The term mantra, originally meaning an aid to concentration, and associated with meditation, has come to mean almost the opposite — mindless, thoughtless, repetitive chanting. It’s modern usage was illustrated last week when BBC Radio 4’s PM programme featured a discussion about CBT.
Following a Department of Health press release about additional funding for talking therapies, much of which will be spent on CBT, the BBC broadcast a brief discussion as part of its regular news and current affairs magazine programme, PM. Unfortunately, and perhaps typically, neither of the invited guests was a CBT therapist, or represented either CBT therapists or the Department of Health.
Instead, the BBC invited two authors who are regular broadcasters and who can be relied on to have weird opinions. The result was beyond satire. The presenter foolishly tried to set the scene by asking what CBT is:
Cognitive Behavioural Therapy…well, I haven’t…I’m not a cognitive behavioural therapist, but I’ll have a go…
The dumbed-down perception of CBT is that it’s, well, er, cognitive and, well, er, behavioural. And that’s about it. So Philip Hodson, media relations consultant, counsellor, and official spokesperson for a counselling organisation, despite claiming to want “a full range of psychological therapies” to be available, had come along to the discussion with no clear idea of what CBT is and how it works.
The other participant, clinical psychologist and author Oliver James, was more interesting. He had done some research. Alas, his research was not very thorough and he ranted that CBT is:
…basically akin to hypnotism. You know, it’s training you to tell a very positive story to yourself, to call black white. And consequently when you fill out a questionnaire at the end of the treatment you tick the right boxes. But you may well not really be better deep down.
And anyway, the ‘think positive’ mantra quite quickly wears off. I mean, it’s a deliberate and disgraceful lie on the part of the Department of Health…
James actually referred to a research paper, which was impressive for a short radio discussion. Alas, the paper is not about CBT in particular, but about the difficulties involved in clinical research: Empirically Supported Psychotherapies
The paper argues for much the same kind of empirically informed psychotherapy as the CBT book I referred to here in Reliability, and it details extensive criticisms of purely ‘evidence-based’ approaches, all of which many CBT therapists would agree with.
Oliver James seems to have difficulty distinguishing between CBT itself and the kind of dumbed-down pseudo-CBT that is widespread:
I mean, CBT — I really object to this about it — explicitly discourages patients from considering the true causes of their ailments.
Well no, CBT uses a process of guided discovery to discover the true causes. And again:
So the evidence is actually coming in that…methods which…work through the relationship with the therapist are what work best.
Well yes, CBT is based on a sound therapeutic alliance.
But he also claims that people can only be helped by long-term work on the things that happened to them as children, which sounds to me more like an amateur’s approach to Freudian psychoanalysis than a modern form of therapy.
As an aside, a CBT Boot Camp in London next month offers two days of training for CBT therapists in the basic competencies, which include the therapeutic alliance and guided discovery.
Therapists who do not form a close alliance with their patients, or who do not work at identifying the true causes of their patients’ problems, are not doing CBT.
Politics and the BABCP
It is informative to consider the politics (with a small ‘p’) behind this radio discussion.
There was a time when any discussion of this sort would have involved psychiatrists. But psychiatrists long ago became associated with what were seen as the outdated methods of psychoanalysis. Psychiatrists as a profession failed to be flexible and forward-looking enough to maintain their leadership position, and psychologists became increasingly important in working with psychiatric patients.
Oliver James, a clinical psychologist, is a member of a profession that once seemed poised to take control of psychological treatment. But psychologists, too, failed to be flexible and forward-looking enough to maintain their leadership position as counselling came to the fore.
Paul Hodson, a counsellor, is a member of another profession that once seemed poised to take control of psychological treatment. But when CBT was invented, counsellors as a profession failed to embrace it. As counselling fell out of favour, the BAC renamed itself BACP to try to give the impression that it represents psychotherapy as a whole, but this has not worked and the BACP now seems increasingly out of touch.
Now, with CBT firmly in favour, it’s the BABCP’s turn to fail. The development of CBT has been derailed by poor training and the limitations of ‘evidence-based’ approaches, but the BABCP is not active in fixing the problems. Psychotherapy looks set to move on, leaving the BABCP behind.