The BABCP is finally having to address uncomfortable questions about what CBT really means, because of problems with its web designers, of all things. What does CBT really mean, anyway?
The Find a Therapist link on the BABCP web site now redirects to a separate site that is shared with the AREBT (a separate organization). The shared site is: CBT Register UK At the time of writing this, the title of the shared site is “AREBT | AREBT” and the banner text reads: “The complete UK register of accredited AREBT and CBT therapists”
Just to make the elementary mistakes in this clear, there are two very similar therapies: REBT and CBT. And there are two organizations: AREBT and BABCP. So the page title should read “AREBT | BABCP” and the banner text should be: “The complete UK register of accredited REBT and CBT therapists”
The BABCP’s new web sites have been littered with elementary mistakes of this kind. Ironically, the old site was developed by a BABCP member, and although the site had some limitations it was quite professionally done. Ever since the BABCP started paying money for web development, the results have been consistently amateurish.
The mistake that raised uncomfortable questions was in the list of therapies that members of the public could choose when finding a therapist. It included things that that the BABCP does not support. Some members complained, and the list was hurriedly changed.
But the hurried change to the website does not fix the real problems.
Behavioural and cognitive
The fundamental problem for the BABCP is that it is an organization for “behavioural and cognitive psychotherapies,” meaning behavioural psychotherapies, cognitive psychotherapies, and any psychotherapies that combine behavioural and cognitive approaches. This covers an uncomfortably wide range of approaches.
At the same time, other organizations claim parts of the same territory. For example, the Association for Cognitive Analytic Therapy (ACAT) promotes a therapy that is certainly cognitive and that is based in part on CBT, but the BABCP does not recognize it. (Talks between the two organizations broke down for mysterious reasons.)
And within these therapies there are specific techniques that are not well-developed enough to be therapies in their own right, but nevertheless have their own supporting factions. Examples are the Compassionate Mind (CMT) approach and Acceptance and Commitment Therapy (ACT).
Another problem is that the BABCP has never been an important player in the politics of psychotherapy, in which the the big hitters have been the BPS (representing psychologists) and the BACP (originally representing counsellors, but later rebranding itself to include psychotherapists).
The BABCP’s political salvation was the UKCP, an umbrella organization that provided an overall national registration scheme and allowed many smaller organizations to feel they had a voice. However, the BABCP always felt sidelined within the UKCP and tried to pull out, soon having to move part-way back to a kind of sitting-on-the-fence position.
Then the UKCP shot itself in the foot by encouraging government to take over registration of psychotherapists. This now looks set to happen, and it will leave the UKCP without anything concrete to do, (as I described in Pickles).
So on Friday the BABCP pulled out again (along with the AREBT). This leaves the BABCP/AREBT partnership rather exposed. It is not clear to me what proportion of CBT therapists they actually represent — certainly not all, and possibly not even the majority. Even so, exposure might be a good thing if it toughens up the organizations’ leadership and creates some clarity of thinking.
How can it be that the BABCP/AREBT partnership might not represent a majority of CBT therapists? Because of the NHS.
The NHS employs various kinds of people to provide various kinds of psychological therapy. Much of the time, I suspect, NHS management does not know what kind of therapy each therapist is actually delivering. The only unifying factor in the NHS is that “CBT” is flavour of the moment, where the term “CBT” is defined as loosely as possible.
So if you examine the people who actually deliver something called “CBT” in the NHS, some of them are BABCP/AREBT accredited psychotherapists, some are psychologists, nurses, occupational therapists…you name it, they do “CBT” these days. Few of these people have any reason to join the BABCP/AREBT, let alone jump through the hoops to get accreditation. They are accredited enough through their own organizations, thank you very much.
At the time of writing this, the mess has been half-resolved by removing some of the questionable therapies from the list on the website. The list now reads:
|Acceptance and Commitment Therapy (ACT)
Behavioural Activation (BA)
Compassionate Mind (CMT)
Dialectical Behaviour Therapy (DBT)
Eye Movement Desensitisation (EMDR)
Rational Emotive Behaviour Therapy (REBT)
Notice that pure cognitive therapy and flavour-of-the-moment cognitive behavioural therapy are not there!
Also missing is Cognitive Analytic Therapy (because it has a rival organization). There are other therapies and techniques just as closely related to CBT that are in a similar position.
But present in the list are techniques like Compassionate Mind, Acceptance and Commitment Therapy, Eye Movement Desensitization, and Mindfulness. Their relation to CBT is questionable, to say the least.
To resolve these questions and live up to its ambition to be “the lead organisation for CBT in the UK”, in its new exposed position outside the UKCP, the BABCP will have to confront some issues.
Banana, cream and other mushy stuff
One issue is that the mere words “cognitive” and “behavioural” are not sufficient to define a class of therapies. There has to be clarity about what the words mean as technical terms in the context of psychotherapy.
Consider banana therapy. Banana therapy? Yes, banana therapy for depression. (If you need to be reminded of the details, see the article at Mr. Breakfast.) You can see a banana, smell a banana, taste a banana, so the approach clearly has cognitive features. And eating is certainly a behaviour, so the approach has behavioural features too. It’s cognitive behavioural therapy!
Or perhaps you would prefer a spray-on therapy — a cream that you spray on and rub in. Spraying and rubbing are behaviours — do I really have to explain everything? And the ingredients help your cognitions. It’s cognitive behavioural therapy! Oh…nearly forgot to tell you where you can buy it: Health Pro Labs in California.
This is an issue for the BABCP because it’s not presently exclusive enough in the way it defines psychotherapies.
The other issue is that rival organizations and other people ouside the BABCP have developed therapies that have a good claim to be part of the “cognitive and behavioural” family, but that the BABCP presently excludes. The example I’ve used in this article is CAT, but it’s not the only one.
The issue for the BABCP is that it’s not presently inclusive enough in the way it defines psychotherapies.
The BABCP can look forward to a very limited and declining role if it cannot confront these issues, drawing the boundaries of CBT with much more clarity.