Focus on the here and now, not the past

In last week's Southern Star, I explained why CBT largely focuses on the here and now rather than the distant past. The column is reproduced below.

“I’m very good at the past. It’s the present I can’t understand”.

That line – from a character in Nick Hornby’s novel High Fidelity – is one many people will relate to. Focusing on past events might help you understand where a problem originated, but it does not necessarily solve that problem or improve your day-to-day life. That’s why cognitive behavioural therapy (CBT) largely focuses on the here and now. Dr Harry Barry gives the example of someone stuck on a motorway after suffering a puncture: is it better to have the skills to know how to change the tyre or to walk miles back to the scene of the puncture?

Now, there are exceptions. With some difficulties – for example, post-traumatic stress disorder (PTSD) or childhood trauma – past events obviously tend to be a focus of therapy. Additionally, it’s fair to say all of us are shaped by our past and develop core beliefs about ourselves at an early age, beliefs that can shape our adult behaviour.

Nevertheless, it’s important to be aware that the factors that can start a problem are not necessarily the same ones that keep a problem going. To give another example, one used by the late Oxford CBT expert Prof. David Westbrook; look for the factors keeping a fire going rather than looking for the match that started the fire.

Consider the following story told by American psychologist and writer Dr Nick Wignall. One of his clients – we’ll call her Mary – came to therapy because she had, in her words, “daddy issues”. For years, she wanted to change career, leaving teaching to become a health coach. However, every time she seriously considered the move, she would be crippled by anxiety and panic attacks and would inevitably stick with the “safety of teaching”. Mary felt her anxiety and “stuckness” were related to her alcoholic father, who had been abusive to her and her siblings during her childhood. Her guess was she hadn’t properly “processed” her anger toward her father.

Mary’s father was certainly awful to her. The family lived in fear and, as the oldest sister, Mary felt responsible for protecting her siblings. Sometimes, during his drunken rages, she would lock herself and them in a bedroom closet for hours. Additionally, she always had to be watchful. Sometimes, her father would be sober and fun-loving, but you never knew for sure. As a result, she would plan for the worst and devise escape routes in the event her father had been drinking.

These mental habits – preparing for the worst and always looking for escape routes – were necessary for her to stay safe at the time, notes Dr Wignall. The problem is those same mental habits followed her into adulthood. Her world was no longer uncertain and dangerous, but she still fell into the habit of predicting the worst and playing it safe by looking for escape routes.

“Recounting her story didn’t eliminate the pain of her childhood or suddenly imbue her with the confidence she needed to make a change in her life”, he writes. Mary had spent years feeling angry towards her father and “processing” that anger with other therapists, but she stayed anxious and stuck. “What was really holding her back (and causing her anxiety) were the habits she learned in the past but carried with her into adulthood — catastrophising, escape planning, reassurance seeking, etc”. She didn’t have “daddy issues”; she had “daddy habits”, and these habits were maintaining her anxiety and resistance to trying a new career. 

Mary could talk about her past until the cows came home, but it wouldn’t change a thing. To think otherwise is “romantic but naive”, says Wignall. Instead, the focus of therapy was to gradually replace those old habits with new ones, which meant Mary learning new ways of thinking and behaving over the following months.

 This is “really good news, because while there’s nothing we can do to change our past”, Dr Wignall points out, “we can change our habits”. Or, as the cognitive therapist Dr Albert Ellis put it; we can't change the past, so we change how people are thinking, feeling and behaving today.