on this topic but for concise discussions see the summary of an excellent article by Jesse Wright and Denise Davis in the archives of this forum at http://www.behavior.net/forums/cognitive/1996/msg121.html,  a quote of Ellis comments on this topic at http://www.behavior.net/forums/cognitive/1996/msg128.html, and a summary of Larry Beutler and Benny Martin’s proposed principles of therapeutic change at http://www.behavior.net/forums/cognitive/1996/msg1034.html.

Similarly, many individuals have learned to give a privileged status to a minority of emotions, “All you need is love!” Consequently, individuals will try to permanently banish other emotions, as if they were political dissidents placed in exile, “I try never to feel jealous.” And others beat down any emotional rebellion with brutality. One person told me that after yelling at or hitting his girlfriend, he would punish himself by punching his fists into a brick wall, until they were bloody. Needless to say, that strategy worked no better than any other compulsory strategy. The reason these strategies fail is because dictatorship is a lousy form of self-governance.

So, what happens when you seek to force conformity on a group of people? And, what happens when you give a privileged class absolute power or when you seek to eliminate diversity from the population? The answer is that it works only so long as repression can be kept in place, as illustrated by North Korea. But when something happens to end the repression, such as with the Arab Spring, the result is massive uprisings and interruptions in governance. (Notice, the term “repression” has duel meanings. It describes a limitation of awareness that can occur in large societies or at a psychological level.) Similarly, anytime a person attempts dictatorial control over his or her emotions, some form of repression or denial is required.

In contrast, when self-governance is conducted as a democracy, there is freedom of choice. Accordingly, there is also freedom of expression, tolerance for diversity, and fair and equal representation. This allows for greater integration both within the brain and throughout the body, as emotions, thoughts, and behaviors stimulate one another.

As most of us know, behavior, thought or emotion can be used to regulate and check the other (i.e., behavior modification, CBT, and emotional process work). However, I have special interest in emotions because they seem to both precede and motivate the other two. In other words, when a person feels angry, he will have angry thoughts and angry behavior. When a person feels happy, he will have an entirely different set of thoughts and behaviors at his disposal. Thus, when a person chooses a particular emotion, he or she is also choosing a corresponding set of thoughts and behaviors.

Using the analogy of a democracy, we assume that the leader currently in power has been voted into office by the majority. Though I doubt that our emotions vote on one another, individuals do have the ability to reflect on events that have occurred in the past, speculate on events that have yet to occur, and become mindful of experiences as they occur. If all three of these branches are controlled by the same emotion, nothing new will emerge. However, if a person feels angry when something occurs, but later looks back and feels guilty for how he reacted, and then speculates on how helpful it would be to feel greater compassion in the future; the result is an expansion of experience and an increased capacity for self-determination.

When I was a 12 year-old boy, I saw something that really stuck in my mind. There was a beautiful collie dog locked inside a fence. I wanted to pet him, but the owner warned me not to open the gate, “He will run away and we will never get him back.” The dog looked friendly, but he was jumping up in the air and running back and forth in a wild manner. Later, I found myself walking in the alley with an elderly woman and her small dog. The dog was not on a leash. He did not need to be. He came whenever she called and sat when asked to sit. It was then that I recognized the irony, “The ability to follow rules really does lead to increased freedom!” Now as an educated psychologist, I have modified that idea so that it can apply to emotions, “Effective self-governance leads to greater emotional freedom, in which the range of available thoughts and actions is greatly expanded.” When a person learns how to establish a psychological democracy, there is greater freedom of expression, situational fluidity, and an increased capacity for self-determination.

The natural reaction to a problematic emotion, such as anger, is to try and control it through suppression. Most make a conscious decision to never again get so angry, repeatedly. Though the strategy may work for a short while, there is always a blowup, followed by increased self-loathing or desperate attempts at ego preservation using denial and blame. The person might say to himself, “I would not have this problem if you would not make me so angry.”

Even therapists make the mistake of attempting to suppress the client’s anger, teaching new ways of thinking, so that anger is not aroused. Many clinicians turn to CBT techniques based on the false assumption that anger is postcognitive. However, as those who struggle with anger will tell you, in most cases, anger takes control before there is time to think. That is why emotions must be transformed using new emotional energy, rather than relying on cognition.

