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Paperback: 262 pages ISBN-10: 036721914X ISBN-13: 978-0367219147
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The Philosophy of Cognitive-Behavioural Therapy (CBT) demonstrates how techniques and concepts from Socratic philosophy, especially Stoicism, can be integrated into the practise of CBT and other forms of psychotherapy. What can we learn about psychological therapy from ancient philosophers? Psychotherapy and philosophy were not always separate disciplines. Here, Donald Robertson explores the relationship between ancient Greek philosophy and modern cognitive-behavioural psychotherapy.
Highlights
Philosophy teaches us to act, not to speak; it exacts of every man that he should live according to his own standards, that his life should not be out of harmony with his words, and that, further, his inner life should be of one hue and not out of harmony with all his activities. This, I say, is the highest duty and the highest proof of wisdom – that deed and word should be in accord, that a man should be equal to himself under all conditions, and always the same. (Seneca, Moral Letters to Lucilius, 20.2)
CBT emphasizes that, insofar as it is reasonable to do so, beliefs should be tested out in practice, in the laboratory of our personal experience.
Man, in short, suffers quite differently from the animals and he suffers more than they. He does not content himself, so to speak, with brute suffering which is adequate for the physical disorders; he increases them by imagination, aggravates them by fear, keeps them up by his pessimistic reflections. (Dubois & Gallatin, 1908, p. 20)
Grief is light when opinion does not exaggerate it; and if one encourages one’s self by saying, ‘This is nothing’, or, at least, ‘This is slight; let us try to endure it, for it will end’, one makes one’s grief slight by reason of believing it such”. And, further: “One is only unfortunate in proportion as one believes one’s self so”.
The most famous formulae associated with the Delphic Oracle of Apollo, a patron of philosophy, were “Know thyself” and “Nothing in excess”. However, the doxographer Stobaeus recorded a list of 147 maxims attributed to the Delphic Oracle. They include a number of very Stoic-sounding sayings such as “Follow god”, “Think as a mortal”, “Master yourself”, “Control anger”, “Cling to discipline”, “Long for wisdom”, “Praise virtue”, “Guard what is your own”, “Shun what belongs to others”, “Foresee the future”, “Speak plainly”, “Be happy with what you have”, “Love your fortune”, and “Be not discontented in life”.
Moreover, Baudouin and Lestchinsky recognized that the Stoic concept of our sphere of control and responsibility offers a possible philosophical solution to the issue of morbid rumination over the past and the unhealthy and excessive sense of guilt, self-blame, etc., so common among clients in modern psychotherapy. As for regret and remorse, as for the tortures we inflict on ourselves on account of a past which we cannot change, these also fall within the category of the wishes that relate to things which are not in our power. They involve a futile expenditure of energy. Let us see to it that we do better in the future, but let us cease to deplore having done ill in the past. Phocylides, the poet and sage who lived in the sixth century B.C. wrote: “Do not let past evils disturb you, for what is done cannot be undone”. (ibid., p. 44)
If guilt serves a purpose, it is surely to motivate us to change today, in order to prepare for tomorrow, but not to condemn ourselves to endless complaining about yesterday
Marcus Aurelius speaks of the Stoic philosopher training himself to become, “an athlete in the greatest of all contests – the struggle not to be overwhelmed by anything that happens” (Meditations, 3.4).
The psychological effects of Stoicism and other therapeutic philosophies depend upon the complete internalization of certain key ideas, or rules of living, and their future recall in the face of stressful situations.
The Stoic love of condensing philosophical doctrines into short summative phrases employs the rhetorical technique known as aphorism. The two most famous examples of such aphorisms used in Greek philosophy are probably the inscriptions from the Oracle of Apollo at Delphi: “Know thyself”, and “Nothing in excess” (the principle of the Golden Mean, “all things in moderation”).
At the top of the Stoic hierarchy of dogmata was a handful of core principles from which more elaborate formulations were derived. In this sense, paradoxically, the philosophical framework of Stoicism was both incredibly simple and incredibly complex. Its essence could be stated in a few words, but this simplicity was necessarily deceptive and required lifelong study to fully assimilate at a practical level into one’s daily life.
