Sunday, January 10, 2010

Debate over cognitive, traditional mental health therapy

Advocates of the medical model of psychotherapy are pushing ever harder to get their pet approaches to be the ONLY approaches for working with clients. They are ever louder in their calls for evidence-based therapies, which means cognitive behavioral therapy (CBT), which is largely the only one being studied for most disorders.

These folks reject traditional talk therapies and autobiographical approaches as being voodoo science, yet they advocate for an approach that is little more than a band-aid for a wounded mind (or soul). CBT addresses cognitions, but it does nothing to address the underlying causes of those dysfunctional cognitions.

This is what happens when health care of any kind is based on profit and not what is best for the patient. The system is effed up.

This article from the LA Times presents both sides of the argument, but does not address the full-range of therapeutic options - psychoanalysis is not the only other option. Parts work, schema therapies, somatic approaches, and so on, all look toward the idea that emotions are body-based and consciousness is shaped by that less-than-conscious aspect of our lives (Damasio, 2000) - and dysfunctional thoughts are shaped by emotions.

Debate over cognitive, traditional mental health therapy

Psychologists who favor the more medical-minded cognitive behavioral model point to growing evidence of its efficacy. Proponents of psychoanalysis deride a one-size-fits-all approach.


Marsha Lucas, PhD said...

Reading (again) about this "debate" reminds me of the arguing couples I see in my office...

I am a PhD-level clinician, and I do indeed look to science. (Part of my training was in CBT, by the way, and almost none of it was what is technically psychoanalytic.) The only results that I see which fit with what we know about human development, social psychology, and brain mechanisms for lasting change, to mention a few, are the repeated, validated studies which show that the relationship between the patient and his/her therapist is the single most important variable in determining the efficacy of treatment.

Attuned communication (verbal or non-verbal) with contingent responses in childhood are what play an enormous role in wiring our brains for well-being. As we learn more about neuroplastic changes which occur in adulthood as well, the *same* benefits of attuned, contingent relationships can also be seen then as well.

Human beings thrive in relationship, and they suffer without it. To get what you so appropriately call "band-aid" therapy is giving humans little credit, and short shrift.

william harryman said...

Thanks Marsha, I appreciate your perspective.

As a student, I get the message that the empathic therapeutic relationship is the most important thing, this message coming from the masters level therapists teaching in our program (who are about to be let go in favor of PhD and PsyD level faculty) - while the doctorate level faculty are all about evidence-based therapies, by which they mean CBT.

CBT is great for some things, and I will use it when needed. However, many other issues do not respond to CBT, especially the trauma/abuse survivors my girlfriend works with.

One of the reasons I love Dan Siegel's work is that he is providing empirical support for the therapeutic alliance which we all know is so crucial to healing.

Marital Therapy Services said...

Great insights! Thoughts, which are thoughts that arise spontaneously in response to certain situations and are more a reflection of a client's appraisal of a situation rather than the actual situation itself.