Lasting transformations are achieved when there is a slight shift in emphasis, from emotional contraction to emotional expansion. In other words, rather than seeking not to feel a certain emotion, it is important to learn how to proactively select which emotions to seek. This adjustment will impact both the behaviors and the thoughts that the person can access. Even more importantly, there are key emotions which tend to balance or even exclude feelings of rage and anger. When proficiency is acquired in these new emotions, the changes in the client seem almost miraculous.

To the best of my knowledge, the three most import emotions for an angry-raging person to practice are remorse, compassion, and forgiveness. Some individuals come to therapy knowing only two emotional states: anger and triumph. I have found that even those who seek to suppress all emotions occasionally explode with these two. Other individuals, who have a larger emotional repertoire, may feel compassion or remorse on occasion, but it occurs at random, without the benefit of intent.

When I am seeking to teach a new feeling state, often I am asked, “But how do I start to feel that way?” The short answer is, “You make a conscious choice. You decide in advance to have a new emotional reaction.” The longer answer is that this requires practice and help, from someone who is more emotionally fluid. Another strategy that is helpful is to know what thoughts to think while attempting to summon a particular emotion.

One thought that seems to help generate remorse is, “I made a mistake when I …” A thought that seems to summon compassion is, “The other person probably felt …” And for forgiveness, ideas such as, “I would like to make things better by …” can really help. If this sounds like cognitive therapy, it should be noted that there is another important shift in emphasis. Rather than assuming one only has the power to choose thoughts, the act of self-determination is expanded to the idea that one has the responsibility to choose his or her emotions as well. Rather than not feeling anger, the individual decides to balance anger with feelings of remorse, and compassion, and forgiveness.

One last point, if you are an angry individual, and you are wondering how you are going to be able to feel more compassion for others, know that it will not happen until you learn to feel the same compassion for yourself. Similarly, you will not be good at forgiving others until you learn to forgive yourself (which means you have to first get honest with yourself about the mistakes you have made and how those mistake have effected others). The road to happy relations with others is a circle rather than a line. What we send out to others, comes back to us. And, what we create within ourselves ultimately determines what we have available to share with others.

As a thought experiment, imagine walking across a 6” wide plank that is lying on the ground. No problem. Now imagine walking across the same plank 20 stories up in the air. There is a big difference, but why? The person who developed this thought experiment was Émile Coué, a French apothecary, hypnotist, and discoverer of what is now known as the “placebo effect.”  According to Coué, “…every time the WILL and the IMAGINATION come in conflict, not only can we not do that which we wish, but we do precisely the contrary.” (Coué, 1923: 63). The more a person imagines falling, the more difficult it becomes to stay balanced. Similarly, the more a person imagines that he will forget to remember something important, the more likely that he or she will forget. The more a person imagines failing at dating, the more difficult it is to get someone to ask you out. The list of ways in which a person can become his own worst enemy is endless. Of course, most of this is driven by fear, and whenever fear begins to dominate the imagination, problems with basic functioning begin to occur. Even something as simple as breathing, or swallowing food, can become horribly impaired by imagining the worst.

One person who certainly appreciated that power of imagination was Charles Dickens. Most are familiar with how Dickens used the concept of imagination to transform unforgettable characters such as Ebenezer Scrooge,  “I have but to swallow this, and be for the rest of my days persecuted by a legion of goblins, all of my own creation. Humbug, I tell you; humbug!’‘ But what is lesser known is how intentional Dickens was in mesmerizing his readers. As a student of John Elliotson, Dickens practiced the art of “magnetizing” or hypnotizing subjects. By 1841, he demonstrated his considerable ability in both public and private arenas.

Dickens must have known that magnets were not needed for magnetizing subjects because, 50 years prior, King Louis XIV assembled the world’s most accomplished academicians, which included Benjamin Franklin, the chemist Lavoisier, and the physician Guillotine, to determine the validity of “animal magnetism.” The conclusion of the Royal Commission was, “…The imagination of sick people has unquestionably a very frequent and large share in the cure of their diseases…Hope is an essential constituent of human life; the man that yields us one contributes to restore to us the other.”  This event would later come to be known as the world’s first documented psychology experiment.  To this day, research continues to support the finding that hypnosis achieves its results by means of hope and positive expectation. Authors such Irving Kirsch  and myself have written books explaining how suggestive therapeutics create hope and thereby achieve extraordinary outcomes. Equally fascinating, new research shows that the structure of the brain can be physically altered by imagining the performance of specific activities, such as playing piano.

