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'Evidence-based' therapy?

My thoughts on the IAPT model and the real meaning of 'therapy'

· Psychotherapy

CBT emerged from Beck’s cognitive approach (1976) and the behaviourists (e.g.Pavlov, 1927 and Skinner, 1938). The origins of the methods are pure and noble; however in 2008 the NHS decided to use CBT to promote a sort of accessible model of therapy that became known as IAPT (Improving Access to Psychological Therapy). From that moment, IAPT CBT became extremely manualised and simplified. CBT lost its own essence in the NHS. Why did the NHS create such a model? They wanted to create something accessible and they used the so-called scientific method of seeing what type of therapy was more quantifiable. CBT seemed the most appropriate.

The common phrase used to describe CBT is ‘evidence-based’. The NHS created guidelines that legitimise and encourage the used of ‘evidence-based therapy’ (NICE guidelines). But what does it actually mean ‘evidence-based’?

Therapy is an art, not a science and the results cannot be measured with a CORE-10 questionnaire. The results might be long-term. But what do we mean by results? The NHS means:
1 - Going back to be functional and productive (i.e. going back to be part of the productive-machine)

2 - and most of all, the NHS wants symptom reduction.

The first point is easily addressed: I think therapy is not at the service of productivity. Therapy is about understanding our existence and thinking about meaning. It may or may not make things more productive. If anything, therapy should aim to make you feel more unique and value your uniqueness, instead of promoting a culture of ‘going back to work’ and conformity.

The second point is a consequence of the previous one: the client might or might not experience less symptoms as a result of therapy. If, for example, a client is very avoidant and lives a very superficial existence, therapy will actually increase their existential anxiety. The IAPT model is nothing but a plaster on an existential wound.

What is now taught for IAPT therapists is nothing but a bastardised version of Beck’s vision. Beck talked about a relational approach, but IAPT is nothing but a sausage factory where people come and go thinking that they are going to be ‘fixed’ in 6 sessions. Therapy has nothing to do with IAPT. The term therapy is used inappropriately by the NHS. The IAPT model should be called psycho-education, or ‘guided self-help’.


CBT is nothing a buzzword and is losing touch with its noble origins because of IAPT. There are two possible ways forward for CBT: either it reconnects with its original roots; or it will slowly pass, a just another ‘therapy fashion’.
It’s sad to see so many clients coming to therapy disappointed by the IAPT service. I wish the NHS would open up to other forms of therapy and include something that would be worth calling ‘therapy’.
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