Response to Jeff Young's comments

I'm surprised to see that my comments have been declared "uninformed" since Jeff supervised me years ago and knows that I've read his books, visited his Web site, and have discussed his work in workshops I've presented. Furthermore, I wasn't even criticizing his approach, Schema Therapy. I was responding to Ian James' critique of schema-focused approaches in CBT. James' criticisms apply to Schema Therapy, of course, but they also apply to other schema-focused interventions such as those presented by Judy Beck and Chris Padesky, and they apply to my own work.

While I am not particularly interested in criticizing Jeff's approach, he has asked me to reply to the substance of his comments, so I will:

Jeff writes "It is worth noting that a large number of cognitive therapists have integrated many of my schema concepts and techniques into their own work since I began to develop this model in the 1980's. Some of the more recent outcome studies using CT actually incorporate some schema-based techniques, although they have been relabeled as 'changing core beliefs.'" It certainly is true that Jeff has put a great deal of time and effort into developing his schema concepts and techniques over the past 20 years and has developed a distinctive treatment approach. I do not know how many Cognitive therapists have integrated Schema Therapy concepts and techniques into their owm work but I do know that there are a large number of Cognitive Therapists who deal with schemas using techniques which were developed independently of Jeff's work. Identifying and modifying dysfunctional beliefs/underlying assumptions/schemas has been an important part of CT since Cognitive Therapy and the Emotional Disorders (Beck, 1976) or before. When I read Judy Beck's discussion of changing core beliefs it doesn't sound like she's incorporating Schema Therapy into CT, it sounds like she'd further developing CT's basic approach to core beliefs. I believe that Chris Padesky's work has been independent of Jeff's and I know that my work has been independent of his.

Jeff also writes "As for hypocrisy, some cognitive therapists make claims about the usefulness of cognitive therapy for personality disorders. Yet there is little or no data supporting its usefulness for PD's (other than DBT). Yet the Beck, Freeman, et al. book on CT for PD's was published in 1990, the same year as my own first book. Shouldn't criticism regarding the lack of empirical evidence for treating PD's be applied equally to CT and to Schema Therapy?" Yes, of course, criticism regarding the lack of empirical evidence applies equally to all the various schema-focused approaches and to all the various approaches to treating personality disorders. When I discuss CT with personality disorders I make a point of acknowledging the limited empirical support for the interventions I advocate and the need for more research. However, the empirical support for the usefulness of CBT with clients diagnosed as having personality disorders isn't as limited as Jeff's comment implies. I've summarized the empirical support for CT with persopnality disorders in a number of publications, most recently in my chapter for Cognitive Psychotherapy of Psychotic and Personality Disorders (Perris & McGorry, 1998). While fewer than a dozen outcome studies have been published and much more research is needed, there is decent empirical support for the proposition that CT and CBT can be effective treatments for individuals diagnosed as having personality disorders.

Jeff asks " Do Jim and Paul refuse to treat patients with PD's because there is not yet a validated treatment for most of them?" I can't speak for Paul, but Jeff knows perfectly well that I not only treat clients with personality disorders but also publish quite a bit on this topic and conduct workshops on CT for personality disorders. While it would be great to have a solid empirical base for every intervention, practicing clinicians often face clients who present problems for which empirically-supported treatment protocols have not yet been developed. It would hardly be doing the individuals a favor if we refused to do our best to help them because no one had researched their problem yet. However, there is no need for "therapists ... to muddle around with PD's, trying existing approaches that seem promising, because patients cannot wait for empirical data to receive treatment." We have a small but growing empirical base which we can work from.

I agree completely with Jeff's comments about the difficulty of doing good research into the treatment of personality disorders. Jeff, thanks for the offer to support me in doing outcome research but I haven't been able to figure out a way to be a practitioner and do big-time research as well. It seems that there simply aren't enough hours in the day to run a practice and have an active research program as well.

For some reason, Jeff assumes that I am unaware of Arntz's study in Holland but this is not the case at all. I've been following Arntz's research for some time and am looking forward to seeing the results of this study. Hopefully, Arntz will be writing the chapter on borderline personality disorder for the second edition of Cognitive Therapy of Personality Disorders and it will be very interesting to see what he has to say. Other outcome studies are reported to be under way as well, so we may have a larger research base available in the forseeable future.

I hope that I am not one of those Jeff has in mind when he says "Before attacking me, or others working with personality disorders, critics should become more informed about the difficulties of researching PD's. Furthermore, impugning the character of researchers like myself, or ascribing mercenary motives, has no empirical basis whatsoever and probably reflects the schemas of the critics themselves." I have not been attacking Jeff or his work, have not been impugning anyone's character, and have not been ascribing mercenary motives to anyone. I don't think that any of my comments earlier in this discussion give that impression, but if they do please email me (jpretzer@apk.net) and I will correct them.

P.S. I'd like to thank Jeff for taking time to post his comments and hope that he'll continue to participate in this forum.

Replies:

Response to Jim Pretzer's Comments, by Jeff Young, 01/07/02 Re:Response to Jim Pretzer's Comments, by Jim Pretzer, 01/09/02

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