Abstract
This article presents an interview with Dr. Arthur Freeman, an expert in cognitive behavior therapy (CBT). Freeman shares the process of his therapeutic training and the experiences that led him to choose CBT as the model for his work with clients. Freeman provides a brief explanation of CBT concepts and discusses the application of CBT in work with family systems, with couples, and with children.
Robey: Thank you for taking the time to talk with me today, Art. Let me start off by asking you to tell me a little bit about your background.
My background, let’s see, where to start… I’m board certified, first in clinical psychology in 1977, a long time ago! And after I got board certification, I received a diplomate in cognitive behavioral therapy and then family and couples therapy.
Then this is the perfect topic for you!
Yes! I do individual and couples and family work within a CBT perspective. As you know, in my early years I trained from a psychodynamic perspective, from an Adlerian perspective, and certainly from the cognitive behavioral perspective. I studied with Albert Ellis in New York also. So, I see myself as a neo-Adlerian in many ways, but my identification would be cognitive behavioral.
Tell us a little more about that evolution. I’m somewhat familiar with your story and I think it is fascinating. I think the readers would really enjoy it, too, if you don’t mind sharing it.
Sure. I lived on the upper side of Manhattan and I was walking around one day exploring the neighborhood and I saw an apartment building, it was 333 Central Park West, and there was a sign on the building that said Alfred Adler Mental Hygiene Clinic. That interested me because I remember as a graduate student I was interested in Adler’s work. At that time I said to the graduate student teaching the course, “Are you going to spend any more time on Adler?” And he said, “No. You know, he was a minor individual; we’re not going to spend any time on him.” The text for the course was Hall and Lindzey (1957) Theories of Personality. In fact, there was a chapter on Freud, a full chapter on Jung, and then there was a chapter called the Social Psychologists, which included Sullivan, Horney, Fromm, and Adler. So, it’s not even given much focus in the text. But, I was interested in Adlerian work, so that day I went into the Adler Mental Hygiene Clinic, as they called it then. We’re talking about the late 60s, you didn’t go walking into apartment buildings; you could have been a stalker. It was a “changing neighborhood” as they called it. There was an older woman in the room when I walked in and she spoke with an accent and she said, “What do you want?” I said, “Is this the Alfred Adler Mental Hygiene Clinic?” She said, “Yes, what do you want?” She was rather abrupt! And, I said, “Well, I’m a graduate student and I’m interested in Adler’s work.” And she said to me, “Sit down.” And, I sat down, and she said “Tell me what you’re interested in.” Her name was Danica Deutch and she had worked with Adler in Vienna and that was my introduction to Adlerian work. After our discussion I told her the questions I had about Adler and why I was interested, and what parts of this theory I found interesting, and she said, “I’ll make you a deal. If you work under supervision at our clinic, I’ll allow you to take courses at our institute.” And I thought, well hey, for free, that’s good. In addition to my graduate work, I worked, I think, 6 hours at the clinic, under supervision. I took courses at the institute with Kurt Adler, Alexandra Adler, Ernst and Helene Papanek, and others. So, it was a great opportunity!
I got my first teaching job in ’66 at a community college.
The chair of the department was a fellow by the name of Marven O. Nelson. When he interviewed me for the position of Instructor, he asked, “Do you have a theoretical orientation?” And, I said, “Well I’m kind of psychodynamic, but I’m interested in the work of Adler.” He said, “Oh, tell me about that,” and I thought, oh shit, here I am applying for a job and I’m talking about a minor theorist. This guy is going to think I’m really limited. I kept trying to get away from the topic and he kept bringing me back to it. What I didn’t know was Marven was an Adlerian, so I got the job because of my Adlerian connection! He ended up as the Dean of their institute, but at that time he was chair of the department at Rockland Community College.
