Thursday, February 16, 2006

It's all about the now.

The NYT has an interesting article on contemporary psychotherapy approaches, and specifically the rise of cognitive behavioral therapy (CBT) over the more traditional psychoanalysis. One of the major differences between the two is their attitude towards the importance of understanding one's past in order to change one's present. In psychoanalysis, this is of paramount importance: you better delve deep into that relationship with your mother if you're gonna fix your neuroses. For CBT practitioners, it's far less important to create a coherent narrative about your past than it is to find techniques to change your present behaviors:

[CBT] was introduced in the late 1960's by Dr. Aaron T. Beck. The underlying theory says it is not important for patients to return to the origins of their problems, but instead to correct their current "cognitive distortions," errors in perception that lead them to the conclusion that life is hopeless or that everyday activity is unmanageable.

For example, when confronted with severely depressed patients, cognitive behavioral therapists will not ask about childhoods, but will work with them to identify the corrosive underlying assumptions that frame their psychic reality and lead them to feel bad about themselves. Then, systematically, patients learn to retrain their thinking.

Two reasons CBT has become so popular are 1) its practitioners have done the clinical trials to support its effectiveness, and 2) insurance companies like it because it typically takes 1/2 the time that psychoanalysis does to treat the same complaint. Anything that helps insurers cover mental health care is OK by me, but I'm not sure that I'm convinced that understanding the past is totally irrelevant to changing the present. (I mean, I'm a historian, for chrissakes.) I can certainly see how obsessive delving into past traumas could be disruptive to the healing process, but I also think that in certain circumstances it could be quite important to reassess one's relationship to one's past and try to gain a better understanding of the underlying causes of one's disturbance. You know, a little from column A and a little from column B. Or am I just hopelessly old-fashioned?