Monday, February 19, 2007

Anyone For CBT...?

The government is proposing an expansion of psychotherapeutic services within the NHS. Fabulous news. Currently, the only modality being considered in this expansion is Cognitive Behavioural Therapy. Not so fabulous news. Please sign this petition, asking the government to give due consideration to other psychotherapeutic approaches and modalities. And then tell your friends.

PS. Following a lively debate with the lovely Clare at Boob Pencil some time ago, I promised a follow up post on the whys and wherefores of CBT and other therapeutic approaches. I still haven't got round to it. So in the absence of a post discussing why CBT is not necessarily a panacea for all mental distress, I refer you to the aforementioned discussion which just about covers the issues. I can only apologise for my inefficiency....

11 comments:

THE PERIODIC ENGLISHMAN said...

Hmm. I'd quite like to see a post about the "whys and wherefores of CBT and other therapeutic approaches", as it happens. In the absence of such, however, I enjoyed re-reading your previous discussion with Clare (and the later contribution from Liz). Just as a complete aside, that particular thread shows that it is possible to disagree and remain civil - something often lacking on the internet. Mind you, I think you both pretty much agreed that it was each to their own, ultimately.

That would be my view, certainly. It's a wee bit tricky, because I'd like to talk about this without giving anything of myself away - and I'm not sure if that's possible.

Very broadly speaking then - my mum was a clinical (later, chartered) psychologist. I have grown up with a slight bias against psychotherapy, for whatever reason, and this rather coloured my judgement. I later discovered that this bias was bollocks and was based on nothing but misguided prejudice. I consequently have an abiding dislike of one side claiming superior methodology over the other. Does that make just enough sense to be clear?

I should also say that I have very good reasons to believe that CBT can be extremely useful. As always, it comes down to the skill of the practitioner and the personal preferences - or comfort - of the patient.

This may just have been a very long way of saying "each to their own". A dull conclusion, no doubt about it, but almost certainly true.

Kind regards etc.....

nmj said...

I followed this v interesting debate too, & echo what PE says, & what I've said before, robust debate is great as long as no one gets hurt, & nice to see it done here with such civility. With therapy there is so much at stake, & if something works for you, you are going to, of course, promote it, but doesn't mean you can shred other therapies as being useless. I had CBT a few years ago when a relationship was failing, but in my case, I hade to make sure the guy knew I wasn't there to have my ME treated but because I was having difficulties with a relationship. (And that is my bias against CBT that it is being touted by some very dodgy people as a cure for my illness.) The sessions were quite useful, but only up to a point & the guy (who was actually an NHS clinical psychologist) was quite young & I honestly felt he didn't have enough experience of relationships, for him to truly get what I was going through. I also had to wait almost a year for the appt.

Ms Melancholy said...

Hi Mr PE - I will do this post at some point. I would like to do the arguments some justice though, which means finding a bit of time to write it. I agree with you entirely that the argument gets polarised perhaps unnecessarily (my theory is better than your theory)and that psychologists and psychotherapists have traditionally had very little respect for each other. Personally, I think we have more similarities than differences but the differences are important. The most important thing is that good practitioners exist on either side of the debate. I like it when you are serious, by the way. Its very sexy.

Hi Nmj - I think you make a really important point, that CBT is touted as a cure for pretty much everything! That is my gripe with it: different issues, processes, depth of trauma or rupture are all treated in the same way by someone who has learnt a technique. I do like CBT - hell, I practice it with a lot of clients. But some clients need something different and I don't think CBT can offer that kind of depth.

Thanks for sharing with the group, y'all. How are you feeling, now?

nmj said...

It is sexy when PE is serious, isn't it?

What are your thoughts on cognitive analytic therapy?

Ms Melancholy said...

Hi nmj - strangely so, yes...

On CAT - I think that is actually what most therapy is: analysing our frame of reference, discovering how we redefine circumstances to fit that frame of reference, discovering how we act in order to bring about that frame of reference and what we might do differently to bring about a different outcome. The difficulty is when one's frame of reference is predicated on a very early interruption to relationship: we need a bit more than just a cognitive analysis of it and I think that's where a relational therapist can work with the therapeutic relationship in a more implicit way (not just analysing it) to enable the client to have a different experience of themself in the relationship that is happening in the room. I think that the distinctions between what we do are few, actually, but that a relational therapist can bring a new dimension if that is what is needed. People without a relational training find such rigid defenses very hard to work with, because they are beyond just the cognitive. I think I just wrote my post. Thanks, Nmj! Just curious as to why you ask? Is it something you have come across?

nmj said...

I haven't come across it yet, but someone suggested CAT as an alternative to CBT. And although CBT was fairly hopeless for me (in reducing anxiety), I would be a bit wary of a process that focuses more on the actual dynamic between therapist & client. But I looked CAT up, and I liked the sound of it.

Ms Melancholy said...

If you know that you are not dealing with early attachment issues, then CAT is probably what you are looking for. Am not entirely sure there is a huge difference between CAT and CBT - the main factor is the quality of the therapist. I know of a good Transactional Analyst in Edinburgh that I can email you if you want...? TA can be either cognitive or relational, depending on what you say you want from the work.

nmj said...

yes, ms m, that would be handy to have on file, but there is no rush . . . my email is on blog profile. you are kind, thank you.

Ms Melancholy said...

You're welcome. Will email you his details when I find them...(need to root around a bit for it.)

Phantomias said...

I think there is no one tool to solve all problems. The more tools the therapist has at his disposal, there more likely he is to choose the right approach for each patient. CBT is a nice tool to have, but there are many others that are equally good if not better (imho)

Dr Leila Edwards said...

I'm a therapist, trainer and supervisor whose primary modality is hypnotherapy, but am eclectic in approach, having been trained and worked over a period of 30+ years in person-centred counselling, Gestalt, breathing therapy, psychodynamic and developmental approaches (Tavistock), CBT (and interested in the new 'mindfulness' therapies drawing on Buddhist Psychology), NLP, 'energy healing' (primarily EFT) and, more recently, Satir's Transformational Systemic & Conjoint Family Therapy. I have a positive humanistic approach and in my work as a trainer and supervisor of other therapists, as well as in my own practice, currently based in the middle east, I assertively challenge the pharmaceutical and psychiatric labelling and pseudo-scientific model of human development, behaviour and experience. A close family member has just been admitted to temporary bed in an NHS psychiatric unit. Apart from being given a dose of Norazepam (she wanted to sleep and was given 2 mg despite having been on an alcoholic binge all weekend), she's pretty much been left to rest whilst they try to find a bed in another unit. I'm told that CBT has a 2+ year waiting list and that all the positive recommendations of 'The Depression Report back in 2006 have had little impact on the reality of NHS psychiatric services. She has limited financial resources and is in urgent need of a competent therapist who has the high success rates I have with my own clients. I don't want her fobbed off with a label and medication. Neither does she. I want to support her in getting effective help in developing better coping strategies and to grow up (she's 36, time to start taking responsibility and become a healthy adult!). Some suicidal talk and ideation, but clearly a cry for help (in her own words). If you have any suggestions for good therapists in London, preferably within easy reach of Clapham, who charge reasonable prices, please contact me a.s.a.p. on phileila@me.com or SKYPE: drleila.edwards. Many thanks.