January 9, 2016

"But the most incendiary charge against cognitive approaches, from the torchbearers of psychoanalysis, is that they might actually make things worse..."

"... that finding ways to manage your depressed or anxious thoughts, for example, may simply postpone the point at which you’re driven to take the plunge into self-understanding and lasting change. CBT’s implied promise is that there’s a relatively simple, step-by-step way to gain mastery over suffering. But perhaps there’s more to be gained from acknowledging how little control – over our lives, our emotions, and other people’s actions – we really have? The promise of mastery is seductive not just for patients but therapists, too. 'Clients are anxious about being in therapy, and inexperienced therapists are anxious because they don’t have a clue what to do,” writes the US psychologist Louis Cozolino in a new book, Why Therapy Works. 'Therefore, it is comforting for both parties to have a task they can focus on.'"

From "Therapy wars: the revenge of Freud/Cheap and effective, CBT became the dominant form of therapy, consigning Freud to psychology’s dingy basement. But new studies have cast doubt on its supremacy – and shown dramatic results for psychoanalysis. Is it time to get back on the couch?" — in The Guardian, by Oliver Burkeman.

16 comments:

robinintn said...

That article, with its questionable "studies" as support, should be called "Why That Other Form of Therapy That's Supplanted My Preferred Money-Making Scheme Should Be Banned"

Deirdre Mundy said...

I wonder if they controlled for religious background in the studies? Because the Freudians are arguing that the mentally ill need to know WHY they suffer.

But what if your religious background already explains why you suffer, and you're just looking for a practical way to live with suffering?

Sebastian said...

"Had CBT somehow benefited from a kind of placebo effect all along, effective only so long as people believed it was a miracle cure?" Not in the strict sense, that patients who got a fake version nonetheless recovered. (How could a patient tell the difference between BS CBT and the real thing?) In the broader sense that administering any therapy triggered confidence in healing which then assisted recovery, perhaps. But then why should the size of the "placebo" effect differ between CBT and the Freudians? Riddle me that, Sigmund.

tim in vermont said...

What she needed, she sees now, was real connection: that fundamental if hard-to-express sense of being held in the mind of another person, even if only for a short period each week.

I read a funny book over the summer, The Bohemian Love Diaries and the hero, Slash, often found himself in various situations involving New Agers and superannuated hippies, many with grotesquely pendulous breasts. In one, everybody pairs off with a stranger and that stranger looks at you and "witnesses" you. I remember thinking WTF? at first, but obviously the fact that I even remember the scene says it stuck with me.

n.n said...

The "consensus" by psychos is that if it's stable normalize it opens a basket of cognitive dissonance. Also, if it cries, then abort it, seems to be a prevailing charge by pop cultural elites, female chauvinist pigs, and their male pseudonyms.

Jason said...

This term "CBT" they keep using.

It does not always mean what they think it means.

Michael K said...

Freud and psychoanalysis was one of the most successful frauds of modern times, equal to Marx and Communism in wrecking people's lives.

CStanley said...

Dierdre- I had a somewhat similar thought- there is a lot of straw man fallacy in the way they are presenting CBT, and much of it relates to the idea that therapy is a panacea to replace religious and spiritual development. If CBT is used as a proper tool to redirect behavior, then it works....but it doesn't supplant the need for development of the whole person and relaps will be likely without the rest.

Fernandinande said...

To misquote some old guy, "the more treatments there are for a condition, the less likely any of them work".

Almost all psychologists ignore this:
Steven Pinker on New Advances in Behavioral Genetics
"The findings of behavioral genetics have turned out to be substantial and robust, and new studies are linking genes with behavioral traits like IQ"

Francisco D said...

Psychodynamic approaches differ from CBT in one essentially important way. They are derived from intuitive theories that have no empirical support. CBT is based on theory and practice that has an extensive empirical underpinning. Some psychodynamic theorists point to studies that provide post-hoc support for some of their concepts, but the concepts were never directly tested. That is not scientific, by any stretch of the imagination.

As an empirical CBT-based psychologist, I have often asked Freudian and neo-Freudian adherents where one can find an id, ego and superego. I am also interested in any research that provides any support for stages of psychosexual development and their impact on the mind. Most of those folks were indoctrinated at subpar schools (i.e., not mainstream universities) and really have no idea of what I am asking them.

It's a cult following.

joshbraid said...

I read the article all the way through (practised the real family therapy for 15 years and very interested in neurotherapies such as EMDR, etc). In a way, it illustrates the change in the approach to suffering in life that occurred in the 50's and 60's. That is, suffering was to be avoided, addiction was preferable. Too extreme? The sexual revolution was not about love but about addiction. Even the meaning of love changed--from a sacrificial action directed toward the good of someone else to (temporary) satiation of one's own need to avoid pain and enjoy pleasure. That worldview is now declining as economic and family conditions change. CBT might be helpful for specific symptoms but it became a cheap modality loved by bureaucrats in insurance companies and government to help with "cost reduction". Outcome studies are rarely valid, usually shaped culturally and by the positive reinforcement that comes from getting paid for a desired outcome. In the end, psychological theories and methods of treatment do not exist in some objective "bubble". To operate in such a mindset is very convenient and usually harmful.

rhhardin said...

Therapist is a fancy name for actor.

Francisco D said...

With all due respect Josh,

EMDR is a non-empirical treatment that has limited success. It is more successful if practitioners understood its empirical underpinnings - systematic desensitization.

Your comment on the harmfulness of objectivity suggests that you are a cultist who knows not of what he speaks. What is your academic training?

YoungHegelian said...

There was another important social reason other than the fact that psychotherapy didn't work that got Freud shitcanned: Freud was not beloved by feminists & homosexuals.

Don't assume that because a bad thing that put away, it got put away for the right reasons.

tim in vermont said...

Freud was a great writer.

Peter said...

"What seems to matter much more is the presence of a compassionate, dedicated therapist, and a patient committed to change; if one therapy is better than all others for all or even most problems, it has yet to be discovered. "

Which leaves us ... where? Not only are methods lacking which can provide objective evidence that one type of therapy is better than another for any mental disorder, but there are no objective methods to evaluate whether one practitioner is better than another (or even better than any untrained individual willing and able to display compassion and dedication).

Without standards or even much in the way of objective measurement, it seems only rational to prefer less expensive methods over costlier ones. And if practitioners want respect, well, some real objective performance standards (and perhaps objective measures of outcomes) would earn a lot more respect than more DSMs and/or credentialism.

Although perhaps with enough of that "taxpayer funded therapy" they'll realize that there's little need for anyone's respect anyway, and just stop seeking it.