michael osullivan

Michael O’Sullivan, author of ‘Working with compassion’, explores what literature can tell us about the core qualities of cognitive behavioural therapy and depression 

Cognitive behavioural therapy (CBT) is many things. 

At its root it is about reading and writing. Clients who receive CBT are always reading and writing about something, whether it is a mood diary or a thought record. 

There are reasons for this. When we write we are putting a distance between ourselves and our troubling thoughts and feelings. 

We do this because the words we choose matter.  The words we choose are important and because of this I think it is important to look at some of the lessons that literature can teach us about CBT and depression. 

CBT is based around a number of discrete stages such as understanding the rules for living which maintain depression;  seeing how the illness affects our thinking; understanding the roots the problem and starting the process of change.  

For each of these stages literature can help us in our understanding. 


We manage our lives through the rules passed down by our families.  However, in depression, as Andrew Solomon says in the “Noonday Demon”-

“the rules all change”

We may start to become perfectionists to hide our sense of failure. We may begin to punish ourselves if we break our rules. Although we recognise that the rules are illogical, they are compelling. They are as Solomon says-

“never real and always true.”


The changing rules are preceded by changes in our thinking. Our thoughts begin to feel overwhelming. J.K. Rowling in writing about her depression said that: “Our thinking becomes global. Depressed people find it hard to see individual differences. If someone lets them down it means that no one can be trusted.” 

These thoughts become even more difficult because it is hard to give them a name. This is in itself part of the problem. As David Foster Wallace says, “The impossibility of sharing or articulating this pain was itself a component of the pain.”

How do we deal with this?

How it starts

The roots of depression lie in the past. As we suffer, the past, like a ghost, comes back to haunt us. In CBT we try to re-write the story of depression seeing how the past is experienced in the present. We do this because, as William Faulkner says: “The past is never dead. It’s not even the past.” 


CBT is about freedom from the past and planning for the future. As Soren Kierkegaard tells us, “Life can only be understood backwards but must be lived forwards.”

As we live our lives going forward, we begin to set goals. In doing this we leave our comfort zone and enter, in the words of Hamlet, “The undiscovered country.”

In CBT we use our therapy as a map to navigate this new country. There is much that we can learn from literature both as therapists and as clients.