One of the things Marven did—remember, this was 1966—was sponsor a series called “Sex in Contemporary Society.” It was 1966 and he had a series of speakers, George Hugo Beigel, who was head of a society lime’ that was interested in the scientific study of sex, and others, including Albert Ellis. And, here I was, the lowest man in the hierarchy. I lived in Manhattan and I commuted up to Rockland County. Marven said to me, “Ellis needs a ride up, so we’ll cover your classes tomorrow if on your way up you pick up Dr. Ellis and then drive him home afterwards.” So, I picked up Ellis at his institute and drove him up there, and we were talking in the car. We had a nice conversation, and he talked basically of his view of sex and sexuality. I was impressed because he was very straightforward. He was saying things like, “This business about premarital sex is nonsense.” He said that, “Sex is sex, whether it’s premarital, marital, post marital.” When he said these things to the audience, they were just shocked! But he said, “The only thing you have to do is be honest. You can’t say to someone, ‘I love you, go to bed with me’ because that’s dishonest. But to say ‘I’d really like to go to bed with you,’ that’s honest.” After [the sex workshop] a community group demanded that we schedule another seminar that would be paneled by a priest, minster, and a rabbi, to respond to Ellis’ words. I was really impressed with this guy.
My own therapy had been psychodynamic. I’m more psychoanalytic, psychodynamic; it can best be called a West End Avenue psychoanalytic mode, which the New York readers will understand that nobody else will. Basically, most of these people were psychologists trained by Theodore Reik and his students. I had individual psychodynamic therapy for many years to deal with a number of life issues. When I had problems in marriage, I went to the same therapist for marital therapy. Later, I was finishing my doctoral program and I was having trouble. I went through the first parts of the dissertation process; I wrote my introduction, I did the research for the literature, I wrote my methods section, and I even did the study, all approved. I got the print-out from the computer center and it just sat on my desk for months. I never even touched it and I was getting a lot of pressure. My advisor was asking me “Well how’s the writing going?” It’s going good, good, and my wife was saying, “When are you going to finish?” Oh, it’s going good, good, soon, soon. My mother was saying, “When are you going to finish this doctoral thing?” I said, “Mom it’s really very complicated, it’s a lot of work,” but the bottom line was I wasn’t doing anything. I was having trouble sleeping; I was having anxiety dreams, and the pressure was just increasing. So, I did what any psychology student does, I went to therapy. I called my former therapist and I said, “I need to see you.” He said, “What for?” I said, “I’m having trouble finishing my dissertation.” He said, “Wow, that’s really interesting that you called because I’m setting up a group for people having trouble finishing their dissertations.” So, we met on Thursday mornings from 8 a.m. to 10 a.m. and all of us were people from psychology, English, history, people who just could n’t get their asses in gear to finish their dissertations, and we all had a story. My story was from my psychoanalytic experience. I have an older brother who is a dentist and he had the title of doctor. So, I was reluctant to finish my degree because then I’d also be Dr. Freeman and the sibling rivalry would create castration anxiety and I was reluctant to deal with it. And my group would nod and try to help me work this through.
But I was getting a lot of pressure and months were going by and I wasn’t doing anything. So, I decided, wait a minute, there was this guy that I remembered and later had heard on a couple of occasions. I had gone to several of his lectures and I thought he made very good sense. So, I called the Institute for Rational Emotive Therapy—which is now called the Albert Ellis Institute—and I said I’d like to make an appointment to see someone. The intake person asked, “About what?” I said, “I’m having trouble finishing my dissertation” and she said “What area?” and I said psychology. She said, “Well, would you like to see Dr. Ellis? “He always likes to see psychology students.” So, I said fine, sure, great. So, he had half hour sessions for 25 bucks. This was 1970 or 1971. So, 25 bucks wasn’t a lot even then! I came at the appointed hour. His office was in a Georgian Limestone building right off of Fifth Avenue in Manhattan. It was a former mansion. You walked in and there was this grand staircase and his office was at the head of the staircase. I stopped for a second and was told to go upstairs; Dr. Ellis’ office was up the stairs. So I did what I was told to do. The door to his office was open and I walked in. He said “Close the door and sit down.” I sat down and he said “How can I help you?” I knew I had a half hour, so I had to talk fast. I said, “Well I’m a doctoral student at Columbia and I’m having trouble finishing my dissertation.” He said:
“And why are you having trouble finishing your dissertation?” I said, “Well,”—I was ready for that question—“I have an older brother, he’s a dentist with the title doctor and I’m reluctant to finish my doctorate because it’s sibling rivalry.” And, he said to me, “Stop. Why aren’t you finishing your dissertation?” So, I figured he was hard of hearing, so I repeated, “I have a brother who is…” and he said: “Stop with the Freudian horseshit!”
