Social power: some implications for the theory and practice of cognitive behaviour therapy

Abstract

Practitioners of cognitive behaviour therapy (CBT), are faced by real dilemmas when having to take into account the consequences of unequal power relations in society. Whilst a perspective on social power is not new in psychology, its implications for therapeutic practice have yet to be fully worked out. The problem becomes most acute when clinicians have to confront the shortcomings of individually focused therapeutic models in, for example, inner city Community Mental Health Teams (CMHTs), where a majority of clients face real and corrosive adversities in their lives. Exploring the effects of juxtaposing the individually focused school of CBT (Beck, 1976) with one which explicitly focuses on power relations, e.g. in community psychology (Smail, 1997), is one way to shed light on these issues. Attention is drawn to core differences in the perspectives, e.g. the main focus of CBT on idiosyncratic beliefs and the insistence of community psychology on the social structuring of such beliefs. Ways in which real adversity has been discussed within the CBT literature are outlined and a clarified view of the problem presented. A clinical case example is used to illustrate what a focus on social power could add to case formulation in practice. The aim of this process is to assist clinicians in practice to make the best use of the skills they have acquired within a theoretically coherent framework. Copyright © 1999 John Wiley & Sons, Ltd.