Every now and then I'm asked the question, "Why do you practice cognitive behavior therapy (CBT)?" Aside from the fact that my father, Aaron T. Beck, is the "father" of cognitive therapy, it's the the most widely researched and evidence-based form of psychotherapy; it's been shown in hundreds and hundreds of clinical trials to be effective for a wide range of psychiatric disorders, psychological problems, and even some medical conditions with psychological components (chronic pain conditions, irritable bowel syndrome, insomnia, obesity, for instance). If you had a vision problem, wouldn't you first seek the treatment that's been researched and demonstrated to be most effective? Why should it be different for psychiatric disorders or psychological problems? Beside the overwhelming body of research that supports CBT, this therapy simply makes the most sense to me.
Jennifer, a 36-year-old married woman, is a typical depressed patient. She's been clinically depressed for about nine months. Last year, Jennifer was laid off from work. Since then, she's had difficulty getting out of bed in the morning and completing everyday tasks: washing clothes, straightening the living room, making dinner, opening mail. She talks with friends infrequently and rarely socializes. She reports feeling "sad" and "worn out." She presents as self-critical, often blaming herself for things out of her control. She's lost interest in the things that used to bring her a sense of achievement -- things she used to find enjoyable (cooking dinner for her family, painting, gardening and reading). She reports that her interactions with friends and family members -- her husband, parents and sister with whom she's always had good relationships -- feel effortful, and so she isolates herself.
As a cognitive behavior therapist, it makes the most sense to me to work with Jennifer on the problems she's experiencing now. First I'll orient Jennifer to treatment. We'll work collaboratively, setting specific treatment goals and choosing specific problems to work on that Jennifer expects to encounter in the coming week. I'll teach Jennifer the cognitive and behavioral skills she needs to help get her life in order and reduce her suffering. I'll provide her with the rationales for the strategies and interventions we'll use, and I'll establish and maintain a strong therapeutic rapport by actively listening, demonstrating empathy and support and asking Jennifer for feedback (to make sure I understood her correctly and that she agrees with the treatment plan).
Together, we'll create an activity schedule which includes getting out of bed by 9 a.m., showering and dressing immediately, and preparing and eating breakfast. I'll ask Jennifer for some other activities or tasks she might be willing to try. Together we may decide to add calling a specific friend, doing one load of laundry and reading the newspaper for 20-minutes to her activity schedule. I'll help Jennifer identify and respond to the thoughts and ideas that might prevent her from doing these activities, such as, "I'll never be able to get myself out of bed before 9a.m.", "I don't have it in me to cook breakfast", "Lisa won't want to hear from me." And I'll help Jennifer develop more realistic and adaptive views and modify her more deeply-held beliefs about herself ("I'm worthless"), her world ("Life is too hard") and her future ("I'll never feel better"), which have become activated during this bout with depression (and which could contribute to a future relapse). CBT requires patients and therapists to work actively together. I'll provide direction and keep Jennifer focused on one problem at a time, I'll offer suggestions, and I'll teach skills, all of which will help Jennifer recover more quickly.
I practice this therapy, ultimately, because it's effective and humane, it helps alleviate suffering quickly, and it aims to prevent relapse.
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More to the point, CBT depends upon a therapeutic alliance that is already constructed using psychodynamic or interpersonal or person-centered microskills during the opening sessions. In other words, CBT as an effective therapy is introduced bit by bit into a therapeutic alliance that was built using Rogerian or analytic or psychodynamic methods already. CBT without Rogers or Freud or any of the skills that a "regular" therapist uses would be nothing.
And research is increasingly showing that CBT and other methods of therapy have the same effectiveness. Insurance companies are waking up to that fact. Therapy works because a helping professional listens and helps a client build a strategy for coping with life's problems. Talking about "schema" or "longterm memory" and "incorrect thoughts" is not a panacaea, and for many clients it is counterindicated.
As CBT has gained dominance in the past twenty years, have we seen decreasing rates of depression? Is psychotherapy more "effective" now than it used to be? That's an interesting question, hey?
Without exception, models which do not explore, identify, and resolve early wounding - not to mention actively dealing with the emotions generated by wounding - only treat half of the person. I liken it to trimming the branches of an ugly lilac bush; they just keep growing back uglier than ever unless the painful work of digging up the root ball is done. CBT is the prevailing model mostly because it's non-threatening, present-focused, and relatively non-emotional in nature. Any model in which not only human emotion, but the origins of emotions, is not addressed will serve to reduce the symptoms of distress rather than truly heal long-standing dysfunction. My practice is full of clients who've experienced cognitive-only therapy, only to discover that the same relational problem continue to manifest over & over.