Cognitive-Behavioral Therapy Declining

[ysabetwordsmith]

This article talks about the declining effects of cognitive-behavioral therapy.  I am fascinated to explore why something that used to work pretty well is now not working as well. 

I can think of some possibilities not mentioned in the article:

1) The longer a therapy is around, the wider it is known.  That means more people have access to it before  official therapy.  You can go online and find CBT theory, techniques, thought distortions and how to fix them, worksheets, and other tools.  This raises the chance that someone already knows CBT and has tried at least some of its methods before seeking professional help.  So if the therapist then does more CBT, it looks less effective measured from the start of therapy,  because the client already did some of that stuff and got whatever benefit they got from it earlier.  In this case, CBT only has a high rate of helpfulness for people who really need guidance and/or advanced techniques that don't work well alone.

2) CBT is terrific at treating certain types of problems, but mediocre or useless for others.  If you have bad tape, this is a go-to therapy for fixing that, and you should definitely try it.  Same with any other logical or practical problem.  It's also ideal for people who do better with facts, logic, numbers, or other objective things than with subjective things.  But if you are feeling unheard, your emotions are bent, unacknowledged memories are gumming up your subconscious, or your biochemistry is out of whack, then CBT is not ideal for those problems and won't help much.  It is possible that certain types of problem are more or less common in different decades.  If the problems presenting now are something other than logical/practical ones, this therapy will seem less useful overall.

Bottom line: If you have head problems that you need help with, start by identifying them as best you can.  Then look at the available options for treatment.  Each type of treatment is good at some things and bad at others.  Pick one that's a good match for your problem(s).  Try it for a while.  If it doesn't help, drop it and try something else.

Comments

[(Anonymous)]

Just out of curiosity do you (or perhaps one of the site regulars)know if it's standard practice for therapists to ask what their patients are doing about whatever issue they've come in for?

Because if that information is floating about somewhere, well we'd have some of the answer on if cbt is waning in effectiveness as that article suggests.

And as an aside... grumbles... I'm not too sure if their assumption about people having no drive to change is really appropriate for a site talking about therapy. That statement, as well as the sparsity of data/facts in the whole makes me inclined to take the lot with a spoonful of salt.

[moonvoice]

This...doesn't really surprise me. CBT was always so fantastic for people who really didn't need long-term or in-depth therapy, folks seeing occupational therapists, who needed job advice, who had mild self-esteem issues. And I think initially, those were the people who did see therapists the most and didn't necessarily have the self-help vocab (that you've mentioned) and so would kind of approach ever new technique with awe as opposed to like...so many of us now researching those techniques and going 'wow that seems amazing I'm going to try that.' Which does deprive a therapist of the 'wow' response in person.

I also think back in the 80s and 90s, it was less okay for people to seek out therapists for things like PTSD, dissociative disorders, schizotypal disorders and other types of disorders. Or alternatively, I wonder if there was a higher institutionalisation rate for people with those disorders than there is now (it's harder for people to get inpatient treatment these days because the cost of outpatient therapy is cheaper - at least in Australia - than it is for inpatient therapy).

But...CBT was always useless for me. It felt like...a bandaid at best. And a crude tool at worst. As a logical person, I actually loathed it, because I couldn't see the logic in 'lying to myself to make myself better' given that self-deception was the reason I had such bad self-hatred issues in the first place (a conundrum and a paradox, and one easily solved by bypassing the cerebral cortex and getting down into deeper areas of the brain first).

I also think our media as osmotically absorbed so much of CBT into its own sort of character development arcs. There are so many shows that have characters see therapists, or talk to one another and bring up things like 'it's okay to cry / it's okay to get angry / this self-maligning that you do, it's not healthy, have you tried doing this.' People are exposed to CBT and other therapeutic techniques not just through self-research or the medical world anymore, but very much in the cinema, especially through blockbusters like Good Will Hunting (it's not necessarily accurate therapy, but its popularity does suggest that the world was ready to start 'hearing' more therapeutic techniques en masse some time ago). (My favourite unit at university was Psychology, Psychoanalysis and Cinema and I did that in the late 90s and it's still very relevant).

