CBT

I'm trying to make up my mind about what I really think of CBT (Cognitive Behaviour Therapy). CBT is a bit of a hot topic at the moment - it's the therapy recommended in many of the NICE (National Institute for Clinical Excellence) Guidelines - the treatment of choice for anything from depression to schizophrenia. I've got views of CBT from both a personal and professional point of view. On a personal level, I engaged in 12 sessions of CBT over about 6 months with a private therapist. At the time I also read lots of CBT informed self-help books such as Mind Over Mood: Change How You Feel By Changing the Way You Think and those from the 'Overcoming' series.

The tools of CBT were pragmatic and portable and they made sense to me. I quickly began to spot my own 'cognitive errors' - catastrophising, discounting the positive, labelling, should and must statements etc..... What strikes me about my own CBT was it's utility while I was seeing my therapist ..... However, once my sessions were over and I went back time and again to the books and the thought records, I had this dawning sense that despite knowing it in my head, I wasn't experiencing it in my heart, an observation that has been identified by Deborah Lee in her chapter in Compassion by Paul Gilbert.

I had this sense that there must be something wrong with me. I was 'working the programme' and superficially things were improving but deep down I still wasn't feeling 'right' -whatever that is.

And so with this in mind, how do I experience CBT from the other perspective - that of being the CBT therapist? I have worked with a number of clients using a CBT framework throughout my clinical training to date. Despite CBT theory emphasising the need to be collaborative (coupled with the desperate desire on my part to avoid positioning myself as the expert), it has been my experience that clients want me to be the expert - I am after all offering NHS funded services to the client (referred by their GP or some other similarly identified expert) as someone who can help them. And, implicit in the theoretical basis of CBT is the message, "Your thoughts are not the most helpful, let me help you change them". And I have seen people change their thoughts, schemas and core beliefs and been inspired and privileged to be a witness to this change. But I have also seen people for whom the thoughts that they were having may not have been the most helpful but were the most rational given their individual social environment. Someone living on the poverty line. Or the victim of racism, sexism or homophobia. In which case working with someone's thinking patterns feels like one small part of the jigsaw for whom those 8 NHS funded CBT sessions only succeeded in scratching the surface.