From time to time I have a look at what BABCP members are saying amongst themselves online. Recent discussions illustrate that the way the BABCP is run is often contrary to the professional interests of its members, and thus indirectly harmful to the public.
Only a tiny minority (around a hundred in recent weeks) of BABCP members take any part in these online discussions. A larger minority (around a thousand at the moment) have signed up to follow the discussions, but there is no way to tell how many of those really take an interest, or indeed how much they actually read.
Part of the problem with the BABCP’s discussions is that they are not moderated.
I recently commented about moderation with regard to the vibrant we are the REAL deal blog, run by a group of body image activists “who want every girl to feel beautiful and strong.” But personal comments on the blog had evidently caused some offence and distress.
What I said (and it’s my policy here) was:
Me, I would edit out personal remarks and off-topic remarks without any explanation, just a note in the text like “[personal remarks removed by moderator]” or “[off-topic remarks removed by moderator]“. If a comment contains nothing of substance apart from personal or off-topic remarks, I would not publish the comment at all, and give no explanation at all.
This kind of thing happens within the BABCP, too. You might think it surprising that therapists cannot quickly rationalize about things that they read, and I am a little surprised too, but then this is only a minority of a minority of a minority. I tend to think that it mostly reflects inexperience of the Internet rather than inexperience in relationships.
Still, it has long been common practice on the Internet to make discussion spaces safe places within limits, so that rational disagreement can rage without personal attacks and off-topic remarks. While the we are the REAL deal blog now has a new comment policy, the BABCP has yet to discover this.
Another problem with the BABCP’s discussions is that the organization itself is often unresponsive or even downright secretive. For example, a recent spate of spam was allowed to continue unabated for far too long.
This is partly related to the lack of a moderator, but members experience their organization’s unresponsiveness in relation to professional issues too. Disappointing experiences of trying to use the CBT Register are a case in point.
The CBT Register
I often provide links to the CBT Register, where you can find a listing of accredited CBT therapists.
Whenever I remember to, I warn that the search there only works well when you specify a last name. Other searches are unreliable. This means that you have to know a therapist’s last name in order to be sure of finding their entry in the register.
Searching for all the accredited therapists in a particular area, for example, has never worked well. The result is confusion amongst professionals and the public. This point came up in recent discussions, but there is (as yet, anyway) no response from the BABCP to indicate that those running the show even understand the problem.
Another way to search does exist, and while it is not intended to be public it is child’s play to hack into. Any non-hacker reading this who would like me to run a search for therapists in their area, and who has a blog I have commented on (and who therefore has my e-mail address), is welcome to e-mail me in confidence.
One theory about this ongoing fiasco is that the BABCP makes money from the CBT Register, and that it puts its own financial interest above the professional interests of its members. The therapists who are easy to find using the register, according to this theory, are the therapists who have paid up.
On a related issue, I recently wrote about professional supervision in Buddy. A mysterious comment on my post made the claim that the matter is under consideration in some way within the BABCP.
I was unable to find any evidence of this in recent discussion. Perhaps my commenter has access to the minutes of secret committees meeting behind closed doors — but if that is the case, how extraordinary that an organization of professionals should conduct itself in that way.
An issue of professional boundaries caused a flurry of excitement when a member suggested assessing a patient who had been referred. That doesn’t sound as if it’s anything special. The problem was that the referral included information about the patient. This was not just any patient, but a certain type of patient.
Some members suggested that if you know that the patient is a certain type of patient, then you need to have specialist training for that type of patient, otherwise you are acting unprofessionally.
For example, suppose a man telephones for an appointment and he happens to mention that he is Australian. According to this theory you are not allowed to assess him unless you have specific training in CBT for Australians.
I chose this example to make the foolishness quite clear. In fact there is no problem assessing Australians, because no specific training exists.
This entirely bogus problem is all about training. Many of the folks who run the BABCP are (as I have noted before) part of the training industry. Their game is to make it seem that every training course is mandatory.
So if the training industry chooses to provide courses in CBT for Australians, no one will be allowed to treat Australians without first attending a course. It so happens that the training industry does not, as yet, provide courses in CBT for Australians, but it does provide plenty of other courses that it would like to make mandatory for profit.
The problem for BABCP members is that the BABCP as an organization undermines their individual professionalism. It provides an accreditation scheme, but then it says accreditation is not sufficient to be able to practise CBT and make professional judgements.
My own view is that the quality of many training courses is highly suspect, so that few professionals would attend them without being coerced in this way. Sooner or later the truth will emerge that attending a course may be poorly correlated with competency, and the scam will be exposed for what it is.
What is CBT, anyway?
A related discussion about boundaries concerned the boundary between CBT and other therapies, or non-therapies. The BABCP’s position is that the term “CBT” means pretty much anything anyone wants it to mean.
The term ‘Cognitive-Behavioural Therapy’ (CBT) is variously used to refer to behaviour therapy, cognitive therapy, and to therapy based on the pragmatic combination of principles of behavioural and cognitive theories.
Take, for example, crystal therapy for anxiety. You can see and feel the crystals, and that involves cognition. You might sit on a chair for the treatment, and sitting is a behaviour. So crystal therapy is CBT, according to the BABCP’s flabby definition of it.
Ah, no, not quite. The thing that really defines whether a thing is or is not CBT for the BABCP is whether the training industry provides training courses that describe the thing as CBT.
In the case of crystal therapy there are no such training courses. So crystal therapy is not CBT.
My own view is that CBT uses a therapeutic alliance and a cognitive formulation to address specific emotional and behavioural issues. Take away any of those four components, and what you have is not CBT.
So, unlike the BABCP, I lump mindfulness, eye-movement and crystal therapy together as non-CBT, because, just for starters, none of them depends on a therapeutic alliance. Equally, pure behaviour therapy, which is still very much alive and kicking within the BABCP, is not CBT in my book because it does not rely on a cognitive formulation.
The BABCP was not always the BABCP. The former behaviour therapy organization, the BABP, grew that extra C so that it could incorporate the new and more successful cognitive approach.
Not all the members, alas, yet understand exactly what it was they were incorporating. Here’s one remark that I found quite shocking. Slap my wrist for quoting from a private discussion, but the guy himself promotes his anti-CBT views in public too:
…don’t bother trying trying to change the content of thoughts of [negative automatic thoughts] or assumptions etc. – complete waste of time unless it’s mild.
My own experience, on the contrary, is that CBT is dramatically effective even in severe and enduring conditions (and specifically in conditions like the particular case that was being discussed there).
Several strands of recent discussions in the BABCP, therefore, seem connected. The thing that connects them is the BABCP itself, with its false view of CBT based on the activities of the training industry and on remnants of its behaviourist past.
I wholeheartedly support the BABCP, its accreditation process, and its CBT Register, but cracks are appearing because of its lack of support for the individual professionals who are its members. If a real professional body for CBT therapists were to emerge, the BABCP would quickly become an irrelevance.
Post-script: What happened to Keith?
What happened to Keith? Now don’t groan like that. We all want Keith to recover, don’t we? The story of his search for effective therapy will continue this weekend, when he’ll discover one of the characteristics of CBT that I’ve mentioned here.