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Chris Sorrentino, a.k.a CombatCounselor, is a leader and expert in cognitive behavioral therapy. He combines 30 years of experience in psychology with the discipline from having served as a U.S. Air Force officer for 20 years, 4 of those in combat zones, retiring as a lieutenant colonel in 2005.

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Thursday, December 1, 2011

Freud and Psychoanalysis versus Hayes and ACT: Time for a Change?

Sigmund Freud
It goes without saying, Sigmund Freud is an icon, having had a tremendous influence on psychology in general and psychotherapy in particular.  However, exposure to Freud and psychoanalysis in undergraduate, graduate, and post-graduate programs, I believe, has outlasted his contributions and become rather tedious.  Studying Freud and psychoanalysis in an undergraduate introductory psychology course or even an undergraduate or graduate theories course is understandable and warranted.  I have been exposed to Freud countless times in numerous courses and, to be totally honest, I think it is a waste of time to continue to study a theory that has never been proven and been the laughing stock of serious behavioral scientists for decades.  It is hard to believe that clinicians still practice psychoanalysis in the 21st Century and that a current text applying developmental theories to counseling (Kraus, 2008) or one on theories of human development (Newman and Newman, 2007) would spend as many as 67 pages discussing it.  Surely, there are more deserving, practical, and recent theories that could have been printed on those pages, Relational Frame Theory for instance.
“The third wave of behavior therapy” (Hayes, 2004, p.16), as Steven Hayes and others have called it, has emerged to provide an experiential option for those who practice and are treated with cognitive behavioral therapy (CBT).  This third wave of therapies includes Acceptance and Commitment Therapy (ACT – pronounced as a word, not an acronym) and Dialectical Behavior Therapy (DBT – Linehan, 1993), both of which focus on mindfulness and acceptance, and influenced by the tradition of Zen Buddhism.  ACT is based on the philosophy of Functional Contextualism and a developmental learning theory known as Relational Frame Theory (RFT), a fairly recent theory developed by Hayes over the past 15 to 20 years. 
Relational Frame Theory is a rather difficult theory to grasp, but both Blackledge (2007) and Blackledge and Hayes (2001) helped clarify the theory and the connection between language, experiential avoidance, cognitive defusion, and exposure.  Blackledge and Hayes (2001) also clarified the difference between ACT and CBT, where thoughts emotions, and memories are simply accepted as such (in ACT) rather than trying to modify them as is done in CBT.  According to RFT (Blackledge and Hayes, 2001), language and rule-governed behavior are additive in the sense that what we have experienced (behavior, thoughts, emotions, memories, etc.) can never be eliminated and, therefore, we must create positive, novel, experience-based memories founded on acting in accordance with personal values rather than “replacing” negative experiences.  This concept is quite contrary to CBT, where thoughts are analyzed and manipulated, even though ACT is considered a cognitive behavioral therapy.
            Relational Frame Theory has been studied extensively and Hayes et al (2006) has done an excellent job of describing the framework of ACT, explaining the basic philosophy, theory, principles, and processes in a succinct and easily understandable manner.  There is a large and ever-accumulating body of research and literature, both on RFT and on ACT, empirically supported and validated research as opposed to the unproven psychoanalytic or psychosexual theories of Freud and his cohorts.  In my opinion, the 67 pages spent on Freud in our two texts would have been much better spent focusing on a more recent and exciting theory such as RFT. I have personally seen RFT and ACT in action in my own practice, and the results are quite amazing, results taking days or weeks rather than years, as is the case in psychoanalysis. In conclusion, my reaction to Freud and psychoanalysis are, obviously, quite strong.  Again, my goal is not to diminish Freud’s impact or contributions, only to recommend that our time might be better spent on something more current and relevant to clinical practice in the 21st Century.

Blackledge, J.T. (2007). Disrupting verbal processes: Cognitive defusion in Acceptance and          Commitment Therapy and other mindfulness-based psychotherapies. The Psychological Record, 57, 555-576.

Hayes, S.C. and Blackledge, J.T. (2001). Emotion regulation in Acceptance and Commitment Therapy. Psychotherapy in Practice, 57 (2), 243-255.

Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A., and Lillis, J. (2006). Acceptance and             Commitment Therapy: Model, process and outcomes. Behaviour Research and Therapy,             44, 1-25.

Hayes, S.C., Strosahl, K.D., and Wilson, K.G. (1999). Acceptance and Commitment Therapy:      An Experiential Approach to Behavior Change. New York, NY: The Guilford Press.

Hayes, S.C. and Strosahl, K.D. (Eds.). (2004). A Practical Guide to: Acceptance and Commitment Therapy.  New York, NY: Springer Science+Business Media, LLC.

Linehan, M.M., (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder
New York, N.Y: Guilford Press.

Newman, B.M. and Newman, P.R. (2007). Theories of human development. Mahwah, NJ:            
Lawrence Erlbaum Associates, Publishers.

Walser, R.D. and Westrup, D. (2007). Acceptance and Commitment Therapy for the Treatment     of Post-Traumatic Stress Disorder and Trauma Related Problems: A Practitioners Guide         to Using Mindfulness and Acceptance Strategies. Oakland, CA:  New Harbinger     Publications, Inc.

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