An article, published last year in The Journal of Critical Psychology, Counselling, and Psychotherapy, critiques the dominant view of psychotherapy as a treatment, similar to medication, that can provide a ‘cure’ to people’s suffering. Kev Harding, a clinical psychologist working in England, offers personal construct psychology and logotherapy as alternative philosophical approaches to psychotherapy. He describes the perspective of psychotherapy as a ‘cure’ compared to a more philosophical view, writing:
“The differences between the idea that ‘mental health problems’ have their roots in ‘faulty genes’ etc. to be somehow (and implausibly) ‘managed’ or ‘cured’ by psychiatric medication, CBT, or a bit of both, in contrast to the idea that such problems have their roots in a person’s life experiences, circumstances, societal expectations, and do not necessarily mean that there is something inherently ‘wrong’ with the person in distress.”
Harding, along with many others, challenges the ‘faulty genes’ narrative—the idea that there is a ‘chemical imbalance’ that can be ‘fixed’ with medication—since years of searching has yet to result in clear evidence for this narrative. Harding addresses the fact that psychiatry as a field has a vested interest in promoting this narrative. He states, “In current times, it is possible in the worlds of psychiatry and clinical psychology to find ‘evidence’ to support just about any hypothesis that is stated.”
Harding applies the same critiques to psychological treatments as he does to pharmaceutical ones, describing results from research on Cognitive Behavioral Therapy (CBT) as “pseudoscientific narratives that are short on credible facts.” He argues that statements about psychotherapy ‘curing’ someone cannot be objectively ‘proven.’ For example, literature reviews find about 85% of beneficial effects from therapy can be attributed to ‘nonspecific factors’ such as therapist qualities, which, by definition, cannot be quantified in any scientific way. In fact, research supporting the Common Factors Theory, which argues there are certain characteristics that are present and necessary in all good therapy, has been gathered since the 1930s.
In the article, Harding critiques the emphasis on ‘managing’ an illness in order to return to work and be a productive member of society. He argues that this focus on the individual ‘fix’ is fostered by the Western ideal that people shape their own futures. Therefore, people are both responsible for their own ‘recovery’ and to blame if they ‘fail’ to get ‘better.’ Although Harding acknowledges the benefits of mindfulness, he highlights issues with Westernized Buddhism that may encourage people to find an individual solution to their stress (such as meditation), which may “facilitate people becoming more accepting of a neo-liberal status quo which isn’t in their best interests.”
Harding describes the harm that can be done by the ‘cure’ narrative: “If they’ve already tried numerous concoctions of psychiatric medications or ‘courses’ of ‘psychotherapy’ and they haven’t been ‘cured’ then this can compound the despair of the person the therapy was meant to ‘cure’.”
Harding would like a paradigm shift in how people view psychotherapy where simply having a space to genuinely share one’s distress and have that distress be attuned to and taken seriously is valued. Harding strongly distinguishes this conceptualization of therapy from something that provides a ‘cure.’ He writes:
“It seems to me that providing a place for people to reflect on their lives and circumstances in what is essentially a philosophical manner can at times be beneficial and provide consolations, if only to challenge the tendency for self-blame about problems caused by governments and politics.”
To replace the concept of psychotherapy as a ‘cure,’ Harding suggests two approaches to psychotherapy: personal construct psychology (PCP) and logotherapy. He suggests these approaches offer “more ‘philosophical inquiry’ than ‘psychological intervention’.”
PCP was developed by George Kelly, who was a clinical psychologist during the Great Depression. Kelly believed that people could author their own futures, but did not ignore the fact that people’s problems are significantly shaped by their life circumstances. Kelly is one of many scholars to posit that reality is constructed based on people’s interpretations of events and therefore people can reconstruct their interpretations of their lives. This reconstruction is not a ‘cure,’ but something that many may find beneficial in therapy.
Logotherapy was developed by Viktor Frankl, a Viennese neurologist and psychiatrist, who spent three years in Auschwitz-Birkenau during World War II. Logotherapy is focused on meaning making. Frankl also acknowledged that people may not have control over life circumstances, but do have the choice of how to confront their circumstances. Frankl noted that meaning varies for different people and at different times. He stated that people can experience meaning by fulfilling creative, experiential, and attitudinal values.
In both of these approaches, Harding notes that, “The question as to which is the ‘right’ way is never imposed upon an individual, and this is in contrast to the idea of a psychotherapist judging whether a person’s ideas are ‘rational’ or ‘irrational’.”
PCP and logotherapy offer ways to approach therapy from a more philosophical perspective. They also help establish alternative expectations in therapy for both clients and clinicians. Instead of the goal being to ‘cure’ the client, which sets up a possibility that therapy will ‘fail,’ the only expectation of these approaches is that “it might sometimes be beneficial for a person if only for the fact that one human can help another at times,” writes Harding.
