Sunday, May 27, 2018
Dangers of CBT, DBT, TFT, EFT, and Other TLA Psychotherapies
If any of your lovely readers contemplate entering psychotherapy, or are training in the field of clinical psychology or psychoanalysis, consider these reflections on the potentially dangerous implications of TLA treatments.
TLA stands, deliciously, for three-letter acronyms.
Here are the primary reasons these treatment programs may oppress, limit, and even harm patients. These TLA psychotherapies:
- Objectify: patients by potentially closing down, rather than opening up, psychotherapy processes. They begin with psychotherapists’ agendas, not patients. EFT therapists, for example, promote emotional expression. What if you are highly cognitively oriented? What if you are on the autistic spectrum? Then the therapist’s agenda would be difficult for you; you have been pigeonholed before you entered the EFT therapists’ offices.
- Constrict: patients’ explorations by placing limits on them. An extension of the objectification problem just noted, psychotherapy should expand persons’ consciousnesses. It requires great openness on the part of both parties. Another popular TLA, TFT, emphasizes the relationship between patients and their psychotherapists. What if you are disinterested in this level of discussion? What if you find exploration of the transference uncomfortable? Too bad, your TFT therapist has a set agenda for focusing on transference.
- Commit bad faith: by potentially violating patients’ authenticities. Jean-Paul Sartre, the great existential philosopher of the last century, coined the phrase “bad faith” to refer to any self- or other-directed demand for inauthenticity. The simplest example would be the common human exchange of, “how are you,” responded to with, “I’m fine.” Few respond truly authentically, with “I’m frightened about my cancer diagnosis” or “actually, I’m angry as hell right now.” By entering a psychotherapy with a therapist who has a pre-set agenda, the risk of bad faith occurring is immense.
- Support the medical-industrial complex: because these TLA approaches are adored by the health insurance companies. These corporations, among the largest in the world, literally profit on peoples health. Their first priority is to shareholders, not patients. Therefore, they love treatments focusing on rapid symptoms reduction; they abhor treatments which help patients explore what their symptoms mean. For example, if a Barista at Starbucks becomes depressed, the firm’s Employee Assistance Program (EAP) counselor would likely refer the employee for a short-term course of cognitive behavioral therapy (CBT). The CBT psychotherapist would strive to reduce the employee’s emotional discomfort and return him or her to work as rapidly as possible. Such a therapist would not pursue the meaning of the emotional discomfort. If the symptom represents a minor adjustment problem, then perhaps no harm will occur. But if, for example, the Barista’s psychological problem actually refers to an underlying, deeper conflict or betrays unexpressed authentic interests or needs, then CBT or similar forms of behavioral psychotherapy serves Starbucks rather than the unique individuality of the employee.
- Are of limited effectiveness: because, again, they seek rapid resolution of symptoms rather than patient exploration of what themes in patients’ lives contributes to, or even causes, their emotional discomfort. They usually rely upon shoddy scientific methods. But one example, they often use self-report inventories, given just before and just after brief sets of sessions. These psychological assessment measures fail to account for placebo effects or even for patients’ wishes to show their psychotherapists how much they have improved.
- Make training in them easy for graduate schools or psychiatric residency programs: because they are so educationally-oriented. They can even be put into treatment manuals. Learning to conduct psychodynamic psychotherapy is extremely difficult. It takes years of training and experience to even begin to master them. Major universities, much like insurance companies, focus on financial efficiency. They would rather pay the salaries of professors who can quickly train students to reduce patients’ anxiety, for example, rather than help them access the complicated meanings behind such fearfulness.
In fairness, TLA treatments are often helpful in symptom-specific conditions. If you develop a crippling phobia of flying, these types of treatments are often the best way to quickly resolve the symptoms.
However, and as I have now demonstrated, they do so at the price of introducing patients to a deeper understanding of themselves. Such an understanding, in the long term, has longer-lasting effects. Studies like the ones conducted by Jonathon Shedler clearly support the efficacy of longer-term, psychodynamic approaches.
In the final analysis then, enter any TLA treatment with caution.
Sartre, J.P. (1943). Being and Nothingness: A Phenomenological Essay on Ontology. H.E. Barns Trans. New York: Simon and Schuster.
Sartre, J.P. (1993). Essays in Existentialism. H.E. Barnes Trans. New York: Citadel Press.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98-109.
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