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 http://www.cape.org/2005/pretzer.html. I'll also be posting some of my ideas here (as time permits) and I'd like to hear your questions and comments.

Re: Beck Meets Freud? (Cape Cod, July, 2005)
 

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.

Micah

Re: Beck Meets Freud? (Cape Cod, July, 2005)
 

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.)

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.

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 http://www.leadingedgeseminars.org/).

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)!!

-Doug

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.

Re: Beck Meets Freud? (Cape Cod, July, 2005)
 

A Cognitive perspective on projective tests
 

Good concept (anybody need a dissertation topic?). I don't remember seeing anything written about this but I've discussed it in workshops a few times. It makes sense theoretically and I've found it useful clinically a few times.

One major problem with projectives is the reliability and validity (or lack thereof) of interpretive systems. For this approach to projectives to work well, someone would need to come up with a systematic approach to scoring and interpreting the client's responses so that different clinicians show an adequate level if interrater reliability and then would need to demonstrate an adequate level of validity. I bet it can be done, but it would not be a small project.

If this can be done, another important question will be whether time spent administering and interpreting the TAT is productive enough to justify spending session time in that way. My bet is that there are more efficient ways to get the same information. It probably will turn out that it is more productive to spend session time pin-pointing automatic thoughts that occur in problem situations rather than spending the time interpreting responses to the TAT.

However, it is possible that this TAT methodology could be quite useful in research. CT researchers really need valid ways to assess dysfunctional beliefs, schemas, interpersonal strategies, etc. without just relying on self-report. Structured methods for interpreting responses to TAT-like cards, sentence completion tests, etc. would have a lot of potential.

Re: A Cognitive perspective on projective tests
 

This possibility never occured to me. I wonder how one could possibly check the validity of this kind of assessment without looking for correlations with self-reports. It would be a huge project. Far too big for a Master's thesis, methinks. (Sigh). I have three or four ideas like this a week, and I've already forgotten most of them. Thanks for the feedback.

Validating measures of schemas, etc.
 

Off the top of my head, it seems that one of the things to do is to go ahead and look at correlations with self-report measures. However, you'd also want to look at other ways of assessing the variables you're assessing through scoring responses to projectives. I think that cognitive psychologists (i.e. academic psychologists who research cognitive processes) have some laboratory procedures for assessing schemas and other cognitive variables. I seem to remember studies using the Stroop Test, reaction times, etc. but I don't remember the details at the moment. If I remember right Rich McNally has published some studies of objective measures of cognitive variables.

It wouldn't be an easy project but if your goal is to go into academia it might well be a topic where you can do some innovative and publishable research by using a masters thesis to set the stage for a dissertation on the same topic. If your goal is primarily to go into clinical practice, it may be a bigger project than you'd want to take on.