Hi Website visitors,
I got an interesting email from a brilliant colleague, Rabbi Joel Zeff, who joined one of the Sunday hikes a year or so ago. He asked about the ethical implications of one of the ten cognitive distortions: Should Statements. This is a cool topic, and I hope you enjoy the exchange! Feel free to comment, too, as usual!
David
Dear Dr. Burns,
You might remember me from one of the Sunday morning walks. (I am the rabbi being trained by Leigh Harrington.) I am most pleased to report that I completed the TEAM-CBT Level One training in November. Leigh was absolutely marvelous and I look forward to continuing my training with this powerful approach towards healing.
Meanwhile I have returned to Israel and am completing my dissertation for the doctorate in pastoral counseling from the San Francisco Theological Seminary (Presbyterian), an affiliate of the Graduate Theological Union in Berkeley. I recently posted the following inquiry, for my dissertation work, on the TEAM listserv and wonder if you would consider addressing it (many thanks!):
Dear Friends,
I am currently working on a doctoral dissertation in pastoral counseling. I am creating a source book for Jewish pastoral counseling which presents examples of cognitive re-framing found in the Jewish mystical thinking of Rabbi Abraham Isaac Kook, the Chief Rabbi of Israel during the “Pre-State” period of the British Mandate (died in 1935).
My point of reference is the wonderful TEAM training I received from Dr. Leigh Harrington (thank you so much Leigh!). As part of my writing, I want to address the interface of ethics and cognitive distortions. One gets the impression that cognitive distortions are not defined by ethical considerations. The primary criteria seems to me whether or not the cognition is firmly rooted in reality and to what extent it is helpful in living a relatively happy and productive life.
Do ethical considerations play a role in defining a “distortion” and/or impact on the course of therapy?
This question was particularly accentuated with regards to “Should Statements.” Ethics would posit that people “should,” for ethical reasons, behave in certain ways. Why should we not expect certain standards of conduct, on ethical grounds? I can understand why we might work on not becoming overly emotionally reactive, but that is not the same as saying “why should he/she behave otherwise?”.
I would very much appreciate your thoughts on this, as well, any references to writing on this particular issue that I could incorporate into the dissertation.
If you are able to address the issue, might I have permission to quote you referenced as “in private correspondence?”
Many thanks,
Joel Zeff,
Hi Rabbi Joel,
Good to hear from you! I still have vivid memories of the Sunday hike you joined not long ago!
In my writings (books, blogs, etc.) and teachings (workshops, podcasts) and therapy work, I have always emphasized that there are three valid uses of the word, “should”—the legal should, the laws of the universe should, and the moral / ethical should.
- Legal should: You should not drive at 100 miles per hour because you’ll get a ticket.
- Laws of universe should: If I drop this pen, it should fall to the floor due to the law of gravity.
- Moral / ethical should: “Thou shalt not kill,” which is straight from the Ten Commandments.
Other uses of the word, “should,” are generally not valid, and they can be painful, too. When you say something like this–“I should be a better teacher (or therapist, or Dad, etc.),” or “I shouldn’t be so screwed up,” or “I shouldn’t have made that investment,” or “I shouldn’t be so shy,”—these are not valid uses of the word, should.
Let’s say you have a fear of bridges, like a psychologist I once treated. She told herself that she “shouldn’t” have this fear, and therefore was “screwed up,” and “shouldn’t be screwed i[.” Is this a valid use of “should?”
Well, it is not illegal to be “screwed up,” or to have a fear of bridges. Also, having a fear of bridges does not violate any of the laws of the universe. Nor is it immoral or unethical to have a fear of bridges. For example, you don’t see , “Thou shalt not fear bridges,” listed in the Ten Commandments, or in any of the holy texts from any religion.
If you look up the word, “should” in one of those huge dictionaries, you will see that it’s origin traces back to the Anglo-Saxon word, “scolde.” So, essentially, you are scolding yourself for having some flaw or shortcoming when you use the word, “should.”
You can combat these painful types of self-criticisms in many ways, but one of the easiest is the Semantic Method—you simply substitute gentler language, such as “I would like to be a better teacher” (or therapist, or Dad, or whatever). Then you can focus on the specifics of what you are doing in your teaching, for example, that’s effective, or ineffective, and make a plan for improvement, if needed.
But in a clinical situation, other methods will almost always be needed, especially Paradoxical Agenda Setting techniques, along with empathy and all the rest of the TEAM-CBT treatment techniques. There are numerous techniques that can be used to combat these dysfunctional uses of “Should Statements.” For example, you can say, “It would be great if I could get over my fear of bridges,” and then you can use a variety of techniques to overcome your fear of bridges, if that is your goal. But that is radically different from beating up on yourself.
Should Statements will generally double your trouble. First, you have some flaw, and second, you are filled with self-hatred because you are telling yourself that you “should not” have that flaw. Then you may feel ashamed and defective, or inferior, or even hopeless.
Shoulds directed toward others cause anger, but are equally irrational. Other directed “shoulds” are usually combined with other-directed blame, and are sometimes difficult to combat. That’s because anger and blame usually make people feel morally superior to others—for example, the blame may be directed at certain religious, political, or ethnic groups, and you may enjoy feeling morally superior to the group or the person you are angry with.
The late Albert Ellis, PhD, humorously called this “shoulding on yourself” (or others.) He also called it the “shouldy” approach to life. He tried to show the “shoulding” patient why these statements are irrational, using the technique called Examine the Evidence. He often said things like, “Where is it written that you shouldn’t have this or that problem?” Or “where is it written that your spouse should be different from the way s/he is?” He often made these statements with considerable force and charisma. Those who remember seeing him when he was still alive will know exactly what I mean!
Some people could see his point, and bought it, while others simply could not “see” it, and got turned off by Ellis. That’s why I’ve developed motivational approaches, like Paradoxical Agenda Setting, that therapists can used before trying to modify the patient’s negative thoughts. You can use techniques like Paradoxical Cost-Benefit Analysis and Sitting with Open Hands, for example. This protects the therapist from having to “sell” something to a reluctant “customer,” and greatly boosts therapeutic effectiveness..
There is no conflict I have ever detected between any form of spirituality, religion, or ethics and good, effective therapy. In my experience, individuals who have resolved and recovered from depression, anxiety, relationship problems, or habits and addictions frequently become more spiritual, and have a deeper understanding of spiritual / mystical / theological / philosophical concepts at the moment of recovery, although that probably sounds vague and maybe goofy. That would have to be the topic of another conversation.
I wrote an article on Should Statements that I might publish on my website at some point.
Albert Ellis was one of the first individuals who taught about the problems with Should Statements, back in the 1950s. He pointed out the three valid uses of shoulds that I listed above. The idea that there are valid uses of shoulds, including Moral Shoulds, is an old and well established concept that is embedded in all of the cognitive therapies.
The feminist psychiatrist, Karen Horney, wrote about the “Tyranny of the Shoulds” in the 1950s as well. My mother was struggling with some depression then, and found the books of Karen Horney to be helpful. I was just a kid at the time. I’m still a kid, but more of an old kid now!
Good luck with your dissertation. I’m sure it will be thought provoking, and interesting to many people!
Hope you can come on a hike again one day!
David
