One of the more entertaining parts of my training in Rational-Emotive Behaviour Therapy — an austerely philosophical style of CBT — was how tribal our course leader was about its merits. He got particularly exercised about psychoanalysts. If a prospective client reveals that they’re looking for psychoanalysis, he would say, you need to get them out of your therapy room, stat. Other therapists I knew shared his animus. Psychoanalysts were creepy, power-tripping grifters; the people who went to them were at best naïve, and at worst whiny, self-centred and broken by terrible ideas.
REBT is characterised by a kind of rugged psychic individualism. In this view, if you hope to be psychologically fixed by relying on others, if you seek healing from interpersonal woo-woo like transference, you’ve already made a key philosophical error. You’ve outsourced your agency. And that’s before getting into the most eccentric elements of psychoanalytic theory — penis envy, the Oedipus complex, Melanie Klein’s baffling idea of the bad breast as persecutory object. To read Freud is to grit one’s teeth at the relentless dogmatism of his prose, the certainty with which assumptions that look absurd in the context of observable reality somehow grew legs and ran for decades. If you are looking for relief from mental distress, is it wise to procure it from people who believe in resentment-drenched theories that could only ever make sense to the pathologically horny and disturbed?
More generously understood, psychoanalysis is based on the idea that mental distress tends to arise from unconscious inner conflicts, and that past experiences — especially those of early childhood — exert a long-term effect on our thoughts, feelings and actions. The analyst assists the patient in exploring the depths of their mind, unearthing hidden meanings. Change happens by means of the therapeutic relationship, with the patient unconsciously acting out past conflicts. The process can take years.
Albert Ellis, the originator of REBT, was a psychoanalysis refusenik, as was Aaron Beck, the father of CBT as we know it today. Their early careers were largely an accident of history: both happened to train in clinical practice in the post-war era, when psychoanalysis was dominant. Both soon observed inconsistencies between the theoretical claims of how analysis worked and their own observations of patients. Beck noticed that negative views of the self, the world and the future characterised depressive episodes in patients, rather than the repressed feelings that Freud held to be their cause. The psychoanalytic process was only supposed to work if you saw the patients daily, maintaining the relational magic, but Ellis noted that his patients who only came in once a week did just as well, and that they did even better when he ditched the psychoanalytic theory and talked to them about philosophy instead.
What emerged from this was cognitive behavioural therapy. Rather than getting stuck into the past, it operated in the here and now, looking for the habits of thought and behaviour that maintain our distress, and finding ways of thinking and behaving that might work better. The therapist’s role was not as ersatz parent or interpreter, but as Socratic teacher, helping guide the patient’s reasoning to more pragmatic ends. This seems to have worked well: in the English-speaking world, the dominance of CBT makes Freud look more like a kooky curiosity in the history of ideas than the father of psychology.
The ideological descendants of Freud have strong feelings about this. They’re not all psychoanalysts: there’s a genealogy of therapeutic styles that see human distress as the product of relational problems, from maternal attachment to structural oppression. They tend to see the solution as lying in the deepest layers of the self. Another thing they often have in common is really, really hating CBT.
The arguments vary. Psychodynamic psychologist Jonathan Shedler has suggested that its evidence base for CBT is skewed by selective reporting. Its heavy reliance on manuals, which therapist Nancy McWilliams criticises as rigid and simplistic, leads it to be mistakenly thought of as scientific. By focusing on the individual locus of control, CBT is a tool of neoliberalism, ignoring the systemic inequalities that shape people, telling us to grit our teeth and smile rather than try to change the world. For Jungian psychotherapist Paul Atkinson, CBT mostly serves industry, rather than the people it’s supposed to treat; it’s designed to make you a better cog in the machine. Since 2008, it has been provided for free by the Improving Access to Psychological Therapies (IAPT) programme, conceived by New Labour’s “happiness czar” Richard Layard, to improve economic productivity by way of public wellbeing. As a public investment, CBT was a good one: it is short-term, taking as few as six sessions to complete in straightforward cases, and therefore cheap. It is also highly structured, gathering its own data via regular symptom inventories, meaning it could be accountable to the public purse. Choosing CBT was following the science.
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SubscribeI think it might be helpful to point out how it is that psychoanalytic psychotherapy is supposed to work, since this doesn’t come across in the piece.
a) We have lurking within us, largely out of our awareness (ie ‘unconscious’), a bunch of unhelpful expectations of how relationships with others will go down if we don’t manage ourselves.
b) But these self-management strategies unfortunately cause problems, both in our relationships, and also within us (ie they cause psychopathology).
c) A superficial therapy doesn’t unearth these, and so gets stuck with providing coping strategies, superficial remoralisation, new ideologies to believe in, etc.
d) A depth therapy involves us in a relationship with a therapist which brings these latent expectations to the fore. When they show up in the therapeutic relationship, we call these the patient’s ‘transference’.
e) The trick is to foster a relationship which can do two things at once. First, it’s close and trusting enough for the patient’s latent relational expectations to show their face, and for what the therapist says about them (the ‘analysis of the transference’) to be trustworthy enough. Second, the therapist helps the patient see these expectations of how they’ll be met with by their therapist, get some distance from them, and develop a sense of what a relationship not encumbered by them would look like.
f) If the patient starts simply swallowing down what the therapist says, this is itself further material for analysis. (The patient’s trust and respect must be earned.) Ditto if the patient refuses to even consider them. The point is not to convince the patient of anything, but to work together respectfully.
g) Through this process the patient can come to ‘know thyself’, and is liberated from their unconscious shackles. The name of the game is self-possession, agency, and the ready flow of manageable emotion.
Thank you. I’ve been in an actual analysis and this was my experience. A decade later I am so much better for it.
That was a clear and informative explanation. I appreciate your time.
Thank you. I’ve been in an actual analysis and this was my experience. A decade later I am so much better for it.
That was a clear and informative explanation. I appreciate your time.
