Cognitive Behavioural Therapies in Britain: Welfare, Society and the Individual since 1948

Cognitive Behavioural Therapy is the most widely-used talking treatment in the contemporary world, with significant political and economic backing within the UK health service. Its techniques are also widely influential in private psychotherapeutic practice, self-help, social work, educational, occupational and criminal justice contexts. It is also one of the most controversial treatments, widely discussed in the public sphere, with some clinicians and service users arguing it is a "quick fix" that fails to address individuals' complex emotional, social and economic needs. Others, by contrast, campaign vehemently for its expansion. These contemporary debates lack a historical background - and professional politics often obscure the experiences of patients themselves. This research project addresses this gap. The adoption and development of behaviour therapies since the 1950s, and CBT in recent years, has been closely bound up with the history of the NHS, the rise of evidence-based medicine, and changing understandings of the individual and the welfare state. This research will result in a book, along with peer-reviewed research papers, based on archival sources from key research hospitals, the Wellcome Archives, universities' special collections, professional societies and mental health charities, and advocacy and service-user organisations. In addition, it will draw from a substantial printed literature including psychological research publications, specialised journals, clinical trials, professional memoirs, and policy and campaign literature from government, political parties, the third sector and patient groups. It will also use oral history interviews with clinicians, service-users, and policy-makers.

Placing cognitive and behavioural approaches centre-stage challenges the continued over-representation of psychoanalysis in the historical writing on 20th century psychotherapeutics. Given the prominence of cognitive and behavioural approaches in contemporary society, a critical eye needs to be cast upon the history of its emergence and justifications for its use. Crucially, the experiences of service users needs to be written into the story, which I will do through extensive oral history interviews. This project will uncover the intertwined relationship between innovations in therapeutics and the rise of evidence-based research and governance, within an economically rationed National Health Service. It explores the development of new forms of service delivery, from specially-trained nurses and clinical psychologists, through to self-help books, 1970s innovations in computer programmes and later internet- and telephone-based services, examining the implications of these for patient experience. It also interrogates the clinical and cultural controversies surrounding its use in non-western and lower-income settings, in light of the increasingly influential Global Mental Health movement. Finally, I trace how CBT has become a cypher in wider cultural discussions about the relationship between the individual and the welfare state, the governance of labour and employment, and controversies around the psychological professions and coercion. Cognitive and behavioural therapies have long been the focus of vociferous debates about the nature of mind, rationality and personal responsibility, offering a prism through which we can better understand contested visions of human nature and agency since the Second World War. I also explore the cultural and political reasons why these approaches came to be so dominant in Britain in particular, by comparison with other European countries where it has not been so widely influential in policy.

The finding of this research will offer new insights for contemporary debates about the use of cognitive and behavioural interventions in health, and in broader governance. In turn, it will be used to inform clinical training, and will have implications for clinical practice and policy.

This project is designed to be of benefit to a range of stakeholders and beneficiaries. It aims to impact upon understanding of contemporary practices and policies and how these have been shaped culturally, politically, economically and scientifically in the longer term. It will also improve understanding of service user experience of CBT interventions, and the methods by which historical experiences of psychotherapeutic treatment can be captured, using approaches from the humanities and social sciences. In turn, this research is intended to facilitate reflection on practice and policy in clinical settings relating to mental health, as well as other arenas where CBT interventions play an influential role, including criminal justice, social work, pedagogical and occupational contexts. It is also specifically intended to shape the training and reflexive practice of clinicians and others who use these interventions in their work. This research adds an important historical dimension to the ESRC's cross-council mental health network, particularly complementing work by Rob Ellis, Felicity Thomas, Eleanor Bradley, Konstantina Poursanidu, and Ian Tucker in relation to service user experience, with whom I will look to collaborate.

Cognitive and behavioural therapies are not only the most widespread talking treatment in the contemporary world - they are also one of the most controversial, with vociferous debates playing out in the public sphere and the clinical world. This research will enable target audiences to engage in better informed debate by providing the historical background. It also looks to give, as far as possible, an impartial voice to service user experiences, distilled from the professional politics and political ideologies which often shape the public and media coverage of CBT in polarising ways.

In addition to publications in a broad range of academic and non-academic publications, blogs and magazines, the project will generate an oral history resource with recordings and transcripts of interviews with clinicians, service-users and policy-makers. Where participants have given their consent, these will be made available online and, in the long term, in a national repository (such as the British Library's National Life Stories or Wellcome Library repositories). They will be publicised through social media and relevant mailing lists, publications and newsletters. These can act as a resource for opening up more in-depth public debate, mobilising changes or improvement in clinical practice and service delivery, training students and trainees in mental health related roles, as material to support service user and advocacy campaigns, or to provide service users and the public with a more informed understanding of these practices and individuals' experiences of them.

I will engage with key stakeholders from mental health service user and professional organisations, clinical educational directors and policy think tanks early in the research process to best identify how collaboration and facilitation could be developed. I will present research at stakeholder conferences and will invite stakeholders to attend two interdisciplinary conferences hosted at Birkbeck. A cafe-style public engagement event with service users will invite responses to the oral history testimony. This will explore how these resources could be adapted for use in information presented to service users on CBT to enable more informed choices about treatment, and how they might be used for campaigns to mobilise changes in policy or service delivery.

I will work closely with directors of clinical training programmes to develop pedagogical material drawing on the research for use in reflexive clinical education and disseminate the research widely at a range of disciplinary and interdisciplinary conferences and seminars nationally and internationally, and will draw on my existing networks to explore a radio documentary, and use within exhibitions.