Psychology's New God (a critique of Cognitive-Behavioral Therapy)

http://hbmag.com/jungian-psychology-series-psychology’s-new-god/

by gnosis • 15 years ago

24 22 15 years ago

Not really a critique, just some rather muddled FUD from a once fashionable rival.

gwern• 15 years ago

The real criticism, as it were, is in the final paragraphs where the author points to the usual study of psychotherapies which found small advantages for CBT. (I couldn't help but sarcastically think, 'and is 8% more effectiveness not worthwhile?')

gnosis4• 15 years ago

Read that again. It didn't find an 8% advantage for CBT.

Here's the sentence that mentions 8%:

"Dr. Wampold found that the methods and techniques unique to a given therapy account for only a modest portion (roughly 8 percent) of the overall treatment effects."

Note that he's talking about "a given therapy", not CBT in particular.

Also, it's not clear from the summary whether 8% was within the margin of error or not. And what kind of "effectiveness" are they measuring? Has the "effectiveness" been shown over the long-term or just the short-term? How large were the studies? Etc...

MarkPNeyer2• 15 years ago

i tried CBT when my life was a mess last year. it helped me accomplish some goals for a while, but it didn't last.

now i'm going to analysis 5 times a week, and it's made a world of difference.

awakeasleep• 15 years ago

How many hours a week do you spend in therapy? And what is the price to you?

Not trying to make a point in reference to CBT, I'm just curious about the numbers, if you feel like sharing.

MarkPNeyer2• 15 years ago

i go to 5 one hour sessions each week. the therapy and medication cost me over 2 thousand dollars each month, but i credit them with totally turning my life around. before this therapy i had zero emotionally intelligence; i would feel things so intensely that i would be overwhelmed with the emotion and unable to think about it rationally. now i am building the ability to step back and see what is happening.

another really helpful move i took was to build the website https://www.thoughtplot.org, which has been incredibly valuable for me in understanding my mood.

at cbt, i told the guy that i sometimes become convinced that i am supposed to trigger the singularity via a giant public sex orgy. instead of trying to figure out why that is or what i could do about it, he was like "why dont you make it a goal to eat vegetables today?" it actually helped, but it was adressing the symptoms (psychosis) rather than the problem (a feeling of lonliness and self hatred.)

gnosis4• 15 years ago

Also very interesting:

  Post Qualification Training in Selective Ignorance

http://www.midpsy.org/training_in_ignorance.doc

Excerpts:

"the assumption .. [is] that [CBT] represents a lucid treatment framework, founded upon a solid body of theory and research... [but] when this approach is examined from a historical perspective, it is revealed as a self-contradictory mishmash of psychiatric ideas, behavioural techniques, crude clinical pragmatism and post hoc justifications from the academic discipline of 'cognitive psychology' - or at least those bits of it that can be made to fit with the claims of the therapists.

In other words, CBT is a 'tradition' rather than a distinct modality, owing most of its success to its appeal to a superficial rationalism and to the promise of delivering 'cheerful efficiency'"

The papers presented in one of the conferences mentioned in the above report are collected in this book:

http://bjp.rcpsych.org/cgi/content/full/195/6/557

MaxGabriel• 15 years ago

Another critique of CBT, this one from a psychoanalytic perspective

http://www.guardian.co.uk/science/2008/sep/09/psychology.hum...

The Guardian article is theoretical or philosophical at best, but presents some interesting ideas, such as criticisms of the methodology of CBT studies. Specifically, the focus on solving one symptom while not taking into account development of others.

gohat• 15 years ago

I've written a lot of articles in the health field (around 200), and, iirc, the efficacy data for therapy of psychoanalysis and CBT is similar, actually, again, now that I think about it, iirc, any psychological type of therapy (within reason) is roughly as effective as the other.

As such, from the insurer's side, which is preferable: one that lasts something like 12 weeks and has limited amount of sessions, or one that lasts years and can have 4 sessions a week?

People need to feel listened to, cared for, important - in one form or another.

steve-howard2• 15 years ago

4 sessions a week is always excessive. It's not that people don't need the help -- it's just that you need more time to process information.

gnosis4• 15 years ago

I don't know about that. It's not like people aren't "processing information" either during or after the therapy sessions.

And is 4 sessions a week really "excessive"?

Remember that most therapy sessions are only 1 hour long (sometimes as little as 45 minutes, or even 30 minutes long).

It can feel very rushed to have to cram a description of and then a discussion of everything significant that's happened to you in the course of a full week in to just 1 hour of therapy, especially if you are going through a very rough time where there's a lot going on (both external and internal).

That's why many therapists prefer "intensive therapy" (ie. more frequent or perhaps longer sessions) for people going through a crisis, and then advise less frequent sessions as their lives stabilize.

That said, I think 1 hour per week is the norm in most types of therapy. 4 hours per week is relatively unusual.

jdietrich• 15 years ago

This. CBT works as well as any other talking therapy, but is orders of magnitude cheaper.

As the article states, most talking therapies show the same efficacy, whether they involve six one-hour sessions or a decade of intensive analysis. To me, this is a clear indicator that nobody has beaten placebo and we really need a different model.

If we practiced surgery the same way we practice psychiatry, we would be routinely trepanning people if they seemed 'resistant to conventional treatment'. There is no sense in psychiatry that it is unethical to administer unproven treatments without clear informed consent. This has to stop. Psychotherapy needs to develop a firm framework to prevent patients from being subjected to pseudoscience, or it should be abolished and reformed from scratch.