I think it might be helpful to point out how it is that psychoanalytic psychotherapy is supposed to work, since this doesn’t come across in the piece.
a) We have lurking within us, largely out of our awareness (ie ‘unconscious’), a bunch of unhelpful expectations of how relationships with others will go down if we don’t manage ourselves.
b) But these self-management strategies unfortunately cause problems, both in our relationships, and also within us (ie they cause psychopathology).
c) A superficial therapy doesn’t unearth these, and so gets stuck with providing coping strategies, superficial remoralisation, new ideologies to believe in, etc.
d) A depth therapy involves us in a relationship with a therapist which brings these latent expectations to the fore. When they show up in the therapeutic relationship, we call these the patient’s ‘transference’.
e) The trick is to foster a relationship which can do two things at once. First, it’s close and trusting enough for the patient’s latent relational expectations to show their face, and for what the therapist says about them (the ‘analysis of the transference’) to be trustworthy enough. Second, the therapist helps the patient see these expectations of how they’ll be met with by their therapist, get some distance from them, and develop a sense of what a relationship not encumbered by them would look like.
f) If the patient starts simply swallowing down what the therapist says, this is itself further material for analysis. (The patient’s trust and respect must be earned.) Ditto if the patient refuses to even consider them. The point is not to convince the patient of anything, but to work together respectfully.
g) Through this process the patient can come to ‘know thyself’, and is liberated from their unconscious shackles. The name of the game is self-possession, agency, and the ready flow of manageable emotion.
I know people for whom CBT has been extremely valuable (myself included) when suffering from profound mental health crises. I never had CBT because I was a bit sad or my girlfriend dumped me. I had CBT as part of a treatment program for enduring something quite horrible. So it has its place. In that context, I found this article trite. It’s like comparing people who have plastic surgery for, say, burn injuries, to people who have plastic surgery to look better.
Have to agree. CBT is very helpful in managing health conditions which require overcoming pain and physical limitations. It is a tool for practicing mind over matter, especially when the source of physical pain is poorly understood.
I too found the article trite and clever. It completely misses the relational mysteries in therapy.
I agree. It gives you some rudimentary tools to help get over an event or behaviour so it’s more practical or pragmatic to get you over a bump in the road and deal with now.
Have to agree. CBT is very helpful in managing health conditions which require overcoming pain and physical limitations. It is a tool for practicing mind over matter, especially when the source of physical pain is poorly understood.
I too found the article trite and clever. It completely misses the relational mysteries in therapy.
I agree. It gives you some rudimentary tools to help get over an event or behaviour so it’s more practical or pragmatic to get you over a bump in the road and deal with now.
I know people for whom CBT has been extremely valuable (myself included) when suffering from profound mental health crises. I never had CBT because I was a bit sad or my girlfriend dumped me. I had CBT as part of a treatment program for enduring something quite horrible. So it has its place. In that context, I found this article trite. It’s like comparing people who have plastic surgery for, say, burn injuries, to people who have plastic surgery to look better.
If there is such a thing as happiness, then it’s transient. I don’t have much to say about the therapy “industry” but I believe CBT has it uses in reframing unhealthy behaviours.
Cervantes – do not pursue pleasure because you may have the misfortune to overtake it – which probably equally applies to happiness. Happiness is a byproduct not an end in itself.
Cervantes – do not pursue pleasure because you may have the misfortune to overtake it – which probably equally applies to happiness. Happiness is a byproduct not an end in itself.
If there is such a thing as happiness, then it’s transient. I don’t have much to say about the therapy “industry” but I believe CBT has it uses in reframing unhealthy behaviours.
This essay brings into focus something i’ve been commenting on over various articles recently: our ability to control our own psychological states in order to not just function but to enhance our experience of being alive; and by doing so, enhance the experience of others we associate with.
Let’s start with a fundamental point. For countless generations stretching back towards prehistory, humans have navigated their lives without recourse to the mental health industry (reading this essay demonstrates it is an industry); successfully so, otherwise we wouldn’t be here.
That basic resilience is still possible to attain. We’re having to navigate changes to our living conditions at an unprecedented rate (anyone remember Alvin Toffler’s “Future Shock” from the 1970s?) and i’ve previously referred to the human capacity to cope with the pace of change.
As someone born in the 1950s and having experienced the changes of the past 6 decades, i know it can be done; i know the human capacity to withstand the pace of change is possible, and importantly – without recourse to a set of beliefs or the mental health industry.
In stating the above, i fully realise that each of us has a different threshold. I personally came into contact with my own threshold as a student, and know that there’s a limit beyond which we shouldn’t venture. But that was through my own exploration, not that which the world imposed upon me. So, by way of conclusion…
Perhaps it’s more difficult for younger people to take the time to really “get to know” themselves now, but i’m absolutely convinced that the mental health industry won’t help them. As the diverse strands within the essay demonstrate, the industry doesn’t even “know” itself! Anyone finding themselves caught up in it would be far better saving their time (and money) by disengaging with it and just doing something simple but worthwhile, preferably in the service of others, and giving themselves the chance to listen to their own minds, bodies and spirits.
I was also born in the 1950s and agree with you to some extent. However the concept that we, Western boomers, have had one of the easiest rides in human history has some validity.
In my formative years, and I’m talking about up to mid 20s, I lived in a society where there was a level of homogeneity about fundamental moral concepts. It’s a cheap shot to say now we can’t even agree on what is a man and what is a woman, but that debate is a symptom of a much wider societal shift, leaving many people adrift in a fractious world with few certainties.
This lack of firm ground can’t be blamed just on wokeness, or late stage capitalism, or technology, or globalisation. It is an effect of all these things acting as a system. I don’t believe that it’s all being directed by some cabal of lizard people, it’s an almost inevitable outcome of advancing human ingenuity. Nevertheless the impact of these fundamental shifts on mental wellbeing is real.
It’s easier for us to navigate the changes because our characters were formed in a much more stable environment.
On CBT, my understanding is that it is closer to a structured version of stoic philosophy than mental health treatment. I have personal experience of a close family member, who was helped immensely by CBT, which effectively just reversed some of the more pernicious impacts of the zeitgeist.
I suppose I’m saying, the fact that we grew up in an era of calm seas should make us careful about disparaging lifebelts for those now adrift in much stormier waters.
As a final anecdote, the impact of these changes is accelerating. My 40 year old daughter and 27 year old son are at polar opposite ends of the woke spectrum. Both successful graduate professionals with the same parenting. No prizes for guessing who’s woke.
I can understand that. It’s just that i became aware of a void… an unfathomable depth, into which the human psyche could fall, and the knowledge of it wouldn’t be dependent on the era in which one grew up. I took a long, hard stare at it, then moved on. Words aren’t sufficient to encompass it; it lies beyond rationality.
