Poor working and social conditions are being propped up by the mass provision of CBT


According to the Counsellor’s Guide to Working with EAP, by 2013, almost 50% of the UK workforce was supported by an Employee Assistance Programme (EAP), representing 13.79 million people. The EAP industry began in the UK during the mid-1980s and has since become firmly established, with a rapid expansion in schemes following the recommendations made by Carol Black and David Frost in their report on sickness absence (Black & Frost, 2011). A high percentage of the larger public and private sector organisations and an increasing number of small to medium sized enterprises provide their employees with access to some form of short-term EAP service.  

The EAP association say, in their 2013 Market Watch report: “The difficult economic climate of the past five years may also be a driver, as employers look to support staff with non-work related issues to prevent these from intruding on the workplace.”

The Conservative’s austerity programme in the UK has presented the wellbeing industry with many lucrative business opportunities, and there are many profits being made on the growing poverty, inequality, social injustices and inevitable subsequent psychological distress of the population.

The relentless political drive towards the privatisation of government functions has turned traditional public services, social security and other safety net provision into profit-making enterprises as well. 

A major cause of economic inequality within market economies such as the UK is the determination of wages by the market. The systematic (and partisan) undermining of trade unions over recent years via Conservative legislation has seen the collapse of collectivism as the main way of regulating employment, and a substantial loss of space for bargaining for working rights, conditions and pay. The substantial cuts to social security support over the past few years have also served to drive wages down further

Neoliberalism, which was adopted as an overarching socioeconomic policy during the Thatcher and Reagan era onward, is premised on an idea that tight monetary control will contain inflation, and that labour market deregulation combined with regressive tax and benefit reform will somehow secure full employment. The expectation is that the more unequal redistribution of income and the freeing up of markets will dramatically improve competitive economic performance, and that the benefits of this higher rate of growth will trickle down the income distribution, benefiting everyone. Of course, that hasn’t happened.

The CBT technocratic sticking plaster

EAPs commonly use Cognitive Behavioural Therapy – usually in digital form – online or by phone – and it’s a “workplace-focused programme” to assist in the identifying and resolving of employee concerns, which affect, or may affect, performance. Such employee concerns typically include, but are not limited to:

Personal matters – health, relationship, family, financial, emotional, legal, anxiety, alcohol, drugs and other related issues.

Work matters – work demands, fairness at work, working relationships, harassment and bullying, personal and interpersonal skills and work/life balance.

According to NHS Choices, Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave.

CBT is a talking therapy that can help you manage YOUR problems by changing the way YOU think and behave. It doesn’t address your circumstances as such, nor does it address the socioeconomic and political context that imposes constraints and increasingly untenable living conditions on people.

In fact, the briefing document for counsellors working with EAP says:

“When working with an EAP referral it is important to remember that the organisation is your client as well as the individual concerned, therefore there will be two people who will be ‘in the room’ with you. It is, after all, the employer that is indirectly funding the sessions. Developing your understanding of the organisation will help you work with both ‘clients’ since an insight into the type of business and the pressures of this work can help you build up a rapport with the client.

[…] The employer is often keen to know whether the support offered by the EAP is having a business benefit. This will be part of the implicit or explicit requirements of the employer and they may need to have evidence of any return on investment. For instance, is there evidence that the employee/client has returned to work more quickly as a result of the counselling? Has the counselling prevented the client from taking time off work for sickness?”

This presents a constraining framework of conflicted interests for counsellors with favourable “outcomes” invariably weighted towards employers and not employees. How, for example, does a counsellor support someone in a decision to leave their job and find another with better conditions, more security and pay? In this context, the mass provision of CBT may be regarded as a technocratic “fix” for poor employment and social conditions, and is rather more about policing critical thinking and dissenting behaviours in the workplace than providing support for employees. Treating each individual as if the problems lie “within” their thoughts and behaviours also serves to discourage collective bargaining to improve workplace (and social) conditions.  

Although the briefing paper doesn’t tell us if 50% of the UK workforce have actually accessed the EAP services, the perceived need for this service provision and the growth of the industry tells us a lot about employment and social conditions in the UK.

And what does the mass provision of CBT tell us about how this is being addressed?

CBT has become a means of re-socialising those who have become casualities of neoliberalism to accept and internalise the normative “logic” of neoliberalism. It’s a repressive state “therapy” for micromanaging dissent and critical thinking. It inhibits progressive social change, by locating all of our socioeconomic and political problems within the thoughts and behaviours of individuals.

Meanwhile private providers are making lots of profit on something that can never work in the long term. By coercing individuals to accept the terrible burdens and ravages of neoliberalism, the state and co-opted agencies are propping up a socioeconomic system that is collapsing, and in the process, it is profoundly harming people.


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22 thoughts on “Poor working and social conditions are being propped up by the mass provision of CBT

  1. Thank you for an excellent article on this use of CBT. As a social worker I became aware of the importation of CBT from usa sometime during the 1990’s and was astounded at the people it was recommended for, and for what was a fixed term of 6 weeks?! I understood that this period was what the USA health insurance plans would pay for and not what had been proven to work. I have never accepted it for myself or others as most issues are not, as you say, how one feels about an issue rather than how they impact on you.
    Other ‘hobby horses’ I have are to halt the overuse of being resilient or robust, as if that doesn’t work for me, then just like CBT, it must be me who is the failure.

