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James Pretzer January 2nd, 2005 10:30 PM

Beck Meets Freud? (Cape Cod, July, 2005)
A few months ago the Academy of Cognitive Therapy mailinglist had an interesting discussion of CBT approaches to dealing with some psychodynamic concepts such as "defense mechanisms." The discussion was interesting in its own right, but it also reminded me of previous discussions/debates about CBT's ways of dealing with psychodynamic concepts and the question of whether we have anything to learn from psychodynamic approaches. One thing led to another, and the end result is that I'll be presenting a week-long seminar on Cape Cod this summer on CT's approach to "depth issues".

Can CT address "deep" issues such as resistance, family of origin problems, transference and countertransference, defense mechanisms, childhood traumas, dreams and fantasies? Do we have anything to teach psychodynamic therapists about dealing with "deep" issues? Can we learn anything from psychodynamic approaches? I'll be arguing that the answer to each of these questions is yes and will be exploring how all this applies to clinical practice.

Join me on Cape Cod for Beck Meets Freud? Cognitive Therapy in Depth, July 25-29, 2005. For more information, go to I'll also be posting some of my ideas here (as time permits) and I'd like to hear your questions and comments.

JustBen January 7th, 2005 01:11 PM

Re: Beck Meets Freud? (Cape Cod, July, 2005)
Sounds like a fascinating topic. I'm especialy eager to hear your thoughts on defense mechanisms and dreams.

Micah Perkins January 10th, 2005 09:29 AM

Re: Beck Meets Freud? (Cape Cod, July, 2005)
I too am very interested in hearing your thoughts. I know that Ellis has written some about that topic. He, basically, states that the unconscious probably exsists, and that people probably do engage unconscious defense mechanisms. He states that it may be helpful to recongnize and identify these occurances (for the client to gain some 'insight')But, that for therapy to be most effective, it is important for the client to realize their conscious and unconscious self defeating beliefs, to evaluate them, and to act against them.


JustBen January 10th, 2005 10:09 AM

Re: Beck Meets Freud? (Cape Cod, July, 2005)
From a cognitive therapy perspective, identifying defense mechanisms may provide some valuable information in conceptualizing the client's core beliefs (i.e. if someone is "projecting", it might be very useful to know the content of what they're projecting, for example.)

James Pretzer January 10th, 2005 10:17 PM

CT and Defense Mechanisms
The concept of "defense mechanisms" is an interesting and complex one.

I'm suspect that CT's view will vary a bit from defense mechanism to defense mechanism. For example, Rachman and colleagues have done a bit of research into avoidance of affect. How does this apply to defense mechanisms? Well, suppose an individual relies on avoidance as their primary way of coping with anxiety. If they encounter an external stimulus that elicits anxiety, what will they do? They will try to avoid or escape that stimulus in order to avoid experiencing anxiety.

Well, suppose the individual encounters internal stimuli (i.e. thoughts, images, memories, ...) that elicit anxiety. It wouldn't be at all surprising if he or she avoided those thoughts/images/memories in one way or another. This could easily produce the behaviors that analysts interpret as revealing repression, reaction formation, and the like. Now, if what's actually going opn is avoidance behavior, this has clear treatment implications.

Other apparent defense mechanisms may work a bit differently. (More on that when I have a little more spare time.)

James Pretzer January 10th, 2005 10:45 PM

Dealing with dreams in CT
This is a topic with a fairly long history, Dr. Beck wrote about dreams back in 1971. Beck suggests that the schemas, core beliefs, etc. that shape our waking cognitions also shape dreams (as well as spontaneous daydreams and drug-induced hallucinations). He suggests that this view provides a useful alternative to Freud's assertion that dreams embody wish-fulfilment. If it is true that dreams are shaped by the schemas and core beliefs that play an important role in psychopathology, then dreams may turn out to be a useful source of data when we are trying to identify dysfunctional beliefs.

