What is the difference between Cognitive Behavioural Therapy and Humanistic Psychotherapy?

Human beings are meaning-making creatures. We are compelled to make sense of the world in which we live: compelled to order, classify and structure it in order to create meanings that will allow us to both interpret and predict our experiences. The world does not come with ready-made or fixed meanings, however. We create our own meanings via our experience of the world and our relationship with our environment.

As a small baby this is primarily a sensory experience.

I feel hungry/cold/tired, I cry, I am fed/cuddled/soothed to sleep.

And so we learn that our environment is safe, holding and reliable. As we move from small babyhood we start to use our cognition to make meanings.

I fall over, I hurt, grown-ups soothe me: I am important to them. I am loud and happy, grown-ups laugh with me: I am a loveable person.

When the environment is validating and our parenting good-enough, our sense of self develops in a cohesive way. When our environment is consistently invalidating, ambivalent or even hostile, however, this has a significant impact on the meanings we create and the way we understand and experience ourselves.

I am sad, I want a cuddle but the grown-ups consistently ignore me or get angry with me….how do I make meaning from this experience?

When our primary relational needs remain consistently unmet, we have to make a cognitive adjustment in order for the experience to make some sense. Put very simply, there is either something wrong with my caretaker or there must be something wrong with me. Very small children rarely decide that the caretaker is unreliable or unloving. This is too threatening to a small child who remains dependent on the other for their very survival. Initially, therefore, the cognitive adjustments become centred on ourselves:

I am unlovable, I am not important, I am too needy, I am too much for others

We back this up with further decisions about the world and others to create a reasonably cohesive belief system about how the world operates and our particular place in this world we have constructed. These cognitive adjustments become the framework that informs our behaviour. In transactional analysis we refer to this as the life script. We then proceed to behave in ways that will create an outcome consistent with our expectations, thereby unconsciously shaping our experiences of the world to fit within the largely unconscious script we have created. This is an on-going, dynamic, life-long process.

Working with our individual meanings is the therapist’s bread and butter. This is what we do. We work to bring our clients’ frameworks into conscious awareness and make them alive to change. Whether we are a CBT practitioner, a Humanistic therapist, a Person-Centred counsellor or a Psychoanalytic therapist: we all have the same initial focus of enabling clients to make conscious their personal meanings and bring their life script and individual cognitive adjustments into a place of awareness.

CBT, in the hands of the right practitioner, can be very useful at making these meanings explicit and opening up the potential for change. But it is limiting in a number of ways.

Firstly, many of these meanings occur before the child fully develops cognition and therefore remain the ‘unthought known’. Much of our early meaning making is held in the body as a sensorimotor process or held in the limbic system as an emotional process and is therefore very difficult to access via our cognition. Recent evidence from neuroscience confirms that most of these important attachment processes are stored in a part of the brain that is simply not accessed by cognitive therapies.

Secondly, the CBT practitioner will focus almost exclusively on changing one’s behaviour, without paying full attention to the meaning or function of that particular behaviour and it’s protective function. This becomes akin to sticking a plaster on a gaping wound, rather than enabling the wound to heal from the inside.

This is primarily because CBT is rooted in a medical model. It focuses on pathology: on the client as a dysfunctional organism which requires ‘fixing’ in order to function ‘normally’. In my experience this often serves to actually reinforce an aspect of the original pathology: there is something wrong with me, I am bad/wrong/inadequate in some way and I must change in order to be acceptable to the world. And the more we focus exclusively on changing our behaviour, the more the original pathology becomes fixed.

Humanistic therapy comes from a radically different philosophy. The Humanistic model asserts that we are essentially functional organisms and that our defensive processes represent a healthy choice given the early environment we experienced. The Humanistic practitioner will seek to engage fully with the client’s frame of reference, including their deeply rooted affect, in order to permit/facilitate the client to move into a place of autonomy. Humanistic therapy is a collaborative inquiry, where the client is the expert on his or her own experience and the therapist is the expert on the theory only.

Change is still important, of course. We come to therapy because we require something in our lives to be different. And herein lies the greatest paradox of a process filled with paradoxes – that change really only occurs when we fully accept who we are. When we stop trying to change, our defences start to shift their ground and we find we can reach our potential.

In the words of Beisser,

change occurs when we become who we are, not when we try to become who we are not…..

This entry was posted on Tuesday, June 23rd, 2009 at 9:12 pm and is filed under Humanistic therapy, Psychotherapy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

Leave a comment....