Likewise, in modern CBT, clients take complex affirmations of healthy, rational belief and turn them into short “coping statements”, brief phrases which can easily be committed to memory and made ready to hand during future adversities.
They make it very clear that the first step in Stoicism consists in learning to carefully distinguish between our own voluntary judgements and intentions, for which we have responsibility, and external events and the actions of others, which lie outside of our direct sphere of control.
In order to obtain this result, they had, on the one hand, to develop and teach their philosophical doctrines, but, on the other hand, they were perfectly conscious of the fact that the simple knowledge of a doctrine, beneficial as it was, did not guarantee its being put into practice. To have learned theoretically that death is not an evil does not suffice to no longer fear it. In order for this truth to be able to penetrate to the depths of one’s being, so that it is not believed only for a brief moment, but becomes an unshakable conviction, so that it is always “ready”, “at hand”, “present to mind”, so that it is a “habitus of the soul” as the Ancients said, one must exercise oneself constantly and without respite – “night and day”, as Cicero said. (Ilsetraut Hadot, quoted in Hadot, 1995, pp. 22–23)
So, in the first place, pass judgement on your [faulty] actions; but when you have condemned them, do not give up on yourself, nor be like those mean-spirited people who, when they have once given way, abandon themselves entirely, and are, so to speak, swept off by the flood.
The best of us encounter setbacks and temporary relapses, but the crucial difference between failure and success is the attitude of relentless perseverance, the indomitable spirit of the ideal Stoic student who keeps picking himself up and starting again with renewed vigour, each time refusing to give in.
In Greek philosophy generally, but especially in Stoicism, the word pathos specifically denotes emotions which are irrational, unhealthy, and excessive.
First, bear in mind that, for the Stoic, arete means psychological virtue and not just moral virtue, for want of a better way of putting it. The cardinal “virtues” of Greek philosophy were wisdom, justice, courage, and moderation. The possession of these excellent character traits is the key to happiness and well-being (eudaimonia) in the Stoic view.
The Stoic technical term sometimes translated as “serenity” or “indifference” (apatheia) actually means an absence of irrational or excessive passion (pathos).
For the Stoic, it is the tendency to judge things as being inherently or absolutely good or bad which leads to irrational craving (epithumia) or fear (phobos), respectively. In Stoic psychology, irrational desire, or craving, which places too much value on external things and other people’s opinions, is the root cause of anxiety. Believing that “I have to” have (or avoid) something, or that other people “must” behave (or not behave) in a certain way, as REBT would put it, is tantamount to saying that these things are of overriding importance in themselves, or absolute external values, as Stoicism would put it. Sometimes the Stoics also articulate these irrational value judgements as demands.
So is it possible to be altogether faultless? No, that is impracticable; but it is possible to strive continuously not to commit faults. For we shall have cause to be satisfied if, by never relaxing our attention, we shall escape at least a few faults. (Discourses, 4.12.19)
If it relates to external things, outside of our direct control, we should constantly affirm in our minds, “It is nothing to me”, focusing instead upon our own sphere of control, primarily our responsibility for our own thoughts and judgements.
“The map is not the terrain.”
The Stoic must perpetually separate his own mental activity from his perception of the outside world. This is the original philosophical-therapeutic meaning of the term katharsis (“purification”), which Plato used to refer to the careful separation of opinion and perception,
Epictetus, likewise, discusses the example of a man temporarily assailed by impressions of irrational avarice or inappropriate sexual impulses and emphasizes that, although these initial impressions may occur to almost anyone, we are immediately presented with a choice as to whether we indulge or challenge them. He makes it clear that his students must remind themselves that to give in once to an unhealthy impulse is to weaken ourselves so that we become more vulnerable to it again in the future, whereas to question it forcefully is to strengthen ourselves by forming a stronger habit of resistance to it in the future.
