Therapy wars: the revenge of Freud by Oliver Burkeman
Stephen Williams stashed this in psychology
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.”
The most incendiary charge against cognitive approaches is that they might actually make things worse
Not surprisingly, leading proponents of CBT reject most of these criticisms, arguing that it’s been caricatured as superficial, and that some decrease in effectiveness is only to be expected, because it’s grown so much in popularity. Early studies used small samples and pioneering therapists, enthused by the new approach; more recent studies use bigger samples, and inevitably involve therapists with a wider range of talent levels. “People who say CBT is superficial have just missed the point,” said Trudie Chalder, professor of cognitive behavioural psychotherapy at the King’s College Institute of Psychiatry, Psychology and Neuroscience in London, who argues that no single therapy is best for all maladies. “Yes, you’re targeting people’s beliefs, but you’re not just targeting easily accessible beliefs. It’s not just ‘Oh, that person looked at me peculiarly, so they must not like me’; it’s beliefs like ‘I’m an unlovable person’, which may derive from early experience. The past is very much taken into account.”
Nonetheless, the dispute won’t be settled by adjudicating between clashing studies: it goes deeper than that. Experimenters may reach wildly different conclusions about which therapies have the best outcomes. But what should count as a successful outcome anyway? Studies measure relief of symptoms – yet a crucial premise of psychoanalysis is that there’s more to a meaningful life than being symptom-free. In principle, you might even end a course of psychoanalysis sadder – though wiser, more conscious of your previously unconscious responses, and living in a more engaged way – and still deem the experience a success. Freud famously declared that his goal was the transformation of “neurotic misery into common unhappiness”. Carl Jung said “humanity needs difficulties: they are necessary for health.” Life is painful. Should we be thinking in terms of a “cure” for painful emotions at all?
“What happens in therapy,” Pollens said, “is that people come in asking for help, and then the very next thing they do is they try to stop you helping them.” His smile hinted at the element of absurdity in the situation – and in the whole therapeutic undertaking, perhaps. “How do we help a person when they’ve told you, in one way or another, ‘Don’t help me’? That’s what analytic treatment is about.”
Interesting battles. You would think we would sort this out sometime soon.
I hope we sort it out soon. What do you think of CBT?