Opinion/Commentary: Cognitive Behavioural Therapy (CBT) revisited

Three years ago, I wrote a post about how Cognitive Behavioural Therapy (CBT) is often misconstrued, reduced to nothing more than thought challenging, and blamed when it does not appear to work in therapy. Common misconceptions about CBT were addressed in my article then.

Today’s post is perhaps a timely update of my previous article, featuring excerpts (in black and italics) that are quoted directly from an interview done by Dr Judith Beck with the Australian Psychological Society. In writing this post, what was comforting to me was recognising that my understanding of CBT is aligned with the official narrative espoused by Dr Beck. Nevertheless, CBT continues to be misunderstood and wrongly implemented in therapy. I have witnessed how training programmes continue to teach CBT the way it was first conceptualised in the 1960s. That is a great disservice to trainees and clients alike. Hence, I hope that through writing about it someone out there will be positively impacted. That is the motivation behind this post.

Source: The past, present and future of cognitive behavioural therapy with Dr Judith Beck.

So… What is CBT according to Dr Judith Beck?

“Our definition is that CBT is a psychotherapy based on a cognitive model – that the way people perceive situations is more closely connected to their reactions, behaviours, emotions, than the situation itself.”

– Dr Judith beck

“In my book, the third edition of Cognitive Behaviour Therapy: Basics and Beyond [2020 edition], I talk about how to integrate mindfulness into CBT, as well as dialectical behaviour therapy techniques and acceptance and commitment therapy techniques.

“A lot of people think cognitive therapy is just a psychotherapy that uses cognitive and behavioural techniques, but that’s not the definition we use.” 

“Our definition is that CBT is a psychotherapy based on a cognitive model – that the way people perceive situations is more closely connected to their reactions, behaviours, emotions, than the situation itself.” 

Treatment is based on that cognitive conceptualisation, and then psychologists can draw on techniques from a variety of evidence-based practices, she says. 

“That could be compassion-based therapy, schema therapy, positive psychology, strength-based psychotherapy, interpersonal psychotherapy or others. We’re not limited in techniques, we just need to have a good rationale for why we want to use a particular technique with this particular patient, and base that on our cognitive conceptualisation.” 

CBT is not static; it is evolving and will continue to evolve.

“I get a little distressed when I hear people talking about CBT as if it should be practised the way it was first developed in the 1970s and 1980s because there has been so much progress.”

– dr judith beck

“I get a little distressed when I hear people talking about CBT as if it should be practised the way it was first developed in the 1970s and 1980s because there has been so much progress.”

Applying a recovery-orientation is just one advancement, she says. 

“Another is the recognition of the importance of adapting CBT for the individuals’ culture, socioeconomic status, level of education, societal environment, family situations, sense of spirituality – so many different adaptations are needed.”

“Learning CBT takes a lifetime, there’s always more research and evidence to shed light on mechanisms of action – for example, what we should be primarily focusing on with an individual client.”

CBT is more than just techniques.

It is first and foremost a psychological therapy. This means that factors common to all psychotherapeutic treatments apply, such as the human element.

“A third element is a very strong emphasis on the therapeutic relationship. My father devoted an entire chapter to this in his first book on how to treat depression, which was called Cognitive Therapy of Depression, back in 1979.” 

If you don’t have a solid relationship with your client, they’re less likely to do the important work in between sessions, to share what’s really on their mind, or attend all their sessions, says Dr Beck. 

“This is why my father and I have always recognised the importance of the therapeutic relationship, but there has been much more emphasis on that in recent decades.” 

Closing

It is my wish that people be informed. I hope that this post (as well as the interview which I heavily quoted from) does what it had set out to do. Through it, may the ever-so-present myths about CBT be clarified.

Eugene