Book Review: CBT: The Cognitive Behavioural Tsunami
By Farhad Dalal (Routledge 2018)
When asked to review a book for Contexts by a colleague and friend, I foolishly agreed without asking about the book’s subject or author. Much to my dismay, I discovered it was Fahad Dalal’s book critiquing the rise of CBT in the treatment of psychological distress and suffering. As I learned about the subject of my reading, a type of Tsunami washed over me. I could not imagine a subject I would like to read about less, let alone review a book upon. Embedded in my foolhardy position was the idea that I knew this subject and had covered the subject to death with colleagues and supervisors alike. However, how foolish I was and how little I really understood. From the start this book is a page turner, so much so, I had to implore myself to slow down, so as not to miss some important revelation.
In my view, this is perhaps the best of Mr Dalal’s books to date, I have read them all and learned a great deal. In this work, he puts his mind to how CBT became the dominant, state sanctioned psychological therapy we know now. Dalal takes a forensic approach unpacking this question and dissects the underlying: philosophical, political, economic, psychological, sociological and historical underpinnings to CBT and goes as far as to question the nature of scientific methods that given CBT it’s rather dubious credence.
In this book, important attention has been paid to the Layard report that begun the cognitive Tsunami. Dalal examines in detail Lord Layard’s philosophical and essentially economic influences and motivations. In doing so, he importantly furthers the understanding of Layard’s ultimately flawed thinking. For me this is where the book really begins to cook. With Dalal informing the reader of Layard’s essentially Utilitarian ideals borrowed from the philosopher Jeremy Bentham. Importantly, the social and political context of the time is illustrated and how Layard was part of the: New-labour, New Deal and Neo-liberal plan for us all and how for his participation in their project, his reward was to become a part of the state itself; honoured with a lifetime peerage and seat in the house of lords. Importantly, what is also illustrated, is Layard’s outright aggression towards psychodynamic and insight-based therapies and how his thinking could only be to render them obsolete within the treatment models NHS provides. Dalal takes this one step further and quite correctly describes Layard’s aggression on the same people that CBT claims to support.
A central theme of this excellent book is the way several false dichotomies and splits have been curated to further the claim of CBT to be the one true god of treatment of emotional suffering. As such, CBT places itself as the victor of a great war against psychodynamics (a war we probably did not turn up to fight, as no one had told us it was on) and gained the spoils of it’s victory. As for all victors, your privilege is to be able to write, rewrite and revise the history that comes before it, in addition to setting the rules for the future.
Dalal thinks closely about the nature of evidence and the idealised use of empirical evidence over any other. Importantly, he also discusses that whilst the world of cognitive therapies relies heavily on this to assert it’s dominion over other therapies, it does so dishonestly. Dalal illustrates that within their own standards of measuring effectiveness, powerful exclusion criteria operate and that within clinical trials, a great number are eliminated from participating. As such, evidence of the studies is heavily biased in terms of creating positive indicators for CBT’s effectiveness, but also swayed towards proving that CBT works better than anything else. As such the books goes on not only to questions the scientific basis of CBT but also to question science itself.
The theme of ‘centralised control’ and illustrated to great effect and how a new fetishized managerial caste presides over a carefully brand managed, state sanctioned therapy that favours ‘doing well’ over ‘doing good’. The doing well is of course a part of the neo-liberal ideal in which profit and commerce is king. No longer is it important to do good work, only that that work is done for the lowest cost and greatest financial gain.
Dalal has been fearless and relentless in his critique of the rise and precedence of CBT. He has taken great care in breaking down how this this has come to pass. Once Dalal’s deconstruction is complete, it leaves the strong impression that perhaps CBT represents the proverbial emperor’s new clothes of therapies and that there has been a very calculated and sustained effort for it to become the behemoth that it is now.
Whilst this was a book, through my own ignorance, I would not have chosen to pick up, once I did, found it almost impossible to put down. This is an important book that all that wish for something better should read. By the end, in the right sort of way, I felt re-educated by reading it and motivated to keep pushing back against the Cognitive Behavioural Tsunami.
Michael Caton
Group Psychotherapist