The Government-vs-The Depressed. A Panacea? Maybe not.

Cognitive Behavioural Therapy (CBT) is;

"a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviours and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures." Wikipedia.

So CBT addresses and overcomes the dysfunctional through reasoning and reality checks and if the practitioner is properly trained and qualified, skillful, and experienced it's good therapy that can work very well believe me. It is said to be time limited in as much as it is often claimed it can work to relieve and/or cure a problem of the psyche in a set number of sessions. It is therefore cost calculable. If each session is charged at £100 and it is estimated that the problem can be overcome in 10 sessions then the total cost is £1,000. Simple. Or so it seems. Read on.

Now from here I would like you to keep in mind that anyone can set themselves up as a Psychotherapist. They do not need any academic or practical qualifications 'proper'; if trained at all many are churned out by quack-factories that rely on gullibility and lack of regulation; there is no official state licensing; there is no meaningful regulation other than voluntary regulation; 'training and accreditation bodies' they may join could well have been set up simply as a way to add street cred to their claim of being qualified; - or they simply may read a book, take an on-line course lasting a couple of weeks, or just merely have business cards printed and get on with their version of the job. Again, simple.

But let’s say that you’ve sourced a properly trained, properly qualified CBT practitioner who is a member of a well respected exemplary and unimpeachable organisation. Good stuff to come no doubt. And if you form an efficient working partnership with the therapist, commonly known as the ‘therapeutic alliance’ then good things may very well come. However, there is a potential down side.

As much as CBT is heralded and touted as being a ‘one-size-fits-all’ form of intervention it simply does not suit some. Not all people react in a positive manner towards CBT and come out at the other end ‘cured’ or even feeling that they have improved in any way. In fact, if it fails after them being told by all and sundry and especially by those that should know better that it is the only way forward and that the ‘one-size-fits-all’ approach works universally then it can well add to their feelings of negative self-worth and actually deepen the problem – “I’ve failed again. I fail at everything.” I’m afraid the ‘one-size-fits-all’ approach is not much good then, indeed potentially counter-productive. People are individuals and react to CBT (indeed all forms of therapy) in different ways. Sorry, but that’s just a matter of fact. Being a CBT practitioner myself I would love to tell you otherwise, but that would be a lie.

However, one of the reasons CBT is latched on to as ‘super therapy’ by those with an eye more on money than anything else and who would like to convince themselves but more importantly the general public that it is the magic bullet of therapeutic interventions is that a cost per head can be calculated in advance and a spending limit can be put on it. 

As an example let’s just take what has been called “the common cold of the psyche” – Depression. (By the way I would describe it in far more serious terms but this is just a working definition ok?) Thus, if it can be said by the CBT therapist that he/she can raise someone out of their depression in 10 sessions at £100 per session then the spend will be £1,000 and to get that back from taxes and NI contributions when they then return to work post treatment will make that treatment ‘cost neutral’ within months. Once again – simple eh?

Now please don’t get the wrong end of the stick at this point. I am not criticising CBT. It can be one of the most effective and efficient therapeutic intervention strategies on the face of the planet. All I am saying is that it is not efficient and effective with everyone that walks through the therapist’s door. Now and again it just doesn't work and if that’s the case it should be substituted for a more appropriate patient orientated, tailor made therapeutic approach that suits the individual seeking help. It's the patient and their needs that should be at the centre of any therapy. Not trying to force fit them into a rigid therapeutic straight-jacket (excuse the pun) that isn't fit for purpose.

The problems that I see at the moment are rooted firstly in the idea that this government are looking to make therapeutic intervention mandatory (a bad idea in itself) for people unable to work due to mental health issues (let’s stick with depression) and the idea that, if after a short course of CBT, their depression has not lifted then they will be stripped of all and any state benefits on the then ‘proof’ that they are/were faking it. And that because, based on recent experience, it seems to me that this is the kind of flimsy ‘evidence’ this government would be looking for in order to justify to Joe Public that ‘these people’ are ‘scroungers’ and ‘benefit cheats’ and that really there’s nothing wrong with them and they should ‘get out and get a job’. More hate, more division, more grist for the propaganda mill.

Secondly that, in the spirit of the neo-liberal god of ‘competition’ this will be offered out to the private sector where firms like Atos will be able to apply for contracts to deliver this ‘service’ to those that are suffering mental health problems and, again keeping in mind recent experiences, in concert with the fact (above) that anyone can set themselves up to be a Psychotherapist the temptation would be to employ the badly (if at all) trained therapist at say £40 per session (the unqualified work cheap), cut the session numbers to the bone, and make huge profit not only from the surplus charged to government but at the very same time shovelling people out in to the workplace declared as ‘fit for work’ on the word of a quack not properly qualified to pass judgement after delivering a therapeutic intervention they were not qualified to administer in the first place.

Perhaps though I am being too cautious, even maybe suspicious, but sorry as I may be about that it sounds so plausible to me as a way forward for this government to justify even more cruelty that I am leaning more and more towards this as the minutes pass.

Is it me?