Tools… not Schools of Therapy
Fabrice asks David about the title of his TEAM-CBT eBook for therapists—Tools, Not Schools, of Therapy. David explains that the field of psychotherapy is dominated by numerous schools of therapy that compete like religions, or even cults, each claiming to have the answer to emotional suffering. So you’ve got the psychodynamic school, and the psychoanalytic school, the Adlerian school, the Beckian cognitive therapy school, the Jungian school, and tons more, including EMDR, behavior therapy, humanistic therapy, ACT, TMT, EMT, and so forth. Wikipedia lists more than 50 major schools of psychotherapy, but there are way more than that, as new schools emerge almost on a weekly basis.
David describes several conversations with the late Dr. Albert Ellis, who argued that most schools of therapy were started by narcissistic and emotionally disturbed individuals. Ellis claimed that most were self-promoting, dishonest individuals who claimed to know the true “causes” of emotional distress and insisted they had the “best” treatment methods. And yet, research almost never supports these claims.
David, who is a medical doctor, points out that we don’t have competing schools of medicine. Can you imagine what it would be like if we did? Let’s say you broke your leg, and went to a doctor who prescribes penicillin. You ask why he’s prescribing penicillin for a broken leg, and he explains that he’s a member of the penicillin school. He says he always prescribes penicillin—it’s good for whatever ails you!
That would be like an Alice in Wonderland world. And yet, that’s precisely how psychiatry and psychotherapy are currently set up. If you’re depressed and you go to a psychiatrist, you’ll be treated with pills. If you go to a psychoanalytic therapist, you’ll get psychoanalysis. Or if you go to a practitioner of EMDR, TFT, or Rational Emotive Therapy (RET), you’ll get EMDR, TFT, or RET. David argues that this just doesn’t make sense.
David argues that the fields needs to move from competing schools of therapy to a new, science-based, data-driven psychotherapy. He emphasizes that we’ve learned a lot from most of the schools of therapy, and that many have provided us with valuable insights about human nature as well as some useful treatment techniques. But now it’s time to move on, leaving all the schools of therapy behind. David acknowledges that this message may seem harsh or upsetting to some listeners, and apologizes for that ahead of time.
David and Fabrice also discuss the spiritual basis of effective psychotherapy, and David describes the reaction of his father, a Lutheran minister, on the day that David was born, as well as a tip his mother gave him when he was in third grade.
In the next Feeling Good Podcast, David and Fabrice will describe Relapse Prevention Training, since the likelihood of relapse after successful treatment is 100%. But if the patient knows what to do, the relapse doesn’t have to be a problem.
Excellent podcast as always. I always admire the work done my doctor Burns… I’m a big fan.
However I was surprised that dr. Burns saw CBT as just another school. If the definition of mental health is rational thinking which is the theory behind CBT then this would seem to be the superior School sense it promotes rational thoughts. If other schools have techniques that promote rational thinking then we can use those techniques even though the theories Behind these other schools are often shaky.
In other words it seems important that we still have a school that backs up the techniques that we are using. A school that is data driven. It seems that CBT would be this school since we can show many data-driven studies supporting its techniques and the theory behind why it works.
Thanks, Bill. I really appreciate your thoughtful comment! You are right that there has been a tremendous amount of research on CBT, perhaps more than any other school of therapy in the world. One of the (many) good things about CBT was the emphasis on quantitative assessment of treatment effectiveness. The Beck Depression Inventory was one of the first assessment tests to quantify depression severity, and I used it early in my career, before more sophisticated tests were available. It was always enlightening to see how much progress a patient was making, or not making, and this always guided my treatment. So if you use quantitative assessments at every session, then every patient becomes a kind of mini-research study. However, I don’t want to sound excessively data-driven, as compassion and, arguably, even some “magic” are a crucial part of effective therapy! d
The martial arts community realized that the best martial art took the best components of the various schools (Brazilian Jiu Jitsu, Muay Thai, Boxing, Wrestling, etc.) and created mixed martial arts (MMA) about 30 years ago. Until then, for centuries, people stayed within their own “school.” I hope TEAM- CBT becomes the MMA of the mental health care world.
