Therapy wars: psychoanalysis vs. cognitive behavioral therapy
This is one of those articles that Pocket seems to think I would be interested in, and they weren’t mistaken. It compares psychoanalysis to cognitive behavioral therapy (CBT) for treating emotional problems.
It’s not a bad article at all, but I have a few things to add. The field of therapy has become so complex over time that those are just two of an almost countless array of therapies available out there. Those two are among the more extreme examples of opposing genres: psychoanalysis being the ultimate long-term “talk” depth therapy focused on the irrational and hidden aspects of the human mind and heart, and CBT being short-term and emphasizing ways of dealing with problems by correcting cognitive errors.
Back when I was in school to learn to be a family therapist (which by the way is a very different approach than either of those, and differs in general from techniques of individual therapy), I came to some conclusions about all of this.
The summary version is that therapy can be approached from any dimension: behavioral (action-oriented), emotional (feeling-oriented), or cognitive (thought-oriented). All three dimensions are interrelated and each influences the others, so that whichever one the therapist enters on and concentrates on, it has a ripple effect on the other two. For different clients different approaches can be best; there are no hard and fast rules about it. And different therapists are drawn to working in ways that happen to suit them, so they pick and choose as well.
But overall, the most important factor is the relationship between therapist and client. Some “click” and some do not. It’s not as simple as liking or not liking, either. It’s difficult to define and quantify, but it matters greatly.
The article touches on that towards the end:
…[M]many scholars have been drawn to what has become known as the “dodo-bird verdict”: the idea, supported by some studies, that the specific kind of therapy makes little difference. (The name comes from the Dodo’s pronouncement in Alice in Wonderland: “Everybody has won, and all must have prizes.”) What seems to matter much more is the presence of a compassionate, dedicated therapist, and a patient committed to change; if one therapy is better than all others for all or even most problems, it has yet to be discovered.
My sentiments exactly.
Psychoanalysis is a cult and, in spite of the fact that a friend from medical school still calls himself an analyst, it is hooey. The first chapter of my book, “War Stories,” is about my experience as a medical student in the VA psych hospital in Los Angeles. The chief of the service, named George Harrington, was one of the two or three most impressive people I have met in Medicine. He, as a child, had sat on Sigmund Freud’s knee. His father was a lay analyst, having been a Baptist minister before going to Europe to spend time with Freud. One of his residents at UCLA wrote a book about his methods, called “Reality Therapy.” It is still in print after 50 years.
A timely article about Psychology
More young women have been entering the psychology workforce. The percent of psychologists who are women increased from 57 percent in 2007 to 65 percent in 2016. Within the psychology workforce, the mean age for women (47.6 years) was almost seven years younger than the mean age for men (54.4 years).
Men have been fleeing psychology for years and the only ones left are often male feminist Uncle Tim types who love to sell out their gender. The few decent men willing to get a PhD in psychology can look forward to a politically correct environment where the least slip of the tongue or politically incorrect research could be the end of a career. It’s no wonder men stay away.”
Hmmm.
Mike K:
Most therapists are not PhD psychologists. Also, PhD psychologists include research psychologists rather than clinical psychologists.
Psychoanalysts are not ordinarily PhD psychologists. And many therapists these days are at the Master’s level, primarily MSWs but also many others such as MAs. I don’t know the breakdown, but in the communities I know best the Master’s level clinicians way exceed the number of Psych PhD clinicians.
As far as male to female ratio, therapy has long been somewhat female-dominated, particularly the social work degrees and the other Master’s level degrees. However, although I don’t know the figures, there certainly are many men practicing in the communities I know. And I have not seen much evidence of the type of male therapist described in the quote you offer, although certainly some exist.
The younger generation just graduating recently may be quite different, however.
Psychoanalysts are not ordinarily PhD psychologists.
I think I made that clear but maybe not. The Psychiatric profession was dominated by analysts when I was in medical school. They took over, for example, the Yale Department of Psychiatry in the 1940s. Neurology has been replacing them in recent years as we learn more about brain chemistry. Psychoanalysis may be useful in explaining some human emotions but is useless in the treatment of mental illness.
If men were the automatons that behaviorists claim they
are, the behaviorist psychologists could not have invented the
amazing nonsense called “behaviorist psychology.” So they
are wrong from scratch — as clever and as wrong as phlogiston
chemists. Hienlien
“Had Enough Therapy” on Neo’s blogroll is written by Stuart Schneiderman, a behavioral coach, who calls himself a “recovering psychoanalyst.”
