CBT, bias, and epistemic injustice

So first off, a bit of definition. Epistemic injustice is a situation where some group of people aren't seen as valuable or important as contributors of knowledge. In the original work by Miranda Fricker, it's divided into two types. The first is testimonial injustice, where certain groups of people are either over or under credited as being reliable in what they say. The second is hermeneutic injustice, which is where society doesn't recognize the concepts needed to make sense of certain people's experiences.

Which brings me to my concern about CBT. CBT very much values "rationally" evaluating the evidence. But what if the source of the problem is in what's seen as rational? How do we account for situations where someone's environment, or even the biases of society at large, are set to make them wrongly look irrational?

This brings me to my own experience with a gaslighting parent. I was in therapy long before I understood gaslighting. So when CBT came in, my strong emotional reactions to an abusive environment had no evidence behind them. Not because they were wrong or inappropriate, but because of factors affecting what was considered evidence. Therapy just became a great way of reinforcing that I ought to be able to endure abuse with no effects.

I've noticed over the years that whether a reaction of mine is rational or not seems to have a lot to do with my ability to look and sound reliable. I've especially noticed that my ability to explain events in my past in the terms other people associate with abuse, rather than what matches my experience best, has a huge effect. Being older and working a professional job and generally being able to present as "not mentally ill" is also somewhat important.

I think this is important in part because it can help explain systemic therapy issues. Much of the problem with epistemic injustice is it is often societal rather than merely individual. I've often seen comments that if someone has issues most or all therapists, then it must be an issue with them. With stuff like this that's only partially true - if a bias is widespread then it's not surprising that someone on the wrong side of it would have repeated problems.

I think that you are identifying part of the major issue a lot of people have with CBT, including me. It's also the reason that traditional CBT doesn't work particularly well for people with borderline personality disorder, chronic depression, C-PTSD, and a lot of other problems resulting from childhood trauma. It's also one of the reasons that DBT was developed, (and possibly ACT, but I don't know much about it.)

DBT acknowledges that thoughts affect feelings, but the whole "rational" or "irrational" thing is not part of it. DBT says that every behavior (or thought) has a cause. Sometimes we know what that is and sometimes we don't, but there is a cause. So for example, one of my deep beliefs is that I need to stay quiet and hidden or I will get hurt. You can try to rationalize that away all you want but since that was my experience as a kid, I have that belief. And when I was a kid that belief and behavior made perfect sense. So it's important for a therapist to validate that, and frankly for me to validate that for myself. But does that belief make sense now given the *current* facts? And is it still helpful or effective for me? Not really. So I'm trying to change it, but that doesn't mean that it isn't there for a reason.

What you are describing sounds like therapist invalidation. That's harmful. Trying to convince you that you were not abused or gaslighted is not helpful at all. You were a child and you were hurt. No amount of rationalizing that it wasn't "bad enough" or anything like that won't help. In fact it's more hurt.

I guess I find that to be pretty much the same issue. Whether something is or is not helpful or effective for you now is entirely dependent on the actual facts. Only what the facts are is being run through those same set of epistemic biases. If your family is in fact supportive, then taking responsibility for your part of the relationship and not letting your fears get in the way is helpful. If your family is in fact covertly abusive, those same behaviors are dangerous. If your family is still involved in your life, as mine was for most of this, getting that right is pretty important.

Some of this was based on my research on criticisms of CBT from various minority group standpoints. Most therapists are white, middle class, and heterosexual - including the people who write therapy textbooks. The criticism is that this has often led to therapists misidentifying thinking and behaviors that are a protective response for people who experience discrimination. The therapist doesn't experience that sort of discrimination and as such is liable to attribute the client's awareness of it (especially in covert forms) to the client's feelings, rather than seeing it as a fact of life that the client has to work around.

Personally, I'm less concerned about validation/invalidation on an emotional level here. What I'm concerned about is that CBT and the derivative forms (DBT, CPT, etc.) don't give sufficient consideration to distortions in evidence and rational evaluation. This means it's too easy for a given behavior to appear to be irrational or unhelpful simply because, for some reason, the reality of the client's life appears to the therapist, and perhaps even to the client, to be other than it actually is.

I think your right on target ,the unfortunate truth is it's at the very heart of our medical institutions and training that is passed on from instructors to trainees.

There are only so many ways an engine can go bad or be fixed so auto or diesel mechanics know how to fix most problems (or they know who specializes in X and goes to them for advice ) our bodies are very complex but not nearly as complex as our minds .