As a funny coincidence, just tonight at an Asian-fusion cafe,  I got a fortune cookie with the following message, “Your imagination is important in the next month. Act on your good ideas.”  This is sage advice, but absolute foolishness to limit it to a single month.

When a person comes to my office troubled by nightmares, the first thing I do is offer hope, “There is a solution for this problem!” Then the reoccurring nightmare is abolished with a single set of instructions, “Go to sleep tonight no longer fearful of this nightmare. When it occurs, you will have a great opportunity to use this cure. You are likely to awaken from your nightmare at the moment when the most awful thing that could happen is happening. While still awake, start to daydream a positive ending for your dream. If someone precious has died, then imagine a way to bring him back to life. If someone is chasing you, imagine that you run directly into the arms of a loving and powerful ally. Allow yourself to drift back into sleep with your new, more pleasurable outcomes, circulating through your mind.” This technique is not so different from solution focused therapy and the use of the miracle question, “Imagine what would be different about you or your life if you awoke to find that during the night a miracle had occurred and your greatest problems had been resolved!” This is the intentional use of imagination.

So the next time you find yourself feeling fearful of what might happen, set aside some time to meditate, pray, or spend time talking with an optimistic friend about all the good that is yet to come. Take a lesson from Ebenezer Scrooge and dream the life that you want to live.

Fear is to be Feared

Where my experimentation lacked in scientific rigor, I tried to make up for with sheer numbers.  In addition to my pool of 13 million subjects, I compiled a list of 723 emotional terms. I did not want anything to get left out. From that list, only 20 had a significant number of hits for phrases such as, “controlled by …” or “overcome by ….” After eliminating terms that are too broad (e.g., good, bad), I found that, on average, the top ranking emotional terms registered with 15,500 hits. However, fear (once embedded in compulsory statements) registered with 182,900 hits. Thus, when compared to other emotional terms, “fear” is 12 times as likely to be used to describe an event in which a person feels controlled by emotion.

Love Conquers All, (once a person is no longer frightened)

The second highest ranking emotional term was either “love” (if you include the more ambiguous search phrase, “I felt…”) or “anger” (if you stick strictly to terms that imply a loss of control). However, both of these occurred only half as much as fear.

Can Fear Make a Person Act Insane?

Pondering the possibility that fear is more powerful than anger or love, I recalled a lecture by Steven Hassan (a leading authority on cult abduction and mind control). When asked how cult recruiters are able to convince highly intelligent, well-educated, free citizens to leave the comfort of their friends and family, in order to work like slaves for a cult leader, he responded, “It is done through fear. They intentionally create phobias in the minds of their targets. Having done so, they can make them believe anything.”  The next thought that came to mind is the global upsurge in terrorism, the preferred tool for those who lack money and military might but are still able to dramatically impact the actions of the most powerful nations on the planet. Then I thought about national elections, and the use of fear to shape people’s voting behavior. It was only four days ago that a college-educated person approached me and warned me of Obama’s “secret army,” that has been built by taking guns and ammunition out of the free market. His comment to me, “The stores do not have as many bullets as they used to. Even though I’m not sure what’s happening, we’ve got to be ready, that’s all I know!”  That seems to be the problem with fear.  It does not let you know much, beyond the fact that you are afraid.

Here is the entire schedule of courses.

CAPE COD INSTITUTE
June 17 – August 23, 2013

Rick Hanson June 17- 21
Positive Neuroplasticity: The Practical Science of Turning Good Moments into a Great Brain

Margaret Wehrenberg June 17-21
Anxiety Across the Lifespan

Edith & Charlie Seashore June 24-28
Intentional Use of Self: Strategies and Skills for Consulting, Coaching and Change

Ronald Potter-Efron June 24-28
Healing the Angry Brain: Using Neuroscience to Help Angry Clients Make Long-Lasting Changes

Natasha Prenn June 24-28
The Nuts and Bolts of AEDP: Translating Theory into Clinical Practice

Pat Ogden July 1-5
Embedded Relational Mindfulness: The Dyadic Repair of Attachment Failures and Unresolved Trauma

