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...only did Beck reject Freud's idea of the unconscious self, but he also abandoned the formal reserve of the classic Freudian analyst. Freud believed the analyst should be as neutral and silent as possible. That way, Freud theorized, the patient can project personalities from his or her past onto the analyst and relive past conflicts right there on the couch. Freud called this process "transference." Beck and his followers aren't interested in transference. Instead cognitive therapists talk back to their patients, pointing out their misconceptions and advising them on how to see their lives more clearly...
...therapy is everything psychoanalysis isn't: simple, quick, practical, goal oriented. "There's this mystique about psychoanalysis," says Judith Beck, daughter of Aaron and herself a leading cognitive therapist. "Psychoanalysis is esoteric and creative and interesting, and the psychoanalyst holds himself up as the expert who interprets what the patient is saying and has all the answers. It's kind of the opposite in cognitive therapy." Cognitive therapists tend to follow the same basic script for each session, so the treatment is remarkably standardized. It's also remarkably effective; research shows that when it comes to treating depression, cognitive therapy...
Psychoanalysts are also learning to borrow from other disciplines. According to a survey conducted by the Journal of the American Psychoanalytic Association, more than 18% of patients undergoing psychoanalysis in America also take some form of psychoactive medication. Some psychoanalysts even borrow techniques from cognitive therapy. "The analysts have moved more in the direction of understanding cognitive distortions," says Dr. Glen Gabbard, a psychoanalyst and professor of psychiatry at Baylor University. "If you look at good therapists on videotape, you'll find that the cognitive therapists and the analysts do many things in common." Many psychoanalysts also offer patients...
...entire temperament. Narcissists may be self-absorbed, but they believe they jolly well have a right to be. Histrionic personalities may make too much of things, but how else can they be heard? It's hard enough to persuade most people to see a therapist--harder still when the patient denies there's a problem at all. "People rarely come in with a self-diagnosed personality disorder," says Josephs. "Friends and family push them into...
Whatever the specific roots of the conditions, once those environmental and genetic die are cast, is that it for the disordered personality? The short, bleak answer is often yes--at least as long as PD patients resist acknowledging the problem. Anxiety disorders such as phobias are generally referred to as ego-dystonic illnesses: the sufferer acknowledges the problem and wants to do something about it. Personality disorders are ego syntonic: individuals believe that the drama, self-absorption and other traits that characterize their condition are reasonable responses to the way the world is treating them. That's a hard patient...