He agrees that analysis therapy is hooey.
For those who haven’t visited Stu yet, he writes a funny and informative column.
If you read Plomin’s “Blueprint,” he concludes that 50% of behavior is genetic and that increases as you get older. Steven Pinker, in “The Blank Slate” concluded that most behavior is genetic but Plomin has the DNA evidence. The behaviorists, like Stephen Jay Gould, were trying to create “the New Soviet Man.”
In my student days I worked a year as an aide, a.k.a. Mental Health Worker, in a private psychiatric hospital. The psychoanalytic approach was being phased out, as the long-term care implicit in psychoanalysis did not fit the shorter term payouts of the insurance companies.
One of the psychiatrists gave directions for aides and nurses writing up notes that I also found useful guides for dealing with patients: 1) What did you observe? 2) What were the dynamics of what you observed? 3) What was your intervention?
I quit after a year, basically burned out. Several years later, a peer interested in a career change interviewed for an aide position at the hospital. The director of nursing informed him that most aides quit after a year, when they feel they are going crazy. So, it wasn’t just me. Some can do it for an entire career.
For what I was paid, it was probably the most interesting job I could have had.
The main psychiatrist- who owned the place with her MD general practicioner husband- had a good joke. “My mother made me a homosexual.”
“Oh, can she make me one, too?”
Q. How many therapists does it take to change a light bulb?
A. Only one, but the lightbulb has to be committed to change.
The director of nursing informed him that most aides quit after a year, when they feel they are going crazy.
I spent a summer doing it and was exhausted every night coming home. Harrington considered everybody part of the treatment team. The guys who buffed the floors were included in staff meetings where patients were discussed and sometimes interviewed.
@Artfldgr:If men were the automatons that behaviorists claim they
are, the behaviorist psychologists could not have invented the
amazing nonsense called “behaviorist psychology.” So they
are wrong from scratch — as clever and as wrong as phlogiston
chemists.
Heinlein didn’t think very hard about that one. Behavioral scientists don’t really claim humans are automatons; he’s sliding between using “automaton” as hyperbole and using it literally.
But automatons do invent new things they were not specifically programmed to come up with, all the time, and those things are useful to humans who never would have thought to design anything that way.
According to Heinlein’s epigram, the antenna design linked to their either a) should not exist or b) the computer that designed it was not really an automaton, which would greatly surprise the factory that assembled it and the humans who programmed it.
I bet an automaton could be programmed to invent psychological theories.
Back when I was in school to learn to be a family therapist…
neo: Aside — Do you have any word on Cloe Madanes, a family therapist with enough oomph to have a wiki page? She teamed up with Tony Robbins in the early 2000s.
I could never tell where that partnership went. She showed up now and then at Tony events and is still listed as a partner. At the time Tony was concerned conventional therapy wasn’t making enough of a dent in people’s problems and the antidepressant solution wasn’t helping.
https://en.wikipedia.org/wiki/Cloé_Madanes
https://cloemadanes.com
Tony Robbins is not a psychoanalysis kinda-guy. His approach is grounded in Neuro-Linguistic Programming, which falls between the various therapy stools and definitely has its questionable aspects, but when you watch Tony intervene with a participant on stage, he is an artist and a force for good.
But overall, the most important factor is the relationship between therapist and client. Some “click” and some do not.
The first teaching of NLP is rapport, rapport, rapport.
I’m not a trained therapist or psychologist. More an occasional consumer of therapy over the past 50-odd years; albeit one who’s actually read big chunks of James, Freud (and his epigoni), Jung (and his epigoni), Perls, Rodgers, Goodman, Erickson, Rollo May, Skinner, Laing,and several others whose names I’ve long forgotten as a more or less justifiable adjunct to graduate study of intellectual history. I’ve also had several rounds of therapy, beginning in college and then later in New York and Connecticut. A fairly wide range of styles from (not in this order) traditional Freudian to quasi-Jungian to Gestalt encounter groups and so on.
I’m pretty sure on a theoretical level, almost any theoretical approach can offer interesting insights, but as theory, they’re bullsh*t. There are only great therapists, not sound theories.