Dan Hughes July 1-5
Attachment-Focused Treatment for Children, Parents, and Families

Ronald Frederick July 1-5
Emotional Mindfulness, Connection, and Healing: An Integrative, Experiential Approach

Bessel van der Kolk July 8-12
Frontiers of Trauma Treatment

Bernd Schmid July 8-12
Systemic Approaches to Coaching and Organizational Consulting

Harville Hendrix July 8-12
IMAGO: A Theory and Therapy of Couplehood

Richard Schwartz July 15-19
Internal Family Systems Workshop

George McCloskey July 15-19
Child and Adolescent Learning Disabilities: A Neuropsychological Approach to Assessment & Intervention

Richard Boyatzis July 15-19
Resonant Leadership, Emotional Intelligence, and Inspiring Development in Others

Amy Weintraub July 22-26
LifeForce Yoga: Empower Your Clients to Manage Their Moods

Kathy Kram & Ilene Wasserman July 22-26
Mentoring, Coaching, and Developmental Networks: Creating and Sustaining High Quality Connections at Work

Karen Levine July 22-26
Autism Spectrum Disorders: Current Treatment Approaches Through an Affective, Relationship Based Lens

Bonnie Goldstein July 29-August 2
An Integrative Approach to Working With Our Younger Clients: Child, Adolescent, Family and Group Treatment

George McCloskey July 29-August 2
Assessment and Intervention for Child and Adolescent Executive Function Difficulties

Robert Marshak July 29-August 2
Covert Processes: Exploring the Hidden Barriers to Organizational Change

Flint Sparks August 5-9
Growing Up and Waking Up: Applied Mindfulness in Psychotherapy and Buddhist Practice

Elana Katz August 5-9
The Art and Science of Emotionally Focused Therapy: Helping Couples Create Loving/Lasting Connections

Kelly Wilson August 5-9
Acceptance and Commitment Therapy: Growing Psychological Flexibility

Jeffrey Zeig August 12-16
Advanced Techniques of Therapy

Michael Carroll August 12-16
The Mindful Leader: How Mindfulness Meditation Cultivates Natural Leadership Talents

Edward Hallowell August 12-16
Unwrapping the Gifts: A Strength-Based Approach to ADHD Across the Life Span

Elkhonon Goldberg August 19-23
Clinical Neuropsychology of Executive Dysfunction and Other Disorders

Deborah Korn August 19-23
Treating Complex Trauma: Optimal Integration of Treatment Models

Click here to register today!

Until recently, the only way to join the Academy (and be able to read the ListServ) was to become a certified cognitive therapist. Certification through the Academy requires submitting a recording of a session, a written case conceptualization, etc. Many practitioners, students and researchers are interested in joining the Academy but do not feel ready to take this step.

Now there is a new opportunity to become a General Member of the Academy. No work review is required. No case write-ups are required.

NEW GENERAL MEMBERSHIPS

1. Professional Colleague
2. Research Scientist
3. Student Affiliate

GENERAL MEMBERSHIP BENEFITS

• Access to ACT’s listserv which connects you to a community of high level cognitive behavioral therapists and experts in the field.
• Receipt of ACT’s newsletter, Advances in Cognitive Therapy
• Publisher Discounts
• Publicize training programs Advertise cognitive therapy lectures around the world
• Post job and internship listings free of charge on ACT website
• Post advertisements for clinical trials free of charge on ACT website
• Discounted rates when you apply for certification (i.e. becoming a Diplomate)

The Academy ListServ puts its members in touch, almost instantaneously, with cognitive therapists worldwide. Each year, the ListServ receives over a thousand queries, responses and extended discussions covering: clinical advice, self-help materials for consumers, theoretical questions, treatment protocols, references, assessment instruments, side effects, teaching resources, questions regarding culture and religion, and more.

FREE CBT RESOURCES
If you have not yet visited the Academy’s website, we encourage you to take a few minutes and look around. From the home page “What’s New” section to the PROFESSIONAL section, you will find great CBT resources including the RESEARCH CORNER with abstracts of recently published research, READING & RESOURCES with a wide range of cognitive therapy materials as well as the Cognitive Therapy Rating Scale and Manual, and TRAINING with information about cognitive therapy training programs and workshops around the world.

