CBT is the NH’s standard front-line therapy. It has an excellent emphasis on how what we think controls controls our lives, how we have choice to think useful rather than un-useful thoughts, and how that leads to life-changing behavioural change. For some people this is revolutionary knowledge. NHS therapy presents this simply and directly in a way that’s easy to understand. Many people get good results from it.
I nevertheless confess to a curmudgeonly attitude to CBT. It’s good therapy in it’s right place. But I object to its claims to be the best or outstanding therapy.
These two links put this viewpoint well and I don’t need to repeat what they say:
“Therapy wars – the revenge of Freud” by Oliver Burkeman and
A quick fix for the soul by Darien Leader.
There’s good evidence that another cognitive-behavioural method, Solution Oriented Therapy (SOT), can be much more effective. In a study of offenders in California who were spared prison as long as they did therapy, prisoners who did SOT had half the reoffending rate that prisoners who did CBT did, and got the result in half the number of sessions. You could reasonably say SOT is four times as effective as CBT.
CBT stands for cognitive-behavioural therapy. A large part of what I do is cognitive and it is behavioural; but almost nothing of what I do has the rationalist, protocolised and emotionless philosophy of CBT.
CBT was invented by American psychoanalyst Aaron Beck in the 1960s and was at the time a breakthough in therapy. Beck decided that psychoanalysis, in the form of endless talking and self-reflection, simply didn’t work (I agree, endless talking gets nowhere). He took the bold step of sweeping away all the processing and found his patients did much better when he instead said to them (in my words) “Stop telling yourself worrying thoughts and step by step, get on with life.”
It is true that therapy which focusses only on looking inwards can take forever to get nowhere. But what makes for real, deep personal change is a flexible, balanced mixture of action and inner process, a balance of thought and emotion. In my view Beck threw out the baby with the bathwater. CBT, even when useful, is shallow. That’s not just my opinion, it’s what a proportion of my clients who’ve previously had CBT have told me.
The spirit of CBT is to choose to think rationally about a problem (“cognitive”) and take active common-sense steps (“behavioural”) to challenge fears and insecurities. For example: do cats really bite if you stroke them? – try it, and find out; wise advice. In particular CBT changes what we say to ourselves about things. For example, you might change “I must succeed, or there will be unbearable consequences” to “I prefer to succeed. If not, there may be consequences, and if so I can cope with those.”
But CBT has crucial omissions: feelings, emotions and the all-important inner mind. In the CBT view, emotions arise from thoughts. And for some feelings and emotions, this is true. But most certainly not the deepest core feelings. Core emotions arise from a profound place inside us, far deeper than words. CBT is often appears to be just ignorant of these human depths. What more, when emotions are connected to thoughts, the thoughts are often buried in the subconscious mind.
What’s missing from CBT – joy, emotions, the subconscious
Human life is about joy, discovery, courage, truth, risk, adventure, compassion, love, spirituality, finding and following the inner voice, commitment, sex, passion, joy and fun. To me, so is therapy. With its one-dimensional academic emphasis on rational thinking, it is close to impossible to find anything of these in any CBT manual I have ever seen. Yet it is not difficult for a highly effective, highly research-supported psychotherapy to be alive, empowering and human and reflect all these qualities. Solution Oriented Therapy does so magnificently.
Life is also about deep unconscious and superconscious forces. Again, it is impossible discover anything of these in CBT.
Although CBT has over time been forced to recognise the value of the client-therapist relationship, when I look at CBT books I find them dry. By contrast, solution-oriented therapy textbooks are inspiring and full of respect and appreciation for human beings and their capacity to overcome problems. CBT lacks a loving or expansive vision of human potential. It is incomplete or more often simply wrong in its academic understanding of feelings and emotions. It is highly structured (“manualised” or “protocolised”) with little room for the creativity of the moment. All in all, CBT is a valuable therapy. But its self-belief that it is the best or only therapy, is plain crazy.