    Liked by 5 people

    1. Yes, it was during the noughties that I was a practising social worker, expected to deliver CBT, which wasn’t appropriate for those young people I worked with to support. I refused to deliver CBT and pitched in with two psychologists from CAMHS to deliver groupwork and one to one sessions based on an adaptable, needs-led and multiperspective model that was much better, and that had a strong element of narrative.

      Liked by 2 people

  2. I see it as the commodification of the poor, the vulnerable and the disabled,
    By privatising social programs and creating the environment for them they have created a revolving door gravy train for the middle classes.

    We are no longer a manufacturing country but now manufacture need and the programs to insure there is always going to be a need.

    Work and Health, Health and Work programs. Troubled Families program. Employee assistance programs. Doctors referring to CBT. Jopb Centres offering/coersing @CBT.
    Money Money Money.

    If its not CBT then its Mindfullness…. and Welbeing being turned into a lucrative business model, sold as the golden chalice of life eternal, and offered to anyone who has been brainwashed enough not to know they are being sold down the river….

    This is indeed a lucrative business. Im still appalled at how many psychologists, therapists and counsellors are willing to throw ethics to the wind in order to make a buck.

    Liked by 4 people

    1. From a state perspective, to prop up a collapsing system – neoliberalism – we can’t afford NOT to. It’s a means of enforcing austerity, among other untenable conditions, and controling the population. In this respect, CBT is part of a centralist state panopticon.

      Liked by 4 people

  3. I had a few weeks of CBT a few years back. It didn’t really solve the issue that I had it for. I still struggle and live with that. But it did kind of help me out of a 12 year depression and re engaged me socially with my surrounding community.

    That said. I don’t get how they can use it to get people that cannot work into work.

    Its useful for some things, but like anything. It will only work to a point.

    If they try to use it to manipulate people though. That ain’t on.

    Since have recently moved into WRAG it would not surprise me in the least if they try it on with me. Won’t work though. I’m autistic. If you try to bend me to far I’ll snap. And having been bullied most my life I can now spot stuff like this a mile off.

    I’m kind of dreading the work related interview things though. I’ll just go, “Look. I volunteer here and here and I am employed on a casual basis by such and such. I’m already doing as much as I can cope with.”

    And the little work that I do do kind of helps train social workers and other public sector workers such as police, NHS workers and the like. So while it is casual. Its actually important and for the social good. Wish it paid more though. I hope that one day they actually have me giving an autism awareness talk to a group of politicians from all the major parties. They all need a reality check. Especially the Tory and Libdems. Labour are okish otherwise I would not be voting for them. Plus id tell them all what I think of them without any reservations. I’m not known for holding back.

    Liked by 3 people

    1. CBT is useful in temporarily boosting confidence and self esteem. It can help in the short term to get you reconnecting, as you said, but it can’t address the reasons for your problems, as it isn’t an in depth therapy. It doesn’t really facilitate any long lasting learning about your previous experiences, it addresses how you can participate rather than why you don’t want to, for example.

      But it is being used to deflect from the socioeconomic reasons why people are struggling. It’s easy to manage your thoughts and feelings when you know where your next meal is coming from, and when your home is secure. Basic Maslow’s hierarchy.

      Liked by 2 people

  4. What a great article and discussion. I’m now a counsellor, but previously worked in the corporate sector so I feel I’m lucky to have seen a bit of both sides. I’m glad to say that when I used EAP Services, at no point was CBT forced on me. However, I’m aware of others who did receive EAP. Some found it a useful tool, and I’m being careful in my wording here. CBT as a tool, not as a therapy. Some did not find it useful.

    The challenge of using such a therapy as a catchall is that it will only work for a proportion of individuals. My experience tells me these individuals are generally cognitive and logical in nature. It will also only work where someone wants to address a thought pattern that they would like to change, but find it embedded and habitual. Even then, I think the straight delivery of a diary framework or such like often doesn’t sit well. Sometimes clients do not need to change their thinking, but want to address a life challenge and figure out how they handle it. In no way can CBT support this.

    Clients who walk through the door of a therapist will all bring something unique. Someone who is creative in their thinking will simply not understand the linear approach of CBT. It would be damaging to the client to force an approach that does not support their mode of working. Firstly, as it may add to their belief that they cannot be helped. Secondly, for those using CBT to also produce ‘stats’, it will no doubt show a limited results for populations assessed. Unfortunately, this then translates into ‘counselling’ not producing the results – when in fact we are seeing that CBT is not producing the results.

    If a client wants to change a thought process (client decision, not counsellor decision) then I look at ways we can do this without necessarily using the framework itself and integrate it into the client-centred work. I believe many modern counsellors do this. For example, journaling can be one of many tools to explore what CBT is trying to address. The client can then use a highlighter in their journal to pick out statements, thoughts, feelings and beliefs to discuss and explore during the next session. I’ve had clients who like to explore using the colours they see, or their somatic feelings. Spider diagrams, even the use of OH cards if they are struggling to formulate the feelings or words. The choices are endless.

    Good counselling and coaching work with clients is about seeing them, understanding their whole and acting accordingly.

    Liked by 1 person

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