In Defense of Cognitive Behavioral Therapy
Cognitive Behavioral Therapy catches a lot of shit for the way it's abused by the system, and ok, fair enough. But no one who's doing it well is using it as a standalone modality - which it is not designed for - or forcing people into ill-fitting, cookie cutter treatment plans.
CBT, at its best, is a rigorous, comprehensive study of human ritual, performed at the closest possible level, undertaken by the subject themselves and guided by a scientist-artist. When it's done well, it unveils a beautiful, sui generis record of a life lived. Combined with Zen Buddhism, it has become a lifesaving treatment for people who suffer from extreme suicidality and extensive trauma. Combined with psychodynamic therapy, it's made extraordinary breakthroughs in treating obsession and addiction.
The founder of CBT, Aaron Beck, was clear that it's not intended to be used alone - it's not as effective and could even be harmful. He mentions this twice in the first ten pages of the book he authored on the modality! Beck certainly never intended for it to become about regimens, worksheets and AI therapy scripts. This misuse is a monstrosity that HMOs have invented. In a way, the troubles of CBT are the troubles of Western psych writ large: a tradition brimming with vitality & potential, constantly corrupted by the institutions who ostensibly administer it. This is religion's problem, too. It is an Achilles' heel of subjectivity.
The reflexive condemnation & dismissal of "checklist therapy" is a tragic missed opportunity. Perhaps the strictures of institutional self-concept can be effectively transcended via apprehension of institutional tools. Haven't we all seen for ourselves how mastering a subject makes us calmer, steadier, more present and reasonable when we approach it? How could it not be the same for life skills?
As part of a holistic, multimodal approach, CBT has more than earned its place in the clinic and in support/healing relationships across disciplines. Instead of resisting it, why not take a position of "it's better to have it and not need it, than need it and not have it?"
This article was adapted from a tweet thread, originally published on January 9th, 2023.