Article

Favouring the Freudians: A Critique of Cognitive Behavioural Therapy (CBT)

featuredHomenonfictionstaffwriters

Content warnings: heavy discussion of mental illness

 

“If he isn’t seeing a therapist, that’s a red flag.”

 

These are the sorts of statements written online and echoed in-person by many operating under the empty auspices of hot-topic progressivism. Sure, the services provided by mental health workers are imperative for developing the tools to deal with ongoing mental illness or one-off tragic events, but what is one to do when they find themselves at therapy, but don’t feel therapised, per se?

 

Exemplifying this dilemma are freely available, short-term psychological services such as CAPS here at Melbourne University, however I have heard the same qualms repeated by customers of private clinics. 

 

Currently, the predominant psychological treatment is cognitive behavioural therapy (CBT), which aims to rewire negative thought-patterns (‘cognitive distortions’) and behaviours in order to improve a patient’s quality of life. For example, if one tends to catastrophise when a family member is late from work, it is encouraged that they practise grounding techniques and remind themselves that there are a million likely reasons they aren’t home other than a fatal 20 car collision on the freeway. This is to form the well-adjusted ego. The ego is the conscious part of ourselves which mediates impulses and inhibitions, and a well-adjusted one would be able to withstand the toils of everyday life by looking at what can be done about the present instead of focusing on the past. Negative thoughts and attitudes are identified through talking with a practitioner, making CBT a form of talk therapy. 

 

Aaron Beck, who is credited as developing CBT, took this methodology directly from his psychoanalytic teachings, where therapy investigates the various conscious and unconscious elements of the mind and brings them to light. Originally, this was done through dream interpretation and free association, which aim to overcome the various layers of self-censorship and mediation with the outside world that the mind experiences. To Beck, these methods were not scientifically rigorous enough, and there was a lack of empirical evidence supporting Freud’s theories of depression, which in a 1959 paper, Beck described as masochism or aggression turned inwards, rather than experiencing a lack of desires as outlined in his seminal text on depression, Mourning and Melancholia. Although he correctly observed the depressive’s tendency toward this thinking, he then concluded that their condition was caused by these internalised beliefs and not the other way around, meaning treatment would centre around preventing these automatic thought patterns. 

 

Though originally a staunch psychoanalyst himself, Beck saw the toxicity of his university medical board’s internal politics, which attempted to safeguard key positions from non-Freudian (especially behaviourist) faculty members. Throughout his career, he struggled to balance his support of innovation and experimental science against a primarily theory-driven practice. Until his death in 2021, Beck saw CBT not as an attack on psychoanalysis, but a form of neo-Freudianism which privileged experimental reasoning over dogma. He modified and utilised Freud’s own process of dream interpretation to refute his theories on depression. These dream experiments were operationalised in such a way as to reduce participant retellings into discrete data points, which, devoid of individual context, would inform the researcher about the exact purpose and context to words used. In this, we see how the ideals underpinning the development of this new school of psychological treatment are simply not present throughout its experimental phases, and its insurgence largely due to office politics rather than pure therapeutic merit. 

 

In contrast to its ‘outdated’ predecessor but still mirroring its experimental origins, CBT offered a more streamlined, less extensive solution to those who do not want their childhoods and innermost workings prodded by a stranger in a clinical setting without the promise of results. Besides, does it matter whether your agoraphobia stemmed from your mother’s relentless criticism, or years of accumulated social blunders weighing upon your shoulders when you cannot bring yourself to leave the house either way? You can pick up a CBT workbook very easily and learn helpful skills, with the express aim of bringing one back to a baseline level of functioning which stresses work or school life contribution whereas psychoanalysis is often advertised as requiring several sessions a week long-term for optimal effect.

 

In saying this, CBT is only a framework for managing stress. It cannot restructure our economy and solve the rental crisis, nor can it attend to any root causes of triggers, such as deep-seated trauma. How is it possible for a simple guide to attend to the unique aspects of each case? The ways in which our world places certain, understandably stressful and occasionally unrealistic standards upon us is barely acknowledged and instead it is our job to conform. 

 

Despite this, mental health providers through step-by-step programs like CBT are granted a disciplinary, curative power over the psyche. Exercised optimally, this is reflected in actions which are self-disciplinary in nature even if punishment is not explicitly the aim. In those who inherently fail to see sub-optimal patterns of thinking as anything other than evil, guilt and shame become a part of the maladaptive mechanism—though CBT aims to be innovative, it is reminiscent of 16th century practices to prevent sinful acts. The problematic thoughts are masturbatory and the cure involves amputating the genitals, hypothalamus, and hands though often small remnants are left behind. Imagine if you complained of a stomach ache to your general practitioner for years, and every time they would send you back home with increasing doses of painkillers, or they recommended a crash diet in order to reach a healthy weight. Rather than accept the inevitable violence within our social order which seeps into our very biology, informing us of the ideal image of personhood which often manifests in harmful ways, the inability to reason one’s way out of an entirely emotional reaction to a trigger is a personal failure. As long as you return to work, CBT is considered successful. 

 

While many benefit from the skills taught in order to de-escalate immediate crises, not understanding the root of these responses is a stressor in itself. Conflict within the constituent parts of the self is inevitable, and it appears more useful to form a new relationship with the body which does not involve the destruction of its components simply because it cannot see itself. This is where we see a fundamental disagreement over human nature and the reason or purpose for suffering. 

 

Although cognitive behavioural therapy has proved itself effective from testimonial to testimonial, it is worth reconsidering the hegemonic status we have granted it within our institutions, and worth researching avenues now considered archaic. 

 

 
Farrago's magazine cover - Edition Two 2023

EDITION SIX 'PHANTASMAGORIA' AVAILABLE NOW!

The harpsichords sound like skeletons. The wings of butterflies open and close like lungs. The trees are murdered for pianos. The dust in the abandoned antique store glows gently, as if made from the powdered skulls of fairies and changelings. Welcome to the weird and wonky world of Edition Six, Phantasmagoria. We bid you to tread carefully...

Read online