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There is currently a petition running to “reform the NICE guidelines and end the bias towards Cognitive Behaviour Therapy (CBT) in the IAPT programme”.

I am supporting this because, metaphorically speaking, 1% of the UK’s Counselling and Psychotherapy profession is in danger of enjoying more influence over the delivery of mental health services than the remaining 99% combined. I have no official figures to back that up with, but you have to admit it sounds good!

Ok, so that’s mostly artistic licence; however, I’m not making the comparison lightly. Nor do I really have much beef with CBT in itself; gestalt integrated cognitive and behavioural approaches to therapy back in 1951 (see Perls, Hefferline and Goodman‘s Gestalt Therapy on working through introjects cognitively (pp189-210) and behavioural experimentation (pp14-17). Maybe I’ll write more on this at some point, but in essence, I think that good gestalt therapy already encompasses much CBT).

My objection, along with the authors and co-signatories to this petition, and the people involved in the Occupy movement, is the concentration of power into a small minority. And that is what is currently happening with respect to the provision of officially sanctioned therapy services in the UK, as CBT is promoted as the evidence-based therapy of choice. And this despite the relevance of the measures underpinning that evidence-base being questionable, and a lack of longitudinal and follow-up studies. As well as the inherent logical flaw in claiming that any form of therapy has an evidence-base for efficacy in treating conditions such as depression, when there isn’t really any solid professional consensus about what depression actually is.

I support the need for evidence-based therapy and for research into counselling and psychotherapy generally. If we are to avoid a bizarre therapeutic turf war between Great Houses (my theory’s harder than your theory!) then counselling and psychotherapy as a profession needs to live up to its own values and support the part that research plays in developing reflexive practice. But that means developing a research tradition that is appropriate to the area under research. Which must include philosophical exploration into what can realistically count as a measure by which efficacy can be assessed, if indeed such a thing is possible. Remember, all information is potentially evidence; the term ‘evidence-base’ merely means an amassed body of information used to argue for a specific position. It does not constitute a proof.

In my experience, there is no such thing as the cure-all magic pill when it comes to the human condition. There is great danger in pinning so much hope on CBT, and it is the same danger that applies in any idealisation of another. Sooner or later, the idealised other will fail to meet the impossible ideal of perfection and fall from grace. At which point, the idealised other becomes demonised. That is the inevitable fate of any therapy that is pointed to as the answer to every individual’s problem. If gestalt therapy were being lauded in place of CBT, I’d be arguing the same thing; probably more passionately, as on top of my general feeling that therapeutic efficacy has more to do with the relationship than the theory involved, I’d also see the risk to myself as a practitioner of an idealised theory.

Consider my argument to be one in favour of biodiversity in the therapeutic field and you’ve probably got it in a nutshell. I won’t demand that you agree with me. Rather, I present you with my opinion, a petition, and an invitation to consider your own position on the issue.

You’ll find the petition here.

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