What it revealed is that each of us has a ‘life force’ – an animus – which stretches back into our evolutionary past, prior to consciousness, and which must be embraced. The entire edifice of civilisation requires it, and we do ourselves immeasurable harm by playing deconstruction games with the conscious element.
This ‘life force’ also provides the basis for the answer to what someone recently in Comments enquired “what is spirituality?”
Young people’s minds have been violated in ways you perhaps cannot imagine. There are people who grew up watching the most horrific things imaginable: real murders, real rapes, real torture. Social media’s deliberate manipulation of the human mind is very real and damaging, even to adults. The ‘mental health’ industry may not help these people but there are many young people who have no more than a single, overworked parent and little or no extended family. These people have no ‘community’ to turn to for natural psychological relief. Do you really believe you’d have the chance to get to know yourself or have your “basic resilience” if you were born in 2005, had an iPad since you were a toddler, lived in desperate circumstances with a single mother and went to school with Afghans?
Being born and brought up in a northern (UK) working class environment, I had an itinerant lad placed next to me in junior school who turned up with ill-fitting boots, no laces or socks, filthy and regularly fell asleep through exhaustion; then disappeared for weeks at a time. I know what depravation looks like, and your insistence (on more than one occasion now) that i “cannot imagine” something reflects your comprehension, not mine.
I agree that very many young people throughout the world grow up in desperate conditions, and that even those in relatively privileged circumstances have to contend with tech advances which may be fundamentally altering the way human beings engage with the world. None of this changes anything in my comments.
Your childhood experiences are closer to those of someone living in a rural part of the developing world in 2023, rather than a British child who has been groomed by adult perverts in an educational app. They are being manipulated by the most sophisticated methods yet devised and you don’t get it. Try to imagine being exposed to a steady diet of hideous pornography throughout your childhood. Combine that with Mexican cartel torture and murder videos, and perverts ‘grooming’ you over years. What would that do to your humanity? You’re fortunate to have experienced a pre-internet world but for a young Briton those experiences might as well be the middle ages.
Once again, you make wrong assumptions with your “and you don’t get it.” It’s becoming a trait.
I’d simply reply that you’re failing to understand what i’m writing since your replies are, in effect, non sequiturs.
On the other hand, you’ve clearly had experience of several different environments, ranging (at the latest reading) from Afghanistan to Mexico. Anywhere else you’d like to enlighten us all about?
OK boomer
Yawn
so lame.
Oh dear – you’ve made yourself look like a right t*t now.
Yawn
so lame.
Oh dear – you’ve made yourself look like a right t*t now.
You edited your response only to demonstrate more ignorance. It’s not entirely your fault. Last week a 30-something journalist was reassuring the FT’s middle-aged readers that sinister internet subcultures are just a right-wing moral panic. He’s young enough to know better but maybe he knows his readers prefer certain lies.
The UK has a lot of Hazaras and they’re always charmed by someone who knows about, and is sympathetic to, their people. North Africans and Arabs are astonished and delighted when you, after the briefest interaction, correctly identify the city or region they’re from. Excepting Syrians who are disturbed. You really ought to wonder why so many Syrian al-Qaeda fighters are living comfortably and unmolested in the UK with their dependants. They didn’t get here in dinghies.
Mexico would be terra incognita if not for a lovely Mexican-American girl in Colorado. After meeting her it was no wonder so many Americans in the South-West are called John Smith or Martin Kruger but look ‘Hispanic’.
OK boomer
You edited your response only to demonstrate more ignorance. It’s not entirely your fault. Last week a 30-something journalist was reassuring the FT’s middle-aged readers that sinister internet subcultures are just a right-wing moral panic. He’s young enough to know better but maybe he knows his readers prefer certain lies.
The UK has a lot of Hazaras and they’re always charmed by someone who knows about, and is sympathetic to, their people. North Africans and Arabs are astonished and delighted when you, after the briefest interaction, correctly identify the city or region they’re from. Excepting Syrians who are disturbed. You really ought to wonder why so many Syrian al-Qaeda fighters are living comfortably and unmolested in the UK with their dependants. They didn’t get here in dinghies.
Mexico would be terra incognita if not for a lovely Mexican-American girl in Colorado. After meeting her it was no wonder so many Americans in the South-West are called John Smith or Martin Kruger but look ‘Hispanic’.
Once again, you make wrong assumptions with your “and you don’t get it.” It’s becoming a trait.
I’d simply reply that you’re failing to understand what i’m writing since your replies are, in effect, non sequiturs.
On the other hand, you’ve clearly had experience of several different environments, ranging (at the latest reading) from Afghanistan to Mexico. Anywhere else you’d like to enlighten us all about?
Your childhood experiences are closer to those of someone living in a rural part of the developing world in 2023, rather than a British child who has been groomed by adult perverts in an educational app. They are being manipulated by the most sophisticated methods yet devised and you don’t get it. Try to imagine being exposed to a steady diet of hideous pornography throughout your childhood. Combine that with Mexican cartel torture and murder videos, and perverts ‘grooming’ you over years. What would that do to your humanity? You’re fortunate to have experienced a pre-internet world but for a young Briton those experiences might as well be the middle ages.
Being born and brought up in a northern (UK) working class environment, I had an itinerant lad placed next to me in junior school who turned up with ill-fitting boots, no laces or socks, filthy and regularly fell asleep through exhaustion; then disappeared for weeks at a time. I know what depravation looks like, and your insistence (on more than one occasion now) that i “cannot imagine” something reflects your comprehension, not mine.
I agree that very many young people throughout the world grow up in desperate conditions, and that even those in relatively privileged circumstances have to contend with tech advances which may be fundamentally altering the way human beings engage with the world. None of this changes anything in my comments.
Reminds me of something I once read in some of Sartre’s writings.
Young people’s minds have been violated in ways you perhaps cannot imagine. There are people who grew up watching the most horrific things imaginable: real murders, real rapes, real torture. Social media’s deliberate manipulation of the human mind is very real and damaging, even to adults. The ‘mental health’ industry may not help these people but there are many young people who have no more than a single, overworked parent and little or no extended family. These people have no ‘community’ to turn to for natural psychological relief. Do you really believe you’d have the chance to get to know yourself or have your “basic resilience” if you were born in 2005, had an iPad since you were a toddler, lived in desperate circumstances with a single mother and went to school with Afghans?
