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Originally Posted by MikeWaters
there are many things that are common to almost all therapies that are helpful. Positive regard, therapeautic alliance. Someone just danged listening to you and giving a damn.
CBT in many way requires more effort in my opinion. You have to be more verbal, you have to explore their worldview, their cognitions. CBT is hardly plug and play in my opinion. Because everyone has a different set of issues, beliefs, and behaviors.
The dangerour therapist can be the one that knows more about the philosophy that you would ever care to listen to, and is very invested in that school or this school, etc. I picked up a Freudian journal once, started reading an article. It made Sleeping in EQ writing seem like a kids book. So much jargon, back story, etc. as to be meaningless but to about 200 people in the country.
I'm much more interested in efficacy that philosophy. One needs to be careful not to say "I won't use a SSRI because I don't understand how it really treats depression, despite a lot of evidence to show that if helps people."
You look at most discoveries in medicine, and it was efficacy that was noted, and mechanism was explored secondarily.
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It's hard to explain what I mean in this forum, and I sense that I'm probably not doing a very good job. I don't mean that I sit and talk philosophy with all my clients. In fact, I don't ever do that. I'm with you on minutiae, unneeded intellectual exercise, jargon, etc. I'm just saying that in the enterprise of helping people--who are in their very nature quite complex--you better darn well have a good understanding of why you do what you do, what the costs and benefits are, and what the underlying assumptions about truth and the world are. So a journal article said CBT works. Okay, what do they mean by 'works?' From a cognitive-behavioral philosophy, what do we care about? What don't we care about? Why or why not? What is de-emphasized in favor of changing how one thinks? What if changing how someone thinks brings only temporary relief, while they're actively practicing those techniques, but can't possibly hold up in the long-term in other important areas having to do with quality of life? What does a CBT approach assume about the primacy of thought to emotion? Is it reductionistic in any way? Is it deterministic in a linear way, or can it allow for teleological action? How does it address the quality of one's relationships with others in their world? etc etc etc.
That's before we even get to the complexity of the person sitting in front of us, and how that whole picture interacts with the treatment modality we might intend to use.
As for CBT not being plug and play, that's good if it's true for you. I assure you that for many many clinicians, that is not the case, and plug and play is most assuredly what happens.
Lastly, you are going to do what you're most comfortable with, but allow me to implore you (and me and us) to continue to make efforts to combine conclusions about efficacy with critical thinking about those same conclusions (ie, philosophy). I don't necessarily mean reading Kierkegaard or Heidegger, I mean the enterprise and practice of critical examination beyond the surface level. I need not point out the dangers evident throughout our world's history in imposing practices based on assumptions about their efficacy, without ever critically thinking about them. There is a place, and a need, for both. To ignore the philosophy side is in my humble opinion to be lazy and unprofessional.