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Pastoral Psychology ISSN 0031-2789 Pastoral PsycholDOI 10.1007/s11089-013-0588-7

Cognitive Therapy and the Punctual Self:Using an Ascetical Framework to CritiqueApproaches to Psychotherapy

Joseph A. Stewart-Sicking

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Cognitive Therapy and the Punctual Self:Using an Ascetical Framework to Critique Approachesto Psychotherapy

Joseph A. Stewart-Sicking

# Springer Science+Business Media New York 2013

Abstract Theological examinations of counseling and psychotherapy have typically focusedon theory rather than practice. The current study takes a different perspective by studying theimplications of cognitive behavioral therapy interventions through the lens of MichelFoucault’s framework of technologies of the self. In this analysis, the fundamental exercisesof care for the self in Beck’s cognitive therapy are identified along with the characteristics ofthe self that these exercises presume. The results of this analysis show a close correspondencebetween cognitive behavioral therapy (CBT) and the punctual self identified by Charles Taylorin his studies of modernity. Three aspects of CBT—distancing reflection, thought replacement,and self-mathesis— are identified as potential barriers to integrating spirituality through thistherapy, thus pinpointing the practices that lead to the criticisms of perfectionism and natural-ism that theoretical studies have identified. These results suggest the utility of a practice-centered approach to critiquing psychotherapy and also call for more research using socialscience methods to determine how to implement these critiques in practice.

Keywords Cognitive therapy. Asceticism . Selfhood . Theories of psychotherapy . Foucault

Introduction

As interest in the clinical integration of spirituality and religion into counseling has increasedin the past decade, there have been explorations from a variety of perspectives of the moral andethical issues such integration raises (e.g., Browning & Cooper 2004; Butman & Jones 1991;McMinn, 1991; Richards & Bergin 2005). Given this history, it might seem that the valueimplications of counseling and psychotherapy have been well investigated. However, animportant pattern emerges upon examining these studies that suggests that this may not bethe case. These projects share a common standpoint from which to view the intersection ofcounseling and values: articulating the assumptions behind counseling theory and comparing

Pastoral PsycholDOI 10.1007/s11089-013-0588-7

J. A. Stewart-Sicking (*)Department of Pastoral Counseling, Loyola University Maryland, 8890 McGaw Rd., Columbia,MD 21045, USAe-mail: jastewartsicking@loyola.edu

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these (for enrichment, dialogue, or critique) with the fundamental assumptions of differentworldviews, e.g., theism or Christian theology.

As fruitful as this theoretical focus has been, it tends to elide a key distinction betweenmorals and ethics made by such philosophers as Paul Ricœur. Ricœur (1992) differentiatedbetween morals, which are stated as norms, and ethics, which is the aim to which one aspiresthrough the practice of one’s life. Ricœur (1992) considered ethics to be primary in practice;while ethical aims are sifted through norms in practical reasoning, the norm takes recourse tothe ethical aim at impasses. Theory shapes practice, but practice changes the very conditionsthrough which we understand theory. In making a distinction between ethics and morals,Ricœur suggests that the more interesting subject of inquiry is not concrete rules, but the aimstowards which the practice of one’s life points. This conclusion shows a blind spot in existingstudies of counseling theories, which tend to focus on assumptions, principles, and deontologymuch more than virtues, practices, and ethical aims. This study hopes to show the promise ofan ethics-centered approach through examining the ways in which counseling interventionscan shape the kind of happiness and selfhood one pursues.

A framework for understanding counseling practices

To uncover the ways in which counseling practice can be a kind of ethics of self-construction,we need a method that highlights the ways in which the actual practice of counseling andpsychotherapy can be studied and its ethics uncovered. The ethical writings of MichelFoucault, who shares Ricœur’s distinction between ethics and morals, provide such a tool.Foucault’s work allows us to see how the practices of psychotherapy can impact the veryconstitution of the self.

Foucault (1988) outlined a fourfold structure to ethical consideration that can be applied toany field of practice: the ethical substance, the mode of subjectivation, ethical work, and the telosof ethics. Each one can contribute to helping understand the ethical implications of psychother-apy, though only two will be addressed in this study: ethical substance and ethical work.

The ethical substance emerges from an individual’s “will to truth” and is “the way that theindividual has to constitute this or that part of himself as the prime material of his moralconduct” (Foucault 1988, p. 26). Ethical selves are comprised of specific parts that each personacts upon, and the ethical substance is that part of one’s self that is identified as needingattention in order to act in a moral manner. While the ethical substance emerges from one’sown reflection, it is shaped by the circle of moral theory and ethical practice and is thereforedependent upon cultural, historical, and power- and politically related factors. While amedieval Christian might see the ethical substance as lying in a will bent by concupiscencein need of the sacramental grace of being shriven, a modern American might see one’s regimesof diet and exercise as the locus of the ethical substance.

