Trusting your GP with Depression – the CBT car crash

Over the last two posts, I have summarized two of the four reasons why your GP should not be on your list of people to go to for help with your depression. One reason was that depression was not an illness and dealing with illnesses is what GPs do. The second reason is that antidepressants, even though prescribed by the bucket load in the UK just do not do what they say is on the tin.

To remind you, here is the list of the four reasons why your GP cannot be trusted with your Depression.

1. Depression is not an illness and therefore a medical approach is not the right way.
2. The evidence is clear – antidepressants don’t work that well.
3. Cognitive Behavioral Therapy on the NHS is not delivering and there are very good reasons why that is the case.
4. Our depression epidemic has to have a social dimension and doctors cannot be expected to help – afterall, that is not their job.

So why is Cognitive Behavioral Therapy failing to deliver?

The rise of CBT is an interesting parable of our time. It presumably began with the attempt by medical people to find a standardised non medical treatment for depression – one that would work as well anywhere in the country.

The result has been to elevate Cognitive Behavioural Therapy (CBT) above all the rest.

My feeling is that what attracted CBT to medical administrators (such as the NHS) was that they thought that they could see how it could be standardised – that a manual of appropriate CBT could be successfully applied anywhere in the country (like a hip replacement operation) by anyone who had had the appropriate training. CBT was attractive to medically trained people because it would seem to have much less scope than other talking therapies for the experience, prejudices and instincts of the practitioner to vary the treatment or horror of horrors for them to use their initiative.

There is more – just consider what CBT tries to do:

CBT is about challenging thoughts. It’s about changing how you think. It is about breaking down complex thoughts and behaviours that are keeping you stuck. It is about facing up to clearly unhelpful black and white thoughts such as – “I am stupid and people hate me” and “I cannot do anything about this and for the rest of my life, I am doomed” and so on.

But feelings come first. Especially feelings of exhaustion and the terror of not knowing why you are feeling so bad and depressed because you have no idea why you are lost in a vicious circle of tiredness and useless rumination.

In these circumstances and knowing that, why would you think for a minute that someone trained in CBT would have any idea at all what to do for you? Well maybe a tiny bit – but be no more useful than a peashooter attempting to down an elephant.

There is yet one more piece to this puzzle that you might be interested to know – which I think well explains why CBT has proven such a failure when applied in national programmes, such as the NHS’s IAPT programme. IAPT stands for Improving Access to Psychological Therapies and this programme has absorbed massive funding over recent years – to provide CBT across the nation and so stem and reverse our depression epidemic. And this goes to heart of why doctors cannot be trusted to help you with your depression.

Do you vaguely remember the Dodo bird from Alice’s Adventures in Wonderland? He who said “Everybody has won and all must have prizes.” Counselling is like that – everybody wins because they are all equally good. No one model of counselling has ever been proven to be better than any of the others. They all do some good and are better than nothing, but based on mountains of research from all over the world, for all kinds of models of therapy in all kinds of circumstances, the result is always the same. Yes ALWAYS. Everyone must have prizes.

So if you are looking for the model that is best, you will never find it. And neither of course will the NHS. And that really does for CBT if you think about it for a moment.

But there is a second truth that the research also shows to be true. It is that some therapists are better than others. It is not the model that counts but the counsellor.

Now just ponder that. It is a devastating and profound conclusion and flies in the face of so much that we believe instinctively and unthinkingly to be true. The NHS is looking for what does not exist – a counselling approach that is the best. And that is why IAPT is failing – as the evidence of its failure to deliver is now dribbling out.

And by rolling CBT out nationally and not choosing only good therapists or even trying to understand what it is that makes good therapists, but instead taking anybody who can be trained in it, they are dooming IAPT before it begins.

So what do you need to do when looking for help is to find someone good – with a reputation and a track record? Do call me to find our more.

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