I think Burkeman misses a very important point, in favour of a rather flawed idea that therapy somehow gets old and wears out.
Until CBT emerged, there had never been a fashion for a particular therapeutic modality - sure, the 1970s were a time when, in the US at least, "seeing my analyst/therapist" was an essential part of being aspirational and rich, especially if you were Woody Allen, but nobody really got too hung up about what went on there, or what the therapy actually
was. He presents Freudian therapy as if it was the same kind of fad that CBT became in the 1990s and 2000s, and I think that's probably not a valid comparison: Freud gets a hard time because its ideas are couched in the language and values of the 1890s, but - unlike other vogues of the same vintage, like phrenology and electrical contraptions, Freudian analysis has lasted, primarily because it has merit, not because it was once fashionable.
Then along came CBT. I think that, even before it got fashionable, CBT was being oversold - it was the universal panacea, offering a quick fix for every problem, without all that tedious need to spend months or years in therapy, going around digging in the past and raking up stuff. It was the therapeutic equivalent of that other 1970s craze, putting crazy paving on your front garden, burying all that inconvenient past history under a foot of hardcore and concrete, leaving a nice smooth stable low-maintenance surface. And, of course, CBT was sold on its other "advantage" - the fact that it had a kind of built-in performance measuring system. Never mind that clients were perfectly capable of (consciously or otherwise) "gaming" the system and giving the answers they wanted the therapist to hear, none of which was helped by the fact that CBT was seen as simple to administer, and was often being delivered by practitioners with a very thin therapy background - just a few weeks' or months' training in CBT techniques, and off they went. So they were a) not always brilliant at spotting when things were coming up that were problematic, or where the therapy wasn't really working.
But the main problem was that, like the crazy paving, CBT's benefits were being oversold. For a start, it didn't suit everyone. OK, it could be very useful for dealing with the kind of problems that the application of some thought, particularly by a patient curious, smart, and motivated enough to do it, were amenable to fixing, and even someone with deep early trauma might well be moved from a state of total incapability to something resembling normal functioning. But the roots and tendrils were still growing and seeking under the newly-paved surface, and would inevitably find a crack - or make one - through which to emerge. Before long, that new paving was starting to heave and crack as the past shoved its way back out into the light, and people with deep-seated conditions would find themselves returning for "top ups" as the coping strategies put in place started to fail. Or, worse,
not returning for "top ups" and feeling like they'd failed, rather than this bold new therapy.
The first Mrs E was a classic example of someone with significant mental health problems being treated by a mental health service for whom the hammer of CBT was the only tool in the box: time and again, she'd be hoicked in for some CBT, which was invariably almost completely abortive (not surprisingly in the circumstances, given that she was almost certainly suffering with borderline personality disorder, not the most amenable condition to treat in the best of circumstances), and, over the years, reinforced a growing and profound sense of failure on her part - if the best the CMHT had to offer (never mind that it was
all they had) was not going to help, then it was not any surprise that their clients were likely to feel that the failure was in part their own.
Typically, DWP have gone for this option with a 30 year old mindset that ignores any possible drawbacks in the approach. Most therapists who practice integratively (that's to say using a number of different modalities) will be very clear that there are approaches which work best for particular types of issue and with particular types of client: no one modality is universally applicable to all problems and all clients. We also know that the "presenting issue" (what the client is referred for) is rarely ever the primary issue that will end up being dealt with in therapy - very often, it's the safe-and-sanitised issue that is all the potential client felt able to disclose prior to therapy, and that - at least in the hands of a competent therapist - the underlying stuff comes out when the work is underway. In my own experience, I would say that the percentage of people I see who are referred with "depression and anxiety" for whom that is the sole issue is less than 5%, and I suspect even those are burying something deeper.
So when someone is referred to the DWP provider for CBT with "depression", I don't believe that it is likely, especially given the quite narrowly-focused approach that looks likely to be taken, that any underlying issues will really be addressed. CBT doesn't generally do that, and certainly not at the more superficial level that it will be being delivered at - it looks at the current behaviours, thoughts and feelings, and addresses them alone, with the whole focus being to control and manage the symptomatic manifestation of the depression for which the client was referred. It is the equivalent of laying that crazy paving: and, like a street full of houses with crazy paved front drives, what you end up with a few months and years down the line are some where, every so often, someone has bashed down the lumps and bumps and patched up the cracks, and others where it's heaved and broken up to end up as a dangerous, treacherous mess - either way, not the maintenance-free perfect option it was sold as.
This isn't an attack on CBT: I use it myself, and I think it is a fantastic way (with particular kinds of client) of getting people on their feet and out from behind behaviours and coping strategies that served them well in the beginning, but which they are now hamstrung by. Maybe it's dismissing it a bit lightly, but to me it's a "sticking plaster" or a "crutch", something to enable them to function well enough that they can cope with doing some more in-depth therapeutic work to address the underlying causes of their difficulty. To do a particular kind of job, it's an effective and powerful tool. Used in the wrong way, its problem is not that it's become less effective - just that it's probably being more and more misapplied.