Harding summarizes, “the consolations of philosophically informed approaches like PCP and logotherapy might provide a structure for a person to critically question the idea that ‘mental health problems’ are some sort of personal defect/failure rather than the manifestation of distress caused and maintained by numerous factors way beyond our control.”
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Harding, K. (2016, June). Psychotherapy is not a ‘cure’: The consolations of personal construct psychology and logotherapy. The Journal of Critical Psychology, Counselling, and Psychotherapy, 134-144. (Full Text)
I am a CBT therapist, and I would like to offer my support to the view both of George Kelley and Victor Frankl.
You don’t have to think that there is something wrong or with the person or that therapy is a cure. In CBT-The basic premise of CBT is exactly what Kelley stated:
“reality is constructed based on people’s interpretations of events and therefore people can reconstruct their interpretations of their lives. This reconstruction is not a ‘cure,’ but something that many may find beneficial in therapy.”
One of the most important tenants in cognitive therapy is that the behaviors or feelings that are the focus of therapy are not “sick” or “disordered”, but that they are too extreme for the current situation. Paranoia is an adaptive response when a country is under occupation and you don’t know who is your friend and who is your enemy. OCD type handwashing is totally appropriate during a cholera epidemic.
The point with CBT is to help people interpret reality in such a way that they can do what they want to do with their lives. The best CBT for voices and delusions is actually normalization, not trying to get them away. I would tell patients that voices are normal phenomena for many people, and nothing to be more afraid of than normal thoughts that come spontaneously.
We all have our delusions, some limit us and some help us. What CBT can do with e.g. behavioral experiments is getting to an attitude where we actually try to find out if e.g.we are being surveyed by the FBI instead of jumping to conclusions that make our lives hard.
Another aspect of therapy is to find out what functions these beliefs can have in our lives and do something about the cause instead of just taking them away.
If you have such a meaningless life that you have to believe that you will be the next one to be called for a position in the Trump administration, we should do something about helping you find some more meaning in your life, like Frankl would have done.
If you are extremely depressed because your marriage is falling apart, we should do something about that, not try to “cure” the depression. If, however, you are interpreting everything your spouse is doing in a negative way, so that you are both becoming depressed and ruining your marriage, then we should definitely do something about this interpretive style.
So much can be done with our focus and interpretations of reality so that we can have a higher quality of life and not be victims of neither a harsh reality nor an unnecessarily negative interpretation of this reality.
I do not agree with a rather pessimistic and victimizing way of thinking that psychological problems are “ a manifestation of distress caused and maintained by numerous factors way beyond our control.”
We do not react to the real world, but our thoughts about this world. And these thoughts are possible to change if they are negative in such a way that they create a lower quality of life than is possible in the actual life circumstances. Many people have all that they need to lead happy lives, but have thought patterns that limit them severely. A classical example of this is the OCD patient who lives in a perfectly healthy environment but spends 10 hours a day washing and cleaning because he thinks he will be contaminated with dangerous germs if he doesn’t. Then it is our job as therapists to help him change these thoughts, e.g. through exposure training that can be done in 4 days.
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@Kjetil
Where you may be right that your way of thinking about and justifying CBT is in line with the views sided with in the article, CBT generally is not so straight forward as you idealistically propose. CBT proponents have in practice made a pact with the biological view on distress as brain illness. In competing for resources CBT-practitioners routinely refer to ‘the disease’, CBT is promoted as an intervention on par with medication and – although you may think about peoples life circumstances in therapy – there is no real activist side to CBT: No outcry about inequality, no engagement with creating niches for the burdened, and there is no endeavor to understand the complexities of the human mind. CBT is really a way of coaxing language that promote simplicities such as that thinking directly decides emotion, and it isolates the causes of people’s distress to somewhere inside their heads. As a therapist you may bring a wider view, but that’s not the CBT speaking.
Just as psychiatry has done, I think that CBT has consistently oversold itself – often by attacking pluralism in its proponents attempt to achieve hegemony – by using outcome studies molded on medical interventions. Of course there are CBT-adherents who are more thoughtful – and you are probably among them – but generally CBT as a brand really is nicely in line with much of what is wrong with the dominant models in psychiatry.
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Thank you for a very interesting comment.
Do you agree with the following:
1. CBT has no physical side effects.
2. CBT can relieve symptoms as well or better than drugs, without numbing the patient
3. CBT is supported by research done in the same way as medical research so that medical practitioners will accept the results
4. In this way CBT has a chance of replacing harmful drug or ECT treatments, because those who administer the treatments see CBT as an equivalent technology.
5. The above does not mean that CBT is only this. CBT has the potential of permanently relieving problems of feeling thinking or behaving that limit people’s quality of life to the extreme.
