In treating people with Cognitive-Behavioral Therapy:

  • Which people can't be helped by therapy?

  • How are some people more treatable than others?

Additional Info

In the comments of a blog post analyzing male seducers, a psychotherapist explained the effect of narcissistic mothers on their sons. She said that some people have a greater capacity for benefiting from therapy than others. Some people can't be helped by therapy.

What makes a person unable to benefit from therapy?

  • 8
    $\begingroup$ It's an interesting question, but you'll probably need to refine your scope: (a) what kind of therapy are you talking about? (b) what class of symptoms or disorders are you covering? $\endgroup$ Dec 7, 2012 at 6:42
  • 3
    $\begingroup$ Some people can be stubborn and stick to noncompliance. If a patient isn't willing to "try" or "listen", therapy will not be beneficial... working with patients with BPD can be difficult (for example) but could you elaborate on what you mean by "more treatable"? I mean, you're right, CBT is not the befitting form/orientation of therapy for everyone, but do you want to focus on the mentioned narcissistic mothers? $\endgroup$ Dec 8, 2012 at 4:59
  • 2
    $\begingroup$ So people really need to want therapy. They must feel like cooperating for the therapy to be successful. Yes, PheonixEnder. I'd like to focus on people with narcissistic mothers for this question. If you can provide any additional info on psychological mental illness, instances where illness is not caused by phisiology such as chemical imbalances in the brain but rather is the result of experience or destructive thinking, I'd love to hear it. In cases where the illness is "purely mental," what makes a person more, or less, treatable? We can focus on narcissistic mothers if that keeps the $\endgroup$ Dec 8, 2012 at 5:07
  • 1
    $\begingroup$ Could you please provide a link to the "comments of a blog post analyzing male seducers". Thanks in advance. $\endgroup$ Jan 15, 2020 at 15:28
  • $\begingroup$ I have noticed that CBT might be good to reframe one's negative world views due to that person either having had repetitive bad experiences, or due to their brain chemistry not being "healthy". Example, lacking Seratonin. I however posit that most therapists that recommend CBT take into consideration the patient's ability to come up on their own with the "more realistic" possibility or alternative thought to whatever dissonance they have about a certain situation or person. I would love to see therapists be more directive. $\endgroup$
    – user26008
    May 15, 2020 at 15:34

2 Answers 2


I came across this question whilst researching CBT for a course I am studying.

The short answer

As I will cover in the long answer, there has been a lot of articles stating that CBT is very effective, and there are articles which have stated that it is not as effective as has been claimed.

CBT is not a single model of therapy, applicable to all clients in all situations. This has been one of the criticisms levelled at CBT, that its 'one size fits all' approach to the complex nature of human problems will, inevitably, fail to meet the needs of many, or (at best), simply focus on symptom reduction. (Reeves, 2013)

There are a fair few factors which can prevent CBT from becoming effective, and a trained and certified CBT practitioner will be able to assess the suitability of CBT. If they operate ethically, they will not go ahead with providing CBT to someone who it would not benefit.

One of the biggest factors which doesn't allow CBT to work is that if the client is not willing or able to challenge their thoughts and behaviours, then CBT will not be effective.

Long answer

For the long answer, which will help to explain some of the reasons why CBT may not work with some people, I will be using a lot of the work I put into an essay I had to write for my psychotherapy course which covered Cognitive Behavioural Therapy (CBT) and integrative approaches to therapy.

CBT is an integrative model of approach and we had to look at how an integrative approach may be used to support the client within a case study provided.

Case study provided

Hassan has been referred to you for work-related stress and anxiety. He has a management position and is finding it difficult to cope. At present the information you have is that he is a 42 years old Muslim man, married with 2 children. He has lived in the UK since the age of 5 when his parents travelled here. His father died two years later and Hassan, as the eldest son, has felt responsible for the wellbeing of his mother and sisters as well as his own family.

Your referral is through an employee assistance scheme. Hassan’s assessment shows high level of anxiety without depression. He is otherwise fit and healthy. You may offer him six sessions with a further six sessions if appropriate.

An article (Dhami & Sheikh, 2000) adapted from a chapter in Caring for Muslim Patients, published by Radcliffe Medical Press, Oxford, England; provides key insights needed to allow Muslim clients' concerns to be adequately heard. The vignettes section of the article gives a few sayings of Muhammad regarding relationships with parents and one of them points out that you should “strive to serve them”.

If the client has had the opportunity to fully integrate with the western culture they are living in, they may be more open to challenging their thoughts and beliefs, however we need to be mindful that as therapists, just like we are not here to judge, for an example, on sexuality (Pink Therapy, 2016) (UKCP, 2015), we are not in a position to judge whether a cultural or religious belief is right or wrong, especially when we are not priests, vicars, rabbis, imams or the like. Not only that, if the client is devout in their religious beliefs, then we are not going to change those beliefs very easily, if at all. (Babilonia, 2015