As a psychotherapist, I very much appreciated that there was a focus in the Charlie Rose program on depression on the usefulness of psychotherapy when treating depression. I appreciated that the panelists emphasized that the latest research suggests that a combination of psychotherapy and medication management is the most effective strategy in the treatment of more severe situations. There was not a lot said, however, about psychotherapy. And what was said seemed to allude to one form of treatment: CBT (Cognitive Behavioral Therapy). There is a lot of talk these days, when there is talk about psychotherapy, about CBT and its effectiveness. 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 from the past emerge in the present, is 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, then, 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 withdrawal, have a long history over many years. Changing those behaviors means instituting new habits. A client and I will talk about those new behaviors and how, with 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. While that may be effective for symptom relief, it does not address the underlying problems producing the symptoms. There are experiences in a person’s past which, although they cannot be changed nor redone, need attention and healing. Often it has been 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 in the presence of a compassionate other person.
A person, for example, struggling with depression, may have feelings of hopelessness and despair. He may feel inept in managing or charting the course of his life. Through the work that we do in psychotherapy, we may see that these feelings originated in the person’s prior experience, often in his family of origin. Perhaps in that person’s childhood, he was not encouraged to grow towards autonomy. Perhaps there were a lot of experiences causing guilt feelings and an overriding sense of obligation. A person’s earlier experiences, particularly with significant others, form core beliefs about the world and oneself. In this way, the earlier experiences continue to influence the present day – often it’s as if the earlier experiences repeat themselves. It is not enough to point to these beliefs as “distortions” or to help “reframe” newer thoughts. Rather, there is a good deal of work to be done talking about these experiences, grieving them, in order to help the person renounce these beliefs and replace them with healthy new ones. True and meaningful change requires getting to the sources of the symptoms, not just relieving them.