February 14, 2006


More and More, Favored Psychotherapy Lets Bygones Be Bygones (ALIX SPIEGEL, 2/14/06, NY Times)

For most of the 20th century, therapists in America agreed on a single truth. To cure patients, it was necessary to explore and talk through the origins of their problems. In other words, they had to come to terms with the past to move forward in the present. [...]

"Average consumers who walk into psychotherapy expect to be discussing their childhood and blaming their parents for contemporary problems, but that's just not true any more," said John C. Norcross, a psychology professor at the University of Scranton in Pennsylvania.

Professor Norcross has surveyed American psychologists in an effort to figure out what is going on behind their closed doors.

Over the last 20 years, he has documented a radical shift. Psychotherapeutic techniques like psychoanalysis and psychodynamic therapy, which deal with emotional conflict and are based on the idea that the exploration of past trauma is critical to healing, have been totally eclipsed by cognitive behavioral approaches.

That relatively new school holds that reviewing the past is not only unnecessary to healing, but can be counterproductive. [...]

The therapy dwells exclusively in the present. Unlike traditional psychoanalytic or psychodynamic therapy, it does not typically require a long course of treatment, usually 10 to 15 sessions.

When cognitive therapy was introduced, it met significant resistance to the notion that people could be cured without understanding the sources of the problems. Many therapists said that without working through the underlying problems change would be superficial and that the basic problems would simply express themselves in other ways.

Cognitive advocates convinced colleagues by using a tool that had not been systematically used in mental health, randomized controlled clinical trials.

Although randomized controlled trials are the gold standard of scientific research, for most of the 20th century such research was not used to test the effectiveness of psychotherapeutic methods, in part because psychoanalysis, at the time the most popular form of talk therapy, was actively hostile to empirical validation. When research was conducted, it was generally as surveys rather than as randomized studies.

Cognitive behavioral researchers carried out hundreds of studies, and that research eventually convinced the two most important mental health gatekeepers — universities and insurance companies. Now the transformation is more or less complete.

"There's been a total changing of the guard in psychology and psychiatry departments," said Dr. Drew Westen, a psychodynamically oriented therapist who teaches at Emory University. "Virtually no psychodynamic faculty are ever hired anymore. I can name maybe two in the last 10 years."

Insurance companies likewise often prefer consumers to select cognitive behavioral therapists, rather than psychodynamically oriented practitioners. In the companies' view, scientific studies have shown that cognitive therapy can produce results in less than half the time of traditional therapies.

Short version: Stop gazing at your navel and change your behavior.

Posted by Orrin Judd at February 14, 2006 5:31 PM

Shorter version: Cognitive behavioral therapy is all the insurance company is going to pay for.

Posted by: Lou Gots at February 14, 2006 8:03 PM

Shorter yet: Jung good, Freud bad.

Posted by: ghostcat at February 14, 2006 9:03 PM

Remember that Bob Newhart skit from SNL where someone came in talking about his problems and Bob just told him to stop it?

Whenever I hear about these people who are in therapy all their adult lives, it just makes me think that the problem isn't some hidden thing, it's themselves. Usually these are people you are told not to be judgemental of as well.

Posted by: RC at February 15, 2006 1:38 AM

The insurance companies and Medicare/Medicaid decide what procedures are covered. The proliferation of alternate health care options left over from the hippie-dippie movement is costing us a bundle.

Here in geezer country, there's a chiropractor on every corner and lots of acupuncture and other non-traditional "therapies" sprinkled liberally (pun intended) about.

Even so, guess what? None of us feel like we're 19 years old again! What a bummer. After spending all those gazillions, we still have sagging bodies, aching joint, memories not worth a da*m, failing hearing and eyesight and what makes it all tolerable is the sure knowledge that the yuppie baby boomers who think they've dodged that bullet will very soon start feeling the effects of their years and all their lecturing about smoking, health food, gym attendance, etc. won't help a bit. Heh heh.

Posted by: erp at February 15, 2006 11:12 AM