The prevailing mode of psychotherapy today in the United States is clearly cognitive behavioral therapy (CBT). This is an approach to therapy that attempts with considerable success to be anchored in empirical information, and aims with considerable success at relieving symptom distress and reducing the suffering of many patients. But CBT is also accompanied by and linked to a broader philosophy — which constitutes the prevailing current politically correct attitude towards emotional and mental disorders: People with virtually all human conditions and differences are to be honored as they are, patients are to be guided to self-acceptance without “tough love” or other deep therapist-patient relationship-touching techniques that aim at elevating functioning and are intended to facilitate meaningfully deep character and relationship changes.
I definitely do practice CBT techniques in the therapy I practice. On a typical day this week, I taught a patient how to regain control over her breathing which had gotten out of whack (“I feel like I can’t breathe,” she said in panic); taught a patient how to use breathing techniques in order to fall asleep or resume sleeping after waking up in the middle of the night; instructed a couple to schedule units of structured conversation in which each one shares what is going on in his (her) life and then the spouse is to convey his (her) understanding (though not necessarily agreement); and for another patient I designed a daily exercise in which he is to attempt in his fantasy to be angry and even to hate his mother who devoted all of herself and then more to her “genius son” who ended up so pleasured that he is deprived of much of his natural vitality and stamina for standing up to life. My beloved psychoanalyst so many years ago would not have offered me any of the above or anything remotely similar in the way of immediate help and direct active techniques for relief of the considerable pain that I suffered. The techniques simply did not exist.
My own original training was essentially in psychoanalysis and as an alternative in Rogerian non-directive therapy, and then it was with awe and gratitude that I met up with the first works of the great Albert Ellis on “Rational-Emotive Therapy.” Ellis gave me new tools for real help in urgent situations, such as for a college kid who was on the edge of psychosis but had to and wanted to go back to college in another city to begin the Fall semester. I also had the pleasure of being in personal contact with Ellis a number of times and indeed referred several of my difficult patients (in Philadelphia) to him (in New York) for his more expert help. So I am hardly a stranger or antagonistic to CBT.
Yet, I have adopted another kind of philosophy of treatment where, whenever possible, the therapy aims at fighting off renunciations of power and achievement by a patient who is giving up on themselves, e.g., capable people who are looking to stop their education because of learning difficulties; marital spouses who are heading uncritically to terminate a marriage (and family) that do have a potential for decency and pleasure because they are currently miserable, or conversely spouses who surrender to deadness in their marriage who could do better; and even some choices of alternative sexual lifestyles by people who ask for therapy and it becomes clear that they essentially are running away from the pain of heterosexual intimacy, rather than their being naturally among the many people whose psychosexual development intrinsically has been pointed in another direction.
For me many psychotherapies are profound invitations not only to symptom relief but to very meaningful growth of character, spirit, and healthy interactions in relationships. I see no contradiction between the two goals of providing relief and encouraging growth – although of course I am very aware of the significant technical issue that providing relief very quickly can inhibit what might have been a process of deeper engagement of a person with themselves. I believe in a therapy that aims as much as possible at egalitarian experiences with others, banishing prejudice at others who are different than we are in whatever ways, eschewing all violence, and basically living a life where one is good to oneself and decent and good to others – and enjoys living for all its inevitable downs.
To my CBT colleagues, i.e., therapists, clinics, and departments that have fully adopted an only-CBT approach, I extend an invitation to read this book openly, to disagree with me vigorously, but to be open to a possible contribution from my way of thinking and experience.
-Selection from A Democratic Mind: Psychiatry and Psychology with Fewer Meds and More Soul, Rowman & Littlefield.