This is excellent. Thanks for all the efforts on this and just to say that The Midlands Psychology Group have also written a response to the article by Layard in last week's Observer newspaper which we also hope will be published.
Janine
Dr Janine Soffe-Caswell
Clinical Psychologist
N.W. Shropshire CMHT
Unite: Amicus Section Workplace Rep
01691 679500
-----Original Message-----
From: The UK Community Psychology Discussion List [mailto:[log in to unmask]] On Behalf Of Mark Rapley
Sent: 17 October 2007 14:04
To: [log in to unmask]
Subject: Re: [COMMUNITYPSYCHUK] The CBT announcement - who is going to tell them they've been had? FINAL RELEASE
D
That's me signing up for email 101 ;)
17th October 2007
Dear Sir,
Changing politicians' minds about changing our minds?
We write in response to the Health Secretary's recent announcement that £170m
is to be made available by 2010 to increase the availability of low
intensity, high volume, psychological interventions. At present Cognitive
Behaviour Therapy (CBT) is the preferred approach, to be delivered at primary
care level to adults of working age, by people who have some basic training.
While we welcome the belated recognition of widespread emotional distress in
our community, and applaud the government's will to spend public money on it,
we have a number of serious reservations about the approach adopted. Briefly,
the scale of socially caused distress is so vast, and growing so rapidly,
that it is impossible to 'treat it better' , let alone 'cure' it, as Mr
Johnson and Lord Layard have suggested, by training more therapists. It is,
simply, not feasible to treat all of those in distress, one at a time, with
any therapeutic technique.
Even if we could train enough practitioners, there is good reason to believe
that one-to-one talking treatments administered by professionals are little
more than marginally effective. It is certainly the case that a wealth of
evidence exists to suggest that professionally-delivered therapy, in the
hands of some practitioners, for some people, may be of some benefit.
However, and the widely cited NICE Guidelines overlook this, the research
base is also clear that not only may lay people be as effective as
professionals in delivering help through talking and listening, but also that
all talking therapies are effectively equivalent, and equivalently limited,
especially for those in the most difficult living circumstances. This is so
even when delivery is organised through the stepped care model that runs from
use of self help guides to full therapeutic interventions.
That is to say, not only is the effectiveness of CBT and kindred
interventions - in any hands - widely exaggerated, but they are impossible to
apply in many 'real world' situations and with many people. Indeed the widely
reported 'cure' rates in the studies relied on by the government and its
advisers are, actually, quite likely an artefact of the highly controlled
nature of the randomised controlled trials (RCTs) which purport to
demonstrate their effectiveness. As with all such clinical trials, RCTs by
their very design can not, and do not, reflect the 'real world' where
treatment is actually applied. As such, framing policy via reliance on their
artificially-inflated success rates is either scientifically naive or
politically expedient, or both.
Moreover CBT and like treatments individualise social problems, draw
attention away from the more important social, economic and material causes
of distress and propose individual cognitive dysfunction as both the cause of
people's problems and as the most appropriate site for intervention. We note
that a compelling account of the factors which have produced the present, and
remarkably recent, 'epidemic' of individual cognitive dysfunction seems to be
absent from the analyses that government has offered to date. We also note
that the relentless focus on the individual, and their supposed cognitive
deficits, illicitly employs a medicalised metaphor of 'illness' to describe
human misery and thus distracts attention away from the noxious effects on
persons of structural poverty, unemployment, job insecurity, violence, abuse,
racism, sexism, inequality and consumerism (among others) which are the root
causes of human distress. It is, surely, bad enough to be depressed because
of difficult living circumstances or to be anxious because you are subjected
to regular domestic violence, without being told your depression or anxiety
are caused by your own irrational thinking. Blaming the victim like this
simply proffers therapeutic ritual as a cure for societal oppression, whilst
at the same time placing responsibility for distress and its' resolution onto
the individual.
The approach announced is, we argue, not only conceptually misguided, but
also likely to be socially and economically wasteful of scarce resources.
Even assuming therapeutic success, when 'treated' many or most distressed
people will return to the same psychologically toxic environments that
produce distress and will be subjected to the same causes of distress all
over again. If they do not go back into immediately toxic contexts, there
will still be a flood of newly damaged people as a result of the persistence
of the social causes of distress ignored under present mental health policy
settings. CBT and associated approaches are thus comprehensively problematic.
Primary prevention of distress at a society-wide level - not the 'cure' of
individuals - is the only way to substantially reduce socially, economically
and materially caused misery.
To be effective, primary prevention necessitates social not cognitive change.
Contemporary research shows that reducing income inequality in our society
would be just one of the most effective ways to reduce psychological distress
and physical ill health - not just for the disadvantaged - but across society
in general.
Signatories
Julie Bird, Jan Bostock, Mark Burton, Julie Chase, Deborah Chinn, Paul
Cotterill, John Cromby, Dawn Darlaston-Jones, Bob Diamond, Paul Duckett,
Suzanne Elliott, David Fryer, Michael Göpfert, Carolyn Kagan, Annie Mitchell,
Paul Moloney, Moira O'Connor, Penny Priest, Mark Rapley, David Smail, Janine
Soffe-Caswell, and Carl Walker on behalf of the UK Community Psychology
Network.