Reminds me of something I once read in some of Sartre’s writings.
The zeitgeist isn’t merely the result of “human ingenuity”. The lunatic left has been bankrolled for decades by the richest people and institutions in society, on both sides of the Atlantic. Why the Ford Foundation et al want to lavish money on obscure, deranged communist ‘activists’ ought to be the subject of Orbanesque investigations.
Good point. The wealthy and/or well established need ways to signal their virtue and, as they seem to have mislaid their moral compass, activist organisations are ready and willing to school them those 21st Century virtues rendered all but unquestionable by the MSM. Does that explain the Bank of England’s eager acceptance of the Stonewall agenda? Probably.
Good point. The wealthy and/or well established need ways to signal their virtue and, as they seem to have mislaid their moral compass, activist organisations are ready and willing to school them those 21st Century virtues rendered all but unquestionable by the MSM. Does that explain the Bank of England’s eager acceptance of the Stonewall agenda? Probably.
I can understand that. It’s just that i became aware of a void… an unfathomable depth, into which the human psyche could fall, and the knowledge of it wouldn’t be dependent on the era in which one grew up. I took a long, hard stare at it, then moved on. Words aren’t sufficient to encompass it; it lies beyond rationality.
What it revealed is that each of us has a ‘life force’ – an animus – which stretches back into our evolutionary past, prior to consciousness, and which must be embraced. The entire edifice of civilisation requires it, and we do ourselves immeasurable harm by playing deconstruction games with the conscious element.
This ‘life force’ also provides the basis for the answer to what someone recently in Comments enquired “what is spirituality?”
The zeitgeist isn’t merely the result of “human ingenuity”. The lunatic left has been bankrolled for decades by the richest people and institutions in society, on both sides of the Atlantic. Why the Ford Foundation et al want to lavish money on obscure, deranged communist ‘activists’ ought to be the subject of Orbanesque investigations.
I think it is worse than you state. The current “mental health” industry is busy telling young people they can choose their identity and cut off their family at whim, based on some vague notions of seeking their “personal happiness”. Read the articles all over the web promoting estrangement. They owe nobody but themselves anything. Cult thinking.
There is no homogenous ‘mental health industry’ – to think so sounds a little like ‘cult thinking’. Psychologists such as Jonathan Haidt and Jordan Peteresen frequently speak out against radical notions of gender fluidity, the coddling of young adults etc – and they are not outliers in the industry. I suspect you are confusing a relatively small subset of ‘wellness businesses’ and radical gender activists with the legions of psychiatrists, psychological therapists, social workers etc – who tend to very much be realists, working as they do at the coalface – depression, suicide, madness, addictions etc.
There is no homogenous ‘mental health industry’ – to think so sounds a little like ‘cult thinking’. Psychologists such as Jonathan Haidt and Jordan Peteresen frequently speak out against radical notions of gender fluidity, the coddling of young adults etc – and they are not outliers in the industry. I suspect you are confusing a relatively small subset of ‘wellness businesses’ and radical gender activists with the legions of psychiatrists, psychological therapists, social workers etc – who tend to very much be realists, working as they do at the coalface – depression, suicide, madness, addictions etc.
I was also born in the 1950s and agree with you to some extent. However the concept that we, Western boomers, have had one of the easiest rides in human history has some validity.
In my formative years, and I’m talking about up to mid 20s, I lived in a society where there was a level of homogeneity about fundamental moral concepts. It’s a cheap shot to say now we can’t even agree on what is a man and what is a woman, but that debate is a symptom of a much wider societal shift, leaving many people adrift in a fractious world with few certainties.
This lack of firm ground can’t be blamed just on wokeness, or late stage capitalism, or technology, or globalisation. It is an effect of all these things acting as a system. I don’t believe that it’s all being directed by some cabal of lizard people, it’s an almost inevitable outcome of advancing human ingenuity. Nevertheless the impact of these fundamental shifts on mental wellbeing is real.
It’s easier for us to navigate the changes because our characters were formed in a much more stable environment.
On CBT, my understanding is that it is closer to a structured version of stoic philosophy than mental health treatment. I have personal experience of a close family member, who was helped immensely by CBT, which effectively just reversed some of the more pernicious impacts of the zeitgeist.
I suppose I’m saying, the fact that we grew up in an era of calm seas should make us careful about disparaging lifebelts for those now adrift in much stormier waters.
As a final anecdote, the impact of these changes is accelerating. My 40 year old daughter and 27 year old son are at polar opposite ends of the woke spectrum. Both successful graduate professionals with the same parenting. No prizes for guessing who’s woke.
I think it is worse than you state. The current “mental health” industry is busy telling young people they can choose their identity and cut off their family at whim, based on some vague notions of seeking their “personal happiness”. Read the articles all over the web promoting estrangement. They owe nobody but themselves anything. Cult thinking.
This essay brings into focus something i’ve been commenting on over various articles recently: our ability to control our own psychological states in order to not just function but to enhance our experience of being alive; and by doing so, enhance the experience of others we associate with.
Let’s start with a fundamental point. For countless generations stretching back towards prehistory, humans have navigated their lives without recourse to the mental health industry (reading this essay demonstrates it is an industry); successfully so, otherwise we wouldn’t be here.
That basic resilience is still possible to attain. We’re having to navigate changes to our living conditions at an unprecedented rate (anyone remember Alvin Toffler’s “Future Shock” from the 1970s?) and i’ve previously referred to the human capacity to cope with the pace of change.
As someone born in the 1950s and having experienced the changes of the past 6 decades, i know it can be done; i know the human capacity to withstand the pace of change is possible, and importantly – without recourse to a set of beliefs or the mental health industry.
In stating the above, i fully realise that each of us has a different threshold. I personally came into contact with my own threshold as a student, and know that there’s a limit beyond which we shouldn’t venture. But that was through my own exploration, not that which the world imposed upon me. So, by way of conclusion…
Perhaps it’s more difficult for younger people to take the time to really “get to know” themselves now, but i’m absolutely convinced that the mental health industry won’t help them. As the diverse strands within the essay demonstrate, the industry doesn’t even “know” itself! Anyone finding themselves caught up in it would be far better saving their time (and money) by disengaging with it and just doing something simple but worthwhile, preferably in the service of others, and giving themselves the chance to listen to their own minds, bodies and spirits.