Go back to WW 1 and how Veterans with PTSD were treated follow all its names from "shell shock,hysteria & battle fatigue" on up , it's really only the last 30 years that that anybody really figured out live through horrific experiences that's the end result ,it doesn't take war to have PTSD . Now for all intents and purposes what goes on in our brain bucket is out of reach ,sealed at the factory ? Then consider how long we have had x ray,cat scan ,MRI, and in the last 3 years they discovered a new organ in our body , or in the last 3 years a new MRI technique was discovered that revealed that psychosomatic was B'S gap in knowledge ,we have direct pathways from our brain to all of out major organs that are just being discovered exist that's why the comment "it's all in your head" is dead because nothing is all in your head .

Psychology & Psychiatry are light years ahead of where we used to be ,unfortunately that's still infancy ,and alot of it has to do with bias and nobody looking in the right place , our quiver of arrows( treatments) is remarkably empty , they have limited number of medications they pour down our throats ,and various forms of therapy ,if you don't respond to those " treatment resistant X" becomes your label .

I agree that there is systemic racism and injustice in our society and what might look like illogical or unhelpful thinking to a white middle class therapist, could actually be very logical and helpful in a client's life. I would say that is valid.

I would argue that a good therapist will not tell you what is illogical or unhelpful, but will simply encourage you to think about your own reactions and assumptions and let you decide for yourself. Is your thought or behavior getting you what you want in life?

Very little in DBT is really about challenging thoughts at all though. Much more of it seems to be about learning new ways of behaving that don't make the situation worse, accepting reality even when it sucks, and learning how to handle and modify unpleasant emotions.

I think there's a lot of bias in how that's done, honestly. Sometimes even something like framing a client's issues as "anxiety" can be an unacceptable and ultimately harmful form of pushing the therapist's views on the client. So can putting the focus on the client's internal state and reactions. And your standard lists and examples of cognitive distortions definitely have a narrative they're trying to push.

When I mention the studies about minority groups, you have to take into account that it's not just a matter of the therapist's personal biases. The client is quite likely living in a world where many people share the same biases. Not only that, but covert forms of discrimination work exactly in ways that are designed to make the victims doubt themselves. So unless the client is already familiar with covert discrimination and confident in themselves, the "rational" or "helpful" response is going to be that the client must be provoking it somehow and needs to work on their behavior to not do that. Not because that's the case, but because the environment is set up to make it seems so.

I think that can happen on a personal level too. Our environments can be set up to make it look like we're just overreacting when we're not. In fact I think that's a very common problem in our society today. And I think therapy can very much encourage that, by framing our distress within an internally focused model and setting it in contrast to rationality.

I think CBT can be harmful for example when living with a narcissist or when the victim is being gaslighted. Running that problem through CBT will only maybe the victim feel like an idiot and he'll start doubting himself.
CBT in my opinion, only works in an ideal world. It denies any real issues as well as genuinely negative traits of the person (too positive thinking leading to being blind to one's negative character traits or lack of skills). It then leads to disappointment.
I think cbt is so rational that it's in fact irrational :-)

I found behavioral therapies rather helpful. Years after therapy, it is those skills that I go back to over and over again when I find myself slipping into worry, anxiety, depression (which has been my state lately). Going back to those logical thought process when my emotions are trying to take over helps me find a place where I can ground myself, center myself, and get that balance going again.

I dealt with serious PTSD symptoms for decades, and the therapist who combined behavioral therapies with other types of trauma approaches was the therapist who was finally able to help me find a place of stability in my life.

I found this which helped me understand better.

Quote:

