The Third Wave of Therapy

Sunday, Feb. 05, 2006 By JOHN CLOUD

TIMOTHY ARCHIBALD FOR TIME

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The cognitive model permeates the culture so thoroughly that many of us don't think to name it; it's just what psychologists do. When Phillip McGraw ("Dr. Phil") gives advice, for instance, much of it flows from a cognitive perspective. "Are you actively creating a toxic environment for yourself?" he asks on his website. "Or are the messages that you send yourself characterized by a rational and productive optimism?" Cognitive approaches were first developed in the 1950s and early '60s by two researchers working independently, University of Pennsylvania psychiatrist Aaron Beck, now 84, and Albert Ellis, 92, a New York City psychologist. The therapy's ascendance was rapid, particularly in the academy. Although many therapists still practice an evolved form of Freudian analysis called psychodynamic therapy, it's difficult to find a therapist trained in the past 15 years who didn't at least learn the cognitive model.

The debates between cognitive therapists and third-wave critics are sometimes arcane and petty, but few questions seem as elemental to psychology as whether we can accept interior torment or analyze our way out of it. Hayes was received at last year's Association for Behavioral and Cognitive Therapies convention in Washington with reverence--and revulsion. It wasn't uncommon to see therapists gazing at him between presentations as though he were Yoda. (Hayes is given to numinous proclamations: "I see this acceptance conception, this mindfulness conception, as having the power to change the world.") But skeptics dog him everywhere. "He certainly has a following and even an entourage," says Providence College psychology professor Michael Spiegler. "But I do think some of what he does is cultlike in terms of having that kind of following, of having to agree wholeheartedly with it, or if you don't, you don't get it."

Sunset.

When you just read that word, no event occurred other than that your eyes moved across the page. But your mind may have raced off in any number of directions. Perhaps you thought of a beautiful sunset. And then maybe you thought of the beautiful sunset on the day your mother died, which might have evoked sadness.

Hayes uses such exercises to make the point that our thoughts can have unexpected consequences. Get Out of Your Mind & Into Your Life illustrates that unreliability by quoting a 1998 Psychological Science study in which 84 subjects were asked to hold a pendulum steady. Some were told not only to hold it steady but also not to move the pendulum sideways. But the latter group tended to move the pendulum sideways more often than the group told merely to keep it steady. Why? "Because thinking about not having it move [sideways] activates the very muscles that move it that way," Hayes and Smith write. To be sure, cognitive therapy doesn't ask people to suppress negative thoughts, but it does ask us to challenge them, to fix them.

By contrast, ACT tries to defuse the power of thoughts. Instead of saying "I'm depressed," it proposes saying "I'm having the thought that I'm depressed." Hayes isn't saying people don't really feel pain (he has felt plenty of it), but he believes we turn pain into suffering when we try to push it away. ACT therapists use metaphors to explain acceptance: Is it easier to drag a heavy weight on a chain behind you or to pick it up and walk with it held close?