Ethical work is “the work one performs on oneself, not only in order to bring one’s conductinto compliance with a given rule, but to attempt to transform oneself into the ethical subject ofone’s behavior” (Foucault 1988, p. 27). Ethical work is the process of self-transformationleading to the ideal way of life, making one’s thought incarnate. Foucault (1988) noted that thisprocess takes many different forms: long-term training with consistent improvement, suddenand definitive conversion, or long-term combat with marked ups and downs.

Foucault’s categories pose important questions for examining psychotherapy: What ethicalsubstances does psychotherapy encourage clients (and therapists) to act upon? And what ethicalwork does psychotherapy encourage clients to undertake for self-transformation? To answer thesequestions, we can learn from the example of Foucault’s own methods for studying asceticism.

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Technologies of selfhood

In his late work, Foucault increasingly turned towards the concept of asceticism, broadlyconsidered as “models proposed for setting up and developing relationships with the self, forself-reflection, self-knowledge, self-examination, for the decipherment of the self by oneself, forthe transformations that one seeks to accomplish with oneself as object” (Foucault 1988, p. 29).But Foucault approached asceticism from a unique angle.WhereMaxWeber once asked, “If onewants to behave rationally and regulate one’s action according to true principles, what part ofone’s self should one renounce? What is the ascetic price of reason?” Foucault replied, “I haveposed the opposite question: How have certain kinds of interdictions required the price of certainkinds of knowledge about oneself? What must one know about oneself in order to be willing torenounce anything?” (Foucault 1988, p. 224). Foucault was interested not in the “ascetic price ofreason” but in the knowledge price of asceticism. Thus, his work on asceticism explored howtechniques used for transforming the self require certain models of the self in order to work, or, inthe framework described above, how ethical substance and ethical work are interrelated.

Foucault took this broad sense of asceticism and worked it into his own theory of“technologies” (Foucault 1994). Technologies of the self constitute a regime for knowing,mastering, and transforming one’s self, and they can take on different functions: critical/unlearning, struggling, and therapy/healing (Foucault 1994, p. 97). While this definitionmay seem unnecessarily abstract, it is able to include a wide variety of activities such as thoseidentified by Pierre Hadot (1995), upon whose work Foucault built: research, thoroughinvestigation, reading, listening, attention, self-mastery, indifference to indifferent things,meditations, remembrance of good things, and accomplishment of duties. As can be seen inthis list, the traditional disciplines of Jewish and Christian spirituality (e.g., meditations,accomplishment of duties), the activities of ancient philosophy (e.g., attention, thoroughinvestigation), and even the practices of modern psychotherapy (e.g., indifference to indifferentthings, listening) can all be brought under the same banner in this construct. In fact, Foucaulthimself noted that while his studies had focused on sexual technologies of the self, one couldalso focus on “pedagogy, behavior counseling, spiritual direction, the prescription of modelsfor living, and so on” (Foucault 1994 p. 88).

Through technologies of the self, Foucault seems to argue that one has almost infinite freedomto deconstruct and reconstruct one’s self and that the selves one creates are protean and elusive. Yet,in becoming an ethical subject, one foregoes some of these selves in order to pay the knowledgeprice of one’s asceticism. Likewise, new practices lead to new experiences of selfhood (Foucault1994, p. 252). Thus, to understand technologies of the self is to understand the selves theyconstitute and thus the ethical implications of these practices, and in applying Foucault’s analyticstrategies to those technologies we identify in psychotherapy, we can see its knowledge cost.

Foucault’s techniques for uncovering the ethical implications of technologies of the self arescattered across his studies of Greco-Roman and Christian asceticism. In general, the questionshe poses to the technologies follow the fourfold structure of his ethics. While investigations ofpsychotherapy according to all four dimensions of Foucault’s ethics are profitable, this studyattempts to demonstrate the efficacy of this approach through examining the ethical substanceand ethical work involved. From Foucault’s studies, the following questions emerge:

Questions addressing ethical work:

& Of what does the care of the self consist? (Foucault 1994, p. 230)& What are the models proposed for setting up and developing relationships with the self for

self-reflection, self-knowledge, and self-examination, for the decipherment of the self by

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oneself, for the transformations that one seeks to accomplish with oneself as object?(Foucault 1988, p. 29)

Questions addressing ethical substance:

& What is the self? (Foucault 1994, p. 230)& What fields are singled out for attention and highlighted in the discourses surrounding the

technology? (Foucault 1988, p. 249)& How were the experiences that one may have of oneself and the knowledge that one forms

of oneself organized according to certain schemes? (Foucault 1994, p. 87)

Having plunged into the technical details of Foucault’s ethics and his concept of technol-ogies of the self, it is worth recalling the purpose of this excursus. I have argued thattheological examinations of psychotherapy have tended to focus on the moral implicationsof counseling theory to the exclusion of examining the ethical implications of counselingpractice. In light of Foucault’s discussion of technologies of the self, I would like to suggestfurther that a profitable way to investigate the ethical implications of counseling practice is toexamine counseling interventions through the lens of technologies of the self and thus discoverthe selves they create and the ways they suggest that one transform one’s self.

