@[email protected] @wendynather Jungian psychotherapy, as interesting as it is, doesn't (AFAIK) have any serious evidence for effectiveness; I didn't study at a school focused on Freud or post-Freudian theories, so it's not my area.

CBT definitely (often) goes in the "you are not your thoughts" direction. Its core operating model, however, is a relatively direct relationship:

Stimuli (external or internal) --> Thoughts --> Feelings --> Behavior

With the possibility of some feedback loops, etc. A lot of the initial work is in identifying "automatic thoughts" triggered quickly and (at first) without the client's conscious action by stimuli (e.g., an event in the client's life, something someone says, etc.).

Example: a client suffers from anxiety and depression. Observation shows that, often, the client's spouse says neutral-sounding things that the client experiences as criticism, like "Is that the shirt you wore yesterday?" or "I finished the dishes."

There is work on identifying the problematic links between stimuli and those automatic thoughts, which lead to feelings (focusing on the negative feelings, which brought the client to therapy). Later, there is exploration of the more global, generalized beliefs that give rise to the automatic thoughts.

In the example above, perhaps a few weeks of work would lead to understanding that the client has a generalized view of themselves as worthless, leading to an automatic thought that many possibly-innocent comments are criticisms (i.e., observations of their general worthlessness), which leads to feelings of depression and anxiety.

The CBT process is more involved than I've explained here, though I think that's a good basic intro. It provides significant relief for many people with certain kinds of difficulties. However, the underlying theory is very much in conflict with what cognitive science has shown about thoughts, feelings, and behavior. Off the top of my head, we have significant research findings suggesting:

• Thoughts often come after feelings
• Behavioral intention (or even the behaviors themselves) frequently happen before thoughts, with the thoughts we think motivated the behavior being tacked on by our brains as something like a soothing explanation for the behavior
• Behaviors change thoughts and feelings, often more powerfully and lastingly than thoughts and feelings change behaviors (I think this is allowed in the CBT model, but is usually framed as a minor effect)

There are few more, I think, if I can remember them. Fundamentally, what we ask clients to do in CBT makes sense to clients and maybe to us--it is our "layperson's theory" of how thoughts, feelings, and behavior work--but it is not how they actually work. Nevertheless, the therapy is helpful for many people.

@superflippy @[email protected] I'm not exactly a CBT evangelist, but I do think it's a helpful process for many people. It is definitely not "power-through self help." One aspect of CBT that many clients find helpful (and I would, too) is that the therapist tends to take a collaborative, rather than mystical, role. The approach I've seen (and this is what it should be, on paper) is that the CBT specialist is a consultant to you, the scientist trying to figure out your own life. The therapist has some knowledge of processes, etc. that might be helpful. There is a lot of talk (if all goes according to the playbook) of observation and experimenting to test your assumptions and thoughts about yourself and others, and a good therapist is flexible, incorporating what you bring back from your observations into the approach taken.

I suppose it is technically self-help (there are CBT self-help books that seem pretty decent, for instance), but certainly not the "white knuckle" "just stay positive" kind.

Last, it's generally pretty short in duration, compared to previous therapies: six to twelve weeks is fairly common, I think. That's once-per-week sessions. I like the fact that if it isn't helping, you're not committed to some multi-year (or usually not even multi-month) process. Of course you're never really committed to anything--keeping people coming back to therapy is always the challenge, no matter the type of therapy--anyone can stop any time, and many do. :shrug:

@liebach @dk LOL. I hadn't connected CBT with cock and ball torture until now. ha.

CBT is an interesting therapy: there was a lot of buzz about it in the late 80s and in the 90s, largely (IMO) because it was the first psychotherapy modality that showed *any *systematic benefit with *any *clients, after some very big (and, to me, pretty convincing) multi-site studies of therapies up to that point. I think maybe it was Glass and ... someone... (maybe Lambert was involved?) in the late 70s, who summarized their research about a bunch of different psychotherapies with the Alice in Wonderland phrase, "All have won and all must have prizes," because several popular therapies at the time all showed no effect relative to the multiple studies' placebo condition (which was "talking to a 'natural helper' doing active listening" which, to be fair, is a difficult condition to beat).

In other words, nothing worked like it claimed, except meds, and those worked in specific situations with frequent side effects. Psychotherapy wasn't doing well. Notably, I believe this line of research is ultimately one reason we have HMOs in charge of psychological care in the US, now. CBT actually did seem to work, mostly for a subset of depression and anxiety concerns, as well as for several issues that don't reach the "disorder" threshold (these are a lot more common than disorders, unsurprisingly).

The "experts" at the time (Freudians, Object Relations therapists and other post-Freudians, Rogerians, et al.) were vocal about hating CBT. It feels to me like they were upset that this upstart wasn't showing the Elders the Proper Respect, but often the criticism was that CBT was mind-numbingly simple. Someone with a bachelor's degree in pretty much anything can be trained in a few months to do CBT. No PhD or MD required. This simplicity, and the transparent collaborative nature of CBT, were very popular with clients who had been talking to experts of various sorts for decades and being told they could not understand the ultra-complicated techniques being used. CBT was a democratizing therapy.

The 90s saw a slew of studies showing CBT was great for lots of conditions and lots of clients. Then in the early 2000s research started to appear questioning that hegemony. I think part of the issue was that many of the CBT studies (and this is still sometimes a problem) used "rule-out" criteria so aggressive that the only people permitted to enter the therapy effectiveness studies were a small, nonrepresentative sample of the people CBT was supposed to help.

Since then, claims about CBT's effectiveness have been walked back quite a bit. It does seem to help many people, but others don't find it helpful. At this point, I'm at the end of my active reading of that literature (i.e., maybe 2005-2010) so I'm quite out of date. My sense, however, is that CBT continues to show mixed results in real-world studies, which--IMO--are the most important ones.