Friday, January 8, 2010

Is cognitive-behavioral therapy really all that good for schizophrenia?

I am being deliberately provocative with my title. What prompted today's post is an article about careers for the coming decade. Cognitive-behavioral therapist is one of them, the reasons given below.

The Mental Health Parity Act requires that mental health now be covered as fully as physical health, but many insurers will cover only cognitive-behavioral therapy because it’s both shorter and, on average, more efficacious than traditional psychotherapy. Learn more: Association for Behavioral and Cognitive Therapies.

My blog is USA-centric, even though I don't live there, for the reasons that the USA tends to drive the way the world sees things, for better or for worse. Is it throwing the baby out with the bath water by favoring CBT over other kinds of psychotherapy when it comes to schizophrenia? Schizophrenia is not garden-variety depression. It's not about coping with a dead-end job or having your wife leave you or your dog die. Schizophrenia is the larger than life mother of all existential blow-outs. People who come under its influence deserve the best psychotherapy from the most skillful therapists, which may not be cognitive-behavioral therapy and probably isn't in most cases. I don't want to rain on CBTs parade. I just think that schizophrenia is more complex than what CBT can deliver.

Here's another viewpoint about this from ... there are radical approaches in psychotherapy that are especially vulnerable to state regulation, approaches that really do provide the space to speak freely. Some approaches like ‘cognitive behavioural therapy’ are unfortunately compatible with state regulation because there is an assumption in them that there is a correct and incorrect way of thinking about the world.

People experiencing a crisis of schizophrenia do not think about the world conventionally, and I wonder really how effective CBT is in helping them grapple with their myths and heroic struggles. CBT may be cost effective for governments, but will it really up to the job of helping people in severe existential angst get on in a conventional world?


  1. The value associated with CBT is it focuses on goal oriented behavior. Human beings, and in fact all living organisms, are goal oriented beings. The pursuit and achievement of tangible goals are significant in the recovery process.

    Having said this CBT's value occurs somewhat down the road in the entire process of pschotherapeutic recovery. CBT can have a tendency to varnish over the existence of the underlying psychosocial and interpersonal dynamics that give rise to the defensive psychotic response in the first place. As a consequence prior to and concurrent with the pursuit of goal directed behavior it is critical to explore, identify, acknowledge, and reframe the experiences of the individual that gave rise to the psychotic response.

    Something happened and the interpretation of meaning associated with that something, or somethings, was the catalyst in a defensive psychotic response. This interference needs to be understood and resolved in order for CBT to produce the desired effect.

  2. It seems that CBT's value comes into play later when the person is well along in the recovery process.


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