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…

Comments:

  • cbtish says:

    Yes, CBT will one day seem wrong, just as Freud’s ideas now seem wrong. Coming up with wrong ideas is what scientists do — that’s how science works. The point is that Freud’s ideas were less wrong than his predecessors’, Beck’s (cognitive therapy) were less wrong than Freud’s, and whatever comes next will be less wrong still.

    And yes, banana therapy would certainly work, but I don’t think you can claim to have invented it (see: 2 Breakfasts And A Banana – A Cure For Depression). It’s not likely that banana therapy is better than CBT, for the reasons you outline.

    The trouble with meta-analysis is that by choosing which studies to include you can create any bias you want. For example, studies of CBT often use unskilled therapists and restricted methodologies, while studies of older therapies rarely do that. So it’s a trivial exercise to produce a headline-grabbing meta-analysis that “proves” CBT’s worthlessness.

  • Olly R says:

    Hi Jules,

    I like CBT, and I agree that by changing our thoughts we can substantially change how we feel. But sometimes you don’t want to change your thoughts, you want to change you life conditions. Here’s another pair of truisms that are essential to all good psychotherapy:

    1) our emotional state is to some extent the result of how well matched our life environment is to our personality and our aptitudes and how supportive it is of our dreams

    2) we can to some extent change our environments, and sometimes that is the right thing to do

    Olly R

  • Mike says:

    Do you know what circular logic is? You state that you think the best therapy has two components (you state two components of CBT), then you say: therefore I think CBT is best.

    This is like saying: I believe that the best foods contain chocolate and sugar, therefore I think chocolate cake is the best food. But this doesn’t prove that chocolate cake is the best food.

    The actual evidence says that all of the major therapies ARE equal in efficacy. So this proves the is no best therapy.

    You are totally denying the facts. You are falling for cognitive bias which is where someone has an opinion and only looks for evidence that agrees with them. When they find evidence that questions their view, they just disregard it or pretend to consider it while blatantly being biased.

    Other evidence suggests that counsellors (of any type) who have several years training are no more effective than people with little or no training. This ties in with other research that says the therapeutic alliance is the only factor in regards to efficacy which ties more in with person centred.

    Counselling is mostly bogus profession. The counsellors are no different to religious preachers who think that THEIR system alone can save you. CBT practitioners are the most dogmatic. They are fundamentalists.

    Be wary of anyone that says they have all the answers!

  • Mike says:

    The best therapy considers the following:

    1. The unconscious
    2. The ego

    Therefore psychodynamic is the best form of counselling.

    OR

    The best therapy considers the following:

    1. The actualising tendency
    2. A client’s inner world

    Therefore person centred is the best form of counselling.

    We can talk like this OR we can just look at the actual evidence like real scientists might.

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