Thanks for this mark. I'd be really pleased if we could put  out a press release along these lines. When the Layard report first came out ( which was the precipitant for all this)  we had a flurry of discussion on this list, and some os  got a letter together which was published  in the Guardian .: be good now if  we could make a statement as a collective.  your statement here seems an excellent starting point.  I'd be keen to support if you would put it together for us. perhaps my comments below would be of use. 

Seems to me there are two entangled issues at stake. The first is that the clamour for ( cost effective)  psychological therapies ( linked with concerns about "common mental disorders" leading to increased incapacity benefit payouts)  is distracting attention away from the pressing socio-economic causes of trouble.  Thje second is that for those of us who do become casualties of the system ( becoming anxious or depressed), the clamour for medical model evidence based psychological therapies ( and the vested interests involved for those of us who make a living providing them)  distract  from the knowledge that it is certain core contextual and relationship factors, not specific treatment modalities, that seem to determine treatment effectiveness. And that the delivery of effective interventions  need not necessarily be by highly trained experts - but should  be by people who understand the wider context of peoples' lives, and who have respect for clients' world views ( see Wampold B.E. (2001) The Great Psychotherapy Debate). Service users I work with are very sceptical about the claims of CBT( eg of course we know CBT works - we;ve been cured by it several times now)  and I believe the scepticism is rising as of course the history of persuasion teaches us it will do - new technologies of persuasion work well for a while then their effectiveness drops down again until something new again takes their place,,,hypnosis.. psychoanalysis.. CBT etc etc

The whole thing is ironic because Layard  ( in his book Happiness) puts together a compelling argument that it is the underpinning social economic processes that underlie the apparent rise in human distress in western nations.. he talks about the hedonic treadmill.. and there was potential through his analysis ( as well as that of Richard Wilkinson) to make important links from the well-being debate to other critical social challenges.. including war, ecological disasters including climate change and obesity . Instead, the CBT lobby got in, and persuaded Layard that short term psycholgical interventions to get people back to work were what was needed to make us all happy.... ignoring all the evidence about toxic work/ social conditions etc etc and of course a useful distraction from the politically extremely challenging ( of vested economic interests)  changes that would be required if people read the Layard evidence fully.

My understanding is that the new treasury money isn;t exactly  for CBT, but for what are now being called low intensity high volume interventions.. based on CBT concepts, but to be delivered by people who are very slightly trained.. in  some ways I guess could be described as secondary prevention?? Given that the  evidence for treatment effectiveness is that treatment is a social process: dependent on the quality of the relationship between the client and the therapist..and that  lay / mutual help can be as effective as that provided by so called ( and often very expensive ) experts.. just maybe there is something in the latest claims of low intensity high volume interventions???

At the same time good things are being done politically through for example the Social Exclusion Unit where new priorities were announced in the recent treasury review re public service agreement on prioritising promoting social inclusion for care leavers, people in secondary mental health care, prisoners on remand and people with moderate/ severe learning difficulties. Some of us attended a BPS seminar on social inclusion last week where this was being discussed, with some great examples of good work being done by psychologists..  good to see this being on our agenda at last  since where social inclusion/ equality is concerned until now psychology(ists) has/have often been more the problem than the solution.

Annie





Annie



-----Original Message-----
From: The UK Community Psychology Discussion List on behalf of Mark Burton
Sent: Sun 14/10/2007 11:08
To: [log in to unmask]
Subject: The CBT announcement - who is going to tell them they've been had?
 
The CBT announcement - who is going to tell them they've been had?

So far there has been silence form community/critical/really social
psychologists about the governments announcement of £170m by 2010 for CBT.

I propose a press release from the CPUK network making something like the
following key points:

CBT is overrated, its supposed effectiveness being based on the flawed RCT
strategy that under-researches other less treatments less capable of
reduction to a manual, uses short term timeframes, ignores those who don't
improve, uses a restricted sample, excluding complex 'cases'.  When a
broader methodology is used, (e.g. as in Seligman's Consumer Reports study
of treatments in practice see
http://horan.asu.edu/cpy702readings/seligman/seligman.html ) the evidence
for specific treament modalities disappears - the key factors seem to be
treatment duration and competence of the therapist.  This is probably not
to say CBT has no place, but the claims for it are inflated.

We all know that CBT is ineffective and impossible to apply in many of the
situations that trouble Layard - multiple deprivation and associated
problems of everyday life (see the work of the W Midlands critical
psychology group on this).

An approach that individualises social problems and treats the casualties
does nothing to deal with the underlying causes in our profoundly unwell
social system.

The problem is I'm not particularly expert in this area so would need
others to contribute, work up the statement.
We could also link it to some of the work in the Birmingham /York statements.

Quite a good article in Saturday's Guardian:
http://www.guardian.co.uk/comment/story/0,,2190258,00.html

See also
http://www.dcu.ie/health4life/conferences/2007/resources/Health4Life2007_Keynote_Paul_Verhaeghe.pdf
for the talk referenced in the Guardian article.

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