In Fricker's 2007 book Epistemic injustice: power and the ethics of knowing, she defines two kinds of epistemic injustice: testimonial injustice and hermeneutical injustice.[3] According to Fricker, testimonial injustice occurs when someone's knowledge is ignored or not believed because that person is the member of a particular social group[3] (such as a woman, or African-American). A hermeneutical injustice occurs when someone's experience is not understood (by them or by others) because there are no concepts available that can adequately identify or explain that experience.[3] Other scholars have expanded what the term epistemic injustice includes. These contributions have included naming kinds of epistemic injustice such as epistemic oppression,[4] epistemic exploitation,[5] silencing as testimonial quieting and as testimonial smothering,[6] contributory injustice,[7] distributive epistemic injustice[8] , and epistemic trust injustice.[9] Developments in the literature on epistemic injustice has also included José Medina's push for an account that incorporates more voices and pays attention to context and the relationships at play,[10] as well as Elizabeth S. Anderson's argument for looking more closely at structural causes and structural remedies of epistemic injustice.[11] A closely related literature on epistemologies of ignorance has also been developing, which has included the identification of overlapping concepts such as white ignorance[12][13] and willful hermeneutical ignorance.[14] Some scholars, including Kristie Dotson, have warned about the risks of limiting the field of epistemic injustice through definitions that could leave out important contributions to the discussion.[15] Gaile Pohlhaus Jr. argues that this means that the concept should be considered an open one, and many different approaches to the concept should be considered for their unique contributions in any account of the varieties of epistemic injustice.[2] History Although the term epistemic injustice was coined in 2007, analysis of the experience of epistemic injustice has been offered by those who experience it for a long time. Vivian May points as far back as the 1800s, to Anna Julia Cooper writing in 1892 about the suppression of Black women's ideas[16] and Sojourner Truth speaking in 1867 about Black women being denied recognition as knowers because they given as much cognitive authority.[16] Pohlhaus Jr. points to Gayatri Chakrovorty Spivak's 1988 Can the Subaltern Speak? as another example. In that piece, Spivak describes what she calls epistemic violence occurring when subaltern persons are prevented from speaking for themselves about their own interests because of others claiming to know what those interests are.[17] Miranda Fricker's book introducing the term epistemic injustice was published in 2007. In 2017, the Routledge Handbook of Epistemic Injustice was published, compiling chapters addressing both the theoretical work on the concept and efforts to apply that theory to practical case studies.[18] The term epistemic injustice has also been used by Rajeev Bhargava, an Indian political theorist, to describe how colonized groups were wronged when colonizing powers replaced or in some other way negatively impacted the concepts and categories that colonized groups used to understand themselves and the world.[

Quote:

Originally Posted by OnlyOnePerson So first off, a bit of definition. Epistemic injustice is a situation where some group of people aren't seen as valuable or important as contributors of knowledge. In the original work by Miranda Fricker, it's divided into two types. The first is testimonial injustice, where certain groups of people are either over or under credited as being reliable in what they say. The second is hermeneutic injustice, which is where society doesn't recognize the concepts needed to make sense of certain people's experiences. Which brings me to my concern about CBT. CBT very much values "rationally" evaluating the evidence. But what if the source of the problem is in what's seen as rational? How do we account for situations where someone's environment, or even the biases of society at large, are set to make them wrongly look irrational? This brings me to my own experience with a gaslighting parent. I was in therapy long before I understood gaslighting. So when CBT came in, my strong emotional reactions to an abusive environment had no evidence behind them. Not because they were wrong or inappropriate, but because of factors affecting what was considered evidence. Therapy just became a great way of reinforcing that I ought to be able to endure abuse with no effects. I've noticed over the years that whether a reaction of mine is rational or not seems to have a lot to do with my ability to look and sound reliable. I've especially noticed that my ability to explain events in my past in the terms other people associate with abuse, rather than what matches my experience best, has a huge effect. Being older and working a professional job and generally being able to present as "not mentally ill" is also somewhat important. I think this is important in part because it can help explain systemic therapy issues. Much of the problem with epistemic injustice is it is often societal rather than merely individual. I've often seen comments that if someone has issues most or all therapists, then it must be an issue with them. With stuff like this that's only partially true - if a bias is widespread then it's not surprising that someone on the wrong side of it would have repeated problems.

I kind of feel like we all need to collaborate on a paper about this. Though I was unfamiliar with the term “epistemic injustice,” it is a familiar concept (eg the axiom that history is the written record of the victor) and one i have thought about a lot in relation to therapy. More than in other helping professions, psychotherapy is prone to neglecting the perspective of the user/client. It’s easy to see how that can happen, the therapist imagines that all they hear is the perspective of the client. What is largely missing in the literature are the types of truths that come up again and again on these boards: the perspective of the client about therapy and the therapist expressed free of repercussions within the therapeutic relationship.

In addition to sucking at stuff related to abuse, another aspect of CBT (many other forms of psychotherapy as well) that is steeped in epistemic injustice is a non-acknowledgement of the role of systemic oppression in the lives of patients. The experience of racism, for example, does not constitute distorted thought that needs correcting. And yet because there is so much focus on the individual, there is little acknowledgment that they are ok and the world isn’t. This kind of BS is a form of gaslighting in itself and is very unjust.