Let’s see, I’ve got £4 in pound coins, £1.65 in silver, and 42p in coppers in there, and in the other part €5 in 2-euro and 1-euro coins, and…ten, twenty,…
Sorry. I’ll be with you in a moment. I’m just sorting out my loose change.
These pound coins. There are reports in the press that a lot of them (and the euros too) are fake, but it can be difficult to tell. Shouldn’t the banks deal with that? Maybe they can’t tell either.
How can you tell?
How can you spot a fake pound coin? It depends on how clever the forger was. If the forger made an obvious mistake, then it’s easy.
A common mistake is that the design is blurred or not centered on the coin, with perhaps some parts of the design missing. Another is when the design on the head (the obverse) and the tail (the reverse) are not the same way up. And there are many others.
Here’s a BBC article on the subject: How do you spot a fake pound coin?
And here’s a three-part article with lots of examples: Fake One Pound Coins
The point is, there’s no single foolproof way to tell when a coin is fake. Different fakes reveal their fakery in different ways.
And anyway, what should you do when you get one of these fakes in your change? Complain? Almost no one does.
There are parallels between fake coins and fake CBT.
Just like pound coins, CBT can be faked. But the proportion of fake pound coins is only a few percent, while the proportion of fake CBT is probably much higher. Indeed, it’s even possible the there’s more fake CBT than genuine CBT.
As with fake coins, detecting fake CBT depends on what mistakes the forger makes. Different forgers make different mistakes. There’s no single foolproof way to tell, and in any case almost no one complains even when therapy turns out to be completely useless.
The most useful means of detection is one that you can use early on. The sooner you spot the fake, the sooner you can move on for real treatment. Clever fakes look real in the early stages of treatment, but fortunately most fake CBT is not very clever.
Before therapy starts
I would like to be able to tell you that you can always spot a fake before therapy starts, but I don’t know any way that you can. In an ideal world, perhaps the CBT Register would be a definitive guide, but in the real world it’s not.
Some of the people listed in the CBT Register have good academic qualifications but lack essential skills, so when they try to do CBT it doesn’t come out right. It would be mean of me to describe them as forgers, as many of them would probably be very happy to do real CBT if they only knew how, but the end result for patients is the same — treatment that claims to be CBT but isn’t.
Equally, some of the people not listed in the CBT Register are probably very fine therapists. If they have somehow acquired the right skills, and perhaps have read about how CBT works, or perhaps have been patients themselves, then there is nothing to stop them doing everything right and providing you with real CBT.
I do believe that in the absence of any other information (a personal recommendation, for example) the CBT Register is a good starting point for finding a therapist, but I don’t believe that it helps you to spot a fake.
Therapists who have personal websites or advertising literature sometimes reveal what they are really about. A therapist who can really do CBT does not generally need to use other techniques, because CBT is so effective. So when a therapist advertises a wide range of techniques in addition to CBT, that’s an indication that the CBT might not be real.
Some of the other techniques that you should regard as warning signs include traditional techniques like hypnosis and meditation, older psychotherapies like person-centred counselling and Gestalt therapy, and modern inventions like mindfulness and DBT. This is not to say that these techniques neccessarily have no value (though their value in some case may be questionable), but only that they are not CBT, so that if you think you are getting CBT from a therapist who practises these other things too, the therapy you get might not really be CBT.
The first session
The first session is where most fakes reveal themselves. One of the most difficult skills for any therapist to master is the skill of creating a very close working relationship with a patient in the very first session.
If you don’t have an immediate very positive feeling that you can tell your therapist all about the most difficult things in your life, then you don’t have the right kind of close working relationship. And if that doesn’t happen in the first session, it’s unusual for it to happen later.
The common experience of patients who have CBT for the first time is to be utterly astonished by how easy it is to tell the therapist about the worst aspects of their lives, and by the depth of understanding the therapist has of them in only one session. If you don’t have that sense of astonishment, then it could be because your therapist has not mastered the skill.
I have to qualify that just slightly. If you generally have great difficulty relating to people, and if your therapist is clearly making a big effort to create a close working relationship with you, then you could give it a few sessions to see how your relationship turns out.
Other first-session mistakes that reveal fakes are: relying on a workbook or handouts, having a fixed number of sessions, planning for many months of therapy, and focussing on symptoms.
Real CBT is closely tailored to you as a person — you should not have to fit in with a workbook or with sets of handouts. If you feel that you are having to fit in with the therapy, it’s not CBT. CBT fits in with you.
CBT is effective in a matter of weeks or a few months, but the timescale varies a lot from one patient to another. Fixed numbers of sessions and long-term treatments are probably not CBT.
In CBT the therapist has to understand your symptoms in the context of your life as a whole. If your therapist tries to address symptoms immediately in the first session, without taking time to understand your life as a whole, it’s probably not CBT.
In short, after the first session, ask yourself, “Does my therapist really want to understand me as a person before anything else?” If the answer is, “No”, then it’s not CBT.
In subsequent sessions it gets more complicated, because therapy progresses at different rates for different people.
CBT is based on a common-sense understanding of the origins of your illness — how you came to be the way you are. If your therapist is not trying to make sense of things with you, it’s not CBT.
A common mistake is to generalize about your symptoms, treating you as if you are just another case of…whatever your symptoms happen to be. CBT, in contrast, is personal to you.
Another common mistake is to ask you to try and change your own thoughts by distracting yourself or by arguing with yourself. In real CBT you work with the origins of your thoughts, so that your thoughts cease to be a problem. Trying to counter thoughts with other thoughts or distractions is not CBT.
Why does this happen? Why are there therapists who claim that what they do is CBT when it is not?
I suppose in most cases it’s not the therapists who are fake, it’s the training they have received. And the training is fake because training therapists to do real CBT is difficult and time-consuming, and therefore expensive. It’s cheaper to run training courses that focus on the easy stuff and skim over the difficult parts.
In the end it’s about money. If you can make money through a little fakery, and almost no one complains, where’s the harm in that?