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The serious drawbacks of cognitive behaviour therapy

By Dr Marcel de Roos, Psychologist PhD, the Netherlands

Cognitive behaviour therapy (CBT) has become the dominant psychological treatment in the past decades. In the late 1960-ies it spread from the USA to the rest of the world together with the belief of the malleability of people and nowadays it’s presented as the only “scientifically proved” therapy form. While in reality it’s quite superficial and it borders on a snake oil mental health technique.
With CBT there are a few helpful steps like getting a more realistic view on your problems and to actively confront your depression or anxiety. It’s is typical “American” in its assumption that the way you think will influence your feelings. When you are depressed, you should challenge your irrational, negative thoughts (“positive thinking”).
But from the clinical practice we know that you can tell a depressed person a hundred times that he should think positively but that won’t bring about a lasting change. We can’t THINK ourselves happy. You simply have to understand and come to terms with the disturbing FEELINGS that cause these thoughts; you can’t push them away or ignore them. These feelings are too strong and they invariably will surface again but then much more powerful. If you don’t deal with your feelings, your feelings will deal with you……
Especially after the introduction of the “managed healthcare” a lot of emphasis has been placed on the use of the so called “evidence-based therapies”. It created a tunnel-vision by using methods from the pharmaceutical industry (such as “randomised controlled trials”) which when used in the social sciences have strong methodological shortcomings, and as a result it’s only applicable for very few therapy-methods.
Research invariably shows that sustainable psychotherapy efficacy depends for the most part on the therapeutic relationship (trust, attention and willingness to listen) and the extent where clients feel that they can play an active part in the therapy. Psychotherapy based upon emotions(!)/cognition/behaviour plus the present/past(!) is often a far superior approach than mainly cognitive based therapies (these focus primarily on symptoms, thoughts and the present). Removing symptoms without paying attention to the underlying emotional root-causes often leads to “recurrence” of for example depression.
Emotions (simply put, the limbic system regulates them) are in evolutionary sense much older than thoughts (which are controlled by the cerebrum). Since the anatomical structure of the brain is quite a hotchpotch, the different parts of it are not always in sync with each other. Trying to influence your emotions with your thoughts (as CBT tries to do) is a hopeless enterprise.
CBT only focuses on the present, has no environmental or societal context and has the underlying flawed assumption that insight and cognitive change is the correct remedy for symptoms like depression or anxiety.
Short term psychodynamic therapy goes far beyond that. It’s not only the cognitive part (understanding) but most and foremost the emotional realisation that counts. An insight must be experienced and lived through. It should incorporate conscious emotions, unconscious ones and the underlying conflicts. By emotionally experiencing it under proper professional guidance it gets “worked through” and after several times the impact diminishes. Clients time and again acknowledge the richness and depth of this and it often leads to a real change in their lives.

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