And also like you say, I do wonder if the tools for measuring its effectiveness needs to be titrated for a more therapy-aware society.

I guess as well, there are so many people who go into get a clin. psych degree who really should not be therapists. I've met clinical psychologists - while I was at university - who were abusive, who were manipulative, who were like 'oh I can handle those crazies but not *those* crazies.' I'm talking upwards of fifteen students in their second year, who were all really fucking unsuited to doing the degree, and were literally doing it because they a) wanted the paycheck and b) in some cases believed that they could literally fix anyone.

I don't actually really love the curriculums taught to clinical psychologists in Australia. And I've never had much success with them because the first stick they try to hit you with - usually clumsily - is the CBT stick. Followed by vague or specific guilt-tripping that 'it's not working because YOU'RE resistant.' (Bullshit).

So...

So it doesn't surprise me that the actual data says experienced psychologists yield better results than inexperienced. They're more likely to have done additional courses and education and learned more techniques. They have an idea of what works. And perhaps they're the ones that actually genuinely *can* help people, as opposed to the many who just want the paycheck and enjoy the grandeur of thinking they can fix everyone while getting rich.

If I sound cynical about clinical psychologists and therapists and CBT it's because I've seen 19 of them since 1997, and only started doing well with any of them about 6 years ago. I've been emotionally abused by two therapists - one worked in the school system and wanted me to be her surrogate daughter, the other was a clinical psychologist who started off with good boundaries and ended up talking about swingers parties (edit: with a view to using this as evidence that she could 'fix' my touch phobia by wink wink nudge nudge).

Eh so my general thoughts on the industry right now is that I am really not surprised that things don't seem to be going so great, now that the industry has exploded, and there's a lot of mediocrity going around amongst a more therapy-savvy audience who need more in depth assistance and support.

Effectiveness

[heartsinger]

I read all the comments before commenting, so some of what I say here is gonna reflect that, but this is too stressful to try to find the specific bits. I've been trying to do that, and now it's been over a day since I first saw the post. I give up.

For me, setting observable reality against my brainweasels has been somewhat helpful, but I seem to be reaching the end of things it will fix. The trouble is, this entire setup lends itself to an internal argument, so instead of doing things, my brain will start debating the relative merits of the argument in an extremely aggressive, ad hominem manner, and it quickly devolves into telling myself how awful I am. I'm trying to stop that, and just go with "NOPE! NO ARGUING! DOING THINGS NOW!" but it's marginally effective at best. I have a really hard time doing homework, because trying sets off the argument, and it's so much easier not to think about it.

Honestly, a lot of what I get out of therapy is a neutral person who doesn't know anyone else I know and can be honest with me. A lot of the time we end up spending most of the session dealing with immediate problems, which doesn't leave time for more long-term stuff.

Even though I know I can fire my therapist, it's very hard for me to do, because I don't think there's someone better out there, or that I can judge that effectively, and intakes are more expensive than regular sessions. Most of my therapists have been mediocre, but my psych-meds people have mostly been bad. Everyone is just really invested in me being normal and healthy at bottom. Maybe it's because I am, and I think I'm supposed to feel better, but it's mostly disorienting.

It's been theorized that I'm an empath, but if it's true then I've buried it really thoroughly. Of course, I did manage to create shields so strong that they were hurting me, so that's less outside the realm of possibility than it should be, but I'd think that taking down those shields would've also unburied the empathy. But I'm very good at forgetting things.

[siliconshaman.livejournal.com]

There is also this odd thing about CBT ... it only really works well on people who haven't got any idea what CBT is. [No, I don't know why, and reading around, I'm not sure anyone else does either, there's a lot of hand-waving terms like naive presupposition and cognitive bias etc].

Which adds up to the same as possibility 1, but with the cause and effect reversed.