Psychologists talk about the “zeitgeist” – a German word that means the spirit of the times. In the early part of the 20th century, the zeitgeist in psychology was inarguably Freudian; the ways people thought about human behavior, human motivation, the psyche, were all greatly influenced by Freud’s theories. B.F. Skinner’s behavioral theories were profoundly influential in the middle of the 20th century, and the cognitive revolution in psychology swept the field in the 1960s and beyond. Although many of these theories and perspectives were the work of experimental research psychologists, they were clearly influential among clinical psychologists as well. These days, clinical training for psychologists is often weighted toward Cognitive-Behavioral Therapy (CBT), which is a popular therapeutic approach to treating anxiety disorders, depression, and a wide range of issues that bring people to therapy.
What is CBT? CBT is an umbrella term encompassing a wide range of approaches, including Rational Emotive Behavior Therapy, Cognitive Therapy, Rational Behavior Therapy, Rational Living Therapy, Schema Focused Therapy, and Dialectical Behavior Therapy. According to the National Association of Cognitive Behavioral Therapists, these techniques share the following characteristics:
- they are based on the idea that our THOUGHTS cause our feelings and behaviors;
- they are brief in number — the average number of sessions is 16;
- the relationship with the therapist is not the focus;
- CBT is seen as a collaboration between the therapist and client;
- CBT relies on a Socratic method, and is very structured and directive; and
- homework is an important part of CBT.
It is easy to understand why this approach might be appealing to people seeking therapy. The idea that you might only need to see someone 16 times and your problems are fixed is undeniably appealing! However, it’s important to look more closely at these approaches, and evaluate them carefully.
In the March 2010 edition of the APA Monitor, the monthly professional magazine of the American Psychological Association, Dr. Jonathan Shedler reported the results of an important meta-analysis. Meta-analysis is a statistical technique that allows researchers to combine the results of a large number of studies in order to understand the degree to which an effect is important. Individual studies can be informative, but meta-analyses tell researchers just how large or important an effect is, regardless of how it was measured or reported in any individual article. Shedler wrote:
Psychodynamic psychotherapy, which focuses self-reflection and self-examination to get at the root of suffering, is at least as effective as symptom-oriented treatments like cognitive behavioral therapy or psychoactive medication, according to a January review of meta-analyses by Jonathan Shedler, PhD, a psychologist at the University of Colorado Denver School of Medicine (American Psychologist, Vol. 65, No. 2). According to one major meta-analysis, Shedler says, psychodynamic psychotherapy was about three times more effective per treatment than the most popular antidepressant medication. The benefits of psychodynamic psychotherapy seem to persist and even grow larger over time, he says.
Of course, other psychologists have reported similar criticisms of CBT; this wikipedia page offers a starting point if you want to investigate further. In my view, lasting change of an important type cannot come from such goal-directed, externally-driven exercises. CBT relies on a logical and linear system, and in my experience, people in fact act globally, and their actions represent the final common pathway that grows out of a combination of their drives, desires, needs, and unconscious and conscious processes. True change arises from an appreciation of complexity. Lasting change involves integration of different aspects of your personality, of understanding why you do things, of unfolding and deepening your understanding of yourself. Effective work with a good therapist involves facilitating change, not directing it.