To test the utility of Foucault’s methods for examining technologies of selfhood inunderstanding the ethical implications of counseling interventions, it is helpful to begin withthat school of therapy where the links with the ancient philosophical exercises Foucault studiedare the strongest, which is cognitive behavioral therapy (CBT) (Leahy 1996).

Thinking makes things so: cognitive behavioral therapy

At its core, CBT derives from a single insight, best summarized in an aphorism fromShakespeare’s Hamlet: “there is nothing either good or bad but thinking makes it so” (Hamlet,act 2, scene 2). In focusing on thinking as the path to health, CBT takes its place in a long lineof philosophical reflection and practice rooted in the contention that “reality is determined bycognition” (Leahy 1996, p. 10). As I will show, in focusing on the relationship betweencognition and reality, CBT practices cultivate a particular brand of modern empiricism andtherefore constructs a particular kind of self.

Although I have been talking about “cognitive behavioral therapy,” CBT is in reality afamily of related therapies defined by three core commitments (Dobson & Dozois 2001):Cognitive activity affects behavior, cognitive activity may be monitored and altered, anddesired behavior change may be affected through cognitive change.

In stressing the role of thinking in change, CBT reflects the dissatisfaction of its founderswith strictly behavioral theories. As models of cognition advanced in the mid-20th century andsocial cognitive models of personality arose (Sharf 2008), a new and distinct form ofpsychotherapy emerged in the work of psychotherapists such as Arnold Lazarus, DonaldMeichenbaum, Albert Ellis, and Aaron Beck. Given this panoply of approaches, it is importantto single out one form of CBT to act as my test case. For the purposes of this study, I will focuson the cognitive therapy (CT) of Aaron Beck.1 While any of the other therapies is just assuitable for analysis, CT makes for a good test case because it straddles a middle ground

1 In the second edition of her introductory text, Judith Beck changes the name by which she refers to thisapproach to “cognitive behavior therapy” to match contemporary parlance. To avoid confusion with the broaderfamily of therapies, I have retained the older name in discussing the Becks’ approach.

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between Albert Ellis’s rational-emotive behavior therapy (REBT)—marked by its creator’sfocus on logic, strident atheism, and relentless positivism (though open in his indebtedness toStoicism)—and other forms of CBT (such as Lazarus’s multimodal therapy or Meichenbaum’ssystematic desensitization) that are less interested in rational argument and more interested inmeasurement and behavioral interventions.

As formulated in such landmark works as Beck’s own Cognitive Therapy of Depression(1979) and his daughter Judith Beck’s Cognitive Behavior Therapy: Basics and Beyond (Beck2011), CT makes several key assumptions (see Beck 1979, 2011; DeRubeis et al. 2001):

& Therapy can change emotion through changing beliefs. Thus, therapy should be based onever-evolving formulation of client problems in terms of thoughts and beliefs.

& Distortions in cognitive processing of information are responsible for dysfunctionalemotions and behaviors; in order to understand the nature of an emotion or disturbance,we must focus on the cognitions that accompany one’s reaction to an upsetting event.

& Therapy relies on a sound therapeutic alliance (variously defined).& Clients are experts on their own inner worlds; it is the therapist’s job to enter that world.& Collaboration and active participation by the client is essential for therapy to work.& Therapy should be goal oriented, problem focused, and time limited.& Therapy works best focusing on the present.& Therapy should be educative and empowering, emphasizing relapse prevention.

Based upon these assumptions, CT develops some concepts (see Beck 2011) that areimportant to master so that we can investigate CT’s practices more fruitfully: Activating eventselicit automatic thoughts rooted in deeper beliefs, which in turn lead to reactions in emotions,physiology, and behavior. Automatic beliefs are the focus of much of CT. However, it is notenough to work with changing automatic thoughts. All of us have deeper core assumptionsabout ourselves, others, and the world that group together into intermediate beliefs, usuallytaking the form: “If ___, then ___.” Underlying these are core beliefs coming from earlychildhood experiences. In any given situation, the automatic thoughts we have are rooted inthese deeper intermediate and core beliefs. However, the automatic thoughts are what surface.Automatic thoughts can be either functional ordysfunctional.Dysfunctional automatic thoughtscome from cognitive distortions or thinking errors that exhibit faulty logic. The goal of CT is toget clients to identify cognitive distortions and replace these with new thinking patterns.