I first considered this insight in encountering (pun intended) ‘gestalt’ therapy in college. I watched as they facilitators used the ‘break them down, the rebuild them’ method until I could stand it no more: I was in a group where the facilitator (a PhD candidate in psychology) was remarkably skilled at tearing people down, but absolutely clueless are building them back up. It was shockingly easy to turn her own techniques on her and watch her fall completely apart. In retrospect, I suppose I feel some guilt for having destroyed her (she quit school and ended up in a menial job), but at the time I felt only righteous anger at the damage she had done. And yet, later meeting Fritz Perls, and a number of people who worked closely with him, I could see the brilliance of his insights in his hands because he was such a gifted therapist with an intuitive sense of how far to go and what to do. Likewise, the other pioneers of psychology (James and Skinner excepted) were mostly individually great therapists.
I tried various other styes over a period of >20 years, giving each one a year or more for a fair test, and found that nothing really did much good. A few insights here or there, but nothing really earth shattering, and certainly nothing that enabled or caused me to change my life in any significant way. As the joke that was old in the 1920s put it (and I think someone repeated it in these comments) I guess the light bulb didn’t really want to change.
One of my kids had some therapy with a very talented therapist for behavioral issues in elementary school, with really excellent and life-changing results. But, the therapist was notably unsuccessful with other kids. Go figure.
I find some of the more recent stuff based on evolutionary biology interesting, and occasionally insightful, but so clearly incomplete and Panglossian that I can’t really sign on there either.
The more I think about it, and despite my own rather tenuous religious belief, I suspect most people with issues now addressed with psychological therapy of one sort or another would have been at least as well, if not better, off without formal therapy of any sort, but with some decently talented pastoral counseling.
Of course, given the decline in the quality of those going into the clergy, it’s unlikely that we could replace therapy with religion. Curiously, probably the best psychologist I know is an 90-odd year old mainline Protestant minister who also trained as a Jungian analyst.
Cato – interesting observations.
Particularly that almost any type of counseling will work IF the counselor is competent at understanding people and their problems.
I self-medicate with books and blogs.
Neo said “The younger generation just graduating recently may be quite different, however.”
I’ll be graduating this spring with an MSW. In my experience males are still the minority between the sexes. In my cohort there are only three males focusing on school social work. Less than ten males in mental health. Rest are female.
Given that my internship has focused on individual and group therapy with mostly teenagers, I am seriously thinking of becoming a therapist with my own practice one day. I haven’t dedicated myself to any one therapeutic model; I see one may work better than another. It just depends on the client and what their needs are and their personality. Some clients respond to one method over another. It’s a trial and error thing, at least for me. I have one kid who’s the ideal client: he’s responsive to what I say and he’s willing to try the plans we both agree upon near the end of our sessions. For him I mostly use CBT (DBT if we want to get specific).
For genetics playing a role in behavior, I always ask about their family history early in our relationship. I need to know what I’m dealing with besides what’s in front of me, though I only go back as far as their grandparents with inquiry about aunts and uncles and cousins.
In regards to earning a doctorate in psych for clinical work, especially for males, well, it’s tough to attract them in general. Why give five to six years of your life earning a pathetic stipend when once you’re out in the field with your own practice you don’t make that much more than an MSW or other master level therapists? Sure, you can do cognitive tests and assessments which said degrees can’t (or shouldn’t), but so what. Unless you really, really like such activities earning a doctorate is waste of time. Do it only if you want to do research that doesn’t rot the boat.
Add in the political correctness that the field is soaked in, literally, you’re giving up half a decade of your life where you don’t think a certain way your licensed is revoked or your reputation is ruined (Jordan Peterson is the exception). The field of psychology needs to have a serious makeover alongside sociology.
Jordan Peterson is an academician, not a clinician; his published work AFAICT is on studies of personality.
Marcus Bachmann maintained a thriving multisite practice though he’s fairly outre by the standards of most psychologists. He has been harassed by the media and now by state inspectors, I see. I sometimes think the Democratic Party is the electoral vehicle for all the worst people in America.
I have a relation who is the issue of Regent University’s Psy D program. She hasn’t been stripped of her license yet, and she lives and works in a deep blue part of the country. Maybe just under the radar.
Art D,
Dr. Peterson also is an experienced clinician. Per the Great Foot (i.e., Wiki):
I’m fascinated to know how he managed to devote 20 hrs. per week to clinical practice betwixt and between his teaching schedule and his research projects.
Art Deco:
My guess is that Peterson doesn’t sleep much.
GRA:
Thanks for the update.