Tim LeBon on Philosophical CBT

Tim LeBon is a cognitive therapist and philosophical counselor, and the author of the book Wise Therapy. He's one of a handful of people trying to bring together CBT with a more philosophical approach to counseling. Here, we discuss his career, and the possibility of developing something called 'philosophical CBT'.

JE: When did you do your training in CBT, and why did you want to?

TLB: I actually began my CBT training a long time ago, in 1997, which was just before philosophical counselling got going in this country. I had found that some of therapy clients, especially those suffering from depression and anxiety , benefited enormously from learning and applying ideas found in such books as David Burns’ “The Feeling Good Handbook”. I continued with regular CBT trainings as part of my continuous professional development for 12 years and then in 2009 and decided to train as a specialist cognitive therapist. Why? Firstly I was becoming increasingly convinced that CBT, though not perfect , was the single most effective form of therapy. Secondly, I wanted to work in the NHS for which more specialist CBT training was advisable. I should add that my original training, before then, was in Existential Therapy – another therapeutic approach informed by philosophy which also has a lot to offer – I am particularly informed by the ideas of Frankl, Yalom and Van Deurzen.

JE: How did you find the process?

TLB: I loved doing the CBT course at Oxford (with OCTC). I very much enjoyed the intellectual challenges of learning more about CBT and I also appreciated the expert supervision and tuition given by OCTC. Intellectually it was extremely stimulating – especially writing a short dissertation where I wrote about a topic I had previously written about from a philosophical perspective i.e. decision-making.

Briefly, the work I had previously done (with David Arnaud and Antonia Macaro) developed an integrated method for making wise decisions (which we called Progress) – a five-stage model incorporating insights from Epicurus, Aristotle, Mill, the Stoics, existentialists etc … We used it extensively with clients and it usually worked very well. However with a few clients it didn’t work so well – and these tended to be ones who were suffering from decision paralysis – they might well intellectually see that one option was best but then as soon as they made the decision see-sawed back into the other side and were stuck – much like Buridan’s Ass. It occurred to me that CBT could help here, so in my dissertation I wrote about how using a formulation for these clients, with the focus on the process of this see-saw would be of central importance. Conversely, a wise decision-making method like Progress is superior to the simple Pros and Cons method many CBT therapists still use. I think this illustrates nicely how the philosophical element of Philosophical Counselling can make CBT wiser and the psychological element of CBT can make Philosophical Counselling more effective (especially where psychological processes like the see-saw interfere with rationality).

JE: How compatible do you think philosophical counseling (PC) is with CBT?

TLB: That would depend on what you mean by PC and what you mean by CBT!
I would define PC as “a type of counseling that uses philosophical insights and methods to help people think through significant issues in their life in order to live more wisely” CBT on the other hand is a type of psychotherapy which uses cognitive and behavioural techniques to help people overcome mental health issues.I think many philosophical counsellors would not argue that CBT is at all compatible with PC, because it is:

- mainly psychological (as opposed to philosophical)
- largely directive (as opposed to client-centred and open-ended)
- usually Aims at treating mental illness (as opposed to dealing with people with problems at living
- aims at reducing distress (rather than attaining wisdom)

This “non-compatible” view extends to how PC sees itself in relationship to all psychological therapies. It is very influenced by PC’s pioneer Gerd Achenbach, who saw psychology and philosophy in competition and conceived of PC as a space where philosopher and “visitor” (as Achenbach called it) would think through problems together, drawing on philosophical sources.

I believe that Achenbach’s view is too extreme. Certainly philosophy needs to emphasise that it has something different to offer than traditional psychological approaches – such as drawing on two thousand years of thinking and experience, and its concern with values and wisdom. However this doesn’t mean that PC cannot combine with psychology to form a form integrative, holistic view of how to make life go well.

Philosophy aims at living wisely, drawing on philosophical insights and methods.. Psychology aims at understanding psychological processes and providing techniques to help overcome psychological difficulties. Wise therapy needs both – I think that the example I give above regarding decision-making is a good example of this. A five part model like Progress is more likely to help someone make a wise decision than simply looking at the Pros and Cons – because for example it looks more closely at values and what makes life go well and puts a decision in this broader context. But this largely rational process can sometimes get stuck because of psychological processes (such as decision paralysis) and this is where psychological therapies such as CBT come into their own. We need a therapy to be both philosophical and psychological.