This topic of dealing with dreams in CT has received more attention than many cognitive therapists realize including a Special Issue on CT and Dreams in the Journal of Cognitive Psychotherapy (Spring, 2002) and several outcome studies of CBT with nightmares. There are at least three studies of CBT (Imagery Rehersal Therapy) for nightmares and insomnia in trauma survivors with PTSD. The results are quite encouraging. In one study (Krakow, et al, 2001) three sessions of IRT decreased chronic nightmares, improved sleep quality, and decreased PTSD severity.
Krakow, et al., (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association, 286, 537-545.

James Pretzer July 27th, 2005 07:35 PM

Beck Meets Freud? update
I'm currently in the midst of my "Beck meets Freud" workshop on Cape Cod and it is going quite well. Today we covered my ideas about how CT can understand and deal with defense mechanisms.

It turns out that it works quite well to conceptualize defense mechanisms in terms of attempts to avoid affect and/or cope with affect. Just as overt avoidance behavior plays a role in many problems, the cognitive maneuvers that humans use to avoid anxiety, guilt, etc. also play a role in many problems. Cognitive therapists have been dealing with this implicitly for decades but I hope that by discussing it more explicitly we'll be able to be more effective.

More on this as time permits. If you're interested in hearing me expound on this, don't forget that I'll be presenting a two-day workshop in Toronto in December, 2005 (see

Doug William August 6th, 2005 06:20 PM

Re: Beck Meets Freud? (Cape Cod, July, 2005)
Will there be audiotapes that can be purchased? And... are there psychoanalysts having some input at these meetings. That kind of diversity could undoubtedly enrich the discussion (unless the premise is that they would have nothing to offer)!!


James Pretzer August 10th, 2005 09:30 PM

Re: Beck Meets Freud? (Cape Cod, July, 2005)
As far as I know, there are no plans to sell tapes of the workshops. If Toronto isn't practical for you, stay tuned for future developments. I'm open to presenting the program at other locations.

Analysts have input in two ways. First, I base may presentation of the psychodynamic perspective on what analysts actually say and/or write, not my own speculations about a psychodynamic perspective. Second, many of the participants in the Cape Cod workshop were psychodynamic and they weren't afraid to ask tough questions. (In an informal show of hands, about 25% of the group identified themselves as CBT, 25% as psychodynamic, and 50% as eclectic.)

I anticipate the participants in Toronto will be similar.

JustBen August 25th, 2005 02:42 PM

Re: Beck Meets Freud? (Cape Cod, July, 2005)
On a semi-related note -- has anyone from the cognitive/CBT "world" studied the possible use of the Thematic Apperception Test in identifiying automatic thoughts and/or intermediate and core beliefs? I would envision administering the assessment along the same lines as a psychodynamic therapist (i.e. show the patient a card and ask him or her to concoct and tell a story based on the picture); the difference would be in interpretation. Instead of viewing the exercise as projective, the results could be analyzed for patterns which may indicate pervasive cognitive distortions. This would tend to sidestep collaboration, of course, so it wouldn't be an assessment of choice, but perhaps it could be useful for difficult cases in which the patient shows a lack of ability to identify their automatic thoughts. (Who knows, it could help people for whom CT is otherwise contraindicated due to lack of "psychological-mindedness". Also might help jumpstart stalled treatments in which therapist and patient are having a difficult time identifying intermediate and core beliefs.)

A mini-example: After several sessions, Jerry, a patient suffering from depression, seems to understand the cognitive model and tries hard to identify his automatic thoughts in various situations. He's unsuccessful, however, and attempts by the therapist to work with "hot cognitions" in the course of the session have also failed. Both Jerry and his therapist are growing frustrated with these attempts, so the therapist shifts gears and teaches some behavioral techniques for dealing with stress and frustration. Toward the end of the session, she administers a few cards from the TAT. The following week, she continues to work on behavioral techniques and administers several more TAT cards. After analyzing the stories Jerry created for each of the cards, the therapist realizes that 4 of the 6 stories Jerry created were about situations in which the "main character" felt incompetent. During the following session, she talks with Jerry about her perception and they consider the possibility of automatic thoughts revolving around incompetence, failure, etc. (Perhaps they even discuss what impact this might have on Jerry's ability to accurately recognize and record his automatic thoughts.)

What do you all think? Sound crazy? Plausible?

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