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Oliver Burkeman: Why CBT is falling out of favour

Everybody loves cognitive behavioural therapy. It’s the no-nonsense, quick and relatively cheap approach to mental suffering – with none of that Freudian bollocks, and plenty of scientific backing. So it was unsettling to learn, from a paper in the journal Psychological Bulletin, that it seems to be getting less effective over time. After analysing 70 studies conducted between 1977 and 2014, researchers Tom Johnsen and Oddgeir Friborg concluded that CBT is roughly half as effective in treating depression as it used to be.

What’s going on? One theory is that, as any therapy grows more popular, the proportion of inexperienced or incompetent therapists grows bigger. But the paper raises a more intriguing idea: the placebo effect. The early publicity around CBT made it seem a miracle cure, so maybe it functioned like one for a while. These days, by contrast, the chances are you know someone who’s tried CBT and didn’t miraculously become perfectly happy for ever. Our expectations have become more realistic, so effectiveness has fallen, too. Johnsen and Friborg worry that their own paper will make matters worse by further lowering people’s expectations.

All this highlights something even stranger, though: when it comes to talk therapy, what does it even mean to speak of the placebo effect? With pills, it’s straightforward: if I swallow a sugar tablet, believing it to be an antidepressant, and my depression lifts, then there’s a good chance the placebo effect is at work. But if I believe that CBT, or any therapy, is likely to work, and it does, who’s to say if my beliefs were really the cause, rather than the therapy? Beliefs are an integral part of the process, not a rival explanation. The line between what I think is going on and what is going on starts to blur. Truly convince yourself that a psychological intervention is working and by definition it’s working.

Perhaps every era needs a practice it can believe in as a miracle cure – Freudian psychoanalysis in the 1930s, CBT in the 1990s, mindfulness meditation today – until research gradually reveals it to be as flawed as everything else.

Or it could be that we’re changing as people. In 1958, a US psychoanalyst, Allen Wheelis, published a book arguing that Freudian analysis had stopped working because the American character had altered. In Freud’s day, Wheelis argued, people didn’t understand why they felt sad; psychoanalysis gave them explanations, whereupon they found it easy to transform their lives. Modern people were better at self-understanding, but they lacked the gumption to do anything about it. “Lacking the sturdy character of the Victorians,” as Roy F Baumeister and John Tierney put it in their book Willpower‚ “people didn’t have the strength to follow up on the insight and change their lives.”

The old techniques weren’t completely wrong; they’d just outlived their usefulness. If the secret of happiness is hard to find, maybe that’s because the answer keeps changing.

Guardian Article

John Rosemond: Your kids should not be the most important

I recently asked a married couple who have three kids, none of whom are yet teens, “Who are the most important people in your family?”

Like all good moms and dads of this brave new millennium, they answered, “Our kids!”

“Why?” I then asked. “What is it about your kids that gives them that status?” And like all good moms and dads of this brave new millennium, they couldn’t answer the question other than to fumble with appeals to emotion.

So, I answered the question for them: “There is no reasonable thing that gives your children that status.”

I went on to point out that many if not most of the problems they’re having with their kids — typical stuff, these days — are the result of treating their children as if they, their marriage, and their family exist because of the kids when it is, in fact, the other way around. Their kids exist because of them and their marriage and thrive because they have created a stable family.

Furthermore, without them, their kids wouldn’t eat well, have the nice clothing they wear, live in the nice home in which they live, enjoy the great vacations they enjoy, and so on. Instead of lives that are relatively carefree (despite the drama to the contrary that they occasionally manufacture), their children would be living lives full of worry and want.

It was also clear to us — I speak, of course, in general terms, albeit accurate — that our parents’ marriages were more important to them than their relationships with us. Therefore, we did not sleep in their beds or interrupt their conversations. The family meal, at home, was regarded as more important than after-school activities. Mom and Dad talked more — a lot more — with one another than they talked with you. For lack of pedestals, we emancipated earlier and much more successfully than have children since.

The most important person in an army is the general. The most important person in a corporation is the CEO. The most important person in a classroom is the teacher. And the most important person in a family are the parents.

The most important thing about children is the need to prepare them properly for responsible citizenship. The primary objective should not be raising a straight-A student who excels at three sports, earns a spot on the Olympic swim team, goes to an A-list university and becomes a prominent brain surgeon. The primary objective is to raise a child such that community and culture are strengthened.

“Our child is the most important person in our family” is the first step toward raising a child who feels entitled.

You don’t want that. Unbeknownst to your child, he doesn’t need that. And neither does America.

Visit family psychologist John Rosemonds website at www.johnrosemond.com