How Not To Be A CBT Therapist?

‘CBT, CBT everywhere and not a drop to drink’. It has become common currency, but how often do you see it making a real-world difference to a person’s life? Therapists are likely to keep in mind, a ‘case’ were it has worked, recalling it in great detail to keep motivated. They may via the National Networking Forum, share ‘best practice’ with other CBT therapists, exchanging details of their hallmark case. Thereby, fostering the illusion that it is routinely effective.

But even the randomised controlled trials (rcts) of CBT for depression and the anxiety disorders, whose protocols are recommended by the National Institute for Health and Clinical Excellence (NICE), depict the results in terms of differences in average scores between those who have CBT and those who do not. It is not at all clear from the rcts, what proportion of people have a lasting recovery with CBT. However, the NHS Talking Therapies Manual takes the rcts as demonstrating a 50% recovery rate. This has been the basis on which the Service for adults and children has been funded to the tune of £2 billion a year. But there is no empirical evidence of a translation of the results of the rcts to routine practice. There has been no publicly funded independent assessment of NHS Talking Therapies.

As an Expert Witness to the Court I assessed 90 people who had been treated by NHS Talking Therapies, Scott (2018) and found that only the tip of the iceberg recovered. The results were the same whether they were treated before or after a personal injury. My assessment was based on the use of a ‘gold standard’ diagnostic interview, the most reliable metric in a Court of law. By contrast NHS Talking Therapies own claims are based on changes on two psychometric tests (PHQ-9 and GAD-7) over time. If this data was presented in Court, the Barrister would likely ask “is it not the case that people come to you at their worse, so that there will be some change, ‘time heals’?”, with a follow-up ” like members of the jury I do not doubt that people are pleased with your attention and that you offer hope, but there is no evidence that the Service is responsible, for the alleged recovery?” and “can you please explain, to the Court, why this level of funding is necessary?”.

Such cross-examination of the data does not take place either within the lead organisation for CBT, The British Association for Cognitive and Behavioural Therapy (BABCP) or within NHS Talking Therapies sponsored events. The British Psychological Society (BPS) has been happy to validate courses for low intensity CBT, in a rush to extend the empire of psychological therapy, without the methodologically sound database that high intensity programmes were based on, see Scott (2009) Simply Effective Cognitive Behaviour Therapy, London: Routledge.

Dr Mike Scott