What People Are Doing Wrong This Week: How Therapy Works

We are treating it wrong.

The turmoil of the past three years — the pandemic, lockdowns, economic uncertainty, political turmoil, and this is just a snapshot — has affected our collective psyche. Between 2019 and 2021, the number of people receiving treatment for mental health conditions in the US increased across all demographics nationwide, according to the CDC. And that’s not all who can benefit from it – according to some studies , about 45% of people with clinical mental health problems do not seek professional help.

There are many reasons why people reject the idea of ​​therapy, from seeing it as a sign of weakness, to believing that their problems are not serious enough to warrant professional help, to the lack of affordable mental health care. But the reluctance to try talking therapy may also be due to a basic lack of understanding of how therapy is practiced these days.

What People Get Wrong About Talk Therapy

Many people don’t seem to understand how therapy works. When they think about it, they imagine a long, expensive relationship with an eccentric doctor in which childhood memories and traumas are dug up week after week with little tangible result. But the way talk therapy is commonly practiced in 2023 bears little resemblance to the past cliché of “lay on the couch and tell me about your mother.”

About 70% of therapists in the US now practice evidence-based “cognitive behavioral therapy” (CBT), a short-term process that has less to do with complex theories of integrating the past with the present than with production. tangible results.

Where does talking therapy come from?

Discussing your problems with a knowledgeable guide goes back at least to the philosophical dialogues of the ancient Greeks, but its modern incarnation is largely the product of Sigmund Freud. Freud’s influence was so pervasive that a bespectacled man with a faintly European accent and a cigar is still a symbol of this process, although Freud died in 1939.

Freudian psychoanalysis, in a very broad sense, believes that bringing the contents of the unconscious into conscious awareness can lead to the alleviation of psychological stress. It usually takes a long time – even decades – and has no clear definition of success, so it’s hard to know if it “works” or not, except on an anecdotal level.

As psychotherapy has developed, countless other theories and approaches have emerged from Freud’s ideas, which can be divided into two broad categories. Cognitive approaches may ignore or downplay strictly Freudian concepts such as the id and superego, but the basic concepts are similar to psychoanalysis: our behavior is rooted in our thoughts and feelings, so if we understand and master them, we can change our behavior and change it. . find relief from our psychological problems.

Behaviorism, on the other hand, generally holds that human behavior is only conditioned by environmental conditions. The unconscious and even the mind itself are not valuable concepts because they cannot be observed or studied. In other words, change what you are doing; don’t worry about what you feel or what you think.

Squaring the Circle: Cognitive Behavioral Therapy

These two seemingly disparate approaches came together in the mid-1960s in the form of cognitive behavioral therapy, which believes that psychological problems are partly based on unhelpful ways of thinking and partly based on unhelpful behavior patterns. These ideas do not contradict each other, since each of these drivers influences the other.

The role of the therapist in CBT

In many older forms of therapy, finding the right therapist can be important, as the patient-physician relationship is an important part of the process. With CBT, on the other hand, this is not so important. Instead of a confidant or confessor, the CBT therapist acts more like an organizer or coach, working with the patient to set specific personal goals and develop a strategy to achieve them. It’s more about problem solving than personal growth, with a focus on achievable, concrete steps rather than abstract ideas like satisfaction or happiness. Presumably, they come from healthy actions.

CBT focuses on present problems, not past traumas

CBT tends not to be as past-focused as many other forms of therapy, so it often doesn’t include in-depth exploration of childhood (although it can help people overcome past experiences that influence their behavior in the present). For example, if you’re having trouble working on time, a more cognitive form of therapy might suggest that you explore how your parents’ style of discipline relates to how you currently feel about deadlines. CBT, on the other hand, may suggest that you use mental strategies to get out of the house early in the morning or buy a new alarm clock.

However, CBT is not just about behaviorism. It also focuses on recognizing thought distortions that may influence patients’ actions or cause distress. For example, if you wake up every morning thinking, “I can never get to work on time,” CBT can help you see the error in that way of thinking and give you strategies to change it—perhaps by trying to think instead: Of course, I can come to work on time.” (This often sounds silly because it’s so simple.)

CBT doesn’t last forever

While many forms of talking therapy are open-ended and can last for years or even decades, cognitive behavioral therapy tends to be short-term. The course of treatment usually takes six to 20 sessions, usually lasting about an hour. Ideally, by the end of this time, patients can act as their own therapists and use the tools they have learned to better navigate the world. So you won’t be the only friend who’s been in therapy for 18 years and still can’t keep a job.

Is Cognitive Behavioral Therapy Effective?

No single therapy is right for every person or every type of mental illness. There are many approaches to talking therapy. For some, psychodynamic therapy , a longer process based on the study of past experiences, may be suitable. Or you can consider eye movement desensitization and reprocessing therapy , which has been shown to be more effective in treating post-traumatic stress disorder. You can take a spiritual approach . Or think about psychedelic therapy . Perhaps the right decision is a strictly pharmaceutical one : many people benefit by ingesting a little Wellbutrin each morning and going about their business, or by combining medication with talking therapy. You may even be able to find a strict Freudian psychoanalyst if you want to go back in time.

But CBT is a good place to start. It has become the most widely practiced form of therapy, especially for the treatment of depression and anxiety, largely because there is strong evidence for its effectiveness. Other forms of talking therapy may work, but it’s often impossible to tell because they don’t include an objective way to measure success, while cognitive behavioral therapy has been tested against an evidence base for decades. In fact , it has been studied more extensively than any other form of talk therapy and has almost always been found to be more effective than its competitors.

An evidence-based approach also means that the therapy can be refined and have a clear standard for measuring it – approaches like ACT (Acceptance and Commitment Therapy) use many CBT methods but focus on mindfulness and emotional acceptance, while maintaining the action-oriented approach of CBT.

While no form of therapy is a one-size-fits-all, if you’ve never tried talking therapy or have had bad experiences with another form of therapy in the past, cognitive behavioral therapy may provide the answers you’re looking for, or at least give you some strategies for finding them. And you don’t have to tell anyone about your mother if you don’t want to.