In contrast to Albert Ellis’s confrontational REBT, CT stresses a collaborative, empatheticrelationship. Moreover, unlike REBT, practitioners of CT do not assume a priori that somethoughts and beliefs are always upsetting; it is important to get the client’s view (Beck 2011).Nonetheless, clients are taught that some ways of thinking are illogical, even if not upsetting.CT practitioners try to engage client’s cognitive distortions through guided discovery (Beck2011), not giving answers but leading the client through an exploration of the consequences ofthese beliefs, testing the beliefs, and brainstorming new beliefs through a series of carefullystructured sessions.

To help clients change their thinking patterns, CT uses a variety of techniques frombehavioral and cognitive psychology, all of which meet Foucault’s description of technologiesof the self, those exercises that “permit individuals to effect by their own means, or with thehelp of others, a certain number of operations on their own bodies and souls, thoughts,conduct, and way of being, so as to transform themselves in order to attain a certain state ofhappiness, purity, wisdom, perfection, or immortality” (Foucault 1994 p. 225). The mostcharacteristic constellation of technologies used in CT is captured in the dysfunctional thoughtrecord.When used, the DTR requires the client to monitor his or her thoughts daily and, whenupsetting thoughts arise, record them along with the emotion, rate their believability, test them

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through questioning, find gaps in their logic, and then replace them with adaptive thoughts thatare also rated. When used, the log can be the basis for each week’s therapy session. Throughthis admittedly cursory overview of CT, we now have the basic vocabulary and gestalt in placefor delving more deeply into CT practices.

Cognitive therapy and technologies of the self

Cognitive therapy is meant to give clients tools to monitor and change their thoughts and thusbecome free of crippling anxiety, depression, substance abuse, or worry. As mentioned earlier,this regime bears striking similarity to Foucault’s description of technologies of the self, withone notable divergence. Whereas Foucault’s definition states that the purpose of technologiesof the self is to “attain a certain state of happiness, purity, wisdom, perfection, or immortality”(Foucault 1994, p. 225), CT would have a difficult time endorsing the goals of purity,perfection, or immortality. We inhabit a different age than did the ancient Stoics and Epicu-reans. This is a change that should be noted. Nonetheless, the earlier outline of Foucauldianethics helps us to explore in detail the implications of cognitive therapy’s technologies ofselfhood.

Ethical work

What is the ethical work undertaken in CT? Drawing on Foucault’s categories, ethical workconsists of those technologies whereby one makes oneself into that which one would like tobecome. It is the active care of the self, along with those models that allow one to know,examine, and transform oneself. Compared to some other schools of psychotherapy (e.g.,Rogerian or psychoanalytic), CT is replete with techniques for self-mastery, and while otherpsychotherapies rely heavily on counselor-focused techniques, CT puts the toolbox in clients’hands.

The vast majority of techniques are cognitive and empiricist in nature, and many of themare united through an emphasis on measurement and empirical testing. This is the case fromthe very beginning of therapy. In the first session, therapists should assist clients in formulatinggoals for therapy that are able to be expressed in concrete, measurable, behavioral terms (Beck2011). Goals like “stop being so anxious” should be focused and made falsifiable andobservable. For example, “When I start to feel a panic attack coming on, I will be able toidentify and change my thoughts and prevent it from escalating 9 out of 10 times.” Therapistsmay even use concrete measures such as the Beck Depression Inventory (Beck, A. T. 1979) toset a goal for the level of depression clients will be experiencing at the time they complete theircourse of therapy. Everyone involved will have concrete evidence that the goal has beenaccomplished. Goals like “become holier and more open to God’s love in my life” would beseen as inappropriate and even meaningless in the context of therapy. One could perhapsoperationalize activities that give observable evidence of this goal, but in this case, the goalwould be a behavior—something neutral—rather than participation in holiness.

This empiricist orientation is also seen in one of the key techniques of CT: behavioralexperiments. When automatic thoughts make negative, falsifiable predictions, the client andtherapist collaboratively design an experiment that can lead to an experience disconfirming thisbelief (Beck 2011). As with goal establishment, the outcome is to be concrete and measurable.Only such an outcome could dispel the belief.

The concrete, empirical regime of CT is crystallized in the dysfunctional thought recorddiscussed earlier. In the DTR, clients create an empirical record of their thinking, their ability to

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self-monitor, and even a rating for their success in changing their thoughts. While Beck (2011)notes that the use of formal worksheets such as the DTR should not be overemphasized whenit does not work for a client (and would reinforce cognitive distortions), the DTR in essencedistills the practices of CT into a reliable guide. This exercise is complex, and it may be helpfulto break it down into the several technologies of the self that comprise it.

