A Barefoot Therapist Speaks

What is CBT?

2011-06-24T11:57:00.000+01:00

This is a question that often crops up - from students, from clients, from interested outsiders, from people interviewing me for jobs - and I want to give an answer that's both comprehensive and easy. It's up to you to decide how far I succeed!

What you see a lot of, these days, is people using the term 'CBT' as though it were the name of a specific therapy, and often confusing it with Beck's CT. I attended a talk, at the 2006 BABCP Conference in Warwick, in which the speakers described their research into childhood OCD. They said they'd compared CBT with Exposure and Response Prevention. Now that's pretty weird, given that Exposure and Response Prevention is a CBT. But what they meant (it transpired) was that they were comparing Beck's CT with Exposure and Response Prevention. These were well-qualified therapists, doing cutting-edge research, and yet they had been sucked into this terminological confusion.

It's pretty much the definition of what a therapy is (any therapy - including EST, Reichian Therapy, Analytical Psychotherapy, yada yada) that it seeks to replace an unwanted response with a preferred response. Like, if every time I see a worm I shriek and feel nauseous, the purpose of therapy is to change that reaction in some way, such that when I see a worm I stay calm. So what distinguishes CBT from other therapy models?

CBT, I argue, isn't a therapy; it's the umbrella term for a host of therapeutic methods. It includes Stress Inoculation, REBT, Exposure Therapy, Attribution Training, Self-Control methods, Beck's CT, and lots, lots more. On the whole we can categorise the CBTs into CTs and BTs, though any given implementation is likely to have fuzzier edges than that might suggest. For instance: are behavioural experiments a BT or a CT? I'd come down on the side of them being a CT, as they are meant to be persuasive. But opinions differ.

For me, the single concept that unites all of these CB Therapies is retraining. What we are doing is identifying unhelpful habitual responses, and teaching our clients how to retrain themselves out of those responses. In doing this they may exploit (under our guidance) a variety of psychological effects such as dissonance, habituation, overlearning, reciprocal inhibition, response competition and so on. So, exposure therapy retrains a certain visceral reaction, what we call arousal, exploiting the effect we call habituation. Or, practice of disputing irrational beliefs means practising a helpful cognitive habit (and, in Vivid REBT, forging an associative link between the unwanted emotion and the rational self-talk), which is a response that's incompatible with the original, harmful, response; so we're exploiting response competition and overlearning.

This is very different from behaviour modification. In BM the therapist is trying to modify the client's behavioural responses by manipulating the contingencies of their behaviour. For instance: if a child gets a hug every time it interrupts its parent, that's a contingency (if interrupts, then hugged). This is likely to result in a high level of parent-interrupting by the child. BM would look to change that contingency (to - perhaps - if interrupts, then ignored). Behavioural psychotherapy, on the other hand, involves instructing the client how to change their behaviour in order to alter their habitual responses, whether they be behavioural, cognitive or physiological.

Diary of a Nobody

2011-06-23T23:14:00.000+01:00

"Write the vision, and make it plain, that he may run that readeth it"
Habakkuk ii. 2

Here is the first tranche of material - a timeline of events so far. It isn't complete, and supporting documents will be added when we've scanned them:

http://www.thomist.webspace.virginmedia.com/Diary.pdf

Names have been changed to protect the innocent. The diary is the first item I pulled off the shelf - more details will follow as soon as we can get it all digitised.

Written material is MD's record of events: typescript is derived from the emails he had released by Head Office (chalk one up to transparency!)

The game is as follows: try to work out what rules "Zippy" and "Bungle" were following, and what authority they had for doing what they did. Try to work out what they hell was going on in their heads, and who they think they are! Fun for all the family!

Prolegomenon

2011-06-23T14:50:00.000+01:00

Isaac Marks wanted to create a corps of Barefoot Therapists - not doctors, not psychologists, but nurses trained in behavioural psychotherapy. I am (among many others) the fruit of that project. I was trained by Annie Telford, to whom I will always be grateful.

Over the last twenty-three years since I qualified I have gradually simplified and purified my conception of what Cognitive Behaviour Therapy consists of, what its principles are, how it works and so on. I will be be progressively mapping out the results of that period of contemplation.

I will define CBT, and describe what I'm minded to call the "neo-classical" approach. This doesn't mean that my style of CBT has a Palladian architecture, it means it has a Pavlovian architecture - its central point is classical conditioning. That is filtered through OH Mowrer's misnamed "two factor theory" (more properly, I'd argue, called "mediation theory"). It then spreads out into cognitive therapy, Perceptual Control Theory, mindfulness, exposure treatment, behavioural activation, experiential tolerance, cognitive dissonance, hypervigilance and much more.

I will also comment on current political issues within the world of CBT, including the BABCP and the NHS. I will post on subjects such as accreditation, or training, supervision, and so on.

These are the random and unstructured thoughts of a butterfly mind. Enjoy. Argue. Contribute.