Dr Norman


The Friendly Therapist

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PhD (D. Psychotherapy); MSc (Counselling); MA (Mental Health); BSc (Psychology)
BACP Senior Accredited Practitioner; UKRC Registered; Prof Standards Authority Registered

BLOG POST – July/Aug 2015

Posted on June 28th, 2015


Cognitive Behaviour Therapy, (commonly just called CBT), has been very much the ‘flavour of the month’ in the NHS for some time now. These days, NHS patients with mild to moderate psychological problems are usually referred to a CBT service.KKndex This is particularly so in cases of depression or of one of the anxiety conditions. There are two simple reasons why this is so. Firstly, CBT appears to be as effective, (or not), as most of the other types of psychotherapy. Secondly, (and this is the biggie), it is cheap! CBT is cheap to deliver and its practitioners are cheap to train. So, it looks like a win-win situation all round. Well it does until we look a bit closer.

Before we more closely examine CBT let me make one thing very clear. In no way am I against CBT. In the right circumstances it is a very useful type of psychotherapy. It’s a method I very often use with my own patients – but only when it is appropriate. What I am very much against is the over-reliance that today’s NHS puts on to CBT. I am also appalled by the very low levels of training that the NHS requires of its CBT practitioners, especially of its Low Intensity grade of CBT therapists. Now, let’s get back to our closer look at this NHS ‘wonder-therapy’. Is it really so wonderful?

The first point to note is that CBT is only one of the very many types of treatment that properly trained psychotherapists can offer their patients. Obviously no individual practitioner can be an expert in all of these therapies and that is why, like any other profession, psychotherapy has its specialists and consultants. So, if psychotherapists have a wide range of therapies available, (including CBT), why should most NHS patients be directed towards CBT? Clearly patients should be referred for the most suitable type of psychotherapy for their needs, not just CBT for no better reason than it is the cheapest. After all, you wouldn’t expect GPs to prescribe aspirin for everybody simply because it only costs the NHS a few pence to provide. So is CBT a wonder-therapy for all NHS patients or is it really just a wonder-boost for the NHS bean counters.

The second point to take into account is the way in which the NHS trains its CBT therapists. Most of them are graded as ‘Low Intensity Practitioners’. Sad to say, novice Low Intensity therapists do not need to have had any prior experience in mental health work and their training only takes 45 days. Of course, a few of this new breed of low grade therapists, together with a few of the far fewer, (albeit better trained), ‘High Intensity Practitioners’ might, on a personal basis, have acquired additional therapeutic skills from elsewhere. However, the NHS prefers its CBT practitioners to limit themselves to only delivering CBT. They rarely get a chance to use any other skills that they might happen to have. Sadly, most NHS CBT therapists, particularly the Low Level CBT Practitioners couldn’t do so anyway – their training is far too limited.

Thirdly we need to further scrutinize CBT’s actual effectiveness. Clearly, if as is claimed, that CBT is as effective as the other psychotherapies, then do any of its alleged other weaknesses matter. Well yes they do. To begin with, just because a particular therapy apparently works for a particular patient that does not mean that it is the best therapy for that client. After all, an extraction would certainly cure your toothache and do so very cheaply too. However, most dental patients would prefer more modern, more complex treatments even if they cost more. Next, the question of long-term relief versus a short-term quick fix needs to be examined. Many mental health issues, many psychological disorders are of a chronic nature. This means that patients have a life-long, or at or least a very long-term, vulnerability to mental health problems. Without good management these patients are prone to relapse. As CBT is often a short-term fix then it is always possible that one of the more medium / longer term therapies might be more effective in such cases and therefore the true ‘treatment of choice’.

Like many other more extensively trained practitioners, I can, (and do), vary my treatment styles, not just between patients but also within individual treatment programs. In other words I can bring a professional flexibility to my work. Practitioners who only offer one type of psychotherapy, whether that is CBT or anything else, are simply not providing anything like the comprehensive service that today’s complex-needs clients require. Put bluntly, they are failing their clients.

In sum what I am saying is that CBT is an excellent form of psychotherapy but only at the right time and in the right pace. However, it is not the super cure-all that the NHS would have us believe. In my next blog I’ll tell you more about how CBT works. I’ll even let you into a secret. For many patients, using a professional CBT therapist is not always necessary – DIY can be pretty effective too. Next time I’ll tell you how.