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sagramza September 20th, 2005 01:19 PM

Need info on the downside to CT
Hello! I am new to this site and I need some help. I am currently a grad student in an educational psychology program. I am very interested in cognitive therapy and have done some research on it. Though I continue to find many pros to this type of therapy, I have found few cons. I know that there are more and I would appreciate it if some of you would provide me with some information regarding these cons so that I can get closer to deciding which theoretical orientation I wish to pursue.

Thank you,
Stephanie Gramza

Doug William September 20th, 2005 07:01 PM

Re: Need info on the downside to CT
Hi Stephanie--

If you review the different threads in the Forum, this has 'kind of' been addressed, but usually in relativistic terms, When I say relativistic I mean that usually the discussion gravitates to certain areas needing 'more research' and there are 'lots of unanswered questions' about such and such. Dr. Pretzer's replies to the 'Uncertainities thread' kind of address these issues. You'll notice in the general psychotherapy literature there aren't too many texts on the "negative effects" of therapy. Actually I know of one book by Dr, R. Chessick but that wasn't about CBT. I can't recall any discussion that directly talks about CBT having a therapeutic downside per se.

I presume that people with cognitive disabilities and expressive and receptive language disorders would not be good candidates.

I'm sure that even CBT when not practiced in a competent fashion has lots of downsides. The objective competency assessment of comparing one CBT therapist to another must be difficult-- but here again I'm sure Dr. Pretzer will be a valuable resource for you.


sagramza September 21st, 2005 08:10 PM

Re: Need info on the downside to CT
Thank you for your help Doug! I will look at the thread you were referring to.


James Pretzer September 22nd, 2005 10:08 PM

Re: the downside to CT
Obviously, I think the benefits of CT outweigh the downsides (or I'd be doing another form of therapy) but there are some drawbacks worth considering:

Drawbacks for the therapist:
  • A number of critics have argued that CT demands too much of the therapist. One is expected to develop an individualized conceptualization of the client, use this conceptualization to guide a strategic approach to intervention, and use a wide range of intervention techniques skillfully. The critics say a simpler approach is needed. (My experience is that the vast majority of therapists can master CT with good training. We've been training theraapists in CT since 1984 and my sense it that about 95% end up doing decent CT after our 69.5 hour intensive training program. Many are really good by the end of the program, some have considerable room for improvement.)
  • A related criticism is the complaint that it takes too much time and expense to train therapists in CT. Again, the critics argue that a simpler treatment approach is needed (I agree that it takes a fair amount of training for the average mental health professional to master CT. The Academy requires 40 hours of didactics, reading 5 books, and 10 hours of supervision - or is it 20?-. I'd say that's a minimum.)
  • Cognitive Therapy can be hard work for the therapist. It isn't easy to develop a conceptualization, intervene strategically, use a range of techniques, and simultaneously maintaing a good therapeutic relationship.
  • If you're in practice and use an effective short-term therapy, you have to keep generating new referrals because clients actually finish therapy.

Drawbacks for the client:
  • CT is hard work. To get results, the client needs to follow through on homework assignments between sessions and needs to work persistently to make changes.
  • CT can be difficult. It often requires the client to face their fears, be honest with themselves, face memories and experiences they've been avoiding, etc. It isn't always fun.
  • It may not be easy to find a competent cognitive therapist. The client may need to drive a ways, see someone who isn't a provider for their insurance company, or pay to see someone who's in private practice.
  • In CT the client doesn't get to just vent to a sympathetic listener who makes them feel better for the moment, they are expected to take responsibility for making changes even when this means tolerating short-term discomfort and distress.

These are my initial thoughts. What other drawbacks to others see for therapist or client?

sagramza September 27th, 2005 12:37 PM

Re: Need info on the downside to CT
Thank you so much for this info. I really helps me to see a clearer picture of this approach and it's still my favorite.


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