A GREAT OPPORTUNITY!
I encourage you to consider the possibilities and advantages of becoming a General Member of the Academy of Cognitive Therapy (www.AcademyOfCT.org). We invite and welcome your involvement!

Apply on line, by fax or mail. The new “General Membership” category makes it possible for more therapists, researchers and students to interact with colleagues around the world who are dedicated to increased access to evidence-based, cost-effective models of care. Join Now and immediately benefit from contact with CBT colleagues worldwide!

For details, visit the professional section of the Academy of Cognitive Therapy website (www.AcademyOfCT.org) and click on “Become a Member.”

Implications:

1. Hamilton proved how something evolved when there was no need to do so.
2. Genes are a way to achieve certain outcomes in particle physics.
3. Bianconi and Barabasi(2000) applied Bose statistics to emergent networks and found three stages. Bose-Einstein statistics allow of molecular fusing so that large numbers of bosons act as if they were one. (There may be limits to how many socialists – if they were fermions – can be put into a room. On the other hand, there is no limit to the number of socialists who can hold identical opinions. Collapse resources and the ideas of socialists, students, and females start to act like bosons! These possibilities may allow use of a different math for study of social changes…especially in regard to resources, invasions, droughts, famines, heat, radiation, poisons – conditions that also make us more vulnerable to the claims of madmen.)
4. Orphan data challenge traditional neodarwinism: monozygotic twins should compete ferociously with each other for limited parental resources. They do the opposite (Segal, 1999). Also: similarity rules mating: characteristics with greater heritability – including psychopathology – are more likely to show up in good friends and in married couples. Clusters of peculiar people emerge. Also: cooperation springs freely between all sorts of unlikely organizations. For example, my house and I push and pull each other with the seasons.
5. Individuals (weak links) are the stabilizers and guides for the swarms around them. Individualism is essential for collectivism to survive.

Possibility:

Universes fail to emerge if they do not operate according to Kuramoto’s ideas about synchrony. Or I’m mad…
References:

Barabsi, A-L. (2002). Linked: The New Science of Networks. NY: Perseus.
Bianconi, G. & Barabsi, A-L. (2000). Bose-Einstein condensation in complex networks. arXiv:cond-mat/0011224v1, 13 Nov 2000.
Bianconi, G. (2002). Quantum statistics in complex networks. arXiv:cond-mat/0206433v2, 13 Sep 2002.
Brody, J. (2008). Rebellion: Physics to Personal Will. Lincoln, NE: iUniverse.
Csermely, P. (2006). Weak Links: Stabilizers of Complex Systems from Proteins to Social Networks. NY: Springer.
Daniels, Bryan C. (2005). Synchronization of globally connected nonlinear oscillators: the rich behavior of the Kuramoto model. Physics Department: Ohio Wesleyan University, Delaware, Ohio. Demo at The Kurmato Model
Dawkins, R. (1976/1989). The Selfish Gene. New York: Oxford.
Hayek, FA. (1944/1994). The Road to Serfdom. Chicago: Univ. Chicago Press. (See also Goldberg J, 2007, Liberal Fascism: The Secret History of the American Left from Mussolini to the Politics of Meaning. NY: Doubleday.)
Kuramoto, Y. (1984/2003). Chemical Oscillations, Waves, and Turbulence. Orig: Springer. Reprint – NY: Dover.
Pinker, S. (2002). The Blank Slate: The Modern Denial of Human Nature. NY: Viking.
Segal, N. (1999). Entwined Lives: Twins and What They Tell Us About Human Behavior. NY: Dutton.
Segal, N. & Hershberger, S. (1999). Cooperation and competition in adolescent twins: Findings from a Prisoner’s Dilemma game. Evolution and Human Behavior. 20(1), 29-51.
Sober, E. & Wilson, DS. (1998). Unto Others: The Evolution and Psychology of Unselfish Behavior. Cambridge, MA: Harvard University.
Strogatz, S. (2003). Sync: The Emerging Science of Spontaneous Order. NY: Hyperion.
Wilson, EO & Hlldobler, B. (2005). Eusociality: Origin and consequences. Proceedings National Academy of Science, September 20, 102(38), 13367-13371. Published online before print September 12, 2005, PNAS 102: 13367.

James Brody, Ph.D.
Rebellion: Physics to Personal Will
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