6. It is possible to view CBT as a way of creating optimal quality of life, with whatever life circumstances a person may have. The need for the CBT intervention may be that the person has a very hard life situation or that the person has been exposed to extreme trauma. If CBT is then used to help the person live a meaningful life despite of these life circumstances, we are not going into the medical model. We are not asking what is wrong with the patient. We are asking “what happened with this person”, and how can we undo the effects of these events through therapy. All people can crack under the worst circumstances. CBT is a way of getting the person back to a meaningful life. Not fixing defects, but teaching more effective ways of coping with problems. In this way CBT therapists should use all the techniques on themselves to be optimally fit for helping their patients.
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No – I think CBT is so wide and poorly defined a term, and that the questions you ask are of a very generalizing nature, which makes it impossible to either completely agree or disagree.
Question 1, for example, assumes a complete dichotomy between psyche and soma, and it assumes CBT is a completely discrete entity which can be applied and any side effects then neatly measured. Neither assumption holds true, I think.
Question 4, another example: The use of CBT has been steadily increasing in the last decades. So has the use of for instance antidepressants. This does not support the assumption at a societal level.
Question 6: ‘Optimal quality of life’ sounds nice! It sounds like a pretty self-defeating ideal to have, though, considering there isn’t really a stable place of ‘optimal quality of life’ you can reach.
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I’ve never seen any form of psychotherapy as the “cure”. I’ve always seen any therapy as a tool that an individual can use to help effect change in their lives. The “cure” is to be found within the individual and not in any tool. No therapy, in my opinion, can be the end all and be all and in fact, the two best therapists I’ve known use a combination of many things and not just one thing, to walk with people in changing their lives.
And even decent and good therapies can be taken over by the system so that they become something that they were never intended to be.
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I found psychological care to be nothing more than gas lighting a person with one of the made up DSM disorders, based upon a list of lies and gossip from some child molesters, according to my psychologist’s medical records and my child’s medical records.
After defaming me to my husband with this scientifically invalid DSM disorder, and trying to convince me I had some sort of “lifelong incurable genetic mental illness,” that I had no family history of, the psychologist deluded a couple psychiatrists with more lies. She also incessantly denied that my child was sexually assaulted, as well as denied that the psychiatric drugs can create the symptoms of the DSM disorders, via anticholinergic toxidrome poisoning in my case. I found psychological care to be completely counterproductive to my concerns.
Gas lighting a person, to cover up pedophilia for one’s child rapist friends, is the opposite of mental health care, IMHO. But silencing child abuse victims is the number one function of today’s psychological and psychiatric industries today. According to the medical evidence, “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).”
Today’s “borderline” and “psychotic or affective disorders” DSM treatment recommendations, particularly combining the antidepressants and/or antipsychotics (neuroleptics), can create what appears to the doctors to be the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome and also what appears to the doctors to be the positive symptoms of “schizophrenia,” via anticholinergic toxidrome.
https://en.wikipedia.org/wiki/Neuroleptic-Induced_Deficit_Syndrome
https://en.wikipedia.org/wiki/Toxidrome
But since these syndrome/toxidrome are not listed in the DSM, out of sight, out of the minds of the “mental health professionals.” Resulting in these psychiatric drug induced syndrome/toxidrome almost always being misdiagnosed as one of the billable DSM disorders.
I do so hope both the psychological and psychiatric industries will some day get out of the business of profiteering off of silencing child abuse victims by turning them en mass into the “seriously mentally ill,” with the psychiatric drugs. Since the psychological and psychiatric industries historic aiding and abetting of the child molesters has seemingly emboldened them, resulting in world wide child trafficking problems, that even our new President is now talking about having to fix.
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After I reading mans search for meaning I concluded only experiencing extreme pain would give understanding of logotherapy. The way I see it is that logotherapy precisely as it is explained in Frankyl’s book could lead to a person suffering such extreme depressions as president Lincoln to come to grips with their torment.
I just think logotherapy can miss the mark with many people.
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I have found that some psychotic patients seem to be able to be cured by psychotherapy. I had several people who had had many years, even decades, of repeated hospitalizations, drugs, ECTs, who seemed willing to come to see me and to talk about their lives and problems. At first I found it impossible to understand their confused thoughts, but by total good fortune I had a gifted psychoanalyst/pediatrician in London who told me to stop talking and to listen.
With no other choice I did. Much to my amazement I was gradually able to begin to understand him and we began to be able to communicate.
He became very well and thanked me profoundly for helping him to feel human. It had taken 5 years of daily psychoanalytic sessions. The root of the problem was in the war when his parents were away or working and he’d developed a false self.
For the last 20 years of my practice I saw many people with long term psychotic and neurotic disorders. Those who were willing to talk were able to also discover and work through the roots of their disorders and become well.
Unfortunately in our rational, materialistic world it seems difficult for many people to accept that this kind of work can be real and valid. Religions have dominated the spiritual world for so long that it seems difficult to help people with the spirits of the people who have been in their lives.
And the would be therapist becomes a spirit in theirs.
And they in ours.
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