That was an amazing story about you being born when your parents thought they couldn’t have children and they had already adopted your three siblings. I’m scared to think of where psychology would have gone without you to build on Ellis and Beck.
Great analogy, Rob! Thanks! david
David, I value your honest and integrity. I hope your desire for “tools not schools” becomes a reality in mental health.
I hope so too. I am asking for a fairly radical change in our approach to the treatment of anxiety, depression, and other similar afflictions! There will be some who are enthusiastic and who “get it,” and some who resist, not wanting to give up their “school of therapy.” Hope that is not too harsh, but I think a data-driven, systematic, flexible, and individualized therapeutic approach–which is what TEAM-CBT it–will have much more to offer–faster and more complete recoveries for patients.
Great discussion. My answer to the question
On an additional tool will be the philosophical
Tool by the great Dr Albert Ellis who I deeply
respect and admire. I recall reading in many of
his books that REBT is an integrative form of therapy. He talked about USA (Unconditional self acceptance) and UOA (unconditional other acceptance). You separate the thoughts, feelings and behaviour from the person and refuse to the rate the essence or youness of yourself or the other. Thiscan greatly diminish the human ego which can be the biggest cause of inter-personal problems.
I am really not sure whether the David Letterman technique equates with the UOA but, I am quite sure through my own personal experience that I can give thought empathy,feeling empathy, appreciation or stroking to others only when I can unconditionally accept myself in the first place.
Thank you again for all your techniques They all are really very great tools. I am just a follower of cbt and Rebt not an expert:) but in my opinion these tools with a combination philosophical thinking can greatly reduce human distress.
Thanks, Rajesh, I totally agree with your comments. I think we could conclude that Ellis, although he was extremely colorful and controversial, to say the least, was really a kind of modern day Buddha. But these teaching are so simple that it is hard for people to grasp the idea of self- or other-acceptance. So people continue to suffer, both in terms of anxiety and depression, due to not accepting yourself, and anger and rage, due to not accepting others.
The work of the philosophical giant, Ludwig Wittgenstein, is also along the same lines–he likely would have argued that the “self” is a kind of illusion, or language that is “out of gear.” However, Wittgenstein was more focused on classic problems of philosophy, rather than the psychological themes we are pursuing.
I went into psychiatry and psychology because of his book, published after his death, titled Philosophical Investigations. Many experts are convinced that his book contained the solution to all the problems of philosophy. That’s actually why I did not go on to graduate school in philosophy. I read that book my senior year in college–I was a philosophy major at Amherst College–and realized I had no need to continue with philosophy, as all the problems that had intrigued and puzzled me were suddenly “solved,” or “dissolved,” or whatever way you want to think about it.
Commenting bit late, but I think Dr. Burns hinted on the answer to the last question: the criteria to add some technique to the toolbox could very well be when the number of cases for which that technique worked distinctively well exceeds, say, 4, or whatever threshold you want.
Did not find any earlier emails from you on this topice, but this suggestion sounds about right! Thanks! david
Oh, there weren’t any earlier emails, I was answering the last question Fabrice asked about the critetia to add a technique to TEAM CBT (right at the end of podcast 047).
Thanks so much for your teachings!
You are very welcome, Eduardo! Thanks for clarification. david
Again an excellent topic and presentation. I had no idea there were so MANY schools of psychotherapy today! As a MD I am sure you are aware of another systemic issue that still exists today: allopathy, osteopathy, naturopathy, homeopathy and chiropractic. Unfortunately the only two that “get along” are allopathy (MD) and osteopathy (DO) and have they have exactly the same privileges and licensing requirements. The other three are basically outcasts and can only survive in their select environments. It would be nice if they would all “just get along” and share all their skills for the benefit of the patients. Obviously the MD/DO would be much freer to use all the techniques as the last three are limited by their training and license restrictions.
I’ve always felt that there should be a group approach to the practiced of medicine. I hope this makes sense – best regards!
Thanks, EdG, always appreciate your thoughtful comments! d