Clinician's Digest: Has Cognitive Therapy Peaked?
Cooper, Garry, Psychotherapy Networker
By Garry Cooper
Has Cognitive Therapy Peaked?
Cognitive-behavioral therapy (CBT) seems to tower above other therapies in its scientifically demonstrated effectiveness. By itself or in head-to-head comparisons with other therapies, CBT has proven highly effective in treating such conditions as depression, phobias, anxiety, eating disorders, and marital problems. But critics of these findings have maintained that CBT seems impressive not so much because of its superior clinical efficacy as because its concrete, measurable, narrowly focused goals and standardized interventions fit the traditional research designs like a glove. Meanwhile, therapies that rely on variables more difficult to isolate and measure--empathy, emotions, body sensations, or therapist/client alliances--have been slower to accumulate empirical validation. But as their proponents have begun to figure out ways to measure and isolate more discrete therapeutic components, the advantages of other therapies and the limitations of CBT are starting to emerge.
A study reported in the August 2003 Journal of Consulting and Clinical Psychology compares Process-Experiential Therapy (PET) to CBT for treating depression, and finds that the two therapies work equally well. In fact, PET worked better on one aspect of depression that many CBT studies ignore--interpersonal relationships.
PET has been practiced for about 25 years, but most of its components belong in the camp of therapy that's been ignored by quantitative empiricists. It's client-centered--clients set the agenda and lead the process, with therapists following along and deepening whatever the clients bring up. The deepening techniques, which have been around for decades, have previously been considered outside the purview of quantitative research. PET therapists use the Gestalt empty-chair technique, asking the client to imagine a different part of himself or a significant figure from her past in an empty chair, and to talk with the chair. They use psychologist Eugene Gendlin's focusing techniques, encouraging clients to tune in to the physical feelings of their emotions and then connect their sensations with their thoughts. PET therapists also work on establishing trusting, secure relationships with their clients.
If CBT is about controlling emotions, PET is about deepening emotional intelligence. "It's a bit of an oversimplification," says PET psychologist Jeanne Watson of the University of Toronto, lead author of the study, "but CBT is didactic. It teaches, guides, and calls upon the adult part of the personality, while PET is experiential, promotes self-exploration, and nurtures the child part of the personality."
Watson's study of 34 depressed clients used more measurement instruments than many other head-to-head studies. It included an attitudes scale, to capture the types of changes CBT aims for, several instruments to record changes that both therapies strive for, and the Inventory of Interpersonal Problems (IIP), which was expected to record changes that PET often achieves. After 16 weeks of therapy, clients in both therapy groups showed clinically significant improvements in depression and self-esteem. On the attitudes scale, expected to favor CBT, both groups showed significant and similar levels of improvement. However, the PET group reported much more improvement in their interpersonal relationships than the CBT subjects.
PET's proponents claim that depressed clients who need help with relationships might be better served by a therapy that pays more attention to their interpersonal lives.
In any case, Watson's study serves as another reminder that deciding which therapy to use for a client should entail more than just picking the therapy with the most documented research support.
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