Does CBT belittle affect?

The approach of making a point of taking the clients feelings seriously while drawing a distinction between feelings and reality is one that I like a lot. However, when you write that clients may feel ... belittled by the de-emphasis of feelings often seen with CBT, my reaction (which I have probably expressed other times in this forum) is that good CBT does not de-emphasize feelings.

First of all, a good therapeutic relationship where the client feels heard, understood, respected, and accepted is essential as a foundation for effective CBT. I cannot imagine how one could establish this kind of therapeutic relationship without attending to the client's feelings and taking them seriously.

It is true that with problems such as depression or anxiety disorders we may be working to decrease the intensity of the feelings, eliminate the feelings, or replace them with other feelings. However, this does not mean that we need to de-emphasize or minimize the clients feelings. Among other things, the clients feelings can be a valuable source of data, can be a major impediment to change (or facilitator of change), and can have a major impact on the clients quality of life.

For a less intelectual perspective on the importance of emotion in CBT, consider the impact that feelings have in your own life. Think of times when you have been angry, depressed, enthusiastic, in love, discouraged, ... Are these feelings unimportant window dressing or are they phenomena which are important to you in their own right as well as having important impacts on your cognition and behavior? When I consider how hard it is to get myself to face something I fear or to get myself to persist at a task once I feel discouraged, it reminds me how much we ask of our clients and makes it easier to understand the times when they are noncompliant.

I agree, a therapist who does not attend to feelings is overlooking an important part of the picture.

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Untitled, by Mary Deaver, 6/30/97

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