Therapy: One size fits all?
“I believe that a different therapy must be constructed for each patient, because each has a unique story”.
In October 2021 NICE published its updated guidelines for ME/CFS. After what sounds like quite a kerfuffle in the boardroom GET (graded exercise therapy) is GONE. Cognitive Behavioural Therapy (CBT) had apparently been assumed to be a ‘cure’ for ME/CFS, but the new guideline recommends that it should only be offered as part of a ‘personalised care and support plan’. Really?? Isn’t that what we should have been doing all along? For everybody?
I learned a painful lesson very early on in my career as a cognitive behavioural therapist (or ‘cardboard therapist’ as I once heard someone big in CFT* say). Near the end of my training I was being closely supervised at uni and in the workplace whilst working with a very complex lady with a diagnosis of ME/CFS (amongst many other things). To pass the uni course I had to adhere to an evidenced treatment model. To succeed in the workplace there was pressure to get it done quickly. I rushed the poor lady. It did not go well and I did not feel good about it. It shaped my future practice and made working in the NHS very difficult for me because there was always pressure to get things done at a pace that suited the demands of the service over the needs of the individuals making use of the service. It also made me a pain in the backside to manage, but I had the loveliest manager possible and she is now a very close friend.
*CFT is Compassion Focused Therapy – another lovely approach, and really not too dissimilar to ACT, but with a very different history. If you’re interested the biggest cheese is Paul Gilbert and he’s based at Derby University.
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