Posted by Noa on May 22, 2000, at 9:09:21
In reply to Re: Psychotherapy v. CBT, posted by Noa on May 21, 2000, at 15:54:22
More .....
As I mentioned, I think proponents of each of the three approaches you mentioned would argue that their approach accounts for how you arrived at your present problem, how you think about it, and what you might do about it.
With psychodynamic therapy, and I am painting here with a broad brush for all three approaches, the idea is that your early relationship experiences have shaped how you related to yourself and to others. By exploring your history, and by exploring the relationship between the client and therapist in the work of therapy, one can come to a better understanding of how essential emotional needs were or were not met early in life, and how you might be attempting to compensate for parts of your self that have not had needs met. It involves thinking, and in order to make real changes, it also involves behavior, ie, looking at patterns of behavior and trying to address the needs that led to developing unhealthy patterns, and then trying out new ways of behaving.
With the behavioral approach, the idea is that we learn from our environments, and develop patterns of feeling and behavior that become habitual. To unlearn them, one must examine them up close, looking at antecedents (what happens immediately prior to a behavior or feeling), and consequences (how we might be reinforcing our habitual patterns). Then, to change, one must deliberately alter the sequence of antecedent-behavior-consequence, often by breaking the links between them that have been so automatic, and often by substituting other things. A simple example is the common link bewteen coffee and cigarettes or between talking on the phone and cigarettes. Or between various kinds of stress and eating, smoking, drinking, whatever. It involves tuning into physical sensations, and not responding so automatically with one's typical behaviors, to the physical sensations, whether from hunger, fatigue, anxiety, etc., and trying more healthful responses.
In cognitive therapy, the idea is to examine all the previously automatic and unexamined thoughts that are the antecedents of feelings. We all walk around with automatic assumptions about ourselves, and have automatic thoughts in response to all kinds of experiences and stimuli. In cognitive therapy of depression, the idea is to look at all the negative, toxic, automatic thoughts, and try to challenge their validity, to look at how irrational many of them are, and how our feelings and sense of selves are based on those negative ways of thinking. The idea is to increase awareness of thoughts as they occur, and attempt to change the way one thinks to be both more reality based and more positive, in hopes that the feelings will follow.
CBT is essentially cognitive therapy but it makes use of behavioral techniques, as well. The idea is that not only has the person developed negative, self-defeating ways of thinking, but they have also developed self-defeating behavior patterns, as well, and that treatment calls for more than just examining our thoughts, that active attempts to change behaviors is helpful, too. This involves increasing awareness of thoughts, actions, feelings, and what is going on within the body, and focuses a lot on skill development---ie, learning more healthy ways of behaving and interacting with one's environment.
As I mentioned in an earlier post, I believe each of these approaches has something to offer most people, and I am always wary of therapy that is ardently purist in following one approach only.
I think it has been unfortunate that the cognitive school has been partially commandeered by the insurance world, because it has been offered as a short term model. I think that with some people who present with rather uncomplicated problems, short term cognitive therapy probably works really well. For many others, though, the therapy needs to be longer, in which case it is likely that the other qualities of therapy, as Cindy said earlier (eg the relationship with a caring therapist), are just as effective as the specific approach. Unfortunately, because managed care seems to have so much power to dictate what is good treatment these days, short term is usually all that is available. Interstingly, proponents of cognitive therapy acknowledge that the short term cognitive approach does not work for everyone, and that a modified approach, that recognizes the need for a more long term relationship with a therapist, is a better option for some people.
poster:Noa
thread:34042
URL: http://www.dr-bob.org/babble/20000517/msgs/34272.html