I don't know of many clinicians who use CBT (and many who say they use CBT are really only using CBT principles and haven't done any accredited training) who believe this crap about it being a universal panacea. Mental health services have long been saddled with the emotional consequences of inequality and injustice, CBT didn't invent this, this is just a particularly egregious attempt to individualise the cost of political and economic decisions. No therapy should or can be used as a substitute for solidarity, action and social justice.
While it's certainly true that CBT focuses on what maintains a problem rather than what initially caused it, it's absolutely not true that CBT never looks at causes, schemas and underlying beliefs. That is absolute nonsense. The reason CBT focuses on what's keeping something going is that a lot of time has been spent working out that for most people it's the most helpful thing to do. That doesn't mean any therapist worth their salt should think it's the only thing to do.
As someone said upthread, often very progressive ideas can be highjacked by government who see it as a cheap, individualised option. This has absolutely happened to CBT. I'm increasingly concerned that there are a lot of people with vested interests of their own absolutely desperate to kick CBT while it is down though. It still remains for many people the absolutely best chance of recovery.
I can't help but get the feeling that a lot of this is in response to my post about the use of CBT, so let's get a few things straight.
First of all, I don't think anyone has said anywhere (certainly not on this thread) that practitioners think that CBT is a universal panacea. I
have said before that I think CBT has been terribly oversold, and I'd stand by that - and I have also said that part of the reason it tends to be seen as some kind of cure-all in certain quarters is because it's been sold by its proponents as the answer to all ills. It's interesting that my attempts to suggest otherwise are met with such an implacable - and, dare I say, defensive - response, which makes it that much harder for anyone to put the counter-argument that says that, actually, CBT, just like any other therapeutic modality is good at some things, not so good at others.
I take your point that CBT can be used to examine problems in greater depth, but - and be honest here - how often do you think that really happens, when pretty much all the CBT on offer is being delivered as solution-focused short-term therapy, increasingly frequently as a manualised process which doesn't really offer either the time or the space for excursions into deeper underlying factors? In my experience, including as a practitioner of short-term solution-focused therapies (including some elements of CBT), it is something I see happening extremely rarely. I see quite a few clients who have filtered back from CMHT (usual point of contact for adult psychiatric problems) referrals where their sole experience of therapy was a very lightly-trained CPN (community psychiatric nurse) delivering the most superficial interventions where they are often told that the early life stuff is "behind them" and that they should "forget about it and concentrate on moving forward". These are people calling themselves
therapists saying this stuff, and it's the real reason why CBT's ascendancy appears to be coming to an end - because all people know about it is what they're told, and what their experience tells them, and right now what is happening is that a lot of people are associating CBT with an unhelpful, and often somewhat punitive style of working. I have clients who have come to therapy with me suspicious and nervous, and who need strong reassurance that the "therapy" we're embarking on is absolutely not the same as the "therapy" they last had, and which for them was often actively unhelpful. If there is any pique in my attitude towards this, it is largely driven by the fact that clients have been unnecessarily harmed and discouraged from seeking further help directly thanks to such poor interventions - at least for me, the fact that those interventions have been done under the banner of CBT is irrelevant, but it very frequently is not for my clients.
You and I both know that that's not really what CBT - or any therapy - is really about, but that's the perception, and my feeling is that if the therapy industry, and particularly that bit of it connected with CBT training and validation, doesn't get its house in order, the sector as a whole will suffer from the negative perceptions these ham-fisted interventions are creating. And the defensiveness from some quarters of the CBT end of things, whenever it is suggested that it is misapplied or not used appropriately, certainly doesn't help, or encourage a sensible debate.
I don't have a vested interest in "kicking CBT while it's down". I am not ideologically opposed to the use of CBT in therapy - I think it is a fine, and somewhat unique, modality that has a valuable role to play in all kinds of areas. But not the only one, and by no means one that is universally beneficial to all kinds of client, and all kinds of condition. If I have appeared to be being critical of CBT, it is only in the same way that I would be critical of someone who was attempting to drive screws using, say, a paintbrush.
And I think I'd want to see a bit more of an evidential base for your claim that "It still remains for many people the absolutely best chance of recovery" - I suspect that this is predicated on the fact that so many of the commissioners of health services are still hypnotised by the notion that CBT is somehow fundamentally better simply because it has some kind of embedded outcome measurement, and commissioners like measurements, so I suspect that the claim doesn't really relate to CBT's inherent superiority so much as the fact that, for most people, it's the only therapy they can access, regardless of its suitability for them - something which, as I have said above, I have seen ample examples of in my professional experience.
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