To be blunt, psychoanalysts are vampires, extracting huge fees from vulnerable clients with absolutely no evidence justifying the time and expense. I see them as no different to psychics or faith healers. They obfuscate the argument by debating the merits of various therapies with no basis in neuroscience and no strong evidence of efficacy. We look back at the history of psychiatry and are horrified at what we see. I fully expect that our descendants will be horrified at how we practice psychiatry.

j_baker3• 15 years ago

If we practiced surgery the same way we practice psychiatry, we would be routinely trepanning people if they seemed 'resistant to conventional treatment'.

And if we practiced psychiatry the same way we practiced surgery, we'd give people MRIs, CAT scans, and plenty of other expensive tests every time they said they felt a bit sad.

IANAP• 15 years ago

I thought this was posted for it's comic value, but then I read the comments.

This is a critique of a therapy repeatedly proven empirically superior in it's efficacy to other non-pharmacological approaches. And, amazingly, it's a critique coming from what seems to be a Jungian nobody from Reno.

I say this as a huge advocate, and student of, Jung, Freud, Adler and the rest. But come on, if something helps people who can't leave the house, hold a job, or drive a car function again, without 10 years of 5 session a week therapy, how can you ethically justify attacking it this way.

CBT attempts to change negative thoughts and maladaptive behavior by addressing thoughts and behavior. Jungian therapy attempts to help people integrate elements of their psyche carried over from previous lives, an inherited collective psyche (yes Jung was a Nazi).

gnosis4• 15 years ago

"This is a critique of a therapy repeatedly proven empirically superior in it's efficacy to other non-pharmacological approaches."

Well, that's the question isn't it? Has it really been proven to be superior, or is it just scientistic, reductionist hype that is championed by insurers, governments, and societies that values cheap, quick, superficial bandaids instead of potentially more expensive approaches that might actually require a long, hard look at the depths of your own self.

"I say this as a huge advocate, and student of, Jung, Freud, Adler and the rest."

I really wonder about that, considering your later mischaracterization of Jungian therapy.

"But come on, if something helps people who can't leave the house, hold a job, or drive a car function again, without 10 years of 5 session a week therapy, how can you ethically justify attacking it this way."

But does it help them? That is the key question. You clearly seem to think so. Not everyone agrees.

"CBT attempts to change negative thoughts and maladaptive behavior by addressing thoughts and behavior. Jungian therapy attempts to help people integrate elements of their psyche carried over from previous lives, an inherited collective psyche (yes Jung was a Nazi)."

First, it's not like Jungian psychology does not "address thoughts and behavior". It does. It just has a different understanding of what the causes of these thoughts and behaviors are, what they mean, and how and when to change them.

Second, to say that "Jungian therapy attempts to help people integrate elements of their psyche carried over from previous lives" makes it sound like Jungian therapy is based on a belief in reincarnation. This is false.

"an inherited collective psyche"

This is more accurate. Humans inherit certain instincts, such as the sucking instinct a baby exhibits when presented with a nipple. Human brain structure is partially an inherited characteristic. Jungians argue that there are psychological instincts that are also inherited.

For instance, an image of a breast might trigger certain feelings and behavior in an infant. The image of an infant might trigger certain feelings and behavior in a mother.

The actual theory of such "archetypes" the "collective unconscious" is actually much more complex. Entire books, in fact many, many books have been written on these subjects. So the above should not be taken as even an adequate summary, much less an exhaustive account of what they're about.

"Jung was a Nazi"

This is troubling and problematic, but not really relevant to the question of whether Jungian therapy works. It's even less relevant to the question of whether CBT works.

william42• 15 years ago

I'm not sure whether it's a good idea to trust any magazine that includes articles on homeopathy: http://hbmag.com/category/6-holistic_therapies/homeopathic-n...

pnathan2• 15 years ago

"In addition, CBT has been enthusiastically embraced and promoted by insurance companies because it is considered an effective, short-term therapy. Owing to the hundreds of research studies documenting its efficacy in treatment for the above illnesses, CBT is the quintessential 'evidence-based treatment."

If it's more effective, then it should be the program of first choice. Why is this hard to accept? Can we not simply select the maximally effective treatment?

I find the article an appeal to irrationality.

j_baker3• 15 years ago

I'd like to point out that the author doesn't say it is more effective, only that studies have shown it effective. The human mind is more complex than traditional science is capable of handling. In particular, studies can only show you how people behave on average. The problem lies in the fact that there's no such thing as an "average" person. As Jung said, everyone is an exception to the rule.

pnathan2• 15 years ago

What I've read of Jungian is pretty 'woo-woo' and does not lead to any sort of rational trust.

I'd rather go with statistics: statistically, 68% of people are pretty close to the rule, and 95% are fairly close. People are all pretty much the same wherever you go if you look past the superficial trappings.

j_baker3• 15 years ago

I think in a lot of ways, CBT is sort of psychology's OOP. Sure it's useful and has its place, but that doesn't mean it should be used for everything.

ChrisMac• 15 years ago

Another critique you can level against CBT comes from the thinking behind Acceptance and Commitment Therapy (ACT). I've read books on ACT that argue that trying to rationally challenge and control and manage your thoughts often has the paradoxical effect of making them stronger, and making them more prominent in your life. A common comparison is that a person trying not to have negative, depressed thoughts is like someone trying not to think of a red lion; you can't make yourself not think something.

The ACT approach to negative thoughts and behaviors is more mindfulness based and is about accepting the things that come from your mind without necessarily getting sucked into them or being controlled by them. Personally I think bits of several approaches can help.

Psychology's New God (a critique of Cognitive-Behavioral Therapy)

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