Often the question of an intervention’s effectiveness arises, but rarely is it asked why something works, nor is thought given to an explanation of its underlying arguments of change. You would be hard-pressed to find a more evidence-based intervention than Cognitive Behavioural Therapy (CBT), and this robust evidence base certainly extends to the criminal justice system. In our recent paper ‘Exploring the theoretical foundations of cognitive behavioural therapy in the criminal justice system’  my colleagues Kirstine Szifris, Shadd Maruna, Chris Fox and I questioned the dominance of CBT as a tool of rehabilitation in the criminal justice setting. This reason for this paper was driven in part by a suggestion in some of the literature that the effectiveness of CBT may be declining (see Johnsen & Friborg, 2015).

The paper employed a variation on the classic (the literal Greek classic) of the Socratic method with what is sometimes referred to as the method of provocation (Pangrazio, 2016), we convened ‘a set of experts from the fields of philosophy, criminology and forensic psychology to engage in structured, in-depth dialogues organised around a set of pre-circulated provocations’ (pp. 2). These questions discussed CBT as a set of skills, the assumed mental processes of the internal to the external, the implications of different kinds of delivery, and the impacts of taking CBT from its original therapeutic setting to the criminal justice system. Our role was not to take sides, (in fact, the research team held a diverse set of views on the role and effectiveness of CBT), but to create a space of co-inquiry. In order, to grant the intellectual freedom to question the status quo. In this case, this was to collaboratively explore CBT, all the way to its philosophical roots. The process revealed the core premises and assumptions of this treatment paradigm and spoke to the consistency of that foundation.

Through this work we explored and challenged many of CBT’s theoretical underpinnings, the psychological mechanisms at play, as well as the evidence base how it is typically interpreted. We also discussed the ethical implications around how it is applied, and the politics of using this intervention on the prison/probation population. Some of what was revealed in this novel process of inquiry is how the countless iterations of CBT appear to have departed from its original theory of change. The findings were suggestive that the intervention has become a generalised solution to an ever-growing set of complex problems, for which CBT was never designed to combat. These range from therapeutic interventions, and educational courses, to more compelled offender programmes. These insights seem particularly relevant considering the set of crises the CJS is currently facing, from a stark lack of resources to the implications of chronic prison overcrowding.

Ultimately, it seemed that collectively our assembled experts didn’t fully understand the operating mechanisms of these interventions in regard to criminal behaviours, and this has all manner of implications for current and future use. The aim of the paper was not to attempt to bring to edifice of CBT crashing down around us, but merely to shine a light on what is widely considered the ‘gold standard’ of evidenced based treatment. Fundamentally as professionals and practitioners, we should occasionally ask what we are expecting from CBT and whether it is more than the intervention can deliver. Far from creating any sense of therapeutic conflict or rivalry etc, we hope this work contributes to further positive discourses around the continued use of CBT in rehabilitation.

References

Johnsen, T. & Friborg, J. (2015) The effects of cognitive behavioural therapy as an anti-depressive treatment is falling: a meta-analysis. Psychological Bulletin, 141(4), 747–768.

Pangrazio, L. (2016) Exploring provocation as a research method in the social sciences. International Journal of Social Research Methodology, 20(2), 225–236.