2014年经济学人 精神疗法 垂死挣扎

Psychotherapy

Expanding the shrinks

The popularity of CBT is freezing out more traditional forms of therapy

THE unexamined life may not be worth living, but the overexamined life can be difficult, too. Many people are turning to a relatively¹ young branch of “talking therapy”, called Cognitive² Behavioural Therapy (CBT) to get them through the (day and) night. CBT, which teaches people to bypass unhelpful thoughts, has been elbowing aside the talk-about-your-childhood psychoanalysis favoured by believers in Freud and Jung. Up to 43% of all therapy courses in Britain are now CBT, and the practice is increasing: around 6,000 new therapists have been trained since 2007 and CBT absorbs much public funding. In 2012, 213m went on a National Health Service programme delivering CBT, while 172m was spent on all other forms of psychoanalysis and psychotherapy.

The growing popularity of CBT was consolidated³ in 2007, when the government adopted the treatment as standard. Three things had swayed it. The newish practice had accumulated a body of evidence proving it worked (students of Freud and Jung have been slower to move from couch to lab). It was very good at getting patients back to the office: a 1997 study found people with psychological problems had significantly higher employment rates after CBT than after traditional psychoanalysis. It was also speedy, getting results after just ten one-hour sessions (psychoanalysis can, expensively, take a lifetime). So CBT therapists were trained up and given all the plum NHS jobs, consigning⁴ other therapies largely to private practice.

As a result couch-based psychotherapy, once dominant⁵, now caters⁶ mostly to the rich—an hour's session costs between 50 ($80) and 500—and is geographically⁷ skewed: there are more psychoanalysts in NW3, a posh London postcode, says Phillip Hodson, a fellow of the British Association for Counselling and Psychotherapy, than in the counties of Devon and Somerset combined. CBT therapists, via GP referrals and hospital departments, can now reach anyone nationwide for free. Private practice psychoanalysis is also set to struggle as evidence-based results and regulation become more important. In 2007 non-NHS therapists resisted a proposed regulatory body, claiming it would squash creativity—a mistake in a profession so easily infiltrated⁸ by quacks⁹.

Meanwhile the CBT boost has expanded the British therapy industry: since 2007, spending on psychotherapy has moved from 3% to 7% of Britain's mental health budget-the difference mostly spent on CBT. In shrink-happy America, by contrast, the psychotherapy industry is declining. In 1998, 15.9% of America's depression and anxiety cases were referred to therapists. In 2007 that was down to 10.5%. The British therapy boom is also a triumph for consumer choice: a recent survey showed patients preferred therapy to medication by a ratio of three to one.

Peter Fogarty of University College, London argues that CBT has entered a virtuous¹⁰ circle: money pours into research, evidence accumulates, more financial support is given to the newly credible¹¹ treatment and other forms of psychotherapy are excluded. Even if they are not, the complexity¹² of the NHS means it may be hard to switch gears. Policymakers will not be keen to disentangle CBT from the vast NHS machinery¹³, nor to write off years spent training new therapists.

CBT is no panacea¹⁴, and psychoanalysis has been shown to be better in treating illnesses like eating disorders¹⁵. It is finally launching studies to measure its effectiveness in an effort to regain¹⁶ some ground. Either way, it appears the stereotype¹⁷ of the buttoned-up Brit, unwilling¹⁸ to delve¹⁹ into his or her subconscious²⁰, may be eroding²¹.

1 relatively   

adv.比较...地，相对地

参考例句：

• The rabbit is a relatively recent introduction in Australia.兔子是相对较新引入澳大利亚的物种。
• The operation was relatively painless.手术相对来说不痛。

2 cognitive   

adj.认知的，认识的，有感知的

参考例句：

• As children grow older,their cognitive processes become sharper.孩子们越长越大，他们的认知过程变得更为敏锐。
• The cognitive psychologist is like the tinker who wants to know how a clock works.认知心理学者倒很像一个需要通晓钟表如何运转的钟表修理匠。

3 consolidated   

a.联合的

参考例句：

• With this new movie he has consolidated his position as the country's leading director. 他新执导的影片巩固了他作为全国最佳导演的地位。
• Those two banks have consolidated and formed a single large bank. 那两家银行已合并成一家大银行。

4 consigning   

v.把…置于（令人不快的境地）( consign的现在分词 )；把…托付给；把…托人代售；丟弃

参考例句：

• By consigning childhood illiteracy to history we will help make poverty history too. 而且，通过将儿童文盲归于历史，我们也将改变贫穷的历史。 来自互联网

5 dominant   

adj.支配的，统治的；占优势的；显性的；n.主因，要素，主要的人(或物)；显性基因

参考例句：

• The British were formerly dominant in India.英国人从前统治印度。
• She was a dominant figure in the French film industry.她在法国电影界是个举足轻重的人物。

