People struggling to realize their potential or find inner peace often turn to psychotherapy. Yet they find themselves wandering without much guidance through a marketplace of mental-health offerings and claims, lacking the knowledge to distinguish good therapy from bad. More than 150 different psychotherapies are offered in the United States.
In this post, I present some insights concerning cognitive behavioral psychotherapy (CBT), which has become one of the most available forms of treatment. My intention here, as well, is to show important distinctions between CBT and the depth psychology that I practice, particularly as these distinctions apply to clinical depression. This post is twice the length I usually write, and it gets a bit “technical,” so be prepared for some heavy-lifting.
Cognitive therapy, which attempts to address “distorted thinking” by replacing it with rational thinking, originated more than 50 years ago. By the 1980’s, it was merged with the techniques of behavioral therapy to become CBT. This therapy now is widely offered, perhaps in part because it’s a simple, straightforward method for psychotherapists to learn and practice. It offers, as well, a limited, controlled expenditure for insurance companies. I look upon it as the fast food of mental health.
Cognitive therapy originated out of the work of Dr. Aaron Beck, a psychiatrist and psychoanalyst who became convinced in the late 1950’s that depression was not being effectively treated by psychoanalysis. Psychoanalysts believed that depression was caused by anger or hostility toward the self (self-aggression). Unfortunately, these practitioners were insufficiently effective in their treatment of depression because they were addressing only the aggressive side, not the passive side, of the primary inner conflict that produces the malady.
Meanwhile, Beck was finding that his depressed patients, from what they told him of their night-time dreams, were not experiencing anger or hostility toward themselves but instead reported feelings of loss, defeat, deprivation, rejection, abandonment, and incompetence. The inner life of his depressed patients, Beck observed, reflected a profound sense of weakness and helplessness, not the hostile self-aggression that psychoanalysis had identified as the cause of their depression.
Beck concluded from this, as he wrote in a 2008 paper in the American Journal of Psychiatry, that the negativity in his depressed patients, meaning their negative thoughts about themselves and the world, was due to distorted thinking about themselves (“negative cognitions,” as he called it). Their depression, he decided, was produced by “a systematic cognitive bias in information processing leading to selective attention to negative aspects of experiences, negative interpretations, and blocking of positive events and memories.” He wrote that, based on clinical observations supported by research, depressed patients were allowing their cognitive processes to be “hijacked” by “highly charged dysfunctional attitudes or beliefs about themselves,” leading to the symptoms of depression.
Commenting favorably on this “discovery,” Jeffery A. Lieberman, a former president of the American Psychiatric Association, has written that Beck introduced “a radical revision of psychiatry’s conception of depression—instead of characterizing depression as an anger disorder, he [Beck] characterized it as a cognitive disorder.”
This is, as I see it, a flawed premise. Depression is neither an anger disorder nor a cognitive disorder. Rather, it is a passivity disorder. The disorder results largely from the depressed person’s inner passivity, coupled with his or her complete unawareness of the existence and nature of this passivity. Inner passivity is a leftover emotional deposit from childhood years spent in relative states of helplessness and dependence. Because of it, the individual fails to protect himself or herself from irrational, hostile self-aggression.
Passivity in the Psyche
Psychoanalysis was partially correct in asserting that depression was caused by self-aggression. But psychoanalysts did not recognize (and still have not recognized) the part played by inner passivity. This inner passivity, which is present to some degree in everyone, causes people to be inwardly receptive to the self-aggression. (It also causes them to be passive and lacking in self-regulation in everyday situations.)* The self-aggression is almost always derogatory, cruel, and irrational. So why would a person absorb such harsh, unmerited aggression and take it seriously, especially considering how unfair and irrational it is? The answer is that the individual is inwardly passive.
Dr. Beck correctly observed that his patients, in their dreams, were experiencing loss, defeat, incompetence, and so on. (This itself was their direct experience of their inner passivity!) Yet he didn’t recognize inner passivity and thereby didn’t understand that it was the reason why the irrational self-aggression (which, as mentioned, was claimed by psychoanalysts to be the main source of depression) was being absorbed into the emotional life of the depressed patients. As I mentioned, their inner passivity (their emotional resonance with feelings of loss, defeat, weakness, incompetence, and so on) rendered them unable on an inner level to protect themselves from the harsh insinuations and accusations of self-aggression.
