In A School of F/i/s/h Therapists, writer and long-term patient tree_lady compares CBT with other therapies. But there’s something very fishy about it — what she’s describing is not therapy, but something else. Here’s why.
The whole point of therapy (psychotherapy) is that someone gets to know you very well and creates change in you, and the result of that change is that you don’t need therapy any more. But that’s not what happened to tree_lady:
She was my therapist for well over ten years. One of the reasons we parted ways is that she did not know I was on antidepressants…
How is it that “therapy” can continue for so long with so little success? Some clues start to emerge when tree_lady tries to explain CBT.
It’s called cognitive behavior therapy or CBT for short. Each difficulty that the patient/clinet [sic] and therapist choose to address is…
Each difficulty! In the CBT model, there’s an underlying cognitive distortion or schema that creates a recurring pattern of automatic thoughts. The thoughts produce the symptoms. If you try to deal with each difficulty — that is, with each thought — then you will never get anywhere because the thoughts simply recur. “Therapy” will go on for ever, and the underlying problem will never be addressed.
So that’s the mechanism of never-ending therapy. But how can anyone possibly think that it’s a sensible approach? It’s a three-step process.
The three-step process starts with a trigger or event, which results in:
The person’s reaction to this, …colored by the paticular [sic] mental illness that the person is dealing with: depression, anger, anxiety, paranoia, etc;
So the mental illness is a given here. It’s assumed to be unchangeable. The event being discussed is something that happened after the patient became ill, so it cannot possibly be the cause of the illness.
Step three is to think about the event in a different way, but as the event was not the cause of the illness, thinking about it differently cannot possibly affect the illness.
After step three, you go back to step one with a different and equally inconsequential event.
From start to finish
To summarize, let’s go over this twisted logic again from start to finish.
First, there’s an assumption that the mental illness cannot be cured. Therefore there is no point in discussing the things that might have caused it. Instead, you decide to discuss all kinds of things that cannot possibly have caused it. This ensures that you cannot affect the illness, and that therapy can continue indefinitely.
Business models for therapists
Theoretically, you might expect a therapist who cannot make therapeutic progress to go out of business pretty quickly. I’m not sure why that doesn’t happen in these cases.
Perhaps it does happen. Perhaps “pretty quickly” has to be measured in terms of the length of therapy. So a therapist who sees patients for ten years and is completely ineffective will go out of business after just three or four cycles of therapy — a thirty or forty year career.
Or perhaps these therapists provide other rewards or fulfill some other purpose in the lives of their patients. From patients who have moved on from one of these long-term pseudo-therapies to real CBT, I don’t have any clear sense of this, though.
Strategies for patients
Patients can avoid never-ending therapy by being aware of their own progress, and by reviewing their progress with their therapist every (say) ten sessions. In practice this is often quite unnecessary because progress in CBT is so obvious, and because a good CBT therapist will constantly remind you about what you have achieved and what you can still hope to achieve.
Very occasionally progress stalls for a legitimate reason. In those cases it can be helpful to suspend therapy for a few months, and then return to the same therapist to review your situation and agree on whether and how to continue. That way you avoid getting into the habit of attending pointless sessions.