My school teaches four approaches to psychotherapy: psychodynamic (unconscious desires and conflicts, early development and its influence, defense mechanisms), cognitive-behavioral (core beliefs, automatic thoughts, reward and punishment, mindfulness), humanistic/existential (self-actualization; the search for meaning; experience and self-awareness), and systems (interactions and structures within groups of people; usually applied in couples and family therapy). We learn the basics in all of them, but the time has come to choose one orientation, one framework to focus on during the rest of our studies.
AAAAAAAAAAAAAAAHHHHHHHHHHH!
Actually, I went with cognitive-behavioral therapy (or CBT), and I’m fine with that. It’s just that I think all of them are true, and none of them is complete.
The runner-up for me was existential therapy – therapy that wrestles with the Big Questions or the “givens” of existence. I think many clients – especially those suffering from depression, bereavement, adjustment disorders, and the like – are seeing therapists with questions once entrusted to religious and spiritual advisors: what kind of life should I lead? What makes life meaningful or worth living, especially in the face of pain or malaise? How do I cope with or make sense of this challenge I am facing? I am lost; which way shall I go?
Of course, some people do go both ways.
I know these were the questions on my mind when I went to therapy in college. Then I came across the work of Viktor Frankl, a psychiatrist who had this to say:
Existential frustration is in itself neither pathological nor pathogenic. A man’s concern, even his despair, over the worthwhileness of life is an existential distress but by no means a mental disease. It may well be that interpreting the first in terms of the latter motivates a doctor to bury his patient’s existential despair under a heap of tranquilizing drugs. It is his task, rather, to pilot the patient through his existential crises of growth and development.
Frankl knew about despair. The quote is from Man’s Search for Meaning, in which Frankl wrote about his experience as a concentration camp survivor. His idea of logotherapy, a therapy focused on finding meaning in life, resonated with me. But logotherapy is just one strain of existential/humanistic therapy, and I don’t think it’s applicable to all therapeutic problems.
Why CBT, then? Well, the concept of core beliefs – deeply-held assumptions about ourselves and the world that influence our interpretation of events – resonates with me, too. Some people think that CBT is “unromantic” or “not warm and fuzzy,” but uncovering these beliefs and their origins in the past is just as touchy-feely whether you call them “core beliefs,” “introjects” (psychodynamic), or “self-structure” (humanistic). Furthermore, challenging automatic thoughts has long been a habit of mine, although I didn’t notice a lot of them until I learned about them. It isn’t all about arguing with thoughts and shaping behavior, either. Lately, CBT has gotten into this whole mindfulness kick, which is pretty cool.
What really tipped the scale, though, is that CBT seems to offer many more concrete tools. One of the humanistic/existential professors at my school stated that in his view, “The [therapeutic] relationship is the technique.” Well, that doesn’t give me much sense of what I can do to help someone. I already strive to have good relationships with people, and I think I do that pretty well. Studies do show that the quality of the therapeutic relationship is a stronger predictor of success than the particular techniques used, but that doesn’t mean the techniques aren’t important.
In practice, most therapists are “eclectic” or “integrative” in the techniques they use, but their theoretical orientation is the blueprint that tells them when, where, and why to deploy these techniques. I don’t feel comfortable with a blueprint that expects change to arise out of the therapeutic relationship without some other change-agent present. It looks like CBT is the way to go for me. Onward and upward!
Anyone want a t-shirt?
Overwhelming Sanity 