The harsh self-aggressive part (inner critic or superego) is a derivative of the primitive aggression that prehistoric humans needed for survival. The aggressiveness has been muted somewhat by civilization, yet it has not been, by any means, entirely dispelled from our psyche. Self-aggression becomes problematic right from childhood when, in some measure, it’s turned inward against the frail ego, as Freud famously stated. The child’s weak musculature is unable to expend all of the considerable aggression outward into the environment, so it is turned inward against the self because it has to flow somewhere. Later, as adults, we do expend much of our aggressive energy outwards in the form of productive and creative sublimations, providing we’re not too neurotic (too inwardly conflicted), in which case we turn much of it inward against our self.
Cognitive therapy doesn’t recognize these inner forces. It is biased in favor of the ego or the mind, in that it claims incorrectly that the rational mind can consistently be expected to overrule irrational emotions. Many people identify, to some degree, with their mind, which is experienced as their conscious ego, and they are prone to believe that their ego is the master of the self. They believe themselves to be in possession of a mental operating system that, as they see it, is firmly anchored in rationality. It pleases the ego, which strives for a favorable self-image, to believe that it’s in command of rationality and can thereby subdue the forces of irrationality. This impression of reality is also attractive to people because it helps to subdue the inner fear that arises through deep self-exploration.
Stubborn and resistant though it is, our conscious ego is, in this context, still just a minor troublemaker. As mentioned, the big troublemaker is inner passivity, which is an aspect of human nature located in our unconscious ego and constituting, in all likelihood, much of the intrinsic nature of the unconscious ego. Through inner passivity, we become entangled in conflict with self-aggression (the superego, in psychoanalytic language). Our unconscious ego is subordinate to the aggressive superego or inner critic, and it takes a very defensive, weak stand—it represents our best interests very badly—in its dealings with our inner critic. It is from this passive side that our psychological defenses, as well as our inward and outward defensiveness, arise.
The Primary Inner Conflict
In my view, this inner clash between the inner critic and inner passivity is the primary conflict in the human psyche. Often our passive side’s defenses collapse and it capitulates to the aggressive side and accepts punishment—for example, in the forms of guilt, shame, and depression—for allegedly being guilty of weakness, shortcomings, or failures, as claimed in the irrational indictments that flow from the aggressive side.
These punishments themselves frequently serve as psychological defenses. Painful feelings of depression, for instance, become a defense when they are offered up as “proof” that the individual is not passively absorbing self-aggression. The defense might be presented accordingly: “I’m not willing to be harassed and condemned by my harsh inner critic. Look at how depressed I get. I don’t like it! I don’t want it one bit!” This defense covers up the individual’s great inner transgression (the deadly flaw in human nature), namely the unconscious willingness to suffer, of which inner passivity is a prime facilitator. The depressed person has been beaten into submission by self-aggression, and he thereby accepts the inner condemnation and the “appropriate” punishment, often in the form of very bad feelings about himself. This person’s “negative cognitions,” as Beck called them, arise out of this inner conflict. So cognitive therapy, by focusing on negative cognitions and attempting to modify the nature of those thoughts, is only addressing the symptoms.
Dr. Beck found that his depressed patients did have unpleasant dreams with self-debasing content, but he couldn’t establish that the dreams revealed, as some psychoanalysts had claimed, any specific wish to suffer. The data only supported the fact that depressed patients suffered. Why did his data-collecting fail to penetrate deeper into the psyche? Humankind’s unrecognized willingness to suffer is exposed by human consciousness, one person at a time, by way of a learning encounter with one’s own inner reality. A person has to see for himself through inner realization that he is making choices that recycle and replay old unresolved hurts and feelings of weakness. For Beck to have succeeded in his investigation, he would have had to leave behind his data-collection methodology and plunged, personally and existentially, into his own psyche. Psychoanalysts do attempt deep self-exploration as part of their training, but these attempts are not, in my view, adequate or complete.
