ESHS/HSS Annual Meeting

From intergenerational radicalism to manualized treatments: CBT’s transformations from the 1960s to 2000s

• In Event: Taming Psychotherapy: From Radical Experiment to Standards of Practice (1960-2000)

English Abstract

This paper draws on archival, printed and oral history sources to examine a shift within the ethos of cognitive behaviour therapy (CBT) since the early days of its foundation by key figure such as Aaron Beck and Albert Ellis, through to its wide-scale implementation in health services since the 1990s. Conceived originally as a radical innovation in the 1950s and ‘60s that foregrounded scientific rationality, and a striking intergenerational questioning of moral sensibilities and religious imperatives around personal agency and freedoms (in Ellis’ case this also included sexual freedoms), CBT’s early experimental instantiation was imbued by some of the radical philosophies of the mid-twentieth century. As Rachael Rosner (2018) has shown, by the 1970s Beck himself became mindful of the need to manualize and validate CBT in light of Food and Drug Administration concerns after the thalidomide scandal. The rise of evidence-based medicine and the adoption of CBT by British psychiatrists and psychologists operating within a socialised healthcare system from the 1970s onwards led to the need to validate the practice through randomised control trials. This constellation of forces shaping CBT has also been seen – including by some who advocated it – to have diminished the radical nature of the therapy, cancelling out some of the experimental aspects that enabled its original generation and innovation. This paper traces these developments, linking them to wider historical shifts in contestation of evidence, health economics, and regulatory frameworks between the 1970s and the present.

Author

• Sarah Marks, Birkbeck, University of London