I appreciate the framing of Lingua Franca and thinness. I wish I had more fully formed thoughts to give back to that, but I wonder if there’s any relationship between that and the on-its-face experience-distant feeling of CBT. When I was younger and first thinking about getting therapy for myself, and was an obnoxiously scientistic “rationalist” who would have been proud of my alexithymia if I could read, CBT seemed like the thing I wanted both because it had the evidence base and because it could work at the level of something I was aware of and comfortable with (thoughts). Now, I strongly believe that most clinicians and trainers involved in it are more open and human than that caricature I’m making of myself, but there’s still a part of me that wonders if the bad aesthetics are (or at least were in the 90s) appealing because they felt appropriately rational for a therapy at the End of History.
Something else I’m still trying to parse out in all this: why doesn’t goal agreement ever show up as a common factors difference that therapeutic models would weigh on? It’s hard for me to imagine that treatment plans formulated and communicated in line with CBT, Shedler-style modern psychodynamic, IFS and whatever else are all equally believable, meaningful and helpful for guiding concrete action for clients. It’s possible I’m heavily overintepreting what Wampold meant by goal agreement as I’m writing that, but it’s on my mind to go back and read him to find out.
Thanks for reading, Aaron. I agree with you: the thinness is both the feature that lets cbt be interoperable and the bug that keeps it feeling somewhat sanitized, distant.
You bring up another good point in that there are a lot of therapists and clients who gravitate toward CBT *because* of its science/rationality aesthetics. As someone who still would do well to break out a feelings wheel here and there, a lot of my aversion to CBT (aside from the book merchantry of it all) is a reaction to my own undervaluation of emotions when I was a younger.
I hadn't considered a Fukuyama/CBT tie in, but I'd love to read something on that if you ever want to build it out.
That's an interesting take regarding the variability of goal agreement across the orientations. It's my understanding that the cards aren't fully on the table in all of these modalities (e.g., the psychodynamic sage might say: "who knows what they really want?"; IFS apparently involves literal demons: https://www.astralcodexten.com/p/book-review-the-others-within-us). This is the kind of question that seems helpful/productive to talk about, but it's hard to start when we find ourselves mired in adjudicating the Dodo Bird over and over.
I can try to expand on the Fukuyama/CBT tie in although beyond what I think is an observable broader phenomenon, End of History just seemed like a fun turn of phrase. I haven’t actually read the book. I can think of lots of side currents to the Becks, David Burns and similar currents though - polymerase chain reaction, human genome project, fMRI, etc.
I’m curious behind that though - you seem to have a lot of history of the subjectivity and historical situation of the people involved in developing CBT and running studies and early treatment that I don’t. Where is that coming from? What you’re saying seems believable but I haven’t seen it talked or written about publicly. Is there anywhere I can go for more of that or is that an oral tradition in your training program?
A lot of that history is in the 3,000 words I redacted. Maybe I’ll de-vitriolize it and post it in the medium-term. Some of it’s been gotten from those other contra CBT commentaries I linked; Shedler does a great job mapping the territory.
There’s a difference between targets as well, that warrant varying degrees of vitriol: (1) cbt practitioners just doing their best to help folks (all peace and love their way); (2) clinical scientists running treatment trials (some healthy skepticism and eye rolling warranted when they overclaim for careerist reasons); and (3) overpromising book merchants (there is not enough fire and brimstone below for this)
I see you. I hear you. But neither this seeing nor this hearing is on our Negotiated Agenda for today’s session, so let’s return to your Cognitive Restructuring Record pls thx.
I appreciate the framing of Lingua Franca and thinness. I wish I had more fully formed thoughts to give back to that, but I wonder if there’s any relationship between that and the on-its-face experience-distant feeling of CBT. When I was younger and first thinking about getting therapy for myself, and was an obnoxiously scientistic “rationalist” who would have been proud of my alexithymia if I could read, CBT seemed like the thing I wanted both because it had the evidence base and because it could work at the level of something I was aware of and comfortable with (thoughts). Now, I strongly believe that most clinicians and trainers involved in it are more open and human than that caricature I’m making of myself, but there’s still a part of me that wonders if the bad aesthetics are (or at least were in the 90s) appealing because they felt appropriately rational for a therapy at the End of History.
Something else I’m still trying to parse out in all this: why doesn’t goal agreement ever show up as a common factors difference that therapeutic models would weigh on? It’s hard for me to imagine that treatment plans formulated and communicated in line with CBT, Shedler-style modern psychodynamic, IFS and whatever else are all equally believable, meaningful and helpful for guiding concrete action for clients. It’s possible I’m heavily overintepreting what Wampold meant by goal agreement as I’m writing that, but it’s on my mind to go back and read him to find out.
And in any case, thank you for a thoughtful and measured post that it sounds like you also had some fun with.
Thanks for reading, Aaron. I agree with you: the thinness is both the feature that lets cbt be interoperable and the bug that keeps it feeling somewhat sanitized, distant.
You bring up another good point in that there are a lot of therapists and clients who gravitate toward CBT *because* of its science/rationality aesthetics. As someone who still would do well to break out a feelings wheel here and there, a lot of my aversion to CBT (aside from the book merchantry of it all) is a reaction to my own undervaluation of emotions when I was a younger.
I hadn't considered a Fukuyama/CBT tie in, but I'd love to read something on that if you ever want to build it out.
That's an interesting take regarding the variability of goal agreement across the orientations. It's my understanding that the cards aren't fully on the table in all of these modalities (e.g., the psychodynamic sage might say: "who knows what they really want?"; IFS apparently involves literal demons: https://www.astralcodexten.com/p/book-review-the-others-within-us). This is the kind of question that seems helpful/productive to talk about, but it's hard to start when we find ourselves mired in adjudicating the Dodo Bird over and over.
I can try to expand on the Fukuyama/CBT tie in although beyond what I think is an observable broader phenomenon, End of History just seemed like a fun turn of phrase. I haven’t actually read the book. I can think of lots of side currents to the Becks, David Burns and similar currents though - polymerase chain reaction, human genome project, fMRI, etc.
I’m curious behind that though - you seem to have a lot of history of the subjectivity and historical situation of the people involved in developing CBT and running studies and early treatment that I don’t. Where is that coming from? What you’re saying seems believable but I haven’t seen it talked or written about publicly. Is there anywhere I can go for more of that or is that an oral tradition in your training program?
A lot of that history is in the 3,000 words I redacted. Maybe I’ll de-vitriolize it and post it in the medium-term. Some of it’s been gotten from those other contra CBT commentaries I linked; Shedler does a great job mapping the territory.
There’s a difference between targets as well, that warrant varying degrees of vitriol: (1) cbt practitioners just doing their best to help folks (all peace and love their way); (2) clinical scientists running treatment trials (some healthy skepticism and eye rolling warranted when they overclaim for careerist reasons); and (3) overpromising book merchants (there is not enough fire and brimstone below for this)
I have never felt more seen about why and how I use cbt. Also, your point about where we could point our focus of concern is dead on. Great article!
I see you. I hear you. But neither this seeing nor this hearing is on our Negotiated Agenda for today’s session, so let’s return to your Cognitive Restructuring Record pls thx.
BRO AHAHA. Nailed it.