View Single Post
Unread December 12th, 2005, 10:55 PM
James Pretzer James Pretzer is offline
Forum Leader
Join Date: Jun 2004
Posts: 283
Default Re: Is it important to change the client's dysfunctional cognitions?

I think ACT (and DBT) makes some good points and raises some important issues. However, I have some problems with the way in which the differences between CT and ACT are discussed by some ACTers. On several occasions when I've heard Steve Hayes speak, his comments have been framed as though (1) it is obvious that CT consists only of cognitive restructuring, (2) cognitive restructuring doesn't work, (3) therefore CT doesn't work and we should abandon it. In a recent (and very lively) debate on the Academy of Cognitive Therapy listserv, Steve made the point that we should draw a distinction between the principles of ACT and his presentation style. It may be that some of the apparent contradictions between ACT and CT are due to Steve's communication style rather than to inherent contradictions between the two approaches.

I'd argue that cognitive restructuring can reinforce cognitive fusion and collude with the client's control agenda, but that it need not do so. In fact, it seems to me that cognitive restructuring implicitly draws a distinction between the thinker and the thought and explicitly questions whether the client's thoughts/memories/images are "true". It may well be that "rational responses" may be contraindicated when the client is trying to use them to control internal experience. Certainly I wouldn't agree to an agenda of "In order to lead the life I want to lead I will have to change my feelings/body sensations through changing my thoughts first." At most, I might investigate whether helping the client change his or her thoughts is a useful way to help them achieve their goals.

If ACT's agenda is "I will put my energy into actively trying to lead the life I want to lead while accepting that certain private experiences (cognitions,affect/mood/body sensations) may or may not be present", then it has the same agenda that I have with most of my clients. I spend a lot of my time working to get clients to go ahead and do what makes sense despite aversive thoughts, feelings, or physical sensations. It's not that I've abandoned CT, it's that CT never said that humans should eliminate all unpleasant thoughts, feelings, or sensations and never said that one should control all internal experience by changing one's thoughts (or in any other way).

At the recent ABCT convention, Steve complained that CT is a "moving target" i.e. whenever he thinks that he has identified something unique about ACT, Cognitive therapists say "Oh, we do that too." Well, from what I've heard, it sounds as though Steve has had a very narrow view of CT and hasn't grasped the breadth of CT interventions. He's focused on radical acceptance more intensely than most of us have, but actually CT's been using acceptance-based interventions for a long time. He's emphasized values more than we have, but it's not as though values are something new that we never thought of before.

There may be some very useful things CT can learn from ACT but I doubt that we'll need to abandon CT.
Reply With Quote