I was stunned because my analytic therapist never spoke to me that way. He thought my insights were just dandy. And Ellis said, “You just don’t get it, do you? You’re not finishing your dissertation because you’re too fucking lazy.” I was truly appalled at that point because he used the f-word and secondly he called me lazy and I’m a very hard worker. And, I said, “That’s not true, I’m not lazy.” He said:
“Oh yeah, why aren’t you lazy?” He got me to convince him—or so I thought—that I wasn’t lazy, what I have come to know as the Socratic dialogue. He had me convince him that a dissertation was something I could do and within 3 months it was done! So, I learned about CBT up close and personal. And, then in 1975, when I moved from New York to Philadelphia I called Al—I had gotten to know him both professionally and personally at this point—and I said, “I’m moving to Philadelphia, is there anyone I should contact there?” And he said, “Yeah, give Aaron Beck a call.” So, from there the rest is history.
Concepts of CBT
You said you learned CBT up close and personal, but Ellis was actually RET [Rational Emotive Therapy] and now REBT [Rational Emotive Behavioral Therapy]. What’s the difference between the two [CBT and REBT]?
REBT is a cognitive behavioral therapy. It’s one of several that are brand names. Cognitive Therapy is Aaron Beck’s work. Multimodal Therapy is Arnold Lazarus’ work, Acceptance Commitment Therapy is Steven Hayes’, Dialect Behavioral Therapy is Marsha Linehan’s, but we’re all first cousins in that they’re all cognitive behavioral therapies, plural. So, I started learning and I learned CBT or the REBT of CBT up close and personal, but REBT is a cognitive behavioral therapy.
Currently you would say you’re leaning more towards the way Beck would practice CBT rather than the way Ellis would practice it?
I think nobody practices it the way Ellis practiced it. I think I would consider myself a more traditional Beckian if I have to label it, but after studying Ellis and talking with Ellis over many occasions, I think I’m influenced by his work. But I would consider myself more a classical Beckian CBTer.
I know there’s a lot that you could talk about with CBT, but could you just give us the short version of the central concepts in CBT?
Well, again, CBT didn’t invent the wheel, nobody ever said we did. But one of the basic concepts that cognitive behavioral therapy talks about are cognitions and behavior. [People may ask] Don’t you talk about feelings? Of course we talk about feelings. What about family systems? Of course we talk about family systems. When I get a patient and I interview the patient, one of the things that Adler talked about was lifestyle, but one of the things that was key for Ellis and then Beck is the whole idea of schema, looking at basic templates for understanding your life and the world around you. The question is, where do you acquire these? Family of origin. So, let me explore with this patient, where they learn to be who and what they are. But I already know the answer to that. You learn to be who and what you are in your family of origin. CBT looks very carefully at the family system and may indeed take a systemic approach. I think systemic people use cognitive behavioral interventions that are more directed, more focused, more structured. I don’t think family systems people are totally family systems, I don’t think anyone is totally anything.
The basic model of CBT is to look at a variety of aspects of the individual’s development and what they learned. You want to look at the way they process information—cognitions—the way they behave, how they feel, looking at family structure, and what they’ve learned from their families, looking at biological aspects, looking at neurochemical, physiological issues that certainly can play a part also. One of the things I find interesting… I’ll read an article or a chapter and the first thing I’ll do when I read one of these chapters is to look at the reference section. I want to see who they’re quoting. I’ll see a reference to Beck’s book, Cognitive Therapy of Depression; that’s the CBT reference or the Beckian reference. I think what nonsense, what stupidity, what poor science. That book was written in 1979; CBT has grown since then. It would be like saying, Freud wrote a paper and we have to go with exactly what Freud says; there are no modifications. Well, then Adler writes a paper and there’s no revisions to systemic work. Well, then Erikson wrote a paper and the use of Eriksonian work died when he did, that they can’t think of anything new. So, CBT, when I first started working in this model in the late ’70s, was very limited. We worked on depression and then we added on anxiety and then personality disorders and we looked at family systems and we looked at family context, and we looked at family development as they all contributed to the development of schema. There’s a guarantee that if you have a patient sitting in front of you, they acquired their major schema though middle childhood in their family of origin, an idea that Adler put forth more than a century ago. You can’t reject understanding the system. When we choose to work within the system, it’s something else. For example, a systemic therapist is working with a family system in Chicago. Let’s suppose there is a sibling at the University of Michigan, who’s an undergraduate, and another sibling who’s married and in Florida. When you have family system sessions, do the Florida sibling and the Michigan sibling have to come in? [Some therapists might say] you gotta be there, we want the whole system. It’s interesting, but not necessary.