The first aspect of the DTR is vigilant monitoring of thoughts that accompany distressingemotions. Beck (2011) suggests that therapists model how to do this in session. To elicitautomatic thoughts, she suggests that therapists should pay attention to non-verbal behavior,noticing any changes in affect and then getting clients to share what they were thinking at thattime, the automatic thoughts. Sometimes, the thoughts are not formulated in language, but inimages. In order for CT to work, clients must be willing to record their automatic thoughts notonly in session, but throughout the week if this is feasible; the goal is that clients becomeproficient in self-monitoring.

Once clients have identified the automatic thoughts accompanying a distressing emotion,they are to respond to it. As with the other techniquess, this is a skill acquired in the counselingsession that must be transferred to everyday life. To question automatic thoughts, Beck (2011)and others offer concrete questions for both therapist and client to ask. These questions havethe clients step back from the flow of their own thoughts to see their situations as through theeyes of a neutral third person (“What is the evidence?” “What would I tell a friend in thissituation?” “Is there an alternative explanation?”), as opposed to stepping back into the selfthat is bigger than those thoughts. They reinforce the cognitive model by showing the linkbetween thought and emotion. They move the client from rumination to action (“What should Ido?”). And most critically, they lead clients to move beyond “cognitive distortions” to seemore shades of gray, other options, and open outcomes (“What’s the worst outcome?” Thebest?” “The most realistic?”). Thus, where there is apparently one technology at work—arguing with one’s self—it is instructive to see it as a composite of five technologies:distancing reflection on the self as a third-person object, subjectivizing to the cognitive model,activation, opening to new constructions, and replacing dysfunctional thoughts with other,functional thoughts.

Beck’s (2011) advice for responding to images appears to use some of the same technol-ogies. Clients are asked to follow an image to its completion, jump ahead in time (if the imageleads to more and more obstacles), or re-imagine the ending in both realistic and magical ways.These seem to open the client to new constructions. Clients are also encouraged to envisionthemselves coping effectively, a method of distancing reflection. However, these exercises arementioned less prominently and seem not to have the power of the prior ones. Why? Imagesare not discursive. There is no list of logical answers for refuting an image. Thus, it wouldseem that the technologies of CT are incomplete without this discursive piece.

Moreover, images can’t be scaled easily, another key feature of the DTR. For eachautomatic thought, emotion, and adaptive response, the clients are to provide a numericalrating of their degree of belief or distress. Clients and therapists can then look for improvementor residual challenges, and the rating scales themselves attack the belief that all levels ofemotion or degrees of belief are equivalent. However, this rating system in effect imposes aCartesian grid over the client’s experience, allowing both client and therapist to distancethemselves further from the client as subject and replace the client with a measurable,mathematical object—a source of data. Thus, to distancing reflection must be added thistechnology: self-mathesis, in which knowledge of the self is transposed into numericalcoordinates..

CT theorists consider the DTR and behavioral experiments to be the most crucial part ofself-care, but in the case of a core belief, more is necessary. Core beliefs are deeply engrained

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beliefs resulting from early childhood learning. To uncover core beliefs, the therapist engagesin the “downward arrow technique” (J. S. Beck 2011; DeRubeis et al. 2001) by repeatedlyasking variations on “If that were true, what would it mean?” to move the client fromautomatic thoughts downward. While this may resemble psychoanalytic techniques, CT isnot seeking to interpret the signs of frustrated desires to bring the unconscious into conscious-ness, but to find more thoughts to question. Beck (2011) suggests a DTR worksheet for corebeliefs, collecting evidence, scaling the level of belief, and constructing alternate interpreta-tions of evidence that might seem to support it. Again, the client is distanced from his or herbelief and taught to reflect on it empirically from the outside. Other exercises also reinforce thetechnologies of distancing reflection, scaling, opening to new constructions, and thoughtreplacement: behavioral experiments to empirically test beliefs, constructing a cognitivecontinuum to explode dichotomous beliefs, constructing a pro-con list, using others withsimilar or different beliefs as reference point, acting “as if” one were someone else whobelieved something different, and conducting a dialogue between the “emotional” and the“intellectual” sides of themselves.

Another important technology, especially helpful with clients who have depression, is theactivity log (J. S. Beck 2011). Clients are instructed to chart their weeks with days in columnsand hours in rows, listing their activities for each hour and rating them with accomplishmentand pleasure scales created from concrete anchors in past experience. This chart taps into thetechnology of activation by encouraging clients to do activities to show up on the charts. Moreimportantly, it allows clients to turn their entire lives into mathematical data—a powerfulexpression of monitoring coupled with self-mathesis. And in fact, numbers appear again andagain in other adjunctive CT techniques; clients are instructed to create pie charts for factorscausing an event and pie charts for how they spend their time vs. how they would like to spendtheir time. All of life is monitored for data to reflect upon in a disengaged way so that one cancome up with new constructions. And these new constructions are then used as replacements,assuming that changing the surface of the stream of consciousness is key.

