Is Cognitive Therapy Ill-Founded? A Commentary on Lyddon and Weill
Clark, David A., Journal of Cognitive Psychotherapy
Lyddon and Weill (in this issue) have concluded that constructivism is preferred over standard cognitive theory and therapy because the latter is based on postmodern assumptions about knowledge, reality and the self. They argue that the postmodern basis of constructivism enables it to address criticisms that social constructivism, feminism and multiculturalism have raised with cognitive psychotherapy. In this commentary I have argued that Lyddon and Weill's evaluation of standard cognitive therapy (CT) is based on a misrepresentation of the basic assumptions of CT concerning knowledge, the social context and the nature of the therapeutic relationship. I conclude that the relative merits of constructivism over standard cognitive therapy cannot be settled by philosophical debate but only by a consideration of the research and treatment innovations offered by each perspective.
Lyddon and Weill (in this issue) have offered a most thoughtful and cogent critique of the philosophical assumptions of standard cognitive therapy (CT) and constructivism in light of postmodern thought. In contrasting the basic philosophical assumptions of modernism and postmodernism they note that the former holds to an objectivist epistemology, views reality as objective and knowable, and considers the self a unitary, integrated entity in which individualism, autonomy and rationality are reified. The postmodern perspective, on the other hand, is said to emphasize a constructivist epistemology, a localized multiple and socially constructed basis to reality, and the self as a fluid, dynamic socially constituted concept. Lyddon and Weill then discuss three movements in postmodern thought-social constructionism, feminism and multiculturalism-and how each offers a critical challenge to cognitive psychotherapy. They conclude that the reliance of standard cognitive theory and therapy on modern assumptions of knowing, reality and the self is untenable at best, and potentially hazardous at worst, at least when encountered within the therapy session. The solution they advance is for cognitive psychotherapists to adopt the constructivist perspective (Mahoney, 1991, 1993; Neimeyer, 1993), thereby shedding the ill-founded modernist assumptions of standard CT.
There can be little doubt that some of the criticisms and cautions raised against standard cognitive theory and therapy by social constructivism, feminism and multiculturalism must be addressed by cognitive psychotherapists. More attention should be paid to the social origins and context of personal beliefs, memories and thoughts, and cognitive therapists must guard against imposing their own view of reality on their clients. Instead therapists must work toward a greater appreciation of the social context and worldviews of their clients, working with their clients in a collaborative manner to empower them to effect the change they seek in their personal and social realities. All therapists, regardless of their school of psychotherapy, should seek to minimize power relations in the therapeutic relationship, and collaborate with clients in the development of personalized goals for change in thought, feeling and behavior. Moreover I would also agree with Lyddon and Weill that cognitive therapists must be wary of overpersonalizing problems to the point where they fail to recognize that change may also be needed in the social environment of the client.
Having outlined these broad areas of agreement, I believe the authors' analysis of standard cognitive therapy is, nonetheless, problematic because of a misrepresentation of the basic assumptions of CT. Based on these misconceptions, the authors arrive at an erroneous conclusion-that constructivist psychotherapy is preferred over standard CT because the former is more consistent with postmodern assumptions. Let me discuss three major errors or misconceptions of standard CT that are evident in this paper.
RATIONALITY AND OBJECTIVE COGNITIVE PROCESSING
The first misconception can be found in Lyddon and Weill's statement that
cognitive theorists such as Ellis and Beck tend to envision the well-adjusted person as either (a) a paragon of rationality who interprets the world in a manner consistent with authorized axioms of rational thoughts or (b) an objective scientist who consistently makes accurate inferences about him/herself and the world (p. …