Let’s put the “T” back into CBT
| Date | 10 December 2018 |
| DOI | https://doi.org/10.1108/MHRJ-02-2018-0002 |
| Pages | 240-245 |
| Published date | 10 December 2018 |
| Author | James Binnie,Marcantonio Spada |
| Subject Matter | Health & social care,Mental health |
Let’s put the “T”back into CBT
James Binnie and Marcantonio Spada
Abstract
Purpose –The purpose of this paper is to critique the current manner in which cognitive behavioural therapy
(CBT) is delivered, with a focus on the impact of evidence-based practice.
Design/methodology/approach –This paper is based upon the experiences, ideas and clinical practice of
the authors.
Findings –The reductionist approach based on psychiatric diagnosis is put forward as the mechanism by
which CBT has gradually lost its status as a form of psychotherapy.
Originality/value –An alternative framework based on revitalising CBT as a client centred, problem-based
and formulation driven form of therapy is put forward.
Keywords Formulation, Cognitive behavioural therapy, IAPT, Critique
Paper type Viewpoint
1. Introduction
Can you imagine computerised existential psychotherapy? Or even better, a mobile phone app
that delivers psychoanalysis? We cannot either; however, another model of psychotherapy is
frequently available online, via self-help books or in brief workshops. That model of
psychotherapy is cognitive behavioural therapy (CBT). CBT is now seen, by many, simply as a
set of interventions and techniques rather than a form of psychotherapy, which is how it started.
This paper will examine this ideological shift and propose an alternative perspective. This is a
reflective paper and the viewpoints put forward arise from the clinical experience of the authors,
an awareness of current practice and an appreciation of existing literature.
CBT is an umbrella term for different types of psychotherapies, often with conflicting theoretical
frameworks. Dissatisfaction with psychoanalysis led a psychologist (Albert Ellis) to draw upon Stoic
philosophy and develop rational emotive therapy and a psychiatrist and psychoanalyst (Aaron Beck)
to develop cognitive therapy. These were intertwined, over a 30-year period, with the solid theoretical
and research foundations of behaviour therapy to form CBT. Overtime, sub-types of CBT flourished,
with some returning to radical behaviourism, e.g., acceptance and commitment therapy (ACT; Hayes
et al., 1999); Buddhism, e.g., mindfulness-based stress reduction/cognitive therapy (Kabat-Zinn,
1990; Segal et al., 2002); detailed laboratory work, e.g., meta cognitive therapy (Wells, 1995); whilst
others focussed on specific populations, e.g., dialectical behavioural therapy (Linehan, 1993) and
schema therapy (Young et al., 2003); to mention some of the leading perspectives. It is apparent that
the CBT family has only weak bonds between its members if onec onsidersthe diversity of theoretical
orientations and recommendations for practice. One of these bonds is evidence-based practice. Of
note, Beck (1976, 1979) was one of the first to rely on psychiatric diagnosis when developing his
theories. Given his professional background as a psychiatrist, this is hardly surprising; however, his
decision has had far reaching implications that affect virtually all psychological practitioners, applied
researchers and most importantly the clients seeking help.
2. A critique of current practice
The construct of “evidence-based practice”has been taken from evidence-based medicine
(Sackett et al., 1997) and is thus highly entrenched in the medical model of mental health.
Received 2 February 2018
Revised 13 June 2018
5 July 2018
26 July 2018
Accepted 26 July 2018
James Binnie is Senior Lecturer
in Counselling Psychology and
Marcantonio Spada is
Professor of Addictive
Behaviours and Mental Health,
both at the Division of
Psychology, School of Applied
Sciences, London South Bank
University, London, UK.
PAGE240
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MENTALHEALTH REVIEW JOURNAL
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VOL. 23 NO. 4 2018, pp. 240-245, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-02-2018-0002
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