Mark Rapley, PhD,
Professor of Clinical Psychology,
Programme Director - Doctoral Degree in Clinical Psychology,
School of Psychology,
University of East London,
London, E15 4LZ,
U.K.
Tel: +44 (0)208 223 6392 (Direct)
Tel: +44 (0)208 223 4567 (Messages)
Tel: +44 (0)7951 908409 (Mobile)
-----Original Message-----
From: The UK Community Psychology Discussion List on behalf of David Fryer
Sent: Wed 17-Oct-07 13:56
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've been
had? FINAL RELEASE
Mark
You could try just pasting the letter into the body of the email text
instead of attaching
David
-----Original Message-----
From: The UK Community Psychology Discussion List
[mailto:[log in to unmask]] On Behalf Of Mark Rapley
Sent: 17 October 2007 13:52
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've
been had? FINAL RELEASE
Dear all
For some reason or other the UEL server doesn't want to send the
attachment, and the cp listserv won't accept a post from my gmail
account! It isn't that I'm a conspiracy theorist, but if someone
volunteered their email address I could send to you and you can post on
my behalf?
Cheers
M
Mark Rapley, PhD,
Professor of Clinical Psychology,
Programme Director - Doctoral Degree in Clinical Psychology, School of
Psychology, University of East London, London, E15 4LZ, U.K.
Tel: +44 (0)208 223 6392 (Direct)
Tel: +44 (0)208 223 4567 (Messages)
Tel: +44 (0)7951 908409 (Mobile)
-----Original Message-----
From: The UK Community Psychology Discussion List on behalf of Mark
Rapley
Sent: Wed 17-Oct-07 13:45
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've
been had? FINAL RELEASE
Thanks for the heads-up!
Will try via gmail!!!
M
Mark Rapley, PhD,
Professor of Clinical Psychology,
Programme Director - Doctoral Degree in Clinical Psychology, School of
Psychology, University of East London, London, E15 4LZ, U.K.
Tel: +44 (0)208 223 6392 (Direct)
Tel: +44 (0)208 223 4567 (Messages)
Tel: +44 (0)7951 908409 (Mobile)
-----Original Message-----
From: The UK Community Psychology Discussion List on behalf of Suzanne
Elliott
Sent: Wed 17-Oct-07 13:32
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've
been had? FINAL RELEASE
It didn't attach that time either?!!
Suzanne Elliott
Clinical Psychologist
Treatment & Recovery Services
Swithland House (CTT East)
London Rd
Leicester
LE2 2PL
0116 225 5600
E-mail: [log in to unmask]
-----Original Message-----
From: The UK Community Psychology Discussion List
[mailto:[log in to unmask]] On Behalf Of Mark Rapley
Sent: 17 October 2007 13:31
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've
been had? FINAL RELEASE
Not sure the attachment attached - sorry if duplicated!
M
Mark Rapley, PhD,
Professor of Clinical Psychology,
Programme Director - Doctoral Degree in Clinical Psychology, School of
Psychology, University of East London, London, E15 4LZ, U.K.
Tel: +44 (0)208 223 6392 (Direct)
Tel: +44 (0)208 223 4567 (Messages)
Tel: +44 (0)7951 908409 (Mobile)
-----Original Message-----
From: The UK Community Psychology Discussion List on behalf of Mark
Rapley
Sent: Wed 17-Oct-07 13:28
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've
been had? FINAL RELEASE
Dear all
As volunteered, a 'letter to the editor' version of Mark B's release.
Following precedent I too have made a number of editorial tweaks (e.g.
problematising the nature of the 'evidence' for CBT, re-inserting a
specification of some of the social/economic/material causes of misery).
Can I ask for suggested amendments (and recipients) etc etc in time to
allow for sending on Friday lunchtime? Of course if there are any more
folks who'd like to append their names, that's all to the good.
Cheers
M
Mark Rapley, PhD,
Professor of Clinical Psychology,
Programme Director - Doctoral Degree in Clinical Psychology, School of
Psychology, University of East London, London, E15 4LZ, U.K.
Tel: +44 (0)208 223 6392 (Direct)
Tel: +44 (0)208 223 4567 (Messages)
Tel: +44 (0)7951 908409 (Mobile)
-----Original Message-----
From: The UK Community Psychology Discussion List on behalf of Mark
Burton
Sent: Tue 16-Oct-07 20:36
To: [log in to unmask]
Subject: Re: The CBT announcement - who is going to tell them they've
been had? FINAL RELEASE
Here it is then. Two formats, same content.
I've used editorial privilege to make the following final tweaks:
* Left out the examples of types of people for whom CBT is difficult
- this was partly because the sentence was getting too complex and
partly because it was never going to capture the variety of social
and individual circumstances we wanted to.
* Included a brief explanation of the network but (against my better
judgement) left out any attempt to define CP.
* Implied that we can put our hands on back up evidence for our
assertions.
* Made it a bit better slicker in appearance.
Hope you can all live with it.
I'll follow up with a list of the places it went to.
Mark
>
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