Sunday, January 17, 2016

The Evolution of Psychotherapy

     I've been researching CBT a lot recently. I'm seeing more and more that it is a good hook into a client. For many clients, running into insight-based therapy is a bit too much too early. CBT, in this case, can be good. I'm reading Judith Beck's seminal work on CBT, which I am finding to be very accessible and am learning quite a lot. I like how she talks about the core beliefs, especially.
     Anyway, I had a thought relatively recently that confuses me a bit. We see knowledge, to some degree, as a river. The beginning of this river yields less complete ideas. Over time, these ideas become more refined, more "correct." We learn to take the critique on original knowledge as new knowledge. This new knowledge is then critiqued and seen as innovation and the "better way to go about it." I have left the river metaphor behind, but I think that I have illustrated my thought satisfactorily. Taking this idea to my field's end, one could say that the culmination, at this point in time, of the field's knowledge is indeed cognitive behavior therapy. Would it not, then, make sense to study this practice and use it?
     The answer, as usual, is neither yes or no. It is a mixture. Obviously, using some CBT is quite advantageous. As mentioned over and over in this text, it quite depends on the client (as well as the clinician). It is relatively easy to learn and is easily used.
     There are obvious nos to the debate as well - many of which I have already elaborated upon and feel no need to repeat. I do think that the previous thought of evoluation of psychotherapy as one river is perhapse incorrect - or ther emight be a different visualization needed. I like to use the word evolution because I do think that it is a good way to describe it. Just like in evolution, there are offshoots to a central line (and then more offshoots . . . and then more). Allow me to illustrate:

The River Concept

Psychoanalysis -> Behaviorism -> Humanistic/Existential -> CBT

The Evolution Concept*
                                                          REBT ->
                               Behaviorism ->
                                                          CBT -> DBT ->
Psychoanalysis ->                            Existential ->
                               Humanistic ->
                                                         Gestalt ->

     I'm not quite of the mind to go into a whole account of the evolution of the field. I will say, though, that even the evolution concept, as seen by Darwin, might not be 100% accurate. The main addition (and change) that must be made here is that each theory not only creates off shoots, it also comes back into the center an affects the whole (or core) of aggregate theory. I think that this core could be described as common factors in that it is very basic and relatively agreed upon that most clinicians should practice in this way, at least minimally.
     With this in mind, as well as my previous point of every theory in turn re-affecting the core approach to therapy, one might come to the conclusion that there are still more therapies to be imagined. CBT takes an odd place in the model (it is definitely an offshoot theory, in my opinion) as it comes not mainly from the core theory, but more from a behavioristic approach.

*We must understand (because it is illustrated so horribly here) that there are arrows pointing off from each theory (e.g. behaviorism, CBT, existential, etc.) to show that there is further change to be done within each area.

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