For, just as Socrates used to say that we are not to live an unexamined life, so neither are we to accept an unexamined impression, but to say, “Stop, let me see what you are, and where you come from”, just as the nightwatch[men] say, “Show me your token”. Have you that token from nature, which every impression must have if it is to be accepted? (Discourses, 3.12.15)
When you become too remote from what you can perceive with your five senses, it’s easy to enter in to the world of fantasy and nonreality. When you stick with what you can perceive, you’re usually on much safer ground. (Beck, Emery, & Greenberg, 2005, p. 197)
People often find themselves in contradiction because their underlying values subtly conflict with the life they actually find themselves pursuing.
They took solitary morning walks to places which happened to be appropriately quiet, to temples or groves, or other suitable places. They thought it inadvisable to converse with anyone until they had gained inner serenity, focusing on their reasoning powers. They considered it turbulent to mingle in a crowd as soon as they rose from bed, and that is the reason why these Pythagoreans always selected the most sacred spots to walk. (Iamblichus, Life of Pythagoras)
The Stoics therefore, following the Pythagoreans, appear to have specifically set aside time in the mornings for rehearsal of verbal affirmations in preparation for the day ahead.
The theory of determinism does not hold, as this fallacy requires, that all events are completely determined only by external causes, that is, that people are completely passive in relation to the world. Rather, it holds that events are co-determined by the interaction of internal and external causes. My actions are part of the causal network and therefore have an effect upon the things that happen. Nevertheless, accepting those things that are genuinely beyond my control, with philosophical resignation, is a key rational therapeutic strategy and employed extensively by Stoics in the face of adversity.
Do you not know how very small a part you are compared to the whole? That is, as to the body; for as to reason, you are neither worse, nor less, than the gods. For the greatness of reason is not measured by length or height, but by its judgements. (Discourses, 1.12.26)
As Epictetus puts it, “I am not eternal, but a man; a part of the whole, as an hour is of the day. Like an hour I must come and, like an hour, pass away” (Discourses, 2.5.13).
As Dubois writes, “let us beware of placing all our happiness on cards liable to be shuffled at any moment by others’ hands or blown away by the least wind” (1909, p. 26).
Acceptance also does not mean wanting or liking something, wishing it were here, or judging it to be fair, right, or proper. It does not mean leaving changeable situations unchanged – it means to embrace experiences as they are, by choice, and in the moment. (Hayes, Strosahl, & Wilson, 2016, p. 272)
Stoic acceptance also doesn’t mean behavioural inertia or passivity. Stoics reconcile the acceptance of their experiences (the discipline of desire and aversion) with commitment to change in the service of appropriate external goals (the discipline of action). As ACT explains, acceptance is actually required for change because changing things we control inevitably leads to other events that can’t be controlled. We control our own voluntary actions, by definition, but then we have to be willing to accept the feelings and other consequences that follow from those actions. Both ACT and Stoicism therefore stress that acceptance, in this sense, does not mean passivity or “giving in” to things such as domestic abuse, for example. It means accepting the reality of our situation and the feelings we have to go through in order to improve our lives. As Epictetus puts it, when there is smoke in my chamber, if it is bearable I will stay but if it becomes excessive then I will leave (Discourses, 1.25).
Psychotherapist Paul Dubois had his patient draw a circle to represent the Stoic philosophy of acceptance, showing the initial suffering enclosed by additional circles symbolizing preoccupation, worry, and other layers of unnecessary additional suffering. Dubois said that Stoic acceptance consists in letting go of those extra layers that magnify the initial suffering.
The life stories of these philosophers, too, are often remarkable. Seneca? Epictetus? Marcus Aurelius? Our knowledge of their character and circumstances, and the times in which they lived, undoubtedly adds something to our appreciation of their wisdom when it comes to coping with adversity in all its hues. These Stoics were philosophical heroes, veritable warriors of the psyche, who knew bereavement, torture, exile, infirmity, warfare, political intrigue, and betrayal. Vice admiral James Stockdale, the Vietnam veteran, is perhaps our closest modern equivalent. He described the ancient world of Epictetus as a dangerous “buzzsaw” of adversity and misfortune, and he found himself against a similar metaphorical buzzsaw in the dungeons of the Hanoi Hilton prison, where he almost gave his life to avoid betraying the incarcerated soldiers under his command.