经济学人226:精神疗法 垂死挣扎

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　　精神疗法

　　Expanding the shrinks

　　垂死挣扎

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

　　CBT的兴起威胁着其它心理疗法

　　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.

　　不经任何检验的生活是无意义的，但是检验过多的生活也并非容易。现在很多人都比较青睐近来出现的“谈话治疗”，又称“认知行为治疗”(CBT)，借其顺利度过（白天或）晚上。认知行为治疗（CBT）主要引导患者除去无用的想法，现人气已经大大超过了之前曾得到弗洛伊德和荣格支持者的大力吹捧的“说说童年”心理分析疗法。现如今，英国有超过43%的心理疗法课程都采用认知行为治疗方法（CBT），且它的实际运用也越来越普遍：自2007年起，CBT行业已培养6000名治疗专家，并吸收了不少社会资金。2012年，在政府投资的全面健康服务项目中，CBT占2.13万英镑，而其它精神疗法总共才得到1.72万英镑。

　　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.

　　2007年，在政府宣布CBT为标准治疗法后，它的人气再度上涨，地位得以坚实巩固。CBT虽然出现时间较近，但已有大量证据证明它的功效（弗洛伊德和荣格的学生就没能这么迅速地从诊察台转移到研究室，着手深入调查研究。）此疗法在帮助患者重就业方面效果显著：1997年的研究结果显示，接受CBT疗法的群体的就业率要比接受传统精神疗法高得多。并且，该疗法周期也短的多，每次治疗一小时，持续十次就可以看到效果（而那些精神疗法或许会足足耗费一生）。正因如此，国家大力培养CBT治疗师，并且分配他们NHS(英国国民保健系统)的全部美差，同时还允许他们可以自由行动。

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　　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.

　　结果，这种以诊查为主的心理治疗法盛行后，如今主要是为了迎合富贵人家—小时的诊疗收费达50至500英镑—且它的地理分布也是极为不平衡：英国心理咨询和心理治疗协会会员菲利浦·哈德森（Phillip Hodson）称，在繁华地带的NW3地区的心理治疗师比德文郡和萨默赛特两乡村合计还多。CBT治疗师在全科医生和医院有关部门的引荐下，如今已经可以为全国人民免费治疗。个人所开展的心理治疗法也在努力成为有理可循的治疗法，因此制定有关规定显得更加重要。2007年，一名非NHS的心理治疗师强烈反对政府所出台得一套规章制度，认为这会抑制大家的创新力——这是职业通病，却极易被江湖郎中给占便宜。

　　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.

　　与此同时，CBT的大兴又促进了英国心理治疗行业的发展：自2007年以来，国民在精神疗法上的支出由原来只占心理健康总支出的3%升至7%，而多出来的部分主要用于CBT治疗。而相反，在幸福指数下滑的美国，心理治疗行业却日渐下滑。早在1998年，15.9%的忧郁和焦虑患者都会求助心理治疗师。而到了2007年，这个人数降至10.5%。英国心理治疗行业的大兴再次表明现今顾客为大的世道：近期一项调查结果显示，相比药物治疗，75%的患者更倾向于心理治疗。

　　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.

　　伦敦大学学院的教授彼特. 福格蒂认为CBT开始了良性循环：大量资金投入相关研究，研究又积累更多真实数据，带来可靠的研究结果，而后这种新的可靠治疗得到更多财政补助，得到进一步推广，渐渐地把其它心理疗法给淘汰了。即使这些疗法没被淘汰，在NHS这样复杂交错的系统里，它们也很难翻身，扭转当前局势。当局者根本不希望把CBT从庞大的NHS体系中剔除，也不希望这么多年只是在白白地培养新的心理治疗师。

　　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.

　　CBT不是万灵丹，实践也证实，精神分析法在治疗饮食紊乱等问题上比CBT更见效。CBT最终是会激起社会研究热潮，促进其它治疗法大力研究自身治疗效果，以说服大众，保住自己的一席之位。不管怎样，这显示了英国以往沉默寡言和保守不前的内质,不愿意深入研究自己潜意识的想法，而如今这种特质正在不断褪去。

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