I like this

I use Google News alerts to help me find items of interest to write about. I have no idea why this 2003 article happens to appear in Psychiatric Times, but it is good to see a critique of cognitive behavioral therapy just the same. And that the author is in Maine also -- well, that just makes it nicer.

Managed care has stressed cost-effectiveness and a bottom-line related bias for brief therapy. Cognitive therapy fit the bill. Psychotherapy researchers have emphasized 'manualized therapies' to promote standardization to facilitate study. Cognitive therapy fit the bill. Psychodynamics takes a long time to master, with often ponderous readings and substantial irrelevance for the trainee. Trading upon its here-and-now focus, its harnessing of the patient's problem-solving skills, its rejection of the unconscious and transference, the cognitive model can be taught to trainees quickly. Cognitive therapy fits the bill.

He goes on:

What may be good for a subgroup of patients may nonetheless be bad for psychiatry if we elevate it to the dominant worldview of our profession and our major training modality for psychotherapy. Here are some of the reasons why, which I will discuss:

Cognitive therapy does not reflect current knowledge of how the brain works;

Cognitive therapy is not rational;

Cognitive therapy does not really reject transference;

Cognitive therapy unquestioningly supports the social status quo;

Cognitive therapy gives patients no means of responding to unsolvable problems: to the inherently tragic nature of life.

and

Carl Jung once wrote that the most important problems in life are never solved, only outgrown. Pain, loss, alienation from the larger culture, frustrated loves, ambitions that won't go away--such things we do not solve; at best we come to terms with them.

But that process, while often lengthy and painful, yields rewards undreamed of in cognitive therapy's socially adaptive outcomes. For, to finish with James (1902):

The evil facts which it refuses to account for are a genuine portion of reality; and they may after all be the best key to life's significance, and possibly the only openers of our eyes to the deepest levels of truth.

Many patients, products of our American belief that any problem which can be named can be solved quickly and without a lot of fuss press hard for answers. "What do I do to change this?" when no amount of work at changing thoughts yields much of a change. For both therapist and patient, commitment often must be made to taking the time and doing the work of coming to a deeper understanding of the unconscious issues which drive behavior which creates unhappiness.

How much harder it is to deal slowly and thoughtfully with what it is that keeps one person in thrall to her mother's negative judgments or another to a persistent and damning inner critical voice or yet another to a belief that he can never find love than it is to authoritatively suggest thought-stopping exercises and affirmations. It is hard sometimes to resist the pull of the promised easy cure to these rather vague ills which beset so many of us. And heaven knows, it is almost unAmerican to assert that there is meaning in suffering, value in the struggle to become conscious.

© Cheryl Fuller, 2018. All  rights reserved.