Re:Cognitive Therapy for Schizophrenia and psychodynamics

Olsen,

My main reaction is that you have quite a few opinions which you state as facts, i.e. "cognitive therapy ... is insufficient by itself when working with individuals with severe psychiatric disorders", "CBT ... essentially has no theory on development", "it has poorly developed concepts for how people interact", "one is left helpless without a psychodynamic understanding". If these views are accurate, then it sounds as though Cognitive Therapy is not very useful at all. Not surprisingly, I see each of these points differently than you do.

On the question of whether Cognitive Therapy is sufficient by itself when working with individuals with severe psychiatric disorders, we would argue that individual therapy alone (of whatever sort) is insufficient with severe psychiatric disorders. However, this doesn't necessarily mean that Cognitive Therapy has to be combined with other psychotherapy approaches. One can use CT as a basis for group therapy, milieu therapy, family therapy, dealing with medication compliance, etc. Carlo Perris' 1989 book Cognitive Therapy with Schizophrenic Patients gives a good example of how this can be done. Another good source regarding CT in a hospital setting is Cognitive Therapy with Inpatients (Wright, Thase, Beck, & Ludgate, 1993).

You are right in saying that CT hasn't spent a lot of time discussing theories of development. This isn't because we lack of a theory of development. It is because we focus more attention on what to do about the problems the client has than on how they came to have those problems. You can find a concise discussion of how Dr. Beck and I see the development of personality disorders in the chapter we wrote for Major Theories of Personality Disorder (Clarkin & Lenzenweger, 1996; second edition in press).

I guess the question of whether our concepts of how people interact is poorly developed or not is a matter of opinion. The approach is based on some very definite ideas about the therapeutic relationship. You can find this discussed in detail in Interpersonal Process in Cognitive Therapy (Safran & Segal, 1990). The many books on CT with personality disorders also discuss interpersonal interactions in detail as do books on CT with couples and families.

Dr. Beck was psychoanalytically trained before he developed CT and I was a pretty good psychodynamic therapist before I started doing CBT. Neither of us feels we've become "helpless without a psychodynamic understanding." One of the main reasons I became a cognitive therapist is that I find cognitive understandings of clients to be much more useful than psychodynamic understandings were. I remember attending a two-day workshop on treating borderline personality disorder that Masterson presented in 1981. It was very interesting but after two days of hearing him talk about "introjected split-part objects" I realized that I didn't have the foggiest idea of what this understanding suggested that I say or do in sessions with borderline clients.

If you look into Cognitive Therapy a bit more, I think you'll find that there's more to it than you realized.

Replies:

There are no replies to this message.

| Behavior OnLine Home Page | Disclaimer |

Copyright © 1996-2004 Behavior OnLine, Inc. All rights reserved.