Is cognitive behavioural therapy (CBT) gaslighting?

Posts on TikTok and other social media have recently attacked cognitive behavioural therapy (CBT), claiming that it is gaslighting. Is this a fair criticism, or confused hyperbole? I present both sides of the argument below.

Let's take a look at CBT in more detail.

Critics: CBT can be invalidating

Reframing facts as fiction

CBT can push clients to "reframe" facts into fiction. This is problematic when applied to situations involving serious trauma or systemic issues like poverty and racism. We cannot reframe someone out of a harmful experience, and trying to do so is invalidating and can cause further iatrogenic harm (harm experienced by patients resulting from professional care.)

Rote application and invalidation

Formulaic application of CBT can disregard the individual's unique circumstances, potentially making them feel that their thoughts and feelings are "wrong." This can disregard the individual in favour of a cookie-cutter approach.

Pressure to show quick, inexpensive results

CBT’s emphasis on quick results can lead to poor-quality therapy. In the UK, the improving access to psychological therapies programme has massively expanded access to therapies, but the manualised approach and pressure to push clients through can lead to less good outcomes.

Toxic positivity

CBT applied reductively can lead to the idea that it’s just “positive thinking,” which can be particularly invalidating. Further, research shows that toxic positivity can suppress real emotions and be harmful in its own right.

Not suitable for complex trauma

Some feel CBT is not suitable for complex trauma, and that it may feel like gaslighting because it does not fully address the root cause of pain.

Historical and ideological criticism

CBT’s popularity has coincided with UK welfare state benefits being reduced in real terms and the concurrent rise of neoliberal socioeconomic policies. It is unsurprising that CBT has become popular when it reduces human beings and their pain into a paradigm of time and money “efficiency”.

Defenders: CBT is useful when applied correctly

Misinterpretation and misapplication

Problems with CBT often arise from misinterpretation and misapplication, not the modality itself.

Addressing therapy skills

Success or failure in therapy might be more about the skill of individual therapists rather than the specific modality.

Usefulness in specific contexts

CBT might not work for every issue but has been shown to be very effective for some people and specific conditions.

Client-centred approach

As with all other therapies, the best application of CBT includes sensitive integration with other therapeutic approaches, treating the client as an expert in their lives, and ensuring that therapy is adaptable and sensitive to the individual's needs.

The debate around CBT being “gaslight-y” uncovers a complex issue. Critics raise valid concerns about potential invalidation, inappropriate application, and underlying philosophical issues. At the same time, defenders of CBT emphasise the importance of correct application, skilful therapists, and the proven efficacy of CBT in particular contexts.

The conversation points to a broader need for therapists to be mindful of their approach, especially when dealing with trauma and complex emotional issues, and to be flexible in incorporating various therapeutic tools as needed. It also emphasises the critical role of continuous training, proper assessment, and individualised treatment planning in delivering effective therapy.