Jung made an astute remark when he noted that psychology and psychoanalysis alike arose when the modern evacuation of meaning from the cosmos became unbearable, about the same time as Nietzsche called out the death of God.
Human beings can’t live in a disenchanted void, no matter how much self-control or self-understanding they gain. Trauma happens, there’s no doubt. But the lost self also needs the vitality and purpose that is more than itself.
The lost self lives in a community, however alienated such a self might feel. Harking back to a time when “meaning became lost” is so very clearly the wrong answer, if that’s what you’re suggesting we should do (and which others certainly suggest we should do).
There’s a reason why “meaning” became lost, and it’s up to us all to move beyond that point by creating new meaning, as individuals within a wider community and beyond the strictures which the organisation of “meaning” sought to impose upon us from those who claimed to “know”.
Exactly – Viktor Frankl came to the same realisation after the ‘challenges’ of being an inmate of Theresienstadt and then Auschwitz, and ‘losing’ his wife, brother father and mother there. He did not retreat into fantasy to find meaning.
That’s a very telling example, of someone whose existence really was put on the line yet didn’t resort to either despair or refuge in failed structures of meaning.
I entirely agree that nostalgia won’t work and actually think there’s meaning in the alienation, such as prompting realisation. That said, I don’t think transformative meaning can be made, but might be discovered. This is really the insight of Frankl: he found there was more he could hold out for, a more that transcended the very, very worst.
I entirely agree that nostalgia won’t work and actually think there’s meaning in the alienation, such as prompting realisation. That said, I don’t think transformative meaning can be made, but might be discovered. This is really the insight of Frankl: he found there was more he could hold out for, a more that transcended the very, very worst.
That’s a very telling example, of someone whose existence really was put on the line yet didn’t resort to either despair or refuge in failed structures of meaning.
Exactly – Viktor Frankl came to the same realisation after the ‘challenges’ of being an inmate of Theresienstadt and then Auschwitz, and ‘losing’ his wife, brother father and mother there. He did not retreat into fantasy to find meaning.
Love changes everything:
Havens worked on this topic using only pen and paper in his prison cell, exchanging ideas with his co-authors in Italy through hard-copy letters mailed across the ocean.
Prison conditions.
So how could this happen? In Havens’ words:
The lost self lives in a community, however alienated such a self might feel. Harking back to a time when “meaning became lost” is so very clearly the wrong answer, if that’s what you’re suggesting we should do (and which others certainly suggest we should do).
There’s a reason why “meaning” became lost, and it’s up to us all to move beyond that point by creating new meaning, as individuals within a wider community and beyond the strictures which the organisation of “meaning” sought to impose upon us from those who claimed to “know”.
Love changes everything:
Havens worked on this topic using only pen and paper in his prison cell, exchanging ideas with his co-authors in Italy through hard-copy letters mailed across the ocean.
Prison conditions.
So how could this happen? In Havens’ words:
Jung made an astute remark when he noted that psychology and psychoanalysis alike arose when the modern evacuation of meaning from the cosmos became unbearable, about the same time as Nietzsche called out the death of God.
Human beings can’t live in a disenchanted void, no matter how much self-control or self-understanding they gain. Trauma happens, there’s no doubt. But the lost self also needs the vitality and purpose that is more than itself.
The practice of some professions cannot be reduced to a recipe. You expect any dentist to be able to fix a cavity in your tooth or any plumber to be able to fix your broken water pipe — just train them up and they will be able to do the job. Other professions work differently. The difference in treatment you get from a good physiotherapist and a mediocre one, a good litigator and a mediocre one, and a good forensic accountant and a mediocre one is enormous, to the extent that the bad ones are usually not worth engaging in the first place. And often ‘good’ is only in context — being an excellent litigator in the field of injury law doesn’t mean you will be first on somebody’s list when accused of murder. Therapy, especially the sort that relies on a personal relationship between the therapist and the patient, must be one of the irreducible sort.
Not sure about all of that. I’ve been on the receiving end of a bad dentist and a very bad plumber. Dedicated and gifted people can be found in all trades. As well as chancers.
Not sure about all of that. I’ve been on the receiving end of a bad dentist and a very bad plumber. Dedicated and gifted people can be found in all trades. As well as chancers.
The practice of some professions cannot be reduced to a recipe. You expect any dentist to be able to fix a cavity in your tooth or any plumber to be able to fix your broken water pipe — just train them up and they will be able to do the job. Other professions work differently. The difference in treatment you get from a good physiotherapist and a mediocre one, a good litigator and a mediocre one, and a good forensic accountant and a mediocre one is enormous, to the extent that the bad ones are usually not worth engaging in the first place. And often ‘good’ is only in context — being an excellent litigator in the field of injury law doesn’t mean you will be first on somebody’s list when accused of murder. Therapy, especially the sort that relies on a personal relationship between the therapist and the patient, must be one of the irreducible sort.
This essay makes a series of common errors, starting with those of the errant course leader – any psychological therapist worth their salt knows that there is no one-size-fits-all therapy and that various therapies are effective when matched to personality, problem type, and practicalities (few people can afford psychoanalysis). Fonagy set this out in ‘What works for whom’, 20 years ago.
“CBT is a tool of neoliberalism, ignoring the systemic inequalities that shape people, telling us to grit our teeth and smile rather than try to change the world. ”
This is an odd statement – it may be that big business pays for CBT in the hope that it will make their staff more productive – as they pay for private healthcare generally. Further, the idea that psychological therapy is, or should be about changing the world, rather than the individual, is a complete misunderstanding of what psychotherapy is about – though some did apply this politicised angle from the late 1960’s, and it all bit died out a few years later. Moreover CBT does not ignore inequalities, nor the past – rather, these should be explored and recognised as the true origins of the perceptual distortions of thought and feeling, and the dysfunctional behaviours. The author would do well to look up developments in cognitive therapies, such as Schema Focused Therapy or Dialectical Behaviour Therapy – and indeed CAT – Cognitive Analytic Therapy.
“As a public investment, CBT was a good one: it is short-term, taking as few as six sessions to complete in straightforward cases, and therefore cheap…..This infuriated CBT’s detractors, provoking a backlash against IAPT and CBT in general. ”
It infuriates CBT practitioners too – IAPT and their six session model is woefully inadequate, and is a crappy underfunded politicised NHS management decision – not one from CBT or psychology. As such is is an extremely bad investment – similar to the typical British cycle lane – crappy underfunded exercise in box ticking which is often actively dangerous.
