Five Reasons Why Cognitive Behavior Therapy Doesn’t Work

by Mason Bennett

Medical school is full to the brim with exams. Taking tests is a skill all on its own, and to survive, students resort to all sorts of techniques. Common ones are memorization, answer algorithms, and simple rules. One common saying was, “In any question that involves therapy, the correct answer is ALWAYS Cognitive Behavioral Therapy, or CBT.” While this rule was overly simplistic and missed out on nuances of different mental health treatments, it usually worked. To the minds of many in their early medical education, all they know is that CBT is the gold standard.

So, when the opportunity arose to review a book called 5 Reasons Why Cognitive Behavior Therapy Doesn’t Work, I was intrigued. The fact that this hefty claim came in the form of a graphic novel was also interesting. The book is written by Dr. Alan C. Domian who recently retired from clinical practice after 48 years. He has an impressive resume as a psychotherapist for the University of Missouri Kansas City, a clinical director in New Mexico, and director of psychological services for a hospital in Kansas City.

An in-depth treatise on the merits and problems of certain therapies might not seem the best place for a “comic book” but Dr. Domian’s view is, “If you are new to comics, it is important to understand the way comics operate. It is usually a back-and-forth battle between extreme positions. The artwork, coupled with interactive dialogue, operates like music where the formula is tension and release over and over and over [from the Introduction].” In 5 Reasons, “this back-and-forth battle” is fought mainly between CBT trained therapist Dr. C.B. Treater and a dark glowy-eyed apparition named Alter-E-Go-Analyst, or Al for short. They battle over the patient Amelia Marvelle, who is on her third CBT therapist.

The main point of the book is that CBT, “should not be recognized as a legitimate psychotherapy” and that “popularized CBT” has lost its way from “original pre-70s Cognitive Therapy” (from the unpaginated body of 5 Reasons, including later quotes). Al argues that CBT turns “feelings into second class citizens” and that we operate with a “popularized CBT where feelings have not only been dismissed as unimportant but made into a problem themselves!”

True to its title, the book explains five in depth reasons why CBT doesn’t work. To avoid “spoilers” and allow readers the full context of the author’s arguments, instead of a short summary, those five reasons aren’t listed in this review. The reasons are all given in very text heavy boxes, Reason #4 is essentially a whole page worth of text. Dr. Domian does cite research, a lot from the early 1980’s when his argument posits that therapy was losing its way, and some from the recent 2000s as these ideas grow. There are two text boxes within the story to help explain concepts as well as share references.

The idea to give a very theory heavy treatise on the problems with a school of therapeutic practice in a comic book form is bold and novel. The pictures are colorful and well-drawn. However, the subject matter isn’t very visually exciting. It is often just two people having a conversation. There are even two full pages with the same panel repeated with minor variations of the therapist and patient looking at each other. To its credit the book does try to insert some exciting moments, like a pack of dogs attacking the protagonists, or a shootout duel with Wyatt Earp. This was all in the latter half of the book, the beginning was mostly conversation. It is a tall order for a comic book artist to draw stimulating pictures of therapy, and they make a valiant effort.

This made me wonder at times if the book would have been better as a paper or essay on the subject. However, Dr. Domian has tried something ambitious and new, and it certainly makes his book stand out among others. While some of Dr. Domian’s arguments may be meritorious, as a whole they are contrary to the current zeitgeist in therapy. Making his argument in graphic novel format versus an essay may actually be a better method for widespread delivery of his ideas. Seeing an article with the same title as the book would be easy to ignore, but when you see it as a comic book, like me, you may be intrigued enough to give it a chance.

Another good application for this book would be for students learning different therapy methods. It is a colorful format that differs from typical textbooks, and it can provide some controversial ideas that may spark worthwhile debate and discussion in class. So, if you are a professor or a therapist who wants to examine the benefits of CBT, with punny jokes and Kansas City references thrown in, this may be something you want to try.

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M.T. Bennett has a degree in medical science and works in public health. He enjoys writing and spending time with his wife and three sons. Bennett is the author of “Dark and Bright: Poetry and Prose.” His poetry and articles have appeared in Intuition, Chiasm, Poet’s Choice, HEAL, America Media, In-Training, and KevinMD. Twitter handle: @BennettEmpty