3 ms·

CBT gets quite a lot of props. It legitimately deserves many of them but probably gets more than it should, especially relative to "black magic" psychotherapies

by slurry 13y ago

CBT gets quite a lot of props. It legitimately deserves many of them but probably gets more than it should, especially relative to "black magic" psychotherapies. The main reason CBT is so popular in the industry is that it was designed from the ground up to be testable. CBT practitioners and CBT-friendly researchers have run a lot of tests, and they have found that CBT is effective. For a long time, other modalities either weren't tested in this way or were only tested under CBT-friendly conditions. And this is a real black mark against them. But since CBT started eating their lunch from 2001 or so, other schools that could afford to started doing their own tests. Guess what happened when psychoanalysts started running their own tests? If you guessed that they went home crying and gave everything up for CBT, you would be wrong. Instead, psychoanalytic-friendly researchers have found (empiricially!) that psychoanalytic treatments are effective, except for schizophrenia, just like CBT-friendly researchers found that CBT was effective for everything including schizophrenia (which really should have been a tipoff that something was amiss in the first place TBQFH). In other words, which therapy gets found to be effective depends a lot on which therapy the researcher wants to be found effective. There are a ton of problems in measuring psychotherapy. Researcher bias is an obvious one. Ensuring that the things you're measuring are actually the things that you're supposed to be measuring (e.g. that the CBT patients are all actually getting by-the-book CBT, psychodynamic are getting psychodynamic, control are getting...what?) is another huge problem. Across thousands of studies, the biggest variable in effectiveness of psychotherapy seems to be the therapist him- or herself. Some are drastically noticeably effective across a large number of patients and most are not. The effects of treatment modality, assuming you can pin it down at all, are seldom very significant, especially when blinds and control are used. Other reasons CBT tends to be favored: emphasis on short duration is insurance friendly. Also, the 'cognitive' adjective implies that it has something to do with recent advances in neuroscience, which it doesn't. (FWIW I've had both CBT and analysis, benefited from both in different ways.)

skunkworks 13y ago
Agreed on all points. Really when I say "black magic" therapy, I'm being sloppy because what I really mean is that if you're not that good of a therapist, you shouldn't be offering anything but basic, rigorous types of therapy. I wouldn't go so far as to say that a good therapist offers a "human element", but skilled therapists are more observant, have stronger communication skills, have a more intuitive sense on when to challenge their patients, etc., and that allows them to go deeper into murkier waters than others. But to boil all of that down to "the relationship" and the "human element" feels overly reductive. There's still something quantifiable about the qualitative aspects.
thelettere 13y ago
The only therapies you can study scientifically (making sure everyone receives the same treatment in the treatment group), are therapies with manuals. However, only about 3% of all therapies have such manuals (CBT being one of them). Most therapists highly individualize their approach - just because they have the same name doesn't mean they're actually doing anything similar. So claims of "empirical" proof of psychoanalysis is nonsense. The nature of what psychoanalysis is precludes that.
- slurry 13y ago
  There actually are shorter-form therapies derived from psychoanalysis that do have manuals, and studies purporting to show their effectiveness. The point wasn't that these therapies are all that great - they probably aren't - but that measuring psychotherapy is a methodological ball of tar and prone to confirmation bias.

by slurry 13y ago

skunkworks 13y ago

Agreed on all points. Really when I say "black magic" therapy, I'm being sloppy because what I really mean is that if you're not that good of a therapist, you shouldn't be offering anything but basic, rigorous types of therapy. I wouldn't go so far as to say that a good therapist offers a "human element", but skilled therapists are more observant, have stronger communication skills, have a more intuitive sense on when to challenge their patients, etc., and that allows them to go deeper into murkier waters than others. But to boil all of that down to "the relationship" and the "human element" feels overly reductive. There's still something quantifiable about the qualitative aspects.

thelettere 13y ago

The only therapies you can study scientifically (making sure everyone receives the same treatment in the treatment group), are therapies with manuals. However, only about 3% of all therapies have such manuals (CBT being one of them). Most therapists highly individualize their approach - just because they have the same name doesn't mean they're actually doing anything similar. So claims of "empirical" proof of psychoanalysis is nonsense. The nature of what psychoanalysis is precludes that.

slurry 13y ago
There actually are shorter-form therapies derived from psychoanalysis that do have manuals, and studies purporting to show their effectiveness. The point wasn't that these therapies are all that great - they probably aren't - but that measuring psychotherapy is a methodological ball of tar and prone to confirmation bias.