Beck and Psychoanalysis
|Aaron T Beck
|Paul M Salkovskis
So, firstly, so much for the idea that CBT is 'rooted' in psychoanalysis. But more interestingly, how extraordinary to think that the content of dreams might not reflect the patient's general self-concept, along with all the patient's conscious and unconscious wishes, fears and drives. That at any rate is the general idea of analytical approaches such as Jungian dream analysis (see Marcus West's Understanding Dreams in Clinical Practice). Another question one might ask is whether or not someone's conception of themselves as a loser - both in their waking life and their dreams - is born of a defensively motivated identification with a childhood aggressor (a bully at school, for example, or a critical aspect of their father). Are we to believe that dreams never contain wish fulfilling elements? Only yesterday I dreamt of going to shut the curtains to get the sun off my face, only for the curtains to keep reopening - and then awoke to find the sun shining hotly on my head. Are we to believe that people who are depressed never suffer from harsh superegos, that they have not felt the need to suppress their id impulses for fear of their social unacceptability - for fear that love would be withdrawn or that they would go painfully unrecognised? Clearly, I believe, Beck would today be the last to deny that motivational dynamics such as these have any part to play in the psychogenesis or maintenance of psychological distress - whatever he might make of the value of psychoanalytic therapeutic technique.
It therefore remains a bit of a puzzle what we are to make of the birth of cognitive therapy out of his rejection of psychoanalytic therapy. I am however reminded of nothing more than the dramatic conversion experiences of rather literalist-minded devotees of a religion or of atheism into their opposite number. They always seem to be the ones with the dramatic backstory of 'I used to believe minus X but now I believe plus X'. We are supposed, it seems, to be more persuaded by the authenticity of their belief by the fact that they once held so closely to what is touted as its opposite. The real rhetorical effect, however, to my mind at least, is always to incline the reader to wonder whether the author had originally accumulated quite all the sensibilities necessary to fully grasp what was meant by X in the first place. If you start by thinking that unconscious self-hatred would invariably cause a sufferer (who is presumably a stranger to ambivalence, and hence a rather unlikely psychoanalytic subject) to be disappointed if they met with success in their life, it is perhaps no surprise that you end up a cognitive therapist...