“Therapy Wars”: Some thoughts about current psychotherapies

by Judy Koven

In Therapy Wars: the Revenge of Freud (theguardian.com, January 7, 2016), Oliver Burkeman details the shake-up caused by recent research challenging the assumption of the superiority of cognitive behavior therapy (CBT). He cites several examples, including Norwegian research that found that the effects of CBT wore off over time, a large British National Health Service study that found an 18-month course of psychoanalysis more effective than CBT, and a Swedish media report that auditors there revealed expensive investment in a CBT methodology to be ineffective.

For the first time in years, the primacy of this modality is being questioned. Neuroscience discoveries support the idea that the brain processes and integrates information more quickly than we’re consciously aware of; this suggests that not everything can be known and measured quantitatively.

Because CBT is a quantitative approach that treats symptoms, it’s easily measurable. For example, you can keep a journal of your negative thoughts and episodes of physical symptoms of anxiety and measure your progress by looking at changes after you’ve cognitively reframed a thought or applied a behavioral technique. It’s much harder to assess changes such as an increase in one’s internal experience of self-satisfaction or healthy engagement with the world.

It would seem that fewer psychoanalysts, at least here in the western US, still practice in a classic Freudian mode. Analysis has blossomed in many directions, and the emphasis has shifted to other ways of understanding our psyches. The psychodynamic therapists I know focus on the connection between mind and body, “relational” work using the therapy relationship as a framework for exploring our experience of self and other, and the various ways our early life experiences impact our attachment styles. I don’t hear anyone talking about penis envy or such.

We live in a culture that values quick fixes, easy results, and action, and we are more comfortable doing than being. I think CBT speaks to that habit. Exploring and understanding the underpinnings of what makes us tick seems a more lasting approach to how we express our difficulties, but it’s work that can unfold slowly. That being said, I think CBT and related approaches have a real place in the healing modalities. For some people, it’s all they want or can tolerate. And what’s wrong with finding tools to manage or alleviate emotional distress? I just don’t think it’s the panacea that our medical, academic and health insurance systems seem to think it is.

Here’s what psychiatrist Jerome Frank (“Case Study”, Psychotherapy Networker November/December 2015) lists as the essentials for therapeutic success:
• Confiding relationship with a helping person
• Healing setting
• A rationale or mythology that accounts for the client’s symptoms
• Plan that both client and therapist believe can work

These ring true to me and I think argue for no one method being the magic pill. That’s why Women’s Therapy Referral Service emphasizes goodness of fit and congruence of values.