JE: Are there aspects of CBT that you dont agree with?

TLB: As well as the differences mentioned above, a key difference is that PC potentially draws on all philosophy, whereas CBT draws mainly on the Stoics . Noteworthy philosophies that don’t get much of a look-in in CBT include existentialists - which has itself made a big contribution to psychotherapy via existential therapy.

Are there aspects of CBT I don’t agree with? Well, there is more than one way of doing CBT, and there are some styles of CBT I prefer– but this would be true of other therapies too. Until recently, I would have criticised CBT for largely ignoring questions about values and wisdom and instead just trying to make people get better. The the third wave of CBT has brought about some shift here – MBCT and ACT introduce ideas from wisdom-based philosophies especially Buddhism and especially mindfulness . ACT and Behavioural Activation place values and moving in a valued direction in centre stage. That’s not to say CBT couldn’t benefit by becoming more philosophical…

JE: Some people criticize CBT as being superficial or promoting an 'unexamined idea of feeling good' (to quote The Philosopher's Magazine). How fair is that?

TLB: David Burns did write a book called “Feeling Good” so its not totally misplaced ! However when people are suffering from a psychological disorder isn’t it wise rather than superficial to help them feel better. For example if someone’s life is being ruined by severe and numerous panic attacks helping them feel good is a rather helpful thing to do.

But where people aren’t suffering from a specific disorder – and they are suffering more from what can be called problems in living – a dilemma, a relationship problem , a career choice, a mid-life crisis, an ethical problem – CBT doesn’t have so much to say. With third wave CBT this is changing to some extent but a more serious engagement with philosophical ideas would be of benefit.

JE: To what extent do you think cognitive therapists know or are interested in the philosophical roots of CBT?

TLB: I was surprised and pleased to hear about a philosophical (Aristotelian) take on personality disorders being mentioned at the recent BABCP conference in Guildford - so there is some interest. However in general I think CBT practitioners tend to be very busy people who learn only they think will be useful They also tend to have a very scientific view of the world so may be suspicious of philosophical ideas – until they start to see their usefulness. What is missed here is both the need for wisdom (not just feeling better) and the hundreds of years of evidence accrued at the time that Buddhism, Stoicism, Epicureanism etc have been practised.

How CBT therapists developed Mindfulness CBT is a good illustration – they weren’t interested at all until they found a problem that needed an answer, and then they only became meditators themselves when they realised they had to for the treatment to be effective.

JE: And to what extent do you think philosophers are interested in the philosophical roots of CBT?

TLB: I suspect most academic philosophers would have little interest but I may well be wrong. In Practical Philosophy we published a number of articles that critiques CBT- more often REBT was the target as it engages more directly with philosophy than Beck’s CT.

JE: Could 'philosophical CBT' become a new form of CBT?

TLB: Yes, absolutely. I’d be very interested in talking with others who share a vision for helping to develop philosophical CBT. One of my most positive experience of philosophical counseling was running workshops which were in effect group philosophical counseling. For example, 12 week course was called ‘philosophy and the good life’. In the first session, on Socrates, we discussed what we meant by the good life. Then each week, we looked at a different philosophy - Stoic, Epicurean, Existentialist, Utilitarian - and we also discussed themes like work and love. Each week, we discussed what we had learnt and how it affected our idea of the good life. And at the end, we discussed how we could live out our new idea of the good life. I think the course was really appreciated.

JE: What I like about that format is that it’s pluralist. It’s not imposing a particular ethical philosophy on people, but allowing them both to find out about different schools, and then decide for themselves.

TLB: Yes, it was a dialogue. It tried to find a balance between respecting people’s own freedom of choice, but also trying to get them to challenge their assumptions and really think about their values and goals.

JE: So could that sort of workshop be provided within the context of the NHS and IAPT?

TLB: Possibly IAPT services already provide ‘self-help workshops’ and ‘life skills workshops’ to people, on topics like assertiveness and stress management . It I would love to think that in the future there might be workshops on flourishing or well-being which would include substantial elements of philosophy.