A Two-Prong Approach to Healing

There is a lot of talk these days, when there is talk about psychotherapy, about Cognitive-Behavioral Therapy (CBT) and its effectiveness. It seems that CBT has achieved some recognition in the American media. Although I am not strictly a CBT psychotherapist, but rather someone who takes an eclectic approach so as to be able to provide my clients with what is helpful to them, I know there is much good to be gained in focusing on some of the essential aspects of CBT therapy. I often reflect on cognition (the “C” part of “CBT” – the thoughts that someone has) and behavior (the “B” part of “CBT” — the particular patterns of behavior someone is trying to change). And from my years of experience, I also know that that there is more to focus on in order to promote effective and true change.

While CBT has gained a lot of attention as an effective psychotherapy to ameliorate people’s problems, recent research reveals that it does not work any more effectively than other forms of psychotherapy. One such form, with its focus on healing one’s emotional challenges from the past by focusing on that past and by observing how relational patterns emerge in the present, is usually referred to as psychoanalytic psychotherapy. This is a form of psychotherapy that I practice (while being eclectic and borrowing from other approaches when I believe they will be helpful to my client). An article published in 2010 in the American Psychologist by Jonathan Shedler provides a strong argument for the effectiveness of psychoanalytic psychotherapy. And a study published in 2009 in the Harvard Review of Psychiatry used several well-designed treatment outcome studies that found psychoanalytic psychotherapy was considerably more effective than other forms of treatment.

When working with clients to address the issues that are causing them suffering, I typically take what I like to call a “two-prong approach.” Together, the client and I focus on what changes can be made now in the present. This focus usually involves looking at the client’s thoughts and beliefs. A central tenet found in CBT is that there is an intimate connection between thoughts and feelings. The particular approach in CBT is to see what changes can be made in thinking so as to change feelings, particularly distressing feelings.

And inevitably change does mean changing one’s behaviors. Often behaviors, such as those involved in addictions or compulsions, or others such as isolating and social withdrawl, have a long history over many years. Changing those behaviors means beginning to institute new habits. A client and I will talk about those new behaviors and how, particularly through the support of therapy, to instill them as new habits.

The second prong in the approach, however, has to do with healing the wounds of the past. I have found that it is not enough to simply reframe thoughts and begin to practice new habits. There are experiences in a person’s past which, although they cannot be changed nor redone, need attention and healing. Often these experiences have not been adequately addressed. Often it was the case that in someone’s past there was not sufficient help in addressing these events. Healing is an interpersonal process. It takes a relationship with another human being in order to initiate the healing process, which often involves grieving some sort of loss and receiving acknowledgement and compassion from another person and from oneself.

A person, for example, may be struggling in a relationship with feelings of powerlessness and futility. He or she may feel profoundly misunderstood or uncared for by a partner and believe that there is nothing that he or she can say or do to be heard or acknowledged. In the course of therapy we may see that these feelings originated in the person’s prior experience, well before this particular relationship, perhaps in his or her family of origin. A person’s earlier experiences, particularly significant ones, will form core beliefs about the world and oneself. In this way the earlier experience continues to influence the present day – often it’s as if the earlier experiences repeats itself.

In order to address and change these pervasive feelings and core beliefs it is not enough to simply reframe thinking. To effectively change that core belief (for example “I’m not acknowledged or cared about and I’m powerless to change that”), it is not just a matter of changing the thought, but rather also looking at the circumstance that contributed to the thought becoming so core. In the process, there will no doubt be a lot of strong feelings — grief, sorrow and anger – to feel and process. In order for the person to truly see and believe that he or she is not powerless, that he or she can effectively communicate in a relationship and expect to be heard and acknowledged, it is vitally important that the early experience that contributed to these thoughts be healed. Only then can there be a new foundation constructed in which the new thoughts and behaviors rest upon.

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