Saturday, 13 October 2007

CBT vs. psychoanalysis

Heh, a psychoanalyst moaning about the rolling out of CBT in the NHS:
"...why has the government bought into CBT? The answer is simple: it produces results on paper that keep NHS managers happy...Therapy trials tend to follow the medical model, with two groups of patients who have the same profile and the same symptom. Treatments are then standardised to rule out the influence of the therapist."
Yep, CBT interventions seem to work, they don't take that long to do, and are cost effective, how dare they use them to treat psychological disorders instead of sentencing them to years of expensive psychotherapy wich lacks evidence of effectiveness?


Anonymous said...

There is no doubt that cognitive behavior therapy is COST effective.....but as CBT illustrates it is a behavior modification, which devoid of 'cause' only turns up someplace else in the personality...
the human being is a procreation and can never be a one 'fit' does not fix all

pj said...

Well CBT is cost effective because it works in decreasing the symptoms of depression and relapse - whether it is only behaviour modification is debatable since it is cognitive behavioural therapy, in contrast to old fashioned behavioural therapy. I'm not sure what other measure of success you could use?

The evidence suggests that CBT works roughly as well as, and is about as cost effective as, drug therapy. The evidence also suggests that CBT is of similar efficacy to a variety of brief psychodynamic therapies.

There is no evidence as to the efficacy of traditional, expensive, long term psychoanalytical therapy, which is what the author of this piece is arguing for.

There is no evidence that such psychoanalytic therapy truly treats the 'causes' of depression or other psychiatric illnesses any more than there is evidence that CBT or medication treats such causes, whatever these causes are supposed to be (and, of course, the putative mechanisms posited by psychoanalytical therapy have no evidence for them). In fact I'm not sure that there is much evidence as to what the causes of psychiatric illnesses are, and in particular whether these are the sort of causes that can succesfully treated directly, rather than their symptomatic consequences.

avrum68 said...

The debate is silly. CBT, at best, provides simple, concrete solutions for very obvious problems. Though my early-psychosis team felt it rarely worked. And worse, the clients found the Mind Over Mood shtick too much work with very little gain.

To paraphrase Irving Yalom:

When the CBT therapists want therapy for themselves, they don't turn to CBT, they turn to psychodynamic therapists.

I have more training in CBT than psychodynamic psychotherapy. I've experienced both CBT and Psychodynamic psychotherapy myself.

CBT offers the tools and suggestions your mom should've taught ya, but didn't.

Jenaldinho said...

Hi, avrum68 can I please ask you where Yalom said:

'When the CBT therapists want therapy for themselves, they don't turn to CBT, they turn to psychodynamic therapists.'

I'm writing an essay, and that quote would be perfect to use, but I need to source it!!

Many thanks.

Anonymous said...

CBT is not a therapy, it is a set of skills which can be taught to held people modulate their symptoms. This is useful but to claim it is comparable to a psychodynamic approach is preposterous.

I fear the often repeated aphorism about CBT, that it is a sticking plaster on a tumour, is underselling itself.

By all means reign in the symptoms but for goodness sake do not mistake that for lasting change.

And no evidence for psycodynamics? This smacks of wilfull blindness - there are reams and reams of evidence, spanning several decades. Likewise, psychodynamic therapies are receiving far and away the most support from neuroscience, especially with the discovery of mirror neurons and their part in transference/countertransference.

Whoever wrote this piece needs to take their blinkers off. And yes, the Yalom quote is sound, I've come across it several times. Sorry. : )

Anonymous said...

Wow anon - you have NOTHING to back up those silly claims. You're relying on a century old, unsupported technique? Feel free to cite any peer reviewed source which finds psychoanalysis to be effective. You can't. If you don't think CBT is therapy...well, I certainly hope you're not in the mental health field. Disgraceful.