Jennifer Shindman, M.S.

I have a dream that one day we will live in a world where theoretical orientation will not judged by its name, but by its efficacy and evidence base.

Last Sunday, I went to a psychotherapy integration conference. Each presenter, originally trained in psychoanalysis, practiced psychodynamic integration with diverse treatment modalities, including CBT. I was excited to expose myself to something different and hear samples of these therapists’ clinical work. I expected case presentations through vignettes, and I hoped to learn how these psychoanalysts used relational psychoanalysis, aspects of mentalization, intergenerational transmission of attachment and trauma, and combined this all with components of CBT.

However, what I got was something very, very different. In fact, I left the conference more confused than when I had gotten there. Let me give you a few examples. One of the presenters talked about her experience being both a cognitive behavioral therapist and a psychoanalyst. She even spent some time training at the Ellis Institute! She then proceeded to discuss the differences between CBT and psychoanalysis. For example, she said that psychoanalysis will pick up on a patient’s difficulty speaking or anxiety in session, whereas CBT sticks to session plans, homework, etc. Upon hearing this, I was very perplexed, as I was under the impression that CBT therapists address what a client is thinking and feeling. More specifically, if I broached a topic during session with my client and then observed him to be behaving in an anxious way, I would certainly ask him what he was feeling at that moment as well as what he was thinking that led to his anxiety. Moreover, I have had many lectures and read a great deal about “therapy interfering behavior” and the kind of thoughts and feelings that could possibly lead to it.

The next speaker presented a case about one of his clients who had difficulty urinating in public. He treated this client using a relational integrative approach and elements of CBT, including exposure. More specifically, he used CBT to challenge the negative automatic thought his client had upon entering a bathroom. He then spoke to the audience about how he had to switch from CBT to psychoanalysis to pick up on his client’s underlying issues with masculinity and his thinking that he was not a man. I was perplexed by this as well. While it is true that simply challenging this client’s negative automatic thought may not get to his underlying belief about himself (that he is not a man), it does not mean that CBT, and more specifically REBT, would not help this client dig deeper into his belief. For example, if this client were in my office, I would ask him what he was telling himself about not being able to urinate that is leading to his dysfunctional emotions.

Further, I found it particularly interesting that one of the presenters described herself as someone who has “multiple personalities”; there is her CBT self and her psychoanalytic self. This confused me a bit as well. I did not understand why she had such difficulty integrating these personalities and pulling what was most helpful from her well-rounded therapeutic arsenal when necessary. Why couldn’t she identify as both? Would it be too much cognitive dissonance to tolerate?

This conference was supposed to be about the integration of different schools of therapy, yet it consistently seems like there is rivalry between the groups. I wonder what Muzafer Sherif would say. Is our goal to help relieve people’s suffering or to prove that we are the best? Are we experiencing intergroup hostility arising as a result of conflicting goals and competition over power, money, or social status? Do we feel resentment because we believe that our competition will have a zero-sums fate? Isn’t there a superordinate goal here? Isn’t it to reduce our clients’ suffering?

Maybe we need to “check ourselves before we wreck ourselves.” It’s not about being a donkey or an elephant. We need to stop being so wrapped up in “getting the vote” and pay attention to the more important things like our clients’ individual and unique needs.

After all, hasn’t anyone ever heard of the Dodo Bird Effect? Doesn’t treatment depend strongly on the therapeutic alliance and the therapist’s belief in his/her craft? Why don’t people know this? Why can’t we get out of our own way? These thoughts are making me feel very angry!

Alright, let me stop. There is no reason they should know better, even if they are very educated therapists, and it is certainly not helping me to think that they should. Wow, my anger SUDS just went from a 9 to a 5. Yeah, forget everything I said; REBT is the best.

Jennifer Shindman, M.S.