Intended for healthcare professionals

Career Focus


BMJ 1999; 318 doi: (Published 08 May 1999) Cite this as: BMJ 1999;318:S3c-7193
  1. Mark McCartney, Specialist Registrar in Cognitive Behavioural Psychotherapy
  1. Nottingham Psychotherapy Unit, 114 Thorneywood Mount, Nottingham NG3 2PZ

    Cognitive behavioural therapy was ignored

    EDITOR- The recent article on a career in psychotherapy provided useful information about training in dynamic and analytically orientated psychotherapies, but did not present a balanced view of NHS medical training or service provision in psychotherapy in general, particularly with regard to cognitive behavioural therapy (CBT).(1)

    The authors categorised CBT as a type B or eclectic psychotherapy, but this was mistaken: CBT clearly has “an explicit model of psychopathology”(2) and in an NHS review of psychotherapy is clearly defined as a type C or formal therapy, in common with psychoanalyis and systemic therapies.

    Current Royal College guidelines recognise the need for breadth in specialist registrar psychotherapy training. An SpR is likely to spend the majority of their training in either dynamic, systems, or cognitive therapy, but they must also gain formal experience in the other two fields. Key and Dare do not convey this need for balance and specifically omit to mention that it is possible to be an SpR specialising in CBT. The establishment and approval of higher training posts in CBT have been relatively recent developments, and the number of posts nationally is currently in single figure. The development of formalised specialist CBT training for psychiatrists reflects the increasing requests for CBT to meet both NHS clinical demand for empirically effective treatments(4) and the training requirements of the Royal College of Psychiatrists.

    At least nine university courses leading to diplomas or masters qualifications in CBT, and demand for places is high.

    Different approaches to psychotherapy have much to offer, and I value the insights and treatment success I have experienced when practising individual and group dynamic psychotherapy. The NHS needs an integrated psychotherapy service that is safe effective and co-ordinated. Practitioners should be thoroughly trained in their own specialty, but also have a working knowledge of, and good liaison with, colleagues of other schools. By effectively ignoring the importance of CBT, the authors do not appear to share this ideal.


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