November 6th, 2020
When I tell people I am a Cognitive Behavioural Therapist (CBT), a question or challenge like this is one of the most common responses I have had, and there is good reason to have this concern! CBT (especially in the UK) is very often used in a context, for example, the NHS, which is very time-limited and driven by pressure to meet mass-scale quantitative measures. The prevalence of CBT in this setting is because CBT has been very successful in providing evidence for its effectiveness over a short time-scale for many common mental health problems like depression, anxiety, and phobias. This functionality then extends into using CBT as a quick-fix for the mental health problems arising from an economic system that I would argue prioritises economic growth over health and well-being. In other words, getting people just healthy and resilient enough to be ready for work seems more important than giving them a sense of empowerment, self-compassion, and better quality of life.
Unsurprisingly, none of the above lends itself to creating a warm and welcoming environment with time to be holistic and expansive with treatment. There is often little time to look much into a client’s past in these contexts. I would also argue it is unsafe to open up very vulnerable or traumatic wounds with a client when the therapist does not have the time to work through the difficulty and support the client to a place of safety before the course of therapy ends. It must be said however, that many CBT therapists work effectively and with great compassion in these difficult circumstances.
Having said all that, once CBT is taken out of that time-pressured quantitatively-focused, and, I would argue, dehumanising context, it is simply a therapeutic method that facilitates greater awareness of our emotions, behaviours, thoughts, and how they interact. There is the option of exploring the past, the development of coping strategies, and many tools for exploring new goals and behaviours. With an added critical outlook, CBT can even be a framework to understand how we internalise and reproduce paradigms like patriarchy and racism, and how we can use our values to formulate and develop alternative ways of being. It can help us to understand and re-evaluate assumptions and behaviours that are rooted in our privilege or oppression.
I believe, therefore, that CBT is an elastic tool that has become the modus operandi for a certain format of short solution-focused therapy. If a therapist is conscious of how the tool can be used and clear about how they and the client want to use it, potentially in combination with tools from other approaches, the pitfalls can be avoided. Instead, they can work with a rich and flexible structure with the client’s needs in the centre.
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