Cognitive Therapy for Schizophrenia and psychodynamics

I certainly think there are good elements in cognitive therapy, but it is insufficient by itself when working with individuals with severe psychiatric disorders - and especially if one is working in a ward. There are exceptions - Bentall makes some good points, and there are others. These authors have included a larger role for affect in the understanding of psychotic symptoms - which there now is solid empirical support for.

The main problem with CBT is that it essentially has no theory on development. Yes, I know - they say it does - but it is not much more than a collection of facts - which really does not qualify to be called a theory. Thus it is not very helpfull in understanding the patient.

The second problem is that it has poorly developed concepts for how people interact (does it have any?). If one is working at a ward, you and the staff will need a thorough understanding of concepts as transference/countertransference and projective identifications (especially among the patients that have more cognitive abilities). Wards with patients with severe psychitaric disorders will sooner or later experience problematic processes between post-personell, post-personell and therapist, and patient and staff. I read a danish book about CBT with psychotic patients and they acknowledged this fact. However, they had nothing to present about how to understand such processes and how to deal with them.

It is evident that one can not do "old-school" psychoanalysis with psychotic patients, but one is left helpless without a psychodynamic understanding of their current situation.

Replies:

Re:Cognitive Therapy for Schizophrenia and psychodynamics, by Jim Pretzer, 11/17/03

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