“studies of CBT’s efficacy elsewhere have found it to fall over time..with one finding it no more effective than its nemesis.”
Of course it blooming well does – the CBT model of psychological health is analogous to exercise and fitness – if you give up living healthily, you’ll give up your health. NB: a reasonable course of CBT is around 20 sessions – a typical course of analysis is around 300 sessions.
“downplaying the influence of the external world on our wellbeing is unwise. Psychological studies are in agreement: the quality and quantity of our relationships strongly predict our wellbeing.”
External factors and relationships should not be downplayed in CBT – they are seen of huge importance – the issues in CBT often are – ‘how are your psychological problems interfering with your relationships (and vice versa) because we are social beings and good relationships are the single most important aspect of wellbeing; and how do your inner processes (thought, emotion, personality, behaviours, coping strategies) interact with externals (work pressure, ill matched jobs, friends etc, dysfunctional family).
This essay makes a series of common errors, starting with those of the errant course leader – any psychological therapist worth their salt knows that there is no one-size-fits-all therapy and that various therapies are effective when matched to personality, problem type, and practicalities (few people can afford psychoanalysis). Fonagy set this out in ‘What works for whom’, 20 years ago.
“CBT is a tool of neoliberalism, ignoring the systemic inequalities that shape people, telling us to grit our teeth and smile rather than try to change the world. ”
This is an odd statement – it may be that big business pays for CBT in the hope that it will make their staff more productive – as they pay for private healthcare generally. Further, the idea that psychological therapy is, or should be about changing the world, rather than the individual, is a complete misunderstanding of what psychotherapy is about – though some did apply this politicised angle from the late 1960’s, and it all bit died out a few years later. Moreover CBT does not ignore inequalities, nor the past – rather, these should be explored and recognised as the true origins of the perceptual distortions of thought and feeling, and the dysfunctional behaviours. The author would do well to look up developments in cognitive therapies, such as Schema Focused Therapy or Dialectical Behaviour Therapy – and indeed CAT – Cognitive Analytic Therapy.
“As a public investment, CBT was a good one: it is short-term, taking as few as six sessions to complete in straightforward cases, and therefore cheap…..This infuriated CBT’s detractors, provoking a backlash against IAPT and CBT in general. ”
It infuriates CBT practitioners too – IAPT and their six session model is woefully inadequate, and is a crappy underfunded politicised NHS management decision – not one from CBT or psychology. As such is is an extremely bad investment – similar to the typical British cycle lane – crappy underfunded exercise in box ticking which is often actively dangerous.
“studies of CBT’s efficacy elsewhere have found it to fall over time..with one finding it no more effective than its nemesis.”
Of course it blooming well does – the CBT model of psychological health is analogous to exercise and fitness – if you give up living healthily, you’ll give up your health. NB: a reasonable course of CBT is around 20 sessions – a typical course of analysis is around 300 sessions.
“downplaying the influence of the external world on our wellbeing is unwise. Psychological studies are in agreement: the quality and quantity of our relationships strongly predict our wellbeing.”
External factors and relationships should not be downplayed in CBT – they are seen of huge importance – the issues in CBT often are – ‘how are your psychological problems interfering with your relationships (and vice versa) because we are social beings and good relationships are the single most important aspect of wellbeing; and how do your inner processes (thought, emotion, personality, behaviours, coping strategies) interact with externals (work pressure, ill matched jobs, friends etc, dysfunctional family).
I was trained by Ellis in REBT. He opened the session by pointing out “I don’t really know what makes people happy. But I know what makes them miserable.” Our training focused on helping people stop being miserable or self defeating. That was it. REBT was never about making people happy. Nor, IMHO, was Beckian CBT—of which I know somewhat less.
I think a good analogy is to think in terms of someone coming to a doctor with a broken bone. The doctor can set the bone; and then the person can decide how much/what kind of strength they wish to develop in the healed limb.
I was trained by Ellis in REBT. He opened the session by pointing out “I don’t really know what makes people happy. But I know what makes them miserable.” Our training focused on helping people stop being miserable or self defeating. That was it. REBT was never about making people happy. Nor, IMHO, was Beckian CBT—of which I know somewhat less.
I think a good analogy is to think in terms of someone coming to a doctor with a broken bone. The doctor can set the bone; and then the person can decide how much/what kind of strength they wish to develop in the healed limb.
I find this essay puzzling. I have been involved in training people in the practice of psychotherapy for more than 30 years, I have been practicing psychotherapy for more than 30 years, I have following the scientific literature on psychotherapy since the early 1980’s, and I have conducted and published research in psychotherapy. In all that time, I have not encountered the polarized caricature of psychotherapy described in this article. Of the many, many full-time practitioners of psychotherapy that I know – colleagues who are sufficiently successful to pay for their cars, houses, and children’s education with money voluntarily given to them by their patients – very few strongly identify with any specific ‘school’ or ‘theory’ of psychotherapy. Most people who are good enough at this activity to make a living at it have found that all of these theories are very limited, each contains some insights and techniques that are useful, and the successful practice of psychotherapy requires melding the limited good in each of these perspectives with one’s experiences and hard-won knowledge of human psychology. The only people I know who are fully committed to any single school or approach to psychotherapy are people who teach about therapy rather than practicing it, and people who are just out of training and very limited in their skills and experience, who must cling to something to move forward in their careers.
I would also point out that I know no mature and experienced psychotherapists who subscribe to the notion that psychotherapy can provide happiness – or that it purports to do so. At its best, it helps people to better understand the choices they have made, the choices that lie before them, and the real costs, benefits, uncertainties, and compromises that their choices will entail. It helps them to better understand who they are, what they want, and why they have done the things they have done. Once having helped the patient to gain this information and perspective, the psychotherapist gets out of the way and lets the patient make the choices that they must live with. Interactions that are not ultimately directed towards this end are not psychotherapy. This is often misunderstood by those who write about psychotherapy and often leads to the kind of misleading essays that this author has produced.
The article is a typical example of our western desire to have linear explanations and reasoning in medicine ignoring that we are complex systems mostly driven by non-linearity. It has caused us to adhere to a type of medicine (and mental care) that is very limiting. Some people due to their instincts, their broad views and acceptance that nothing is every sure, can do well in medicine and care.
