6 Criticisms of Cognitive-Behavioral Therapy – Schema Therapy

Hello friends!

In this text, I would like to share what I am learning from the book Schema Therapy by Jeffrey E. Young🇧🇷 Despite having many similarities with Cognitive-Behavioral Therapy, Schema Therapy (Young) criticizes these previous approaches, proposing a new form of treatment, especially for the so-called Personality Disorders.

According to the DSM-5, “a Personality Disorder is a persistent pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, begins in adolescence or early adulthood, is stable over time and leads to suffering or harm”.

Through criticism, we can also learn about certain treatment assumptions of Cognitive-Behavioral Therapy (we will use the acronym CBT).

6 Criticisms of Cognitive-Behavioral Psychology

1) Treatment for Personality Disorders

Young’s first criticism is that CBT has been shown to be effective for treating many mental disorders, such as depression and anxiety, but has not shown favorable outcomes for personality disorders, such as Borderline or Narcissistic Disorder.

“Often, patients with personality disorders and characterological problems do not respond fully to traditional cognitive-behavioral treatments” (Beck, Freeman et al., 1900).

It may happen that the symptoms subside with CBT treatment, but personality or characterological factors cause the symptoms to return, as the patient’s old way of thinking, feeling and acting is what he knows and feels comfortable with.

2) Treatment for patients with non-specific symptoms

Another difficulty that occurs in CBT is when the patient arrives for treatment without having specific symptoms: “Their problems are vague and diffuse, or there are no clear activating factors” (Young, p. 18).

Further ahead:

“They are unhappy in important areas of their lives and have been dissatisfied for as long as they can remember. Perhaps they are unable to establish a long-term romantic relationship, fail to reach their desired potential at work, or feel that their lives are a void. They are fundamentally dissatisfied in love, work or play. These life themes, broad and difficult to define, as a rule, do not conform to easy targets to be approached through traditional cognitive-behavioral treatments” (Young, p. 20).

3) Failure to comply with protocols

A third criticism made by Young is that CBT often uses care protocols that, being structured by session, require the patient to do “homework”. It is not uncommon for the patient to say he will do it and he does not. Furthermore, many do not want to learn other strategies to deal with their problems, refusing interventions.

4) Record thoughts and feelings

In CBT, right at the beginning, the therapist asks the patient to make a daily record of their dysfunctional thoughts, emotions and unpleasant sensations. This helps not only in the anamnesis, but the execution itself helps the patient to be more aware of how and when their symptoms appear, what are the “triggers” for their difficulties.

Many patients report not being able to make this record, justify or make excuses about not having done what was requested in the previous section.

5) Resistance to change

“Cognitive-behavioral therapy also assumes that patients are able to change their problematic behaviors and congestion through practices such as empirical analysis, logical discourse, experimentation, graded exposure, and repetition. However, for characterological patients, this often does not happen. In our experience, these patients’ distorted thoughts and self-sabotaging behaviors are extremely resistant to modification through cognitive-behavioral techniques alone. Even after months of therapy, there is often no sustained improvement” (YOUNG, p. 19).

The reason for this is that identity in a patient with a Personality Disorder seems to be closely linked with his problems. Leaving your problems or solving them feels like a death to yourself.

6) Difficulties in the therapeutic relationship

It can also happen that patients find it difficult to relate to their therapists. To the extent that the patient has had a history of troubled relationships in his childhood, and perhaps throughout his earlier history, the establishment of a trusting relationship with the therapist is impaired.

Conclusion

Schema Therapy, as pointed out by the author himself, has many relationships with Aaron Beck’s Cognitive Therapy. However, it also presents significant differences. We will talk in the next text about what Schema Therapy is.

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