Why is CBT such a dominant therapeutic model?

This section is to give an overview of different models, different therapeutic orientations and techniques
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Why is CBT such a dominant therapeutic model?

Post by miriam »

It's about evidence base (and in a broader way it's also about the historical dominance of the medical model).

People are referred to psychological services to address a "problem", normally a cluster of negative symptoms in behaviour, mood or thoughts/beliefs. Therefore, in line with a medical model, the treatment needs to measureably reduce these symptoms in the way that anti-biotics would reduce an infection. And CBT has the best evidence for reducing symptoms, improving client evaluations of themselves, and maintaining that positive change. Other forms of therapy tend to (and I generalise vastly) do something the therapist thinks will help, that the client is prepared to go along with - but there is less (or no) evidence that this leads to measureable improvements (of course there is the argument that some things are not possible to measure, and clearly no research evidence of change doesn't mean there is no change).

I don't personally think that CBT has to be a treatment focussed on negatives - you can work on building up the positive thoughts and behaviours just as easily as reducing the negative ones - and CBT also doesn't have to be used in isolation, for example I often integrate it with personal construct work that is much more client-centred, or cognitive analytic models that are much more about relationships.

I once went to a three day experiential training on building self-esteem, and the closing exercise was for everyone to write a short message for everyone else (we each had envelopes to put the messages in, and the message could be anonymous). I still have my messages, and they really touched me - in fact I totally enjoyed the whole experience of doing a session per week in an NCH Action for Children post-abuse project, as the culture was so positive and nurturing, but that's another story. Anyway, one of my messages was "nice to meet such a human psychologist, stay that way". I took that to mean that his mental image of a psychologist would be someone who was so academic/manualised/burnt out or whatever that they couldn't relate to people just as another human being, and that he felt I wasn't (yet) like this. Well I think that plenty of psychologists are not like that (even ones who are quite academic, or burnt out, or use particular structured treatment approaches) and that one of the joys of being a psychologist is that opportunity to draw upon models, yet integrate them in your own combinations to suit your personal style and beliefs. And that means there are a lot of psychologists who are positive. In fact, if you ask clients I would suspect that most of them would feel "built up" by their work with psychologists, not just that their symptoms have reduced.

I don't know whether that adds anything to your understanding of the topic. Just my thoughts.

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