What then is involved in caring for and transforming one’s self through CT? Many of thetechnologies I have identified would be easily catalogued by any competent practitioner.Through CT, clients learn to monitor their emotions for distress and monitor their thoughtsfor thinking errors. CT also continually socializes clients to the benefits and logic of thecognitive model so that they retain their motivation for subjecting themselves to the practicesof therapy. CTactivates clients who are stuck in ruminations and pushes them to move towardsdifferent activities, provided they monitor and reflect on those activities. And CT providesmultiple techniques for opening clients to new constructions of their lives, primarily throughlogical argument and experimentation. To accomplish change in emotion, dysfunctionalthoughts are replaced with more functional thoughts. To this list of readily apparent technol-ogies must be added two that are more covert: CT teaches clients to reflect on themselves asmeasurable, empirical objects, and CT focuses clients on this-worldly, empirical ends, nottranscendent ones.

Ethical substance

Having explored in detail the technologies of the self employed by CT, we are now in a positionto identify its ethical substance, the self that it constructs through these practices. The best placeto begin is to follow Foucault’s prompting (1988) and identify those “fields that are singled outfor attention and highlighted in the discourses surrounding the technology” (p. 249).

As suggested by its name, cognitive therapy highlights cognitions. The self in cognitivetherapy is one that thinks—either functionally or dysfunctionally. The clients’ attention is

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drawn to monitoring their thoughts, but not just any thoughts—clients focus on those thoughtsthat can cause distress. So the CT self is one that thinks and hurts. But in examining theirthoughts, clients are encouraged to use mathematical ratings to help overlay measurementupon their thoughts and activities. The thinking, hurting self is able to be inscribed withinmathematical measures—so it can be approached as an object from the outside.

To this core are added additional facets of the self. Thoughts are automatically activated bysituations but can be responded to through logic. Automatic beliefs may be automatic, but theyrepresent deeper schemata of intermediate and core beliefs. If therapists and clients wantlasting change, they must challenge these deeper thoughts. But the way to alter these deeperthoughts is not necessarily just by giving them a voice; they must be persistently challengedand replaced through logic and experiment. In fact, all beliefs are able to be tested empirically;just as in Kelly’s famous image (cited in Dobson & Dozois 2001), the CT self is a scientist,objectively collecting and examining data and able to have correct (adaptive) knowledge if itfollows the canons of science and logic.

This empiricism of CT is characteristically modern, and it is modernism of a particular sort,described by the philosopher Charles Taylor (1989) as the “punctual self.” Taylor’s descriptionof the punctual self has many resonances with CT, and these resonances bring into brighterrelief the ethical substance of CT.

Taylor (1989) contends that the punctual self emerged during the 17th century in the workof John Locke, who idealized a “human agent who is able to remake himself by methodicaland disciplined action. . . . What this calls for is the ability to take an instrumental stance toone’s given properties, desires, inclinations, tendencies, habits of thought and feeling, so thatthey can be worked on, doing away with some and strengthening others until one meets thedesired specifications” (pp. 159–160). The punctual self is exactly that self in which onetakes an instrumental stance towards one’s self as an object, just as the client does in CT.Taylor (1989) noted that the punctual self relies on the Cartesian concept of disengagedreason and its ability to objectify and mechanize the natural domain, now reduced to resextensa, an inert material devoid of purposes. Neutral, mechanical science means that natureno longer sets norms for us out of its own teloi. In Locke, this attitude towards nature istaken towards one’s self. One disengages oneself from one’s self through a radical reflexivity,stepping out of normal experience to “fix our subjectivity and deprive it of its power” (Taylor1989, p. 162).

To illustrate the punctual self, Taylor (1989) gave the example of how we might process anirritating aunt: “You tell yourself that you’re overreacting . . . to a perfectly normal way ofbeing. You try to strangle the reaction by treating it as just a reaction, not a valid perception ofannoying features” (p. 164). This is quite different from engaged exploration; the disengagedself sees the world as something from which to detach itself in order to control, not somethingto be contemplated in order to understand. Locke discards the notion of innate ideas and thusremoves any teleological view of human nature, disassembling all in order to re-build a well-founded empirical picture of reality (Taylor 1989). Thus, in Locke we have a radicallydisengaged, punctual self that has no extension or depth; it is just the point from which self-fixing comes.

By making the self a measurable, flat, empirical object of reflection, CT embodies Locke’spunctual self almost perfectly. The various other technologies of CT, such as monitoring,activation, socialization, creating new constructions, and thought replacement, all interact withthe technologies of distancing reflection and mathesis. Thus, CT provides a sense that clientsare eminently transformable through logic and empirical testing and that, in the end, clients arenot their thoughts, emotions, or experiences (those are all neutral clay to be molded), but theyhave the ability to fix and shape those things.

