I found David Veale’s article on CBT (‘Psychoptherapy in dissent’, therapy today, February 2008) both odd and predictable. In particular, the statement that ‘anecdotes and personal experience for a particular approach are for the media – not for making public policy decisions’ struck me as peculiarly interesting, both as a statement of reality, but more particularly as something that could be said by any therapist. In the first place, anecdote and personal experience are constantly used as the foundation for public policy, from the building of motorways to the regulation of therapies – a cause whose supposed benefits are based on no evidence whatsoever. I don’t think, however, that we need be surprised by this. As therapists, we know the power of personal narrative and how often distress results from a growing consciousness of the contradictions it contains. A major part of our work involves allowing the contradictions to come into the open and to allow the narrative to transform. If we are good therapists, we also know that there are two narratives in the room and that neither can be assumed to be the absolute truth.

More to the point, personal narrative is really all that we have, whether as individuals or as a society. Our Western society lives the narrative that we are rational beings; accordingly, scientific evidence always carries more weight than intuition or ‘irrational’ understanding. Indeed, the accusation ‘You’re being unreasonable’ is more damning
(and hurtful) than any amount of racial or other prejudice-inspired invective. We can react to the latter; the former leaves us disempowered.

Like any narrative, the Western self-view is riddled with contradiction. Hence, decisions rarely have anything to do with the rationale that supposedly provoked them. And, as with personal narratives, what does not fit is conveniently ignored.

The difficulty for anyone who tries to step outside the dominant narrative and to present a different view is that we cannot, by definition, provide the ‘evidence’ that is required by the narrative that demands such evidence – certainly not in the form that it prescribes; a bit like going into a pub at 10pm on a Saturday night and preaching the benefits of sobriety. Neither can we provide such evidence from within the narrative. The minute we step back into that world, we are governed by its conventions, and any attempt to explain ourselves becomes a nonsense.

I found it interesting, in this respect, to read in the same issue Richard Worsley’s article, ‘Lived experience’, on person-centred counselling. I found some of it clumsy and ill expressed; I did, however, feel inspired by the end of it.

The article was, I think, bound to be flawed. It is almost impossible to express from within the language of Western logic a concept that is so alien to such logic.

I felt inspired because I knew what Richard Worsley was talking about, and because I could experience the paradoxical tension between creative doubt and intuitive certainty and reaffirm my own commitment to that tension.

I note that Richard Worsley’s article started with an expression of doubt. David Veale’s article on CBT, by contrast, contained not one single word of self-critical examination. He questions who is ‘over-selling’ CBT. He, for one, I think. I noted no ‘scientist’s caution’ in stating what therapists ‘must’ become.

Please note, I am not dogmatically opposed to CBT; often that step sideways from a problem can work miracles. My suspicion of CBT applies to any modality, or idea, that not only works miracles, but can be ‘proven’ to work miracles – a bit like Christians who want to show that their faith is really completely scientific. Give me an old-fashioned, tub-thumping fundamentalist any day; at least I know what I’m dealing with.

I also see CBT as essentially invasive. Like any invasive technique, from cleaning out my ears with a cotton bud to having a tumour removed, enormous caution is required. Have I really exhausted every other possibility?

It is, in fact, more or less inevitable that CBT will become the dominant modality within the NHS.

The NHS is completely caught in the scientific narrative; it has consequently become an organisation first, and a tool for improving the nation’s health second. CBT, with its bias towards organisation, slots right in there.

It makes no difference how much evidence is provided to support other approaches; the dominant narrative will ignore such evidence – just as, on the far larger scale, we ignore
the evidence of technological destruction of the planet, and still believe that a scientific miracle will save us.

There is nonetheless hope, since the NHS (like society as a whole) is still run by human beings, and here and there humanity will always win through over the structures that regulate it. There will always be the practitioners who question what they have learnt and, as a consequence, step beyond that learning.

My first advice to anyone who is looking for a decent therapist is always: never trust anyone who won’t admit to having self-doubt.

William Johnston