Holistic Cognitive Behaviour Therapy

Reviews

1. 

   Roger Bretherton | BACIP President – 19th January 2022

   When CBT isn’t Enough

   I can’t be the only person who, when first introduced to the five-areas approach to CBT, got the feeling that there might just be something missing from it. For me, it was Christine Padesky (and later, Chris Williams) through whom I first encountered this approach to CBT assessment. It was quick and simple. My client came in with some bewildering array of complex psychological complaints and we could bring some order to it all by asking about five different areas: how they felt, what they thought, what they did, what went on in their body and what else was going on around them. It was much more agile and nifty than the long assessment protocols I’d learned by rote as a trainee, the main benefit being that it wasn’t linear. I could start wherever the client started. If they reported emotion, or behaviour, or thoughts, I could start with that and slowly loop round to all the others to get a more complete, coherent and comprehensible picture of the client’s problems. Easy.

   Except something niggled at me. The five-areas approach seemed to make the problem understandable by reducing it to simple elements, usually presented as four connected circles (thought, emotion, sensation and behaviour), within one big all-encompassing circle (usually labelled ‘Environment’). In my early days of cut-to-the-chase therapy in the NHS I spent most of my time trying to get at the four smaller circles and not so much investigating the larger one in which they all sat. But my disquiet grew. My sense that I was missing something increased. And eventually the nature of the problem dawned on me: I was missing the biggest circle of them all. In the Venn diagram of the five areas approach I was delving into the four small circles with my clients but only ever really scratching the surface of the larger environmental one. I was straining out gnats but missing camels. What I was missing in my obsession with the four smaller areas of investigation was, well… absolutely everything else.

   It seems to me that an instinct very much like this drives Hilary Garraway’s approach to Holistic Cognitive Behaviour Therapy (HCBT) outlined in this book The four areas are still there as essential elements of psychological assessment, but they have been placed in an infinitely wider context than is usually considered. The book does this in numerous ways. I’ll just summarise two of them.

   Firstly, it presents a cross sectional model that contextualises the human world of body, thought and emotion, moulded and shaped by numerous influences (social, historical, cultural, environmental and spiritual). At the centre of these concentric circles sits ‘spirit’, which she elegantly reframes as ‘being me’- the authentic self-expression that lends its name to the HCBT programme the author developed: ‘Free to be Me’. This is no superficial or thoughtless evocation of spirituality. She devotes an entire chapter to the exploration of spirit in various religious traditions, including that increasing number of people in the Western World who self-designate as ‘spiritual, but not religious’. I imagine BACiP members will enjoy this element of HCBT immensely, it creates a pathway for exploring what is deepest in life and faith, without sectarianism or partisanship. Practical examples show how this can be done in practice. If we ever feel that explorations of spirituality in psychological therapy are unwelcome, HCBT shows us how to do this appropriately and empathically. We needn’t be unnecessarily cautious; we can be free to be we.

   Secondly, HCBT not only expands the five areas approach but further elaborates the classic longitudinal model of CBT in a way that leans in the direction of flourishing. The HCBT longitudinal model is not just a map of pathology, it represents unhelpful cycles as instances of a ‘limited spirit’, and helpful cycles as embodying a ‘releasing spirit’. Furthermore, it conceptualises the consequences of a releasing spirit as a growing tree- an image familiar to those of us share the Judeo-Christian tradition. It evokes the opening words of the first song in the psalter, describing the person who flourishes in God as, ‘like a tree planted by streams of water, that yields its fruit in its season, and its leaf does not wither.’ (Psalm 1:3, ESV). An image of universal wellbeing common to many spiritual traditions. In HCBT, the tree is a rich picture that can be used to explore numerous sources of strength: talents, significant others, purpose, goals and dreams, moments of vitality and community life. Examples of the tree diagram completed by clients have been scanned into the book to be taken away and used whenever we feel in need of a creative way to explore the flourishing life. This is a model that stretches beyond the deficit model of therapy, in which life is a problem to be fixed, towards an asset model, that envisages life as worth living. HCBT doesn’t just stop people from drowning, it teaches them to surf.