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The implications of CT’s ethical work and ethical substance

To comprehend the significance of this type of selfhood and its impact on psychotherapy, it ishelpful to contrast CT with exercises, ancient and contemporary, that share similar technolo-gies of selfhood but leave greater openness to depth, fullness, and the transcendent. In doingso, several features emerge.

For instance, where the punctual self of CT treats thoughts as raw material for shaping in aperson’s body and mind, a very different significance was given thoughts under ancientphilosophy. In Stoicism, practices were meant to help practitioners discern and order them-selves to be in line with an objective, transcendent Logos ordering the cosmos (Hadot 1995).The punctual self has nothing to align, and there is no pre-existing, non-empirical order withwhich to align its objects. There are no higher purposes for what we are to be, no end goals thatdraw us forward—or if there are, that is not a subject that can be discussed. Therefore, thetechnologies of CT lead towards utilitarianism and instrumental reason.

If CT’s punctual self is rather silent on the ultimate purpose of humanity, then it is morevocal about human ability. As Taylor noted (1989), the punctual self seems immanentlyperfectible. And an identical criticism has been made of CT’s theory: it relies on theassumption that human beings are capable of correcting faulty thinking when we see it(Browning & Cooper 2004). Raw material does not need any supernatural help to reachnatural ends. In Foucauldian terms, the belief price of CT is perfectionism—but since there isno transcendent goal to which one should aspire, perfectionism is a problematic concept. Italso puts the responsibility for any failure on the shoulders of the client.

In its practices of thought replacement and self-mathesis, the punctual self of CT is equallysunny about human knowledge. In contrast to Freud’s (1949) contention that the mostimportant processes that determine human behavior hide themselves from us under a massof defenses, CT techniques such as the downward arrow and thinking logs suggest that all thatis important about the client is observable at the surface and that this knowledge can be gainedempirically through disinterested observation.

Moreover, the mode of self-knowledge in CT is particularly mathematical and disengaged.The process of self-mathesis replaces considerations of time with those of space, making thestories of concrete, embodied persons fade into the background (Pickstock 1998). This type ofscaling of all existence tends to flatten and reduce it into its surface elements. And in walkingthrough CT, one gets the feeling that if this were the entirety of one’s perception of one’s life, itwould be flat, atemporal, meaningless. Even if this criticism seems to make too fine a point,undoubtedly the mathesis central to CT reflects a privileging of measurement over form, truthover beauty, logic over intuition, disengagement over care, mind over body, space over time,individual achievement over relationship—the list could continue. Quite simply, CT practicereflects all of the virtues and vices of high modernity.

A telling contrast to the punctual self can be seen in those emerging approaches topsychotherapy that draw on Buddhism. For instance, acceptance and commitment therapy(ACT) (Hayes & Lillis 2012) argues that “deliberate attempts to control or change unwantedthoughts, feelings, memories, and sensory experiences can in fact cause more suffering in ourlives” (Chapter 4, “Control Is the Problem”). Instead, ACT borrows from mindfulnesspractices and teaches clients to defuse thoughts through being open, receptive, and nonjudg-mental as these thoughts pass through consciousness. Where CT typically sees replacement ofthoughts as the solution, ACT creates an ethical substance that is not identical to one’sthoughts.

Finally, CT has lost the spiritual category of evil. If the client is not able to recover, then theclient is simply not yet well informed or in mastery of CT techniques. For centuries, Christian

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spirituality has seen challenges in asceticism quite differently. Consider the contrast between“thinking errors” and the eight logosmoi (afflictive thoughts) of Evagrius (1972). Whereas theformer is an error in judgment, the latter is evidence of how the psyche is buffeted by forcesopposed to the good it is pursuing. Sin may be a category that is often abused, but as Taylor(2007) points out, “there is a certain dignity in sin, evil. It is a kind of search for the good, butdeviated by catastrophic, culpable error. . . . As against this, just being sick has no dignity” (p.619). It is more dignified to be foiled in pursuit of good than merely to be malfunctioning,since this failure at least has significance.

As these comparisons show, the ethical substance of CT follows the logic of the punctualself. The ethical substance is an infinitely improvable, infinitely knowable, measurable, flatobject that the punctual self may operate on through the rational functions of logic andempirical testing. And yet, for all that power, the ethical substance of CT has lost importantframes of reference; it can be deaf to the transcendent, reductive, closed to grace, and ignorantof evil. Valuing truth over beauty, space over time, and control over consent, it can configurepsychotherapy into a form that makes spirituality and religious traditions difficult to access inany form other than as a storehouse for particularly powerful logical replacement thoughts.

