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On CBT and the NHS


One of the things looked for when assessing someone for suitability when it comes to CBT is how up for it someone is. Being bang up for making changes and the ability to put them to use is almost prerequisite for getting access via the NHS. That highlights some of the limitations when it comes to getting access to talking therapy full stop without having to find your own in England. The fact it is time-limited is no doubt seen as a significant selling point. The public purse is tight, and what is considered to be efficient gets the go-ahead. It does not help that afterwards, we get asked to evaluate how helpful it was! Shouldn’t that be done along the way, and, should it not be obvious?


What this misses is the complexity of the lives we lead —the uniqueness of each of us as individuals. Sure, the techniques can be incredibly useful in the short-term. In my opinion, and to use a floral metaphor, CBT tends to what is above the soil: the leaves and flower get attention. What this misses is we all have roots. We all need those roots and good-enough soil to be watered, tended to, or we cannot grow. The leaves wilt, the plant rots matter how attention is paid to the surface elements if what is below the surface is ignored. CBT with all of its diagrams, gimmicks, and pretensions of ‘thinking your way out of it’ misses this. Many times I have heard positive stories of how CBT has helped, and indeed has, for a time. And yet, time after time, another person is sat with me wondering why with frustration, how they can’t get past what made them seek assistance in the first place.


CBT takes many feelings and reframes them (often unintentionally) as negative or narrow thinking without considering what brought them to that point. How can a worldview be changed if the validity of gets dismissed entirely? What positive change occurs when we told how we feel is invalid or wrong apart from adding shame onto already existing pain? In part, this is the advantage and sheer power of a psychodynamic approach. Exploring and holding raw, challenging feelings in a safe place are some of the most important parts of counselling. The validity of how you feel is not in question, here. The exploration of why, and being able to do so safely, bit-by-bit though painful at times helps detoxify and repair negative past-experiences and self-assumptions. That holding and exploration are what leads to a healthier relationship with not just ourselves but the world around us. The soil and what lies underneath does not get ignored; neither does the flower or the leaves. By reaching back just that wee bit further, there is more to be explored and healed. Core issues addressed, roots tended to.


CBT can be too generalised for complex emotional problems and histories. If some can reverse their negative ruminations and mood swings through CBT, great! I am all for what works for someone, but CBT won’t work for everyone. Look at it this way: if you are prone to irrational thoughts, moods, and anxieties which you don’t fully understand or cannot get a hold on, especially if those issues have been present for a long time, how can you merely think them away? Most people need to dig deeper than hanging their hopes onto simple remedies such as this.


It reminds me of the importance of appreciating the whole and not solely one part of a person. None of us can be summed up in one word in the same way that easy answers rarely solve complex problems. As much as it can be a lengthy business, non-CBT forms of counselling hold no dishonesty and have compassion for the above at its centre. None of us can truly grow and reach out past where we are without that.


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