The article is a typical example of our western desire to have linear explanations and reasoning in medicine ignoring that we are complex systems mostly driven by non-linearity. It has caused us to adhere to a type of medicine (and mental care) that is very limiting. Some people due to their instincts, their broad views and acceptance that nothing is every sure, can do well in medicine and care.
I find this essay puzzling. I have been involved in training people in the practice of psychotherapy for more than 30 years, I have been practicing psychotherapy for more than 30 years, I have following the scientific literature on psychotherapy since the early 1980’s, and I have conducted and published research in psychotherapy. In all that time, I have not encountered the polarized caricature of psychotherapy described in this article. Of the many, many full-time practitioners of psychotherapy that I know – colleagues who are sufficiently successful to pay for their cars, houses, and children’s education with money voluntarily given to them by their patients – very few strongly identify with any specific ‘school’ or ‘theory’ of psychotherapy. Most people who are good enough at this activity to make a living at it have found that all of these theories are very limited, each contains some insights and techniques that are useful, and the successful practice of psychotherapy requires melding the limited good in each of these perspectives with one’s experiences and hard-won knowledge of human psychology. The only people I know who are fully committed to any single school or approach to psychotherapy are people who teach about therapy rather than practicing it, and people who are just out of training and very limited in their skills and experience, who must cling to something to move forward in their careers.
I would also point out that I know no mature and experienced psychotherapists who subscribe to the notion that psychotherapy can provide happiness – or that it purports to do so. At its best, it helps people to better understand the choices they have made, the choices that lie before them, and the real costs, benefits, uncertainties, and compromises that their choices will entail. It helps them to better understand who they are, what they want, and why they have done the things they have done. Once having helped the patient to gain this information and perspective, the psychotherapist gets out of the way and lets the patient make the choices that they must live with. Interactions that are not ultimately directed towards this end are not psychotherapy. This is often misunderstood by those who write about psychotherapy and often leads to the kind of misleading essays that this author has produced.
It seems to me that it’s not nearly as difficult as we think to understand what is going on. Let’s start with the very simple but obvious proposition that human beings have essential needs in order to be healthy. Not just physical needs for food and shelter but emotional needs also – for meaningful relationships, being safe and secure and for meaning, which at its very least means making a contribution to society that is appreciated. And if we are not getting our needs met then will be unhappy and suffering mental distress.
And yes of course, the society in which we live has a major impact on our capacity to get our needs met well. Excessive materialism, unfulfilled work, a breaking down of family and community and the isolation of the new technologies will all feed mental illness, against which talking therapies, including CBT and top-down government efforts, will be pretty well useless.
But good therapy can make a difference – not by talking all the time about what is wrong but shifting patterns, unconscious instincts, and reframing how we see things. And critically by directing effort and attention to changing how we live to get our needs better met.
I have briefly summarised the approach of the human givens. By cutting through the tangling groupthink and vested interests of the blatantly unsuccessful mental health industry, it might be that we can all become a little help happier.
It seems to me that it’s not nearly as difficult as we think to understand what is going on. Let’s start with the very simple but obvious proposition that human beings have essential needs in order to be healthy. Not just physical needs for food and shelter but emotional needs also – for meaningful relationships, being safe and secure and for meaning, which at its very least means making a contribution to society that is appreciated. And if we are not getting our needs met then will be unhappy and suffering mental distress.
And yes of course, the society in which we live has a major impact on our capacity to get our needs met well. Excessive materialism, unfulfilled work, a breaking down of family and community and the isolation of the new technologies will all feed mental illness, against which talking therapies, including CBT and top-down government efforts, will be pretty well useless.
But good therapy can make a difference – not by talking all the time about what is wrong but shifting patterns, unconscious instincts, and reframing how we see things. And critically by directing effort and attention to changing how we live to get our needs better met.
I have briefly summarised the approach of the human givens. By cutting through the tangling groupthink and vested interests of the blatantly unsuccessful mental health industry, it might be that we can all become a little help happier.
This is a rather cynical view of therapy from someone who is training to be a therapist. As a clinical psychologist I have worked with many people whose lives and relationships have been badly affected by psychological difficulties such as Obsessive Compulsive Disorder and Post-Traumatic Stress Disorder, as well as by chronic physical illnesses such as HIV and cancer. Many would have struggled to cope by just talking to a friend about their problems. In fact, some find it easier to talk to a relative stranger, especially if they see their illness as stigmatising. Others don’t wish to ‘burden’ their family or believe they can talk more openly with a therapist about fears that may alarm or worry those close to them. This article belittles the benefit such people have experienced from therapy, including CBT. Perhaps Nina is one of the newer cohort of ‘therapists’ who prefer social justice activism to therapeutic work and wish to change society rather than the individual? My advice would be to reserve her judgement about whether therapy works or not until she has completed her training and got some experience ‘under her belt’.
This is a rather cynical view of therapy from someone who is training to be a therapist. As a clinical psychologist I have worked with many people whose lives and relationships have been badly affected by psychological difficulties such as Obsessive Compulsive Disorder and Post-Traumatic Stress Disorder, as well as by chronic physical illnesses such as HIV and cancer. Many would have struggled to cope by just talking to a friend about their problems. In fact, some find it easier to talk to a relative stranger, especially if they see their illness as stigmatising. Others don’t wish to ‘burden’ their family or believe they can talk more openly with a therapist about fears that may alarm or worry those close to them. This article belittles the benefit such people have experienced from therapy, including CBT. Perhaps Nina is one of the newer cohort of ‘therapists’ who prefer social justice activism to therapeutic work and wish to change society rather than the individual? My advice would be to reserve her judgement about whether therapy works or not until she has completed her training and got some experience ‘under her belt’.
I’ve been a CBT therapist in the NHS and elsewhere for about a decade. I know practice a more robust (in terms of relapse) form of the therapy known as Acceptance and Commitment Therapy. I’m also a researcher in psychology and public health.
The author does not give a fair summary of the current evidence, which is surprising as thorough meta-analysis are available. Traditional ‘second wave’ CBT does tend to be susceptible to problems of longevity when it comes to treatment effect, but it’s also broadly effective for common mental health conditions.