As you’re talking about this, one of the things I’m thinking about is bringing the past into the present. Where do you stand with that? Do you go into a patient’s childhood and talk about where patients developed their schemas?
Sure, of course. The difference is that what I have sitting in front of me, that person, is a product of their experience. So, I’m more interested in what they learned [from their past experiences]. No, let me say it differently, in the process of learning, I’m more interested in what they have taken out of the life experiences. If they’ve experienced trauma, what did they learn from that traumatic experience? If they were sexually abused, what did they learn? Some people learn “I’ve got to be more careful,” and some people learn “I’m helpless, I can do nothing.” What is it that the person learned that then is coded as schema? From a CBT perspective, I will ask, “Where did you learn this particular idea, this way of thinking, this way of behaving, this way of feeling? Who taught it to you?” And, again, we know generically where they learned it—from home and from credible people in their experience. The cognitive behavioral therapist definitely asks about the past, but our focus is much more here and now. So, it’s not why you are the way you are; it’s what keeps you that way? What keeps you stuck? What keeps you from the things you say you’re unable to do?
CBT with Couples, Families, and Children
Suppose now that you have a couple that comes to you for counseling. You’ve upped up the ante because you’ve got two people with the schemas that are driving their lives right now… So, how do you work with a couples system?
I think what we see very quickly are the schemas they come in with. I ask them what are you views on relationships, on marriage? And, where did you learn it? How does it come into play in your relationship? So, these are things we would ask about.
Once you’ve discovered something… for example, you’ve got a couple who has two very different schemas about the way things should be and this is getting in the way of their relationship… where do you go from there?
Making those schema explicit, so it’s clear to both of them, the way that they view the world. Also, asking them what they’re willing to change. What is it you would like to do differently?
So, this is where the behavioral piece comes in?
Yeah. It’s great to have insight, but that in and of itself doesn’t bring about change. I find for most individuals who come in for couples counseling that one of the major issues is skill deficits. They can get from point A to point B and now their life experience and now their relationship therapist wants them to go to point C or D and they don’t know how to do that. Just because they can go to A to B doesn’t mean they can go to C or D. A lot of what we do in working with couples is skill building - communication skills, building skills of empathy, all kinds of skills.
Are there assessments that you use when working with couples?
There are a huge number of cognitive and behavioral scales that one could choose from. In fact, I’m developing one called the relationship status scale, looking at how people look at relationships. Yes, there are all kinds of screening tools.
What about working with children, within or without the family system?
I think it’s a huge waste of time to work only with kids and not with the system. I think whatever you do in the consulting room is going to get undone on the way home. If you’re working with kids, it is essential that you work with a system. That system might include the school, social system, the church, the family.
Is there an age range for children before you would invite them into therapy?
I think it depends on the system. If what the parents do all the time is fight, I don’t think the kids need to be a part of that, they see that at home. As a general rule, Pat, I do not work only individually with kids because, as I said, I think it’s a waste of time. So if I have a 50 minute session, I might spend 10 minutes with the kid and 40 minutes with the parents or I might spend 20 minutes with the family, 10 with the kid and then with one or both of the parents. I’m willing to do something—and I know my systemic colleagues will get very upset with me for this—but I do meet with individuals within the system. I don’t think everything has to be done with everybody in the room. I think some things can be done best individually. And, I don’t think that breaks up the family, they’re in our office because of major problems, and then you may learn family secrets. I think it’s good that I would learn the secrets and to see what they’re doing that screws things up.
Say you were working with a family, including parents and children. As you’re working with behavior changes, are you likely to introduce homework? If so, would everyone have their own assignment?
Yes, family homework, and everyone has their own individual homework. Homework is an essential part of what we do in CBT. I’m not so grandiose to think that everything that needs to be done in therapy gets done in my office, in my presence. An awful lot can get done at home.
Future of CBT
Tell me what you see as the future of cognitive behavioral therapy.