6 caters   

提供饮食及服务( cater的第三人称单数 )； 满足需要，适合

参考例句：

• That shop caters exclusively to the weaker sex. 那家商店专供妇女需要的商品。
• The boutique caters for a rather select clientele. 这家精品店为特定的顾客群服务。

7 geographically   

adv.地理学上，在地理上，地理方面

参考例句：

• Geographically, the UK is on the periphery of Europe. 从地理位置上讲，英国处于欧洲边缘。 来自辞典例句
• All these events, however geographically remote, urgently affected Western financial centers. 所有这些事件，无论发生在地理上如何遥远的地方，都对西方金融中心产生紧迫的影响。 来自名作英译部分

8 infiltrated   

adj.[医]浸润的v.（使）渗透，（指思想）渗入人的心中( infiltrate的过去式和过去分词 )

参考例句：

• The headquarters had been infiltrated by enemy spies. 总部混入了敌方特务。
• Many Chinese idioms have infiltrated into the Japanese language. 许多中国成语浸透到日语中。 来自《现代英汉综合大词典》

9 quacks   

abbr.quacksalvers 庸医，骗子(16世纪习惯用水银或汞治疗梅毒的人)n.江湖医生( quack的名词复数 )；江湖郎中；（鸭子的）呱呱声v.（鸭子）发出嘎嘎声( quack的第三人称单数 )

参考例句：

• I went everywhere for treatment, tried all sorts of quacks. 我四处求医，看过了各种各样的江湖郎中。 来自辞典例句
• Hard-working medical men may come to be almost as mischievous as quacks. 辛勤工作的医生可能变成江湖郎中那样的骗子。 来自辞典例句

10 virtuous   

adj.有品德的，善良的，贞洁的，有效力的

参考例句：

• She was such a virtuous woman that everybody respected her.她是个有道德的女性，人人都尊敬她。
• My uncle is always proud of having a virtuous wife.叔叔一直为娶到一位贤德的妻子而骄傲。

11 credible   

adj.可信任的，可靠的

参考例句：

• The news report is hardly credible.这则新闻报道令人难以置信。
• Is there a credible alternative to the nuclear deterrent?是否有可以取代核威慑力量的可靠办法？

12 complexity   

n.复杂(性)，复杂的事物

参考例句：

• Only now did he understand the full complexity of the problem.直到现在他才明白这一问题的全部复杂性。
• The complexity of the road map puzzled me.错综复杂的公路图把我搞糊涂了。

13 machinery   

n.(总称)机械，机器；机构

参考例句：

• Has the machinery been put up ready for the broadcast?广播器材安装完毕了吗？
• Machinery ought to be well maintained all the time.机器应该随时注意维护。

14 panacea   

n.万灵药；治百病的灵药

参考例句：

• Western aid may help but will not be a panacea. 西方援助可能会有所帮助，但并非灵丹妙药。
• There's no single panacea for the country's economic ills. 国家经济弊病百出,并无万灵药可以医治。

15 disorders   

n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调

参考例句：

• Reports of anorexia and other eating disorders are on the increase. 据报告，厌食症和其他饮食方面的功能紊乱发生率正在不断增长。 来自《简明英汉词典》
• The announcement led to violent civil disorders. 这项宣布引起剧烈的骚乱。 来自《简明英汉词典》

16 regain   

vt.重新获得，收复，恢复

参考例句：

• He is making a bid to regain his World No.1 ranking.他正为重登世界排名第一位而努力。
• The government is desperate to regain credibility with the public.政府急于重新获取公众的信任。

17 stereotype   

n.固定的形象，陈规，老套，旧框框

参考例句：

• He's my stereotype of a schoolteacher.他是我心目中的典型教师。
• There's always been a stereotype about successful businessmen.人们对于成功商人一直都有一种固定印象。

18 unwilling   

adj.不情愿的

参考例句：

• The natives were unwilling to be bent by colonial power.土著居民不愿受殖民势力的摆布。
• His tightfisted employer was unwilling to give him a raise.他那吝啬的雇主不肯给他加薪。

19 delve   

v.深入探究，钻研

参考例句：

• We should not delve too deeply into this painful matter.我们不应该过分深究这件痛苦的事。
• We need to delve more deeply into these questions.这些是我们想进一步了解的。

20 subconscious   

n./adj.潜意识(的)，下意识(的)

参考例句：

• Nail biting is often a subconscious reaction to tension.咬指甲通常是紧张时的下意识反映。
• My answer seemed to come from the subconscious.我的回答似乎出自下意识。

21 eroding   

侵蚀，腐蚀( erode的现在分词 )； 逐渐毁坏，削弱，损害

参考例句：

• The coast is slowly eroding. 海岸正慢慢地被侵蚀。
• Another new development is eroding the age-old stereotype of the male warrior. 另一个新现象是，久已形成的男人皆武士的形象正逐渐消失。