   This is a thoughtful and beautiful book; to which I can’t claim to have done justice in such a short review. Ultimately it helps us to expand our horizons when considering what is possible in psychological practice. Those of us who work in highly secularised environments, may feel limited in our ability to convey the deep grounding and enlivening that a spirit-filled life can offer. HCBT throws us a few practical lifelines, so as not to marginalise these essential elements of the human condition. Most importantly, this book is not written in some kind of spiritual bubble. Whenever professing Christians develop an approach to therapeutic practice that does justice to their deepest convictions, there is always a danger of it being idiosyncratic, quirky, belonging to that strange genre of books that only make sense to those who belong to the same closed-community. Thankfully this is a book for everyone. Even Chris Williams, one of the leading lights of CBT and principle developer of the five-areas approach mentioned above, sees in HCBT a welcome corrective to some of the limiting caricatures that have plagued CBT since its inception. At least, that’s what he says in the foreword, and who am I to disagree?

2. 

   Sahar Beg | MindWorks UK – 2nd December 2021

   A really well thought out piece of writing.

   A structured and easy to read, especially if someone is from a non-clinical background, this is very
   simply worded. The spiritual side of the work is clear without making assumptions or judgement about
   other faiths and how they relate to HCBT practices. The actual approach to CBT is simplified and not
   made difficult to read.

   The explanation of the ‘self’ and where spirituality fits in, is relatable and the explanation that
   it’s not religion is key to anyone reading this. Not everyone has religion/faith but may have a
   spiritual belonging.

   In summary, there is a movement for faith/spirituality in the therapy space and as practitioners we
   need not shy away from this or be afraid to entertain it in the space. Clients welcome this more so
   now than before as it is an integral part of the healing process as well as understanding the ‘self’
   in all capacity. When we are disconnected with our ‘self’the internal and external. Mind, Body, Soul,
   what and how we perceive our logical thinking, our notion of identity and where our ‘self’ is located.
   This is also influenced by philosophy.

   Connection to the heart, Nafs or ego which was mentioned in the Islamic concept page 80 which underpins
   a lot of the psychology of the soul. Of course, Neuroscience plays an important part of how our brain
   functions and how we think and do.

   I really enjoyed reading this book and actually am re-reading it again at a much slower pace this time.

3. 

   Jodie Wozencroft-Reay | House of Healing CBT – 20th October 2021

   Dr Garraway’s book Holistic Cognitive Behaviour Therapy gives a comprehensive and inclusive
   overview of the use of spirituality in CBT.
   The text offers an explanation of how HCBT fits within the CBT tradition, the HCBT model itself,
   different perspectives of the human spirit, a developmental model and a case study example of
   individual therapy utilising HCBT.
   As a practitioner who specialises in Islamic psychology, I was particularly impressed with how the
   author covered this sensitive and accurately, but felt this could be improved by quotes similar to
   other passages from the Qur’an or hadith (sayings of the Prophet), or by drawing on the works of
   Malik Badri, Rasjid Skinner and Abdullah Rothman who have revived the Islamic psychology
   tradition.
   The Holistic view of self, or selves, is similar to the multi-mind in Compassion Focused Therapy or
   subpersonalities in Internal Family Systems. This approach can be very enlightening for clients who
   have struggled with, the very common human problem of, conflicting motivations or values.
   HCBT utilises traditional CBT practices whilst widening the application to include a person’s
   spirituality. HCBT also borrows wisdom from other modalities such as systemic therapy and positive
   psychology. Often CBT is seen as one dimensional, lacking depth, however HCBT gives a deeper,
   more profound perspective, accessible to any clinician, which aids the client in feeling validated,
   heard and understood.