Even the most enthusiastic CBT practitioner will acknowledge that it has, on its own, certain limitations in treating trauma, and, in particular, trauma within the imprisonment experience.
Of course, the technique of CBT doesn’t have to be time-limited – it can be practiced over a long time in diverse environments and sometimes is. But in my experience CBT practice is (generally) biased towards change happening, and when it doesn’t happen quickly enough it is generally the individual who is thought to have the problem, not the modality or the practitioner.
One reason why it struggles to reach people who are carrying trauma is that it is often delivered in time-limited segments, sometimes called courses. These can, of course, be one-to-one, for example ten weekly therapy sessions or in a group setting. Many of the ones that I am familiar with are or have been designed in academia and sold under franchise to agencies responsible for supporting vulnerable people in communities.
Personally, I have never experienced a time limited CBT programme to be attractive to the people who need the most assistance – those in the most acute distress, who are very isolated, who are in continual crisis, and/or who have suffered severe trauma.
They are wonderful for people who have the emotional stability to absorb the cognitive aspects of the programme – and many such people thrive in such programmes. And while not all CBT practice is time limited – as I stated above – much of it is, mirroring mainstream educational, linear, step-by-step learning.
Also, (as might be evident to you at this stage) systems theory challenges the primacy of the reductive or behaviourist methods of exploring the behaviour of living things – and in particular humans. The reason for this is the presence of emergence which I already described.
We do not only react to stimuli and reward, we are not only conditioned to behave in a certain way by constant exposure to particular experiences, we also have our innate potential to grow in whatever direction, and at whatever pace we choose.
With the very hurt person, the primary work that needs to be done is the connection through which the trusting relationship is built, which will, in turn, enable something substantial to be laid down, on which the root foundations will work to heal the hurt.
And remembering the importance of connection, I came to the conclusion that reward and punishment would only work following the establishment of a trusting relationship, where care and nurture was of paramount importance, the primary reward being the relationship itself, the secondary reward (or carrot) being the approval of the adult with whom the young person had the relationship, and, perhaps, the punishment (or stick) being the disapproval, or the withdrawal of that care and nurture.
Not only that; the sincerity, commitment but above all consistency of the relationship would constantly be tested by the young people showing us their most obnoxious selves – almost hell bent on proving, both to themselves and us, that it was impossible for them, or they didn’t deserve, to be in relationship.
When all that work is done – there is a good chance that there will be a place for CBT.
This brings me to the next Sub-Chapter in our Modalities Chapter – Person Centred Therapy.