Sunday, January 10, 2010

Why Is So Much Psychotherapy So Bad?

I have not had much to say about recent reports about the relative effectiveness of anti-depressants. Not out of any exalted sense of humility, but because I am not qualified to pass judgment on medical treatment.

As I read Judith Warner's column about the issue I was struck by the following observation, gleaned from a survey about the psychotherapeutic treatment of depression.

Reporting on a study from the Archive of General Psychiatry, Warner summarized: "The survey found that those who did get care were given psychotherapy more often than drugs. This finding might give heart to those who would prefer to see more alternatives to psychiatric drugs-- if it weren't for the fact that so much psychotherapy is so bad." Link here.

Given the title of this blog, you might understand that I feel a certain basic sympathy with this judgment.

That would not excuse my letting it lay there without comment.

Exactly, what do the psychiatrists mean when they suggest that far too many clinicians are not offering the best psychotherapy for depression.

I assume that they are referring to the treatments that derive from the cognitive theories of Aaron Beck.

Yet, it appears that far too many therapists do not learn how to practice cognitive therapy or do not bother to use what they know in their treatments.

Why not? It seems that too many therapists remain wedded to a therapy model that involves exploring the past to discover the root causes for depression. Or else, they therapists insist on offering insight that will presumably resolve issues.

Beck's cognitive approach considers depression to be caused by bad mental habits-- repeated and unchallenged self-deprecatory judgments-- and aims to treat them by retraining the mind to arrive at more balanced self-judgments.

Cognitive treatment does not involve insight; it involves exercises.

Insight-oriented treatments, which derive ultimately from Freud, pretend that you can cure a problem by understanding it. It assumes that depression, like all psychological symptoms, is an alternative expression of something that is inexpressible or unconscious.

Is depression a bad habit or a meaningful experience? Choose the first and you will be able to offer more-or-less effective treatment. Choose the other and you will offer bad psychotherapy.


Cleo Pascal said...

People are now turning to psychotherapy (a form of alternative healing therapy) perhaps because they are seeing the potential dangers of taking too much antidepressants. Even I would be cautious about being prescribed different pills and having to drink them for all eternity. I don't want to be too dependent on drugstore-bought medicine.

Stuart Schneiderman said...

Of course, some emotional problems are really brain disorders or metabolic disorders. For those, medication is best.

As you say, many people would rather avoid the medication, and nowadays they seem to have discovered that alternative healing like aerobic exercise and yoga are more effective than talk therapy.

tiendas eroticas said...

Well, I don't really suppose this is likely to have effect.