Conclusion

This article has claimed that focusing on the practices of psychotherapy can bring a new lightto the critical engagement of theology and psychology. What then does the preceding analysisshow us about that claim? Several elements of the critique of CT have converged withtheoretically based analyses, especially in identifying perfectionism and modern reductionism(Browning & Cooper 2004; Butman & Jones 1991). On the one hand, this is a sign of theirvalidity; on the other hand, it does not demonstrate anything new. What this study hasilluminated is the detailed ways through which the values often objected to are created andreinforced through practice. Namely, three aspects of CBT approaches—distancing reflection,thought replacement, and self-mathesis—have been identified as practices that may be inconflict with approaches that value more depth and transcendence. Future research couldattempt a similar analysis of other approaches like psychoanalysis that are not as closely linkedwith ancient philosophy.

These results also suggest that the idea of asceticism could be a useful one for integratingand comparing classic traditions of soul care with contemporary ones. If the ascetical framecould be applied in similar ways to Stoicism, Christian asceticism, Buddhist practice, yoga,psychoanalysis, and behavior therapy, it would be a key step in bringing these approaches intofruitful conversation.

In the realm of clinical practice, the findings suggest that therapists who value spiritualgrowth, coping, and exploration consider how the interventions they use, specifically thoseidentified here in CBT, can help or short-circuit these processes. However, before ruling outany technique more detailed study would be needed, especially given the immense good thatCBT has done for countless clients. Future phenomenological and even survey-based researchmight explore what “dose” of this modernist practice interferes with different kinds ofspirituality, and how this happens—if indeed it does. A large caveat must be given in relationto any critique based on academic accounts of psychotherapy: practitioners improvise, and,undoubtedly, in improvising they can subtly change the impact of their interventions (cf. deCerteau 1984). In fact, cognitive therapy is pragmatic and has developed over time to includepractices like thought acceptance (Beck 2011) that mitigate the punctual self. Therefore,critical inquiries into psychotherapy must be in conversation with social science research to

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help build the groundwork for greater and better integration of spirituality and religion intoactual clinical practice. Studying the practices and ethical aims of psychotherapy should be akey aspect of this program.

References

Beck, A. T. (1979). Cognitive therapy of depression. New York: Guilford Press.Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: Guilford Press.Browning, D. S., & Cooper, T. D. (2004). Religious thought and the modern psychologies (2nd ed.).

Minneapolis: Fortress Press.Butman, R. E., & Jones, S. L. (1991). Modern psychotherapies: A comprehensive Christian appraisal. Downers

Grove: InterVarsity Press.de Certeau, M. (1984). The practice of everyday life. Berkeley: University of California Press.DeRubeis, R. J., Tang, T. A., & Beck, A. T. (2001). Cognitive therapy. In K. S. Dobson (Ed.), Handbook of

cognitive-behavioral therapies (pp. 227–317). New York: Guilford Press.Dobson, K. S., & Dozois, D. J. A. (2001). Historical and philosophical bases of the cognitive-behavioral

therapies. In K. S. Dobson (Ed.), Handbook of cognitive-behavioral therapies (pp. 3–38). New York:Guilford Press.

Evagrius Ponticus (1972). The praktikos and chapters on prayer. (J. E. Bamberger, Trans.). Kalamazoo, MI:Cistercian Publications.

Foucault, M. (1988). The history of sexuality, vol.1: Introduction. (R. Hurley, Trans.). New York: Vintage Books.Foucault, M. (1994). Ethics: Subjectivity and truth. (P. Rabinow, Trans.). New York: W. W. Norton.Freud, S. (1949). An outline of psychoanalysis. New York: W. W. Norton.Hadot, P. (1995). Philosophy as a way of life: Spiritual exercises from Socrates to Foucault. (A. Davidson,

Trans.). Malden, MA: Blackwell.Hayes, S. C., & Lillis, J. (2012). Acceptance and commitment therapy. [Kindle version]. http://www.amazon.

com/Leahy, R. L. (1996). Cognitive therapy: Basic principles and applications. Northvale: J. Aronson.McMinn, M. R. (1991). Cognitive therapy techniques in Christian counseling. Dallas: Word Publishing.Pickstock, C. (1998). After writing: On the liturgical consummation of philosophy. Malden: Blackwell

Publishers.Richards, P. S., & Bergin, A. E. (2005). A spiritual strategy for counseling and psychotherapy (2nd ed.).

Washington, DC: American Psychological Association.Ricœur, P. (1992). Oneself as another. Chicago: University of Chicago Press.Sharf, R. S. (2008). Theories of psychotherapy and counseling: Concepts and cases (4th ed.). Belmont:

Thomson/Brooks/Cole.Taylor, C. (1989). Sources of the self: The making of the modern identity. Cambridge: Harvard University Press.Taylor, C. (2007). A secular age. Cambridge: Belknap Press of Harvard University Press.

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