In addition, standard research methodology hasn’t uncovered the possibility of humankind’s emotional attachment to suffering because everyone, including researchers, are loathe to recognize this human perversity or flaw in our nature. While recognizing it requires a breakthrough in consciousness, scientific methods can’t even determine the constituents of consciousness. The willingness to suffer, the masochistic contaminant at the heart of human nature, is a bitter pill to swallow. It strikes the modern mind with the same shocking impact that Darwinian revelations had on 19th Century minds. Just the idea of inner conflict alone, independent of the willingness to suffer, has become a forbidden topic in much of modern academic psychology. When the possibility of humanity’s willingness to suffer is presented publicly, some individuals or groups loudly protest that the victim is being blamed.
A Passive Capitulation
The unconscious wish to suffer does exist. In the context of clinical depression, it can be understood as a passive capitulation to the inner critic’s aggressive bullying. This self-aggression can be registered consciously, unconsciously, or semi-consciously. The passive capitulation, in contrast, isn’t usually conscious because it’s so well hidden behind a variety of psychological defenses. Once the passive capitulation occurs, the individual, as mentioned, absorbs the aggressive bullying and begins to feel truly bad about himself, thereby producing depression. This depression is not likely to be alleviated long-term by rational thinking. To overcome the malady, one’s inner conflict is brought into focus along with increasing insight concerning the role of inner passivity. In our psyche, we can’t fix what we can’t see.
Dr. Beck didn’t see the passive aspect. In 1962, he tried once more to validate Freud’s theory of depression. He reasoned that a depressed person who wants unconsciously to suffer should not be able to tolerate success. He set up an experiment, a card-sorting test, that predetermined whether a person would succeed or fail. “Contrary to what Freud might have predicted,” Beck said, “it turned out that depressed persons who succeeded on initial tasks showed a rise in self-esteem and did better on subsequent tasks than even nondepressed people.”
The self-esteem arises, however, as a defense mechanism. Beck didn’t recognize the unconscious cover-up, the psychological defense, at play in this situation. The depressed person, as a defense, is going to claim that what he truly wants is success, not the weakness and passivity associated with failure. When success occurs, he is likely to feel elated. That elation in that moment has to do not so much with the success of a worthy achievement but with the success of the defense in the cause of self-deception: “I want success, not painful failure. Look at how good I feel when success happens.” (Such a person is likely to collapse into an episode of depression whenever a defense fails to be effective, as often happens.) Beck had also overlooked libido and the pleasure principle, that aspect of the psyche that is often enlisted unconsciously to make one’s “successful” defense feel especially good, thereby strengthening that defense.
I mentioned earlier that depression itself is used as a defense. Guilt and shame, commonly associated with depression, are, in addition to being painful byproducts of inner conflict, defenses as well. Again, the defense goes like this: “I’m not looking to passively absorb criticism and disapproval from my inner critic. Look at how guilty I feel (or how ashamed I am) about my weakness and my failures.”
Claims of Success
CBT therapists claim to have a high success rate following ten or twelve sessions, although new findings from around the world are saying otherwise.** It is true, nonetheless, that many of their clients or patients say they feel better. Why is that? The therapy gives people a sense of hope. They have been told by experts that they have the knowledge and technique required to escape the miseries of depression (or other emotional and behavioral difficulties). As well, they have unknowingly temporarily “borrowed” the cognitive therapist’s strong ego and certainty to bolster themselves. They feel empowered, which in such situations is a temporary antidote to the underlying passivity. In addition, most people have unconscious fears about the “bad news” that can arise from deeper psychological exploration, particularly any revelations concerning their unwitting indulgence in their own suffering. So they feel a temporary sense of relief when their deeper issues are not addressed. They can also be employing a defense against the underlying wish to suffer, which contends: “Yes, I do want positive feelings, not bad feelings about myself. Look at how good positive feelings and aspirations make me feel!” When we’re uninformed, some of our “best thinking” goes into self-deception.
