Psychoanalysis occupies an important place in the modern intellectual landscape, but in the practice of psychotherapists it has begun to be supplanted by cognitive-behavioral psychotherapy (CBT), which claims to be empirically based. However, now psychoanalysis seems to be taking revenge. Oliver Burkeman, a columnist for The Guardian, delved into the comparison of the two approaches. Here are a few abstracts of his long article.
1. After Freud, a huge number of types of psychotherapy appeared, therapists were looking for an empirical justification for their practice. It is more or less generally accepted which of these approaches (which included humanistic therapy, interpersonal therapy, transpersonal therapy, transactional analysis) ultimately won out. Cognitive Behavioral Therapy (CBT) is a practical, down to earth approach. This technique is aimed at the present, not the past, it is not interested in secret unconscious desires, but aims to identify and correct thought patterns that interfere with us, which cause negative emotions. Unlike psychoanalysis with its convoluted conversations, a typical CBT exercise might be, for example, to chart the «automatic thoughts» that we have when we fail, such as when we are criticized at work or rejected after a date.
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2. CBT has always had its critics — not least because it is cheap and aimed at getting a person back to productive work as quickly as possible., which makes it surprisingly attractive to policy makers concerned about cutting spending. But even those who criticized this type of therapy on ideological grounds usually did not deny its effectiveness. Since the advent of CBT in the 60s and 70s, there has been so much research proving its effectiveness that the phrase “empirically based form of psychotherapy” has essentially become synonymous with CBT: it is based on facts. If you ask for a referral to psychotherapy in the British National Health System, most likely you will not be referred to a psychoanalyst at all, but to a short course of formal CBT sessions.
3. Nevertheless, the voices of the representatives of the defeated «old guard» in the person of psychoanalysts never ceased. They do not agree with this interpretation of human nature, they have their own answers to questions about why we suffer and how we can finally find peace (and whether this is even possible). In CBT, unpleasant emotions are considered something undesirable, they must be got rid of or at least learned to tolerate them. Conditions like depression are viewed as something like a cancerous tumor — of course, its origin is also of interest, but the main task is to get rid of it. Cognitive-behavioral therapists do not directly state that happiness is easy to achieve, but it is implied that it is relatively simple: all negative experiences are caused by our irrational beliefs, and it is in our power to control and change them.
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4. Psychoanalysts say that everything is much more complicated. In particular, mental pain must first be understood, and not tried to be destroyed. From this point of view, depression is more like not a tumor, but a cutting pain in the abdomen — it means something, and you need to figure out what it is (no responsible therapist will limit himself to prescribing painkillers and sending you home). And happiness — if it’s achievable at all — is an even more confusing topic. Much in our own psyche is hidden from us, and often we have a powerful motivation to remain in the dark. We view the world through a lens shaped by our earliest childhood relationships with others, although we usually don’t realize it. Our desires are contradictory, and any changes are hard and come slowly. Our consciousness is just the tip of the iceberg on the vast dark ocean of the unconscious, and this ocean cannot be truly explored with simple, standardized, science-based methods of CBT.
5. Proponents of CBT talk about this method in a down to earth and practical manner. Because of this, it is easy to forget how revolutionary the ideas of CBT were in their time. In traditional psychoanalysis (and in newer “psychodynamic” methods, most of which are based on it), the hidden (partly rational) nature of seemingly irrational symptoms is exposed in the course of therapy, such as, for example, the endless repetition of obviously ineffective behavior patterns in love or professional life. These reactions are logical when viewed in the context of the patient’s earliest experience (if one of your parents abandoned you many years ago, it is not surprising that you will constantly fear that your spouse will leave you. This fear can provoke you on such behavior that will eventually begin to destroy the marriage). CBT turns everything upside down. Emotions that seem perfectly rational, such as depression due to a catastrophe in life, are called products of irrational thinking.
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6. If this second approach is relevant, it is obviously much easier to change something — it is enough just to identify and correct errors in thinking, instead of revealing the hidden causes of your suffering. Symptoms like sadness and anxiety are not necessarily important signs of deeply buried fears, they are simply invading enemies that need to be driven out. In psychoanalysis, the relationship between therapist and client forms a kind of laboratory petri dish in which the patient re-experiences his usual ways of interacting with other people in order to better understand them. In CBT, you are simply trying to get rid of the problem.
7. The conclusions of various experimenters about which therapy brings the best results can vary dramatically. But what actually counts as success? Research measures the extent to which symptoms are reduced, but the essential point of psychoanalysis is that a fulfilling life is not just the absence of symptoms. In principle, after a course of psychoanalysis, your sadness may even increase, but if at the same time you become wiser, more aware of your unconscious reactions and your life becomes more complete, it is possible that you will consider such a result successful. Freud is well known for saying that the goal of psychoanalysis is the transformation of «neurotic suffering into ordinary dissatisfaction with life.» «Humanity needs difficulties — they are necessary for health,» said Carl Jung. There is always pain in life. Is it really necessary to set the goal of completely getting rid of painful emotions?
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8. There is something deeply appealing about the idea that psychotherapy does not need a scientific approach. – we have too many individual differences for the kind of generalizations that are required in science. This attitude may explain the success of The Art of Living by Stephen Gross. It came out in 2013 and is a collection of stories from a psychoanalyst’s office. You will not find the results of experiments and clinical diagnoses in it, instead, in the stories told, there is often a moment of sudden insight — the patient suddenly realizes what depths lie hidden in the depths of his own psyche. For example, a man was a pathological liar, secretly hoping to achieve special intimacy with those he could persuade to participate in his lies, similar to how his mother hid traces of his bed-wetting as a child. Or a woman finally realized how much effort she put into denying all evidence of her husband’s infidelity when she saw how carefully someone put the dishes in the dishwasher. “Every life is unique, and my role as an analyst is to find the unique story of a patient,” Steven Gross told me. “There are a lot of things that come out through random slips of the tongue when someone talks about a secret fantasy or uses a certain word.” The analyst’s job is to take in all this information carefully and then use it to «help people make sense of their lives.»
See more at The Guardian.