When it comes to psychotherapy techniques, there are winners and losers – contrary to what the dodo informed Alice. Illustration: John Tenniel/The Bodleian Library
“Everybody has won and all need to have prizes,” declared the dodo in Alice in Wonderland when asked to judge the winner of a race about a lake. As judgements go, it is admirably even-handed and optimistic. But in the globe of mental overall health the dodo’s decision has come to symbolise a bitter dispute that strikes at the very heart of psychotherapy.
The “Dodo Bird Verdict”, first suggested in the 1930s by the American psychologist Saul Rosenzweig, proposes that the numerous and different varieties of psychological therapy are all equally powerful. It tends to make no distinction no matter whether, for illustration, a individual is currently being treated with tactics drawn from psychoanalysis, neurolinguistic programming, or cognitive behaviour treatment (CBT). What actually aids a patient to recover are simple variables such as the possibility to discuss their worries with a experienced and sympathetic therapist or the degree to which they are prepared to engage with the treatment method.
Understandably, the Dodo Bird Verdict has ruffled many feathers inside of the profession, and provoked a slew of scientific studies aiming to corroborate or disprove the thought. Are some kinds of psychotherapy genuinely much more successful than others for certain problems? There is plentiful information to propose that the reply to that query – contrary to Rosenzweig’s theory – is “yes”. But that data tends to come from investigation carried out by proponents of the ostensibly superior treatment, leaving sceptics to conclude that their conclusions are not impartial.
This tends to make the final results of a examine of therapies for the eating disorder bulimia nervosa, published this month in the American Journal of Psychiatry, all the more convincing. Bulimia is characterised by binge eating, followed by attempts to compensate by making oneself vomit, taking laxatives or diuretics (water tablets), fasting, and/or working out frantically. Underlying this behaviour is an intense concern – an obsession, even – with physique form and bodyweight.
Bulimia is fairly widespread. One particular big US examine, for instance, located that nearly one% of adolescents aged 13-18 had skilled the problem at some level in their existence. A lot of of these youngsters reported that their sickness created it extremely challenging for them to have a standard daily life, and it damaged their relationships with loved ones and buddies. The review also found that adolescents with bulimia had been a lot more most likely to think about, or even attempt, suicide.
Provided bulimia’s prevalence and possibly disastrous consequences, it is plainly crucial that we understand what remedies operate best, which is why researchers at the University of Copenhagen recently in contrast the efficacy of two well-known psychotherapies: CBT and psychoanalysis. The benefits were remarkable.
In the examine, 70 patients with bulimia nervosa were randomly assigned both to two years of weekly psychoanalytic therapy or twenty sessions of CBT spread in excess of 5 months. At the core of the psychoanalytic technique is the notion that bulimic behaviour represents an attempt to management problematic emotions and desires. The therapist aids the consumer to speak about these buried feelings and to comprehend how they are connected to the bulimia. And when the personal has realized to accept and control their deepest wishes, the theory goes, the distress disappears and with it the signs of bulimia.
CBT, on the other hand, is targeted at the signs and symptoms themselves: the aim is to cease the binge eating as speedily as possible. For CBT practitioners, bulimia is driven by the belief that one’s self well worth is determined by one’s consuming habits, form and fat. Therapists display the personal how to recognize and challenge such beliefs, make clear the cycle of binge eating, and encourage typical eating patterns and a much more versatile and reasonable set of dietary tips. They work with the patient to devise programs to deal with occasions when binge consuming becomes far more probably, and to minimise the likelihood of a relapse.
Even although the participants in the Danish trial received vastly unequal quantities of remedy in excess of an extended timespan – with individuals provided psychoanalysis seeing their therapist far far more than these allotted CBT – it was CBT that proved a lot more effective. Soon after five months, 42% of the CBT group had stopped binge eating and purging for individuals acquiring psychoanalysis the figure was just 6%. Following two many years, the proportion of the psychoanalysis group who had been free of charge from bulimia had risen to 15%. But this was still a long way brief of the achievement of the CBT group right after two years (44%), in spite of the fact that by then it was 19 months given that the finish of their course of remedy.
The Danish trial gives actual grounds for hope: CBT, it appears, can carry about main improvements for a lot of individuals with bulimia. But the significance of the examine goes additional, since its leaders, Stig Poulsen and Susanne Lunn, are not CBT professionals but hugely skilled psychoanalysts. Indeed, not only was the study conducted at a clinic devoted to psychoanalysis, the program of treatment method was developed by Poulsen and Lunn themselves.
Even far more remarkably, however the CBT therapists obtained two days of specific training and standard supervision from a planet leader in CBT for consuming issues, they have been much less seasoned than people accountable for the psychoanalytic remedy.
Despite all this, CBT simply came out on leading. As an editorial in the American Journal of Psychiatry commented: “we applaud the candor of the lead investigators for being so forthright in their presentation of the findings. This can’t have been what they hoped to locate and indeed was not what they hypothesised.”
So when it comes to psychotherapy, it looks the dodo was incorrect. Whilst quick-term therapies may possibly generate equivalent results for some illnesses, such as depression, we shouldn’t presume that the variety of treatment individuals obtain is in essence inconsequential. Alternatively we need to recognise that some are much better for specified problems than others, redouble our efforts to determine these and increase them, and guarantee that the most successful therapies are obtainable to all who need them.
Daniel Freeman is a professor of clinical psychology and a Health-related Analysis Council senior clinical fellow in the division of psychiatry, University of Oxford. Jason Freeman is a psychology writer. On Twitter they are @ProfDFreeman and @JasonFreeman100. They are the authors of The Stressed Intercourse: Uncovering the Truth about Guys, Girls, and Psychological Well being
