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Thrive: The Power of Psychological Therapy Paperback – 7 May 2015
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Whilst I acknowledge the author's main concern was to address the severe distress and impact on society caused by mental illness, I was also disappointed that the book does not seem to acknowledge (or least I didn't see this mentioned, if it was I stand corrected) the increasing unrealistic demands placed on CBT therapists themselves in their endeavors to deliver a 'small miracle' in the guise of a so called 'evidence based therapy' in the 6-20 sessions they have been commissioned to offer .
Whilst we often hear from reading books, or faithfully attending workshops by experts promoting the humanistic virtues of CBT, that of-course 'it's not a panacea for everyone' , 'nor is it about focusing on changing thoughts' and 'it's formulation led not prescriptive' etc. I feel the NHS has completely bastardized CBT to such an extent that this is now precisely how 'CBT' has become presented to patients. A simple 'bish bash bosh' approach with the expectation of providing a 'cure' for virtually anything relating to the psyche.
This has not been helped by years of various CBT 'big guns' such as Clark & others presenting what is essentially another type of psychotherapy as somehow a form of 'hard science' on a par with medical interventions. If only in reality it was that simple, and 'good' mental health was simply about symptom reduction. I personally feel there is a crisis in the 'world of CBT' ( no doubt the experts would deny such a thing), but I believe history will judge IAPT as an unsuccessful initiative and something that marked the decline of the 'evidence based psychological therapy'. Simply put, CBT can no longer deliver what is expected from it.
The current situation in the world of psychological therapies has also been exacerbated by years of reluctance from various professional bodies to actually 'professionalize CBT' which would protect the public from charlatans advertising themselves as 'doing a bit of cbt'. This in-turn, I fear has not been helped by the political sentiment echoed throughout the book, of 'CBT is for all', which ignores the harsh reality of a 'post recession world' where therapy seems to be the only freely available mental health resource on offer in the NHS . Consequently therapists who understandably are appropriately using their clinical judgement & dare to say that someone may not be appropriate for CBT are looked upon as somehow 'denying a person a service'.To say 'cbt is not for you' is now politically incorrect! This ludicrous position is not helped by the sentiment expressed in this book.
The book also does not address the lack of any apparent robust clinical supervision put in place for more junior staff which with the benefit of hindsight seems incredible, given that CBT experts have banged on about the importance of clinical supervision for years . Clearly CBT is a very effective psychotherapy for some, however the 'one size fits all approach' of some NHS trusts mean that CBT is offered to people whom it may be unhelpful or 'contraindicative' to their current psychological resilience , (e.g see Jeff Young on so called personality disorders and using CBT). As a society we need to open about and transparent about this if the limited resources in the NHS are to be used effectively, not just offer folk therapy because there's nothing else (in fairness to the book this is more obvious in NHS secondary care than the primary care of IAPT).
In summary , I feel it's fair to say the book could perhaps focus less on being so self congratulatory re the success of 'evidence based therapy' paradigm within IAPT and look at the bigger picture for CBT and patient care, in other words what is actually going on 'the shop floor' within the world of CBT.