Why traditional psychotherapy led to CBT, which spawned DBT


Since its inception in the 1950s and 1960s and its systematization in the 1970s and 1980s, cognitive behavioral therapy (CBT) has been the gold standard for non-medical psychological treatment and behavioral health care. Indeed, CBT and its ancestor, behavioral therapy (BT), were the first scientifically based and empirically supported forms of “psychotherapy”.

I put the term “psychotherapy” in quotation marks because the very origin of behavior therapy was a reaction to the idea that the ineffable “black box” of the unconscious or psyche – literally the soul – was the sole target of therapeutic intervention. According to the traditional dogma of psychotherapy, if only symptoms were treated, “symptom substitution” would be the inevitable result. The reasoning is that, without addressing the deep, underlying intrapsychic conflicts and repressed memories established in childhood that are thought to give rise to the current symptoms, others would simply fill the void if the presenting symptoms were the object of successful treatment. Essentially, traditional “psychotherapy” looks to the past, because its fundamental principle is to resolve historical and childhood conflicts that are supposed to produce current problems.

Alternatively, the central tenet of BT states that in most cases the symptoms are the problems, not simply the “smoke” resulting from a deeper, unconscious psychodynamic conflagration that must be extinguished to produce a cure. Therefore, according to BT, a symptom-focused treatment that does not require a deep delving or psychological digging into the inner recesses of the mind and the past is the way to go. Following the evolution of BT to CBT, beyond maladaptive behaviors, irrational beliefs, dysfunctional ideas, misinformation and missing information are now also seen as crucial foci of treatment (e.g. A. Lazarus , 1971). So, with its symptom-focused, goal-directed, and active stance, unlike traditional psychotherapy, CBT is forward-looking.

Evidence supports symptom-focused treatments

Despite the insistence of traditional psychotherapists that treating symptoms will only produce symptom substitution, the real evidence—accumulated over the past 50 years of extensive research—suggests that science-based, patient-focused treatments symptoms produce significantly beneficial and lasting results, much more so than traditional psychoanalytic and therapeutic treatments. psychodynamic therapy for the majority of conditions and people.

Perhaps this is why the last 30 years have given rise to a wide range of next-generation, symptom-focused, active and directive, goal-oriented psychological treatments. These approaches focus on the here and now – in fact, the only actionable moment there is – instead of focusing on the front. It includes methods such as Eye Movement Desensitization and Reprocessing Therapy (EMDR), Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT), all of which are firmly grounded in the ground of CBT (e.g., C. Lazarus, 2019).

Dialectical behavior therapy (DBT)

In my view, DBT is of particular interest because its author, Marsha Linehan (1993), was able to distill the pillars of adaptive and functional life skills (namely, CBT) into a wonderfully elegant, highly effective approach. and friendly. . Also, Linehan’s groundbreaking and original book on DBT is actually called Cognitive-behavioral treatment of borderline personality disorder and attributes to CBT the theoretical foundation on which it rests.

Furthermore, very few people, whether clinicians or clients, understand the relevance of the term “dialectic” in DBT. In CBT, “cognitive” is essentially self-explanatory. Most people have an intuitive understanding of what cognition is—thinking, planning, interpreting, reasoning, etc. But the “dialectic” in DBT tends to confuse many people.

The true definition of “dialectic” is “of or relating to a diameter” (i.e. dividing something into two equal and complementary opposites). Further, dialectic means any systematic reasoning, exposition, or argument that juxtaposes opposing or contradictory ideas and generally seeks to resolve their conflict through an intellectual exchange of ideas and by acting through opposing forces.

Ultimately, dialectical thinking refers to the ability to see problems from multiple angles, often from opposite extremes, and arrive at the most economical and reasonable reconciliation of seemingly contradictory information. Thus, dialectic refers to a synthesis of opposites into an integrated and functional whole. For example, a generally good day can have lousy moments and a seemingly lousy day can have pleasant moments. And someone with significant suicidal ideation may have an equally strong will to live. This is why what Linehan calls “opposing action to emotion” or simply “opposing action” is considered one of the main methods of treating DBT and explains the use of the term “dialectical”. . (A simple example of an opposite action is approaching a fear rather than avoiding it.)

Yet far beyond semantics, DBT emphasizes the four essential targets that effective therapy must address better than almost any other psychological treatment system. (An exception is multimodal therapy – MMT – which regularly incorporates methods such as DBT into its approach, but due to the unique aspects of MMT the reverse is not possible; DBT cannot subsume MMT The interested reader might want to examine the essence of MMT here.)

More importantly, however, the four crucial aspects of psychological functioning that DBT does an excellent job of addressing are distress tolerance, emotional regulation, interpersonal effectiveness, and mindfulness. Obviously, if a person can achieve some degree of mastery over these four pillars of mental and behavioral health, they will feel and function as well as possible. This is why psychological treatment focused on these four areas of functioning is currently considered the way forward.

To be truly effective, psychological treatment must focus on these four essential areas of psychological, social and behavioral functioning; not the so-called unconscious motivations or deep, repressed psychological antecedents that traditional psychotherapy aims to uncover, but rather the corrective thinking and corrective action of methods like CBT and DBT. Science tells us that these methods are necessary to produce desirable results and lasting emotional changes.

With the growing popularity of effective methods like DBT and its ancestor CBT, perhaps traditional psychotherapy could finally enter the showcase of the Smithsonian Museum where it belongs along with many other obsolete relics of the past. No pun intended.

Remember: think well, act well, feel well, be well!

Copyright 2022 Clifford N. Lazarus, Ph.D. This post is for informational purposes only. It is not intended to replace the help of a qualified healthcare professional. The advertisements in this article do not necessarily reflect my opinions and are not endorsed by me.

To find a therapist, please visit Psychology Today’s Directory of Therapies.


Comments are closed.