The Myth of CBT In Routine Practice

search as you might, CBT is a scarce commodity in routine practice. In Coleridge’s poem ‘The Ancient Mariner’, the sailor bemoans that there is ‘water, water everywhere/ Nor a drop to drink’ because it is salt water. The CBT prevalent in routine practice is just this, ‘salt water’. The myth is that this ‘salt water’ can make a real world difference – return the psychologically dehydrated to their usual selves. Dear Clinical Commissioning Group the CBT that you see is salt water.


The reality is that services are populated by terrified therapists, clutching their papers, glancing hurriedly from the PHQ9 to the clock, which will soon announce the arrival of the next test of their exhausted therapeutic skills. The client departs with a promise of intervention strategies that never materialise, because of repeated derailments. The IAPT therapist has the added threat of being shamed in front of colleagues over their poor recovery rates.

But the story from IAPT and BABCP is that therapists are ‘scientist-practitioners’, carefully reflecting on the effectiveness of homeworks set and distilling with the client new, specific challenges.

Nothing will change until we challenge this stereotype of CBT therapists at the coal face.


CAMHS and secondary care are unikely to be the promised land for either clients or CBT therapists. In CAMHS there is a penchant for declaring that everyone is in need of family therapy, even if you are the victim of the Manchester arena bombing! In secondary care the cbt therapist is often a token gesture in a service dominated by a consultant psychiatrist. In private practice it is the ‘Wild West’ with almost anything on offer, from alleged cbt to the real thing.

Dr Mike Scott