A well stocked toolbox.

Recently there has been much discussion of Mindfulness, with many therapists concerned it is being pushed as a universal cure-all by those who seem to prefer newspaper headlines to peer-reviewed research. We have of course been here before, in the UK it is very hard to get anything but a bastardized form of CBT on the NHS, despite the overwhelming evidence showing it is the therapeutic relationship rather than the specific modality which leads to positive change.

I have lost count of the number of people who have told me how CBT failed to help them. However upon closer examination it becomes clear that what they were offered was 6 session with a workbook and someone who does not have counselling qualifications. It was said by the founder of CBT that “the core conditions are necessary but not sufficient” Currently people are being offered a “something” where the core conditions are not even known to the person performing the part of therapist, and in such an environment it is no surprise that for many CBT is known as “crap bloody therapy”.

So the fear that mindfulness, which is a catch-all word for a number of different techniques will replace CBT as the therapy du jour seems justified. MCBT, the form of mindfulness which has been researched by a number of studies, is not just learning to meditate, or exhortations to stop and smell the flowers. It is a form of talking therapy, using techniques that may be familiar to many.

This seems to be the issue for those looking for a quick fix, a magic wand which will move someone from the unwell to well box. Good practitioners have always used a variety of tools. The visualizations of many mindfulness courses will be familiar to any who have studied Gestalt. Exhortations to be “in the here and now” come straight from Carl Rodgers. Letting go of negative thoughts is the basis of CBT. Transactional Analysis teaches us to look at the life scripts we were taught as a child, and to step away from them.

Mick Cooper describes this approach as pluralistic, it is an attitude that says putting the client first may mean accepting different jobs need different tools, sometimes for a short time, sometimes for the whole course of the therapeutic relationship. I am reminded of my experience of therapy, when struggling with my dissertation in my final year at university I approached the college counselling service. The therapist I saw was a classic Jungian psychotherapists, this did not stop him from working with me on a work timetable, and looking at practical ways to help me manage my time better. I do not know if he thought “oh some CBT techniques might be useful here”. I do know that he placed helping the person in front of him above a quasi-religious adherence to one set of beliefs about therapy.

I do wonder how much therapists have been complicit in creating an attitude that wants to see therapy as something anyone with the right workbook can do. As a profession it struggles with professionalism, with some still insisting it is a vocation, or should not be paid for. As the daughter of a nurse I remember the struggles nursing had with similar attitudes.For many years it was a poorly paid job, and only by fighting against the designation of nurses as angels, and demanding respect as highly trained professionals did things change.

This may sound a purely critical post, it is not meant to. However when so many people are already let down by one form of supposedly cheap therapy, I do think as practitioners we need to speak out against history repeating itself. People need the therapy that works for them, and not something pretending to be therapy so a primary care trust can claim to be doing something about mental health.

4 thoughts on “A well stocked toolbox.

  1. I am incredibly grateful for the integrative approach my counsellor has to her work. She certainly has a comprehensive tool box and has consistently surprised me with the way she can out smart my logic and overcome my own training/second guessing. I recognise that I am a very ‘awkward’ client being both terrified of opening up and accomplished in avoidance, as well as having a fair amount of experience as a young people’s mental health worker running CBT based therapeutic groups myself…
    The right tools for the job are essential!


    1. Thank you for your comment, and its so great to hear that you believe this approach works, after all its no use if therapists all use something without the feedback from the other side of the room so to speak!

      Liked by 1 person

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