The How and Why of Cognitive Behavior Therapy

Not all psychotherapy is the same. Research over the past 30 years has shown that Cognitive Behavior Therapy is effective for a whole range of psychiatric disorders.
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I don't understand why anyone would go to a psychotherapist after witnessing how they are portrayed in the media. Especially the know-it-all shrinks who are sure they are right when you agree with them and are sure they are right when you disagree with them. (In the latter case, they would probably say you are using a "defense mechanism" that prevents you from recognizing the truth.) I just cringe when I hear that.

Unfortunately, many therapists who treat actual patients are similar to those on television. This type of therapist assumes the patient's perspective is wrong, and then sets himself or herself high above the patient as an expert who knows all, and who believes that the patient has to spend years gaining insight instead of focusing on problems the patient is experiencing today.

A patient I saw on television goes to a therapist because she has to make a decision about her marriage. Instead of helping her carefully examine her values and look at the advantages and disadvantages of staying in the marriage, the TV therapist had her talk endlessly about her childhood experiences. Another patient was experiencing panic attacks. The therapist did not focus on helping the patient prove to himself that his symptoms, though very distressing, were benign. Instead she focused on the patient's dysfunctional relationship with his mother.

It's enough to drive one crazy.

Well, not all psychotherapy is the same. Some modalities have a strong evidence base that demonstrates their effectiveness. Other modalities have never been shown to be effective. Yet they continue to be practiced by psychotherapists who consider an evidence base to be unimportant.

Research over the past 30 years has shown that Cognitive Behavior Therapy (CBT) is effective for a whole range of psychiatric disorders, such as depression, anxiety disorders, eating disorders, substance abuse and even (in conjunction with medication) for schizophrenia and bipolar disorder. It's also effective for many medical conditions, such as insomnia, obesity and chronic pain, and psychological difficulties such as couples' problems, and school and work problems.

What happens in a typical CBT session? You don't lie on a couch. You don't talk for the whole hour about whatever pops into your mind. You don't assume that you need to delve into childhood issues. Instead, you sit at a desk or a table with your therapist, who asks you at the beginning of each session what problem or problems you want help in solving. In the context of solving your current problems, you learn skills, such as how to correct your unrealistic or unhelpful thinking and how to modify your behavior to reach your goals. You and your therapist discuss what solutions you want to implement and what cognitive (thinking) and behavioral changes you want to work on between sessions.

You don't go back to childhood issues unless your problems stem from childhood and you get stuck just working in the present. Even then, you focus on changing the unhelpful ideas you developed as a result of adverse childhood events and discuss how new perspectives can help you today. CBT is a psychotherapy that just makes sense--and it works.

But consumers tend to be naive when it comes to mental health treatment, much more so than medical treatment. If you were wheezing and had chest discomfort, you would ask your doctor for the treatment that research has shown is most effective. You wouldn't want the outdated treatment that your doctor learned in medical school twenty years ago. You wouldn't necessarily want the medication that the last drug rep left for your doctor to distribute. I hope you would want the treatment that has the best chance of reducing your symptoms--and your suffering--as quickly as possible.

Need a psychotherapist? When you call for an appointment, find out whether the therapist uses evidence-based treatment. At the end of your first session (which should include a diagnostic evaluation), ask the therapist what the treatment plan will be. Make sure the plan makes sense to you. If the therapist doesn't provide you with a cogent, sensible plan, it's probably a signal that you should look for treatment elsewhere.

If you have a problem, don't let television therapists deter you from getting the help you need.

Judith S. Beck, Ph.D.
President, Beck Institute for Cognitive Therapy and Research
Clinical Associate Professor of Psychology in Psychiatry,
University of Pennsylvania and

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