Cognitive vs. Jungian: Comparing Therapies for the Rule/Role Developmental Stage
There are hundreds, if not thousands, of potential therapeutic models that can be employed for any of the myriad diagnoses to be found in the DSM-IV. Knowing which of these approaches is most applicable to a give situation is at least partially a subjective choice. However, there are certain things one can know about each therapeutic modality that allows for selecting the best option for a give diagnosis. The first step in this process is to determine the developmental stage—as much as possible, which is to say, taking a best guess—at which the dysfunction originated. From there, using the Integral Psychology of Ken Wilber (2000), one can then narrow down the best options for treatment. In this paper, it will be proposed that both the cognitive therapies of Ellis and Beck and the Psychodynamic Therapy of Jung are well-suited to the rule/role stage of development, corresponding to concrete operations in Piaget’s model, Erikson’s industry vs. inferiority conflict, or the conventional stage of Kohlberg’s moral hierarchy.
Wilber uses the term “fulcrum” to represent the complexity of developmental stages in his integral psychology approach, and he defines it as follows [AQAL means all quadrants, all levels, all lines]:
A developmental milestone within the self-identity stream, or the proximate-self line of development. Fulcrums follow a general 1-2-3 process: fusion or identification with one’s current level of self-development; differentiation or disidentification from that level; and integration of the new level with the previous level. AQAL theory, and Integral Psychology in specific, focus on anywhere from nine to ten developmental fulcrums. (Rentschler, 2006, p. 10)
For the purposes of this discussion, fulcrum-4 (F4) and its transition to fulcrum-5 (F5) are the developmental stages of interest. F4 (ages 6-12) is best defined as the stage of rule/role identity, meaning that the self begins to become less egocentric and more capable of taking on the role of other in its experience. According to Wilber, when there is dysfunction at this stage, the result is some form of script pathology, “all of the false, misleading, and sometimes crippling scripts, stories, and myths that the self learns” (Wilber, 2000, p. 96). The movement into F5 (ages 12-adulthood, if it occurs at all), when successful, allows the self-reflexive ego to emerge. With a corresponding shift from “conventional/conformist to post-conventional/individualistic, the self is faced with identity versus role confusion” (Wilber, 2000, p. 96). Resolving this conflict of individuation is another stage where Jungian therapy and cognitive therapies are quite useful.
When it comes to dealing with the dysfunctional scripts of F4—or more generally the way conscious and unconscious thoughts shape self-concept—few therapeutic approaches have proven more effective than the cognitive therapies. Cognitive therapies (especially Cognitive Behavioral Therapy) break issues down into thoughts, feelings, and actions, allowing the client to stop the “vicious circle” that can often escalate into either/or thinking, catastrophizing, or other dysfunctional cognitions (Royal College of Psychiatrists, 2005). On the other hand, Jungian therapy has also shown some considerable success in this realm by taking a nearly opposite approach to working with the same material (dealing with the unconscious rather than the conscious). The Jungian approach also seeks to help the patient define his or her place in the world, as to be expected at the stage of the rule/role self. Jung used discussion of archetypes and complexes, the first often viewed as positive and the later often seen as dysfunctional, as the way into how behavior and thoughts have been hijacked by unconscious material. Consequently, rather than deal with conscious thoughts and beliefs as the cognitive therapies do, Jung believed, like Freud, that dreams and images from the unconscious were the best way into the psyche (Corey, 2001, p. 82).
While cognitive approaches attempt to reshape conscious thoughts and beliefs, working primarily with rational and concrete thinking, Jungian therapy circumvents the conscious self for the unconscious and its images. Using techniques such as dream analysis and active imagination, Jung sought to bring into light the shadow material that shapes thoughts and beliefs. Once the images were uncovered, he then used explication (direct interpretation of the image) and amplification (association with other similar images) to solve the riddle of these messages from the unconscious (Adams, n.d.). Most importantly, Jung viewed complexes as one of the central elements of dysfunction: “they are either the cause or the effect of a conflict” (Jung, 1955, p. 79). However, while Jung viewed the complex as an obstacle, he viewed obstacles as an opportunity for growth (Jung, 1955, p. 80).
Despite their differences on the surface, both approaches seek to replace dysfunctional thought patterns with healthier thoughts and beliefs. The end result of successful therapy in both models is a move from being stuck developmentally in F4 rule/role conflicts toward growing into an F5 individuation. In Jung’s model, individuation is the specific goal of all analysis: “the cure will bring about no alteration of personality but will be the process we call ‘individuation,’ in which the patient becomes what he really is” (Jung, 1985, p. 10). Likewise, Dr. Robert Ellis felt that clients were shaped by irrational cognitions that need to be replaced with more rational cognitions, with the end result of restoring the autonomy of the individual.
But if the therapist tackles the patient’s basic irrational thinking processes, which underlie all kinds of fear that he may have, it is going to be most difficult for this patient to turn up with a new neurotic symptom some months or years hence. (Ellis, 1962, p. 96)
The removal of neurotic symptoms can reasonably be viewed as a form on individuation in the sense that Jung uses the word in that the patient is no longer captive to irrational thoughts and can be a more self-directed human being.