I think CBT will continue to grow. I think in some ways it’s kind of reached a circular point where people want to see their name on a theory. So, they come up with cognitive therapy + some other factor, for example CBT + emotion, CBT + compassion; but all cognitive therapy is emotion focused and should focus on issues related to compassion. So someone else came up with cognitive interpersonal therapy, but interpersonal therapy is the work of Harry Stack Sullivan. Someone else will look at attachment therapy. So, they’re rediscovering all these other models. So, maybe I should come up with a cognitive systemic therapy: CST.
Introduction to Counseling Psychotherapy. We had to do a role-play and we had to audio tape it to a reel-to-reel tape. The instructor would grade our effort. He would count words, and if the therapist said 51% or more, you failed. Therapists weren’t supposed to speak. You were not allowed to ask questions. We were very Rogerian in those days. We had to make statements. I think statements are fine, I think questions are fine. With some patients I may do more talking and other patients less talking. There’s no single rule to all of this. So, where I think CBT is going to go, it’s going to keep being applied to more and more disorders to more and more contexts. So, now there is a CBT family therapy, CBT marital therapy, CBT children’s therapy. CBT is applied to just about every context, every disorder, and every group. So, it continues to grow.
And do you incorporate Adlerian concepts into your work?
Of course.
As you were talking about the future of CBT, I was thinking about the concept of integrative therapy, which might once have been called eclectic therapy, which has now become sort of a dirty word.
It always was; eclectic meant you weren’t sure what you wanted to do.
When I think of integrative, I think of borrowing tools from other approaches, but that you’re thinking aligned with one particular theory.
I agree with you, Pat. It’s kind of like saying, “Well, I’m religiously integrative; on Mondays I’m Lutheran, Tuesdays I become Presbyterian, and then Friday night of course I become Jewish, and Saturday night I become Catholic so I can go to mass and sleep late on Sunday.” You have to have a model, so I think you start with a model and you know you have a strategy, but you can borrow techniques from a variety of places.
So, that’s where it’s really important to understand your theory, so you have a good knowledge about your clients even before they come in.
Right. Let me illustrate with a story. There’s a story about a very concerned father in this Russian Jewish Village. He goes to the Rabbi very upset and he says his 18 year old son told him he wants to become an atheist. The Rabbi says to send the son to see him. The man tells his son he has to see the Rabbi, and in the small village you couldn’t turn down a summons like that. The young man goes to the Rabbi’s study, sits down, and the Rabbi says to the son, “Your father says you want to become an atheist.” And he says: “Yes, Rabbi I do, I don’t believe in any of this.” The Rabbi says: “Oh okay. Have you read and mastered the Torah?” He says: “No, Rabbi.” “Have you read and mastered the Talmud?” “No, Rabbi.” So the Rabbi says, “Have you become familiar with the mystical Kabbalah?” And, the young man says: “No.” So, the Rabbi says:” Here’s the answer. You have to go out and master Torah, Talmud, and Kabbalah. It’s only when you’ve mastered them that you can become an atheist.” And, I think it’s kind of the same in therapy. You’ve got to master a model and it’s only after you’ve mastered a model that you can decide to part from it.
Well, that’s an interesting way of thinking about that. My guess is once you master a model you begin to realize that it’s a pretty good model and maybe you don’t have to search for another one.
That’s a possibility.
Or you find that’s just not the right fit for your style or beliefs.
Right.
As you were talking, I was thinking about something I remember you saying in one of your presentations in class. That is about the idea that the client is the expert on his or her life and that therapists should avoid giving advice. I know you have some strong feelings on that. Would you like to talk about that a little bit?
I think in some ways the person is the expert on their lives and in some ways they’re not. I think there are times when I give good advice and I think there are times therapists give advice like “I think it’s a bad time to kill yourself,” that’s advice. I don’t say, “So you’re feeling really bad, so you’re up on the window sill and seems like you’re pretty serious.” No, I’m going to push them off the window sill into the room, and close the window, and say sit down, that’s a stupid thing to do. I think advice is something we do; I never understood why it’s a bad thing to do. I think if the person was that much of an expert on their life, they wouldn’t be coming to see us and save the time, money, and effort.
This is just so interesting, I could keep you talking and talking! I really appreciate this, but I do want to be respectful of your time. So, to close, if people wanted to get more training or more information on CBT where would you suggest that they start?
Have them contact me. Let me give you my e-mail to use. It’s really easy: it’s
Well, I really enjoyed having the opportunity to talk to you about CBT and its application to systems work. Thank you very much for taking time out of your busy day to talk with me.