The Triumph of Cognitive-Behavioral Therapy

I don’t know why The Economist thinks it’s news, but I don’t know all the facts about psychotherapy in Great Britain either.

Apparently, cognitive-behavioral therapy (CBT) has invaded Albion and the Economist is concerned that it is “freezing out” more traditional psychoanalysis, the kind deriving from Freud and Jung.

This should not be very puzzling. After all, Charles, Prince of Wales has long been an aficionado of Jungian therapy, having been a close personal friend with a notable Jungian thinker named Laurens van der Post.

And we recall that when Diana, Princess of Wales was suffering the torments of her borderline condition, her husband sent her first to consult with a notable Jungian, by the name of Alan McGlashan.

Considering how well Jungian psychoanalysis did in those cases, one will be forgiven for finding The Economist’s alarmist rhetoric difficult to understand.

The Economist reports the data:

THE unexamined life may not be worth living, but the overexamined life can be difficult, too. Many people are turning to a relatively young branch of “talking therapy”, called Cognitive Behavioural Therapy (CBT) to get them through the (day and) night. CBT, which teaches people to bypass unhelpful thoughts, has been elbowing aside the talk-about-your-childhood psychoanalysis favoured by believers in Freud and Jung. Up to 43% of all therapy courses in Britain are now CBT, and the practice is increasing: around 6,000 new therapists have been trained since 2007 and CBT absorbs much public funding. In 2012, £213m went on a National Health Service programme delivering CBT, while £172m was spent on all other forms of psychoanalysis and psychotherapy.

In a country that practices socialized medicine, the decisions of the NHS define the situation.

Why did England turn to CBT? Even if you have not read my new book, you could have guessed it. CBT works; psychoanalysis does not.

As The Economist puts it:

The growing popularity of CBT was consolidated in 2007, when the government adopted the treatment as standard. Three things had swayed it. The newish practice had accumulated a body of evidence proving it worked (students of Freud and Jung have been slower to move from couch to lab). It was very good at getting patients back to the office: a 1997 study found people with psychological problems had significantly higher employment rates after CBT than after traditional psychoanalysis. It was also speedy, getting results after just ten one-hour sessions (psychoanalysis can, expensively, take a lifetime). So CBT therapists were trained up and given all the plum NHS jobs, consigning other therapies largely to private practice.

One cannot fail to notice the coy suggestion that psychoanalysis has been “slower to move from couch to lab.”

Allow us to be slightly more serious. Psychoanalysis has been around for well over a century. If it could produce measurably good clinical results, we would all know it by now. The truth of the matter is that psychoanalysis, whether Freudian or Jungian is an ineffective therapy.

Another fact that might be anguishing the editors at The Economist is that in Great Britain psychiatric patients prefer CBT to medication:

Meanwhile the CBT boost has expanded the British therapy industry: since 2007, spending on psychotherapy has moved from 3% to 7% of Britain’s mental health budget – the difference mostly spent on CBT. … The British therapy boom is also a triumph for consumer choice: a recent survey showed patients preferred therapy to medication by a ratio of three to one.

More therapy is being made available to more people. And the people who receive it seem to like it. They like it so much that they stay away from medication. Tell me again why there is something wrong with this picture.

The Economist offers this:

CBT is no panacea, and psychoanalysis has been shown to be better in treating illnesses like eating disorders. It is finally launching studies to measure its effectiveness in an effort to regain some ground. 

Again, if psychoanalysis were effective it would not have waited for more than a century to launch studies.

As for the claim that psychoanalysis is the best treatment for eating disorders, The Economist has allowed itself to be played. And, that's being charitable. Since there is no real evidence for the effectiveness of psychoanalytic treatment of eating disorders, the statement is more wish fulfillment than reality.

Being located in Great Britain the magazine should know, better than any of us do, that the best treatments for eating disorders come to us from CBT. And that the pioneering work in that field has been performed at the Maudsley Hospital in London. 

In fact, the Maudsley treatment program is becoming the standard. No one who knows anything would ever imagine that psychoanalysis could treat anorexia or bulimia.