Therapeutic Solutions

Blame it on Freud.

When he started out, nobody else was asking the kinds of questions he ended up asking.

People debated whether dreams had any meaning at all. Some folks thought there must be part of our thinking that wasn’t conscious, but nobody had figured out how to find out for sure. Nobody had discussed defense mechanisms or slips of the tongue.

Then, Freud invented psychoanalysis, mostly as a method for studying how people were built, only secondarily as a method for curing his patients. Curing problems required years of steady visits to the shrink, and the results were often spotty. Patients learned lots of useful information about themselves but the quality of their decisions changed slowly, if at all.

Quite naturally, this caused a number of reactions. Clients wanted their problems solved, and they wanted it to cost them less in both time and money. Managed care has accelerated those trends, but they reflect something we should all aspire towards.

Insofar as possible, suffering should be reduced as much as possible as quickly as practical. The days of therapists’ hanging onto clients or patients forever, if they were ever acceptable, no longer are.

This is a welcome development. Blaming managed care for it is pointless—the change was inevitable, and the therapy community could have saved itself much grief if they had initiated these reforms themselves (and also policed the charlatans and the unscrupulous, though this is another subject for another time). It makes us all look bad that so many resisted accountability for so long.

Another attempted solution was to explore short-term strategies that reduce symptoms. Two have jumped to the forefront, medication and Cognitive-Behavioral Therapy (CBT). Each reduces symptoms more than placebos (typically, about 30-35%), though many medications on the market have success rates of under 50%. Research has shown that the effects of CBT also last longer than medication’s.

CBT and medication share one feature, an explanation of why they work that’s simple and sounds good when you first hear it. These explanations lead to fairly simple and straightforward solution strategies. However, they share a problem—they’re based on a faulty model of what actually causes the psychological problems that people face.

The physicians believe they’re caused by “mental illness,” meaning (probably innate) biological differences. This ignores the extensive research showing how trauma and even simple social interaction change biology.

CBT is based on the belief that thinking (or belief, or interpretation, or appraisal) always causes emotion. This ignores the extensive research showing that emotion develops first, both in evolution and within the individual. It ignores research showing that higher cognition is more influenced by mood and emotion than vice versa.

Most damningly, it ignores the clinical evidence showing that you can’t talk someone out of a traumatic reaction by reframing the way they think about it.

I’m not against CBT. It works really well in those conditions when thought does come first. It’s invaluable for treating depression and anxiety, to name two.

It works poorly when you’re trying to get at the root of a childhood trauma to relieve the emotional pain and change current relationship patterns.

Once you understand how to do it correctly, emotional processing therapy is just as quick as CBT for treating depression and anxiety and much more effective with traumas and sub-traumatic relationship ruptures.

At my core, I’m a treatment guy. I keep reading that graduate schools teach people how to be good therapists, not good practice builders. I agree with the second part and disagree strongly with the first. I don’t think grad schools teach people how to be the best therapists they can be, or even as good as their clients deserve.

Although I can’t change that, I’ve decided that to live with myself I have to create an impact where I can. I’ve left my job and jumped into practice, where I plan to focus on training, supervision, and consultation.

I want to help programs that know they could be offering better service to their clients but need guidance on how to get the results they desire.

I also want to help strong-minded, empathic therapists who demand that the actions they take be based on science, but who quickly develop trusting relationships and understand how their clients feel, often before their clients do.

If you’re one of those people who clients often tell that they’ve just told you something they’ve never told anyone before, then contact me, especially if you sometimes get confused about how best to proceed after that.


Dr. Steven G. Brownlow trains clinicians and consults with therapeutic programs. If you’re a clinician or run a therapeutic program, please visit the ADEPT Therapy Consulting website. Enjoy the other posts on sgbrownlow, and thanks for visiting!


Share

4 Comments

  1. Alannah
    Aug 28, 2012

    Great post – thank you for expanding a bit on your thoughts regarding why CBT doesn’t work well!

    • Steve
      Aug 29, 2012

      CBT is a subset of what ought to be done for most people. People don’t wake up one morning thinking, “I’m going to develop a faulty belief today,” something happens that they misinterpret or overgeneralize. The especially irrational beliefs are adopted as defensive measures.

      My thinking is that the least amount of time I can waste on defenses, the better. If you can get around them easily, why waste the time addressing them? Once the bypassed emotions they’re defending are treated, the defenses tend to fade away, and even when they don’t addressing them is much easier once the anxiety surrounding the bypassed emotion has been lowered.

      That’s brief, but I hope it made sense.

      • Alannah
        Aug 29, 2012

        Thank you for the response – it does make sense and I agree with you.

        • Steve
          Aug 29, 2012

          You’re welcome. It seems clear to me but apparently not to most people.

Submit a Comment

Your email address will not be published. Required fields are marked *


*

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>