Buzz
We’ve got therapy all wrong.
The chaos of the last few years—pandemic, lockdowns, economic instability, political unrest, just to name a few—has taken a significant toll on our mental well-being. According to the CDC, from 2019 to 2021, mental health treatment across the U.S. increased among all demographics nationwide. And that's still just a fraction of those who could benefit—research shows, roughly 45% of people experiencing clinical-level mental health issues do not seek professional help.
There are countless reasons people shy away from therapy, from seeing it as a weakness, to thinking their problems aren't serious enough to warrant professional help, to limited access to mental health services. But often, this resistance stems from a fundamental misunderstanding of how therapy works in the modern world.
Common Misunderstandings About Talk Therapy
Many people still don’t fully grasp how therapy actually works. When they envision it, they often picture an expensive, long-term relationship with an eccentric therapist who spends endless sessions digging up childhood memories and traumas, with little visible progress. However, the practice of talk therapy in 2023 is far removed from the outdated “lie on the couch and tell me about your mother” stereotypes.
Around 70% of therapists in the U.S. now employ “cognitive behavioral therapy” (CBT), a scientifically-backed, short-term approach that focuses more on achieving concrete results than on exploring complex theories of connecting past and present.
The Origins of Talk Therapy
Discussing your issues with a knowledgeable guide can be traced back to the philosophical conversations of ancient Greece, but its modern form largely stems from the work of Sigmund Freud. Freud's impact was so significant that the image of a bespectacled man with a vaguely European accent and a cigar has become synonymous with the therapy process, even though Freud has been gone since 1939.
Freudian psychoanalysis, in its broadest sense, posits that bringing unconscious material into conscious awareness can alleviate psychological distress. However, it is a long process—often spanning decades—and lacks a clear measure of success, making it hard to determine if it 'works' except through personal anecdotes.
As psychotherapy evolved, numerous other theories emerged from Freud’s foundational ideas, falling into two general categories. Cognitive approaches may disregard or minimize strictly Freudian concepts like the id and super-ego, but they retain the core idea: our behaviors are deeply rooted in our thoughts and emotions, so by understanding and mastering them, we can change our behaviors and alleviate psychological issues.
Behaviorism, on the other hand, maintains that human behavior is entirely shaped by environmental conditioning. The unconscious, and even the mind itself, are considered irrelevant since they cannot be observed or studied. Essentially, it’s about changing actions rather than delving into thoughts or emotions.
Bridging the Gap: Cognitive Behavioral Therapy
In the mid-1960s, these two seemingly opposing approaches merged into cognitive behavioral therapy, which asserts that psychological issues are partially caused by unproductive thinking patterns and also by unhealthy behaviors. These two factors are not in conflict, as they influence each other in a cyclical way.
The therapist's role in Cognitive Behavioral Therapy (CBT)
Unlike many traditional therapies where the bond between therapist and patient is crucial, CBT places less emphasis on this relationship. Instead of being a listener or confessor, the therapist in CBT takes on the role of a guide or coach. The focus is on helping the patient set concrete personal goals and creating a practical strategy to reach them. The emphasis is on problem-solving with specific, measurable steps, rather than abstract concepts such as personal fulfillment or happiness, which are seen as byproducts of healthy actions.
CBT addresses current issues rather than focusing on past trauma
CBT tends to focus more on present-day concerns than past experiences. It doesn’t typically involve deep dives into childhood memories (though it can help individuals address past issues influencing their current behavior). For example, if you're struggling with punctuality, traditional therapy might explore your parents' discipline techniques and how they affect your current view of deadlines. In contrast, CBT would more likely offer practical solutions such as using mental strategies to leave the house earlier or purchasing a more reliable alarm clock.
CBT goes beyond just behaviorism, also targeting cognitive distortions that influence behavior and cause distress. For instance, if you constantly think, “I’ll never make it to work on time,” CBT would guide you to identify and challenge this flawed thinking, replacing it with a more constructive thought like, “I can definitely make it to work on time.” (Although it may seem simplistic, this approach is often surprisingly effective.)
CBT doesn’t take forever
While many therapeutic approaches are open-ended and can extend for years, cognitive behavioral therapy typically follows a shorter, more focused timeline. Sessions generally span between six and 20 appointments, each lasting around an hour. By the end of treatment, patients are empowered to become their own therapists, applying the skills they've acquired to navigate challenges in their lives. In other words, you won’t be that friend who’s been in therapy for two decades and still struggles to keep a job.
Is cognitive behavioral therapy effective?
No single therapy is universally suitable for every individual or all types of mental health conditions. There are countless methods within the realm of talk therapy. For some, psychodynamic therapy—a long-term approach focused on delving into past experiences—might be ideal. Others may turn to Eye Movement Desensitization and Reprocessing Therapy, which has proven highly effective for PTSD treatment. There’s also the option of exploring a spiritual approach, psychedelic therapy, or even a strictly pharmaceutical solution, such as taking Wellbutrin daily, with or without talk therapy. If you're feeling nostalgic, a strictly Freudian psychoanalyst could be available for a more traditional route.
CBT is a great starting point. It’s become the most widely practiced therapy, particularly for treating conditions like depression and anxiety, due to its proven effectiveness. While other types of therapy may work, the lack of measurable success makes it hard to tell. CBT, however, has been tested through evidence-based frameworks for decades. In fact, it has undergone more rigorous research than any other talk therapy and consistently outperforms alternatives in studies.
An evidence-based approach ensures that therapy can evolve over time, with a clear metric for assessment. Therapies like ACT (Acceptance and Commitment Therapy) incorporate many elements of CBT but place a greater emphasis on mindfulness and the acceptance of emotions, all while maintaining CBT’s goal-oriented nature.
No therapy is a perfect fit for everyone, but if you’re new to talk therapy or have had a disappointing experience with other methods in the past, CBT may provide the solutions you need—or at least offer some guidance on how to find them. And don’t worry, you won’t have to delve into personal topics like your mother unless you choose to.
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