One profound difference in the two approaches is the length of the therapy, which also suggests a deeper difference on how each views psychological health. Jung’s depth psychology, similar to Freud’s psychoanalytic model, expects a long-term analysis, lasting sometimes for many years of two or three days a week sessions. A typical successful analysis generally lasts about three years, as recounted by Albert Ellis in relation to his own analysis (Ellis, 1962, p. 4). His own model was much briefer, but not as focused the cognitive therapy of Aaron and Judith Beck. In her 10 principles of cognitive therapy, Judith Beck states that it aims to be time limited, with an average of 4 to 14 sessions for the average depression or anxiety client (Beck, 1995, p. 7). In our modern era of HMO health care—and its limited mental health care commitment—cognitive therapy is clearly more likely to be used than depth psychology.
The difference in time allotted to therapy, however, underscores a basic difference in how the inner life of the patient is conceived by each approach. In the Jungian model, the patient is not presumed to be healthy or cured until she or he is operating as a unique, individuated human being. For Jung this included a willing to include the religious and spiritual elements of human culture in the therapeutic process. Jung believed that “all religions, including the primitive with their magical rituals, are forms of psychotherapy which treat and heal the suffering of the soul” (Jung, 1985, p. 16). To say that this is not a part of the cognitive model would be an understatement. Cognitive therapies rely almost solely on the rational dialectic between therapist and patient to dispel irrational thinking. Judith Beck defines cognitive therapy as “goal oriented and problem focused” (Beck, 1995, p. 6), with seemingly very little interest in the patient as a whole person. In fact, so much of cognitive therapy, especially Cognitive Behavioral Therapy, is focused on behaviorist tenets that there is little room for interiority at all—thoughts are treated as objects and not as expressions of subjective experience. Albert Ellis does not hesitate to dismiss the Jungian and psychoanalytic approaches as semi-logical. While discussing therapeutic models such as “abreaction, catharsis, dream analysis, free association, interpretation of resistance, and transference analysis,” he admits that they may sometimes be used successfully; but he then goes on to say, “Are these relatively indirect, semi-logical, techniques of trying to help the patient change his personality particularly efficient? I doubt it” (Ellis, 1962, p. 37). The difference in the two approaches is fairly clear.
Applying the two models to a case study
A. is an 18-year-old female, Asian college student who was referred to counseling at her school by a friend concerned about her weight loss and diet habits, which include excessive exercise. Her body mass index (BMI) of 16.9 marks her as malnourished, a key indicator of an eating disorder, most likely anorexia nervosa. She will not talk about her diet and exercise habits, but freely talked about her controlling parents (they call her daily) and her own stress at meeting everyone’s expectations for her. Her parents want her to be a doctor, while she has no interest in medicine and expresses an interest in interior design. Part of the parents’ desire to know where she is at all times might be traced back to the death of her younger brother when she was three-years-old. Her mother was depressed for several years, and when she came out of it, she focused all of her attention on A.
There is much to be said for the use of rational therapies in this case. Ellis contends that much of our irrational thinking issues from sentences in our heads that we have heard from others, including not only words, but also gestures, intonations, critical looks, and other non-verbal messages (Ellis, 1962, p. 28). For A., her parents instilled in her the belief that she was never good enough, a script that causes her to feel insecure about a 3.7 gpa, about her weight, and about not having chosen a major yet, even though she is in her first year of college. But these are not the priority scripts. The first advances need to be in the area of diet and exercise, where her inner scripts are putting her life at risk. From there, the therapist might move to the identity issues and her desire to “move on” from her parents.
As much as that will be useful, there is deeper trauma here, likely from the death of her baby brother and the ensuing depression in her mother when A. was three. These scripts are pre-rational and may be only marginally verbal, so a rational approach is not likely to reach them. Taking a Jungian approach here, including dream work and active imagination, might be the best route to dealing with the trauma that underlies the current behaviors and beliefs. The therapist will need to identify and single out the complexes involved as well. The part of her that restricts food is doing so to protect her from the pain of being embodied (which would allow the emotional pain to be more present), and that part is likely a complex composed of messages from her parents, but also has a perfectionist tone to it—there may even be some archetypal energy in relation to the ideal of beauty and femininity. Resolving that complex could go a long way toward easing her eating disorder, while the cognitive work might only be a short-term band-aid.
In the end, neither therapy on its own would be sufficient with this client, although together they get closer to becoming useful. Since her primary conflict seems to be identity and role related (F4 and F5 pathologies), they are suited to her stage of dysfunction. However, adding ego states therapy (Watkins & Watkins, 1997), or Internal Family Systems Therapy (Schwartz, 1995) would likely be more beneficial—both of which work well as stand-alone approaches with eating disorders. As much as every model of counseling would like to be self-contained and suited to all approaches, the reality is much different. An eclectic or integral approach is generally much more useful to the client as well as the therapist.
References
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press.
Ellis, A. (1962). Reason and emotion in psychotherapy. Secaucus, NJ: Citadel Press.
Jung, C. G. (1955). Modern man in search of a soul. New York: Harcourt, Brace and Company.
Schwartz, R. (1995). Internal family systems therapy. New York: Guilford Press.
Watkins, J. G., & Watkins, H. H. (1997). Ego states; Theory and therapy. New York: W.W. Norton.
Wilber, K. (2000). Integral psychology. Boston: Shambhala Publications.
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