Beck cited an example that he claimed showed the effectiveness of his method. A depressed patient, a lawyer, believed his wife had trapped him into marriage and then ”cemented” him in by having children. ”We examined the evidence together and he came to realize he had not been trapped,” Dr. Beck said. After a number of sessions, the man understood that he looked upon any infringement of his freedom as being trapped. According to Beck, the man then started seeing things more objectively.
This claim of success is overstated. The cognitive approach fails to recognize the underlying irrationality. It’s true this client of Beck’s was feeling trapped, and it’s also true, as Beck said, that the man would likely interpret any infringement of his freedom as being trapped. But that feeling of being trapped is a powerful emotional attachment associated with inner passivity. It’s more than just a cognitive problem. The man needs to become conscious of his inner conflict: on the surface, he wants to feel his freedom within his marriage, yet he’s determined unconsciously, even compelled, to experience the weakness associated with inner passivity. Feeling trapped is a symptom of inner passivity, as would be the sense of being beholding or subordinate to his wife. He might be blocked from achieving greater intimacy with his wife because, through inner passivity, he feels that intimacy will swallow him up and that he will lose himself in it. The rationality that Beck provided his patient (to the effect that the patient misunderstood marital responsibilities and obligations as infringements upon his freedom) would most likely collapse under the emotional challenges the marriage presents. That’s because the man has no real choice but to experience whatever is emotionally unresolved, in this case his inability to prevent himself (without assimilating insight from depth psychology) from drifting toward the passive side and experiencing his marriage in such negative terms. He would continue, in a variety of everyday challenges that would likely extend beyond his marriage, to “know himself” through that passivity.
Depressed individuals must see clearly their identification with inner passivity and, in a process that entails acquiring deep insight, start to break free of their unconscious willingness to suffer. This self-knowledge exposes what was previously unavailable to their intelligence.
Another Clinical Example
Here’s an example involving one of my clients: A retired woman, who experienced daily distress and regular bouts of depression, recognized that she was mentally distracted with worrisome considerations and speculations. Her persistent “circular thinking” dwelled on the past and the future, and it generated mostly worry and stress. She knew she was happiest when her mind was quiet, when she was able to focus on practical chores and creative projects. Yet she couldn’t quiet her mind. What could cognitive therapy have possibly done for her when too much cognition was the problem? If she tried to think rationally about the irrationality of every little worry she produced, she would likely to flip her mind into hyperdrive.
Working in my method, she began to feel much better as she understood that she had been producing a steady stream of random, circular thinking because doing so activated the underlying passivity with which she identified unconsciously and which she was unconsciously determined to experience. Her circular thinking, in being so futile and uncontrollable, produced a sense of weakness and a disconnect from self. She felt like a little cog in her own life, which is a direct symptom of inner passivity. That passive feeling, she said, had been with her since childhood, and she had always just taken it for granted. Now she was able to see it in clinical terms, and thereby to use her new self-knowledge and growing consciousness to shift away from it.
The powerful allure of the negative side, to state the problem in another way, constitutes the unconscious willingness to suffer. Like an inner demon, this dark side of human nature laughs at attempts to dislodge it with so-called right thinking. Deeper self-knowledge and the heightened consciousness it produces are highly effective in liberating depressed and other neurotic people from their miseries. This knowledge, in all its relative complexity, might appear to be beyond the assimilation capabilities of everyday people. But most people exposed to the knowledge, and willing over time to reflect upon it, reach a tipping point where self-awareness floods in with all the accompanying benefits.
* Inner passivity is experienced internally in the psyche in relation to self-aggression as well as in relation to situations in everyday life. Inner passivity makes it more likely that people will feel overwhelmed by events and circumstances, victimized by misfortune, unable to flourish, mistreated in relationships, a target of injustices, unable to self-regulate, and intimidated by the assertiveness or aggression of others.
** Reports are now emerging around the world claiming that CBT is failing in a variety of ways. Like modern psychiatric pharmaceuticals, the therapy just addresses symptoms.