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Threats to Clinical Psychology from the CBT Stranglehold

Lloyd, J., 2009. Threats to Clinical Psychology from the CBT Stranglehold. Reformulation, Winter, pp.8-9.

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Currently many NHS jobs in Adult Mental Health are being advertised for Clinical Psychologists / Cognitive Behaviour Therapists as if the two were equivalent. Many Clinical Psychology training courses appear to consider it pragmatic to go along with this and seem to be trying to turn Clinical Psychologists into CBT therapists. Many clinical psychologists consider it is now essential to have an additional CBT qualification, if they wish to work in Adult Mental Health. Clinical Psychology Trainees describe how the academic content of teaching about therapy on the three year doctorates is now almost all CBT, with other therapies, including CAT, psychodynamic, and systemic often being given as little as one or two day’s teaching each on some courses, although others are more balanced. One clinical psychology training course has now withdrawn their CAT and psychodynamic teaching in order to be CBT compliant. Obviously, CAT practitioners in that area are trying to neogiate with them.

The range of therapies offered on placements, however, is wider as whatever is offered depends on the accredited supervisor’s preference and many supervisors trained prior to the current CBT monopoly. This will obviously change as earlier trained supervisors retire. Funding for the IAPT programme is currently ring-fenced but after 2010/11 responsibility for funding will shift to primary care trusts. This means that Trusts will be under further pressure to reduce other treatment options in order to pay for brief CBT.

There are two main problems for clinical psychologists. Firstly, theprofession of clinical psychology was not intended to be a single therapy training. CBT is not just the dominant psychotherapy but also influences the scope of the profession of clinical psychology. Hall and Marzillier(2009) write that CBT’s prominence in the profession of clinical psychology causes a “potential blurring of the boundaries between CBT and clinical psychology as a science and profession.” This reduces the range and versatility of clinical psychology. As Hall & Marzillier go on to say, “Cognitive processes cannot stand equivalent to all psychological processes.”

Viewing Clinical Psychology and CBT as equivalent and interchangeable means that descriptions of what is clinical psychology cannot ring true. The British Psychological Society describes the purpose of clinical psychology as: “to reduce psychological distress and to enhance and promote psychological well-being by the systematic application of knowledge derived from psychological theory and data. The core skills of a clinical psychologist are:

• Assessment
• Formulation
• Intervention
• Evaluation”

‘Prospects’, the UK’s official graduate careers website, describes Clinical Psychology as using “the methods and findings of psychology and psychological theories with clients to enable them to make positive changes in their lives. Clinical psychologists work with people of all ages who experience mental or physical health problems.”

In what way do these descriptions fit into 1 : 1 CBT? Is CBT sufficient or necessary for everybody? Assessment, formulation, intervention and evaluation in clinical psychology are most useful when informed by the whole body of psychological knowledge, not just one branch of it.

The second issue for clinical psychologists is that if they wish to enhance their skills through pursuing training in integrated and relational therapies that use a bio-psyche-social model, how can their training be valued if there is a CBT stranglehold? Unless that training is given the same status as CBT by the Health Professions Council registration, what chance do NHS clients have of accessing these more versatile therapies. Clinical psychologists will no longer be respected for being Jacks of all therapy trades, and Masters of Understanding of what each trade can and cannot do.

Psychologists have been recognised as knowing when to apply each form of therapy and how to develop new psychological insights and methods. If cognition, as only one aspect of the science of psychology, were to be privileged, then the opportunity for psychologists to be scientific, reflective practitioners narrows and weakens. How will that be recognised?

All of this leads to implications for CAT. Obviously, if the HPC awarded Practitioner accreditation the same status as CBT accreditation this could help safeguard the perceived value of CAT training by the NHS and prospective CAT trainees. However, there would also be a second benefit from the perspective of clinical psychology. CAT’s integrative and versatile approaches can help clinical psychologists to retain the well-balanced stance required of a scientist practitioner.

Full Reference

Lloyd, J., 2009. Threats to Clinical Psychology from the CBT Stranglehold. Reformulation, Winter, pp.8-9.

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