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Monthly Archives: August 2008

The Myth of CBT

Reading Webster’s Why Freud Was Wrong, and noting in particular the incredibly dogmatic reverence in which Freud’s nutty ideas were once held, one wonders if CBT – undeniably the ‘received wisdom’ in psychotherapy at the moment – will one day seem as wacky to our descendants.

There are, of course, dissenting voices to the hegemony of CBT. Last month, in fact, the University of East Anglia, which runs a post-graduate course in CBT, held a heretical conference which claimed to explode the ‘myth of CBT’.

The conference organizers, the World Association of Person-Centered and Experiential Psycho-Therapy and Counselling, put forward the following points for discussion:

“The government, the public and even many health officials have been sold a version of the scientific evidence that is not based in fact, but is instead based on a logical error. This is how it works:

1) More academic researchers subscribe to a CBT approach than any other.

2) These researchers get more research grants and publish more studies on the effectiveness of CBT.

3) This greater number of studies is used to imply that CBT is more effective.

This is a classic example of the logical fallacy known as ‘argument from ignorance’ ie the absence of evidence is taken as evidence of absence.

“This situation has direct negative consequences for other well-developed psychotherapies, such as person-centred and psychodynamic, which have smaller evidence bases than CBT. These approaches are themselves supported by substantial, although smaller, bodies of research.

The accumulated scientific evidence clearly points to three facts:

1) People show large changes over the course of psychotherapy, changes that are generally maintained after the end of therapy.

2) People who get therapy show substantially more change than people who don’t get therapy, regardless of the type of therapy they get.

3) When established therapies are compared to one another in scientifically valid studies, the
most common result is that both therapies are equally effective.

A case in point is person-centred and related therapies (PCTs): In a meta-analysis of
more than 80 studies to be presented by Robert Elliott and Beth Freire at the Norwich conference, PCTs were shown to be as effective as other forms of psychotherapy, including CBT.

“In view of these and other data, it is scientifically irresponsible to continue to imply and act as though CBTs are more effective, as has been done in justifying the expenditure of £173m to train CBT therapists throughout England.”

This is interesting stuff. But do all therapies really work equally well? If I invented a new form of therapy, called banana-therapy, which involved me giving a banana to everyone who came to me seeking emotional solace, surely that would work less well than other forms of therapies? If they all work equally well, then why bother training for years on one particular type of therapy?

It seems to me that all good psychotherapy is based on two basic points:

1) Our emotional problems are to some extent the result of our own thoughts.

2) We can to some extent change our thoughts.

CBT seems to me the best form of psychotherapy because it focuses most clearly on these two basic truths. And they are basic – they are there at the centre of Buddhism, and at the centre of Stoicism as well. This is what gives me the confidence that CBT will survive longer than psychoanalysis.

But maybe my descendants will laugh at me for my scientific naivite…

Where are the hysterics of yesteryear?

I’m reading a very good book, Richard Webster’s Why Freud Was Wrong, which I picked up in a great little bookstore in Hay-On-Wye this weekend, called the Addyman Annex, on Castle Street – well worth a visit if you’re ever in Hay, it’s full of great psychology books.

Anyway, the book is a treasure-trove, a very detailed account of the many errors, duplicities and rank speculations of Freud’s tempestuous career, and also an account of the incredible reverence in which he was held – in which he is still held – by the western intelligentsia, particularly by the literati and literary critics. Because, after all, that’s what he really was himself – a literary critic.

I’m still in the early chapters, with Freud studying under Charcot in Paris, and both of them building their theories of the unconscious based on the hysteric female inmates of the Salpetriere. These strange cases, of women who would go into fits, or somnambulist trances, or who would fix in strange poses for hours, were the founding data for the whole theory of psychoanalysis.

And yet where are they now? As Anthony Storr has written: ”the type of case on which early psychoanalytic theory was originally based, namely, severe conversion hysteria in women, is seldom seen today.” Jacques Lacan went so far as to exclaim, “where have they all gone, the hysterics of yesteryear?”

The answer which Webster, and several other writers on hysteria, put forward is that the many women, and some men, who were put forward by Freud and Charcot as suffering from the psychogenic disorder of ‘hysteria’ were actually suffering from a variety of neurological conditions, ranging from epilepsy to closed head injuries, multiple sclerosis and syphilis.

However, because of the crude state of neurology at the time, and because of Charcot’s fascination with hypnosis, Charcot was led to believe these conditions were psychological and not organic. Webster suggests that Charcot’s hypnotic movements may have triggered epileptic fits, just as many other types of movement would. But this, he suggests, had nothing to do with ‘the unconscious’ of the patients. It was merely an organic epileptic reaction to a certain type of movement.

The image of the hysteric convulsive woman still haunts our imagination. It appears in, of all places, the video for the Arctic Monkeys’ video, Brianstorm, where the dancers imitate their convulsions in between archive footage of hysterical women. What a strange idea for a video, in a film about an annoying music executive called Brian!