The fact that on a population level people are less happy than they have ever been is a problem on a grander scale the effectiveness of talk therapy. I can treat someone’s social anxiety or depression, but if that person lacks meaning in the wider context of their life, then this is not a disorder to be treated, this is a problem which belongs to the realms of philosophy and theology. Not that these two worlds don’t overlap, they do, and I often find myself thinking that my patient could do with seeing a good priest more than anything else, but that’s not my job. My job is to treat the malady I’m presented with, and CBT and it’s third wave derivatives are the best tools we have to do just that.
I’ve been a CBT therapist in the NHS and elsewhere for about a decade. I know practice a more robust (in terms of relapse) form of the therapy known as Acceptance and Commitment Therapy. I’m also a researcher in psychology and public health.
The author does not give a fair summary of the current evidence, which is surprising as thorough meta-analysis are available. Traditional ‘second wave’ CBT does tend to be susceptible to problems of longevity when it comes to treatment effect, but it’s also broadly effective for common mental health conditions.
The fact that on a population level people are less happy than they have ever been is a problem on a grander scale the effectiveness of talk therapy. I can treat someone’s social anxiety or depression, but if that person lacks meaning in the wider context of their life, then this is not a disorder to be treated, this is a problem which belongs to the realms of philosophy and theology. Not that these two worlds don’t overlap, they do, and I often find myself thinking that my patient could do with seeing a good priest more than anything else, but that’s not my job. My job is to treat the malady I’m presented with, and CBT and it’s third wave derivatives are the best tools we have to do just that.
We have outsourced listening to each other to the NHS and the private sector, not a great accolade for current society. CBT is popular with mass produced medicine because its simple to understand and apply, and that’s it’s problem. Cohorts of people trained to see the human psyche as like a wiring diagram [this cause leads to this effect] which at its worst, produces unimaginative therapists who lack the curiosity or humility to listen to people in distress, and simply refer them to the wiring diagram. works best for anxiety based problems because this area is quite mechanistic in itself. By and large, there isn’t a great difference in the effectiveness of the different schools of thought, so be eclectic. Who cares if it doesn’t work in theory, so long as it does in practice.
We have outsourced listening to each other to the NHS and the private sector, not a great accolade for current society. CBT is popular with mass produced medicine because its simple to understand and apply, and that’s it’s problem. Cohorts of people trained to see the human psyche as like a wiring diagram [this cause leads to this effect] which at its worst, produces unimaginative therapists who lack the curiosity or humility to listen to people in distress, and simply refer them to the wiring diagram. works best for anxiety based problems because this area is quite mechanistic in itself. By and large, there isn’t a great difference in the effectiveness of the different schools of thought, so be eclectic. Who cares if it doesn’t work in theory, so long as it does in practice.
I like the article but the writer definitely falls into a trap when everything becomes about happiness. When you set a benchmark of how happy you think you should be, everything is framed in relation to that benchmark, most likely not reaching it. Life is every shade of everything and what I’ve learned (my own way) is that this is pretty flipping awesome.
I like the article but the writer definitely falls into a trap when everything becomes about happiness. When you set a benchmark of how happy you think you should be, everything is framed in relation to that benchmark, most likely not reaching it. Life is every shade of everything and what I’ve learned (my own way) is that this is pretty flipping awesome.
There’s listening, and there’s listening. Some of the therapist responses in a CBT manual seem totally wooden, more suitable to an AI than a human helper. It takes some craft, and active listening, to discern which of someone’s “nonrational” thoughts hides the substance of their difficulty. And people can tell when they are being listened to.
I think CBT is on the right track. But when you manualize things, how do you keep the practitioner interested?
Crikey! What ever happened to “pull yourself together “?
Actually that is an axiom of CBT – though it’s usually expressed more diplomatically!
Evidently you lack the capacity for empathy or understanding if you are going to trot out that platitude without a single consideration as to whom you are speaking or what circumstances they are experiencing. It is extremely unhelpful (and at times downright abusive) to trivialise an individual’s mental health problems. Restricting, repressing or making a taboo of discussing people’s feelings or issues is the entire reason that people are being forced to rely more and more on outsourced empathy from counsellors or psychoanalysts. Perhaps, if people like yourself contemplated the situation someone else is experiencing and offered a space where someone could discuss their feelings and freely communicate, you might be able to provide much needed support and validation for another in need, rather than treat genuine needs as nothing but inconvenient whinging. Your carelessness can actually cause someone to feel very much like their issues aren’t entitled to be addressed as they are simply a problem or a burden for others. These thoughts can be extremely damaging and often don’t simply disappear. Please try to consider this before using the words “pull yourself together” in future.
May I congratulate you on such a vanity/virtue signalling post?
Truly extraordinary!
May I congratulate you on such a vanity/virtue signalling post?
Truly extraordinary!
Actually that is an axiom of CBT – though it’s usually expressed more diplomatically!
Evidently you lack the capacity for empathy or understanding if you are going to trot out that platitude without a single consideration as to whom you are speaking or what circumstances they are experiencing. It is extremely unhelpful (and at times downright abusive) to trivialise an individual’s mental health problems. Restricting, repressing or making a taboo of discussing people’s feelings or issues is the entire reason that people are being forced to rely more and more on outsourced empathy from counsellors or psychoanalysts. Perhaps, if people like yourself contemplated the situation someone else is experiencing and offered a space where someone could discuss their feelings and freely communicate, you might be able to provide much needed support and validation for another in need, rather than treat genuine needs as nothing but inconvenient whinging. Your carelessness can actually cause someone to feel very much like their issues aren’t entitled to be addressed as they are simply a problem or a burden for others. These thoughts can be extremely damaging and often don’t simply disappear. Please try to consider this before using the words “pull yourself together” in future.
Crikey! What ever happened to “pull yourself together “?
There is no such thing as “mental illness”.
A good walk / cycle and making a “to do” list sorts out most personal issues. On no account go blabbing to anyone – you’re an adult – sort it out yourself.
When I was younger, my GP frequently prescribed a brisk walk around the river. Saying that, I do think at times it is beneficial to discuss things with someone who is not involved in a particular situation to obtain objective advice.
When I was younger, my GP frequently prescribed a brisk walk around the river. Saying that, I do think at times it is beneficial to discuss things with someone who is not involved in a particular situation to obtain objective advice.
There is no such thing as “mental illness”.
A good walk / cycle and making a “to do” list sorts out most personal issues. On no account go blabbing to anyone – you’re an adult – sort it out yourself.