Thursday, April 11, 2013

Cognitive Behavioral Therapy (CBT) : Why Don't More Shrinks Do It?

First, I'd ask you to read Harriet Brown's article in the New York Times Well Section in "Looking for Evidence That Therapy Works." 

Ms. Brown talks about how there is little evidence-based data to support most psychotherapies, that psychotherapists tend to be wishy-washy about their approach and are vague with their ability to describe what they do, using the catch-all term "eclectic."  Furthermore, therapists over-estimate their success rates, and while there are proven psychotherapies such as cognitive behavioral psychotherapy (CBT), she notes that surprisingly few therapists use this treatment.  She suggests asking prospective therapists a variety of questions including "What manuals do you use."  

So I think this is a fair question.  If CBT works, why don't shrinks employ the techniques more?  I looked at the 365 comments on the article (anything for a blog post).  Most of them were theoretical discussions about therapy.  Many were from therapists.  There were a fair number of comments citing how screwed up therapists are.  There were 3 comments from patients saying CBT helped them.  There was 1 comment from someone saying a CBT book cured them without the therapist, after other psychotherapy had failed.  There were 3 patients who said CBT was helpful in combination with other therapies --so that awful eclectic approach. A number of people wrote in to say CBT harmed them -- unfortunately I read those comments before I got the idea to keep count, but I want to say there were ?3-4 people saying it injured them.  One person was finally helped by a form of energy therapy.

So let me ask you, especially those who have been in therapy:
 Does CBT work?  If you're a therapist, do you use it? Why or why not?  And since Ms. Brown's article questions so-called eclectic treatments, can I ask you to limit your comments to the manualized version of CBT which includes doing homework and is structured and specifically called CBT.