Comment on CBT v Psychoanalysis Debate

Oliver Burkeman opened up the debate on CBT and psychoanalysis the the Guardian.

Vaughan Bell has responded on his blog here, arguing

My comment is as follows:

Whilst it’s true that the Burkeman article is simplistic, I feel that the present rejoinder replicates this simplicity in another form. Namely, it supposed that CBT and psychoanalysis are essentially up to the same thing (especially with ‘sensible’ psychodynamic treatments!) and can therefore be compared on strengths and weaknesses.

It’s quite proper to reject the notion of CBT as ‘empirical’. Its epistemological standards are pure garbage, and its theory is one that would have embarrassed any 19th Century philosopher. Its theory of mind is untenable. Nevertheless, CBT is not funded particularly because of its ‘evidence’ but because of its ideology. Analysts can play the empirical game just as well, if not better that the CBTers – see Fonagy, for instance – but the fundamental difference between the two is ethical rather than empirical.

To elaborate, CBT is technocratic, psychoanalysis is transferential. CBT is authoritarian, with the expert clinician teaching the patient correct thinking through directive methods. CBT does not require its clinicians to undergo any therapy of their own (unlike psychoanalysis) so the likes of Ellis or Beck never need doubt the veracity of their ideas, or the motives behind their interventions. CBT is only sustainable under conditions of philosophical and political ignorance, and is explicitly designed to be cheap and standardised. As such, it is essentially applied neoliberalism, and we ought not to be surprised to find it used in workfare (for instance). Ellis’ ‘philosophy’ is basically that of Ayn Rand but without the money fetishism.

In short, psychoanalysis is not CBT but with a better theory and more detailed treatment. It’s a different ethical approach, aimed at subjective desire and enjoyment, and absolutely singular in its approach to people. CBT is a project of socio-political pacification and control, a method of discipline and surveillance. Consequently, to say that CBT has ‘worked’ means something totally different to saying that psychoanalysis has ‘worked’, and in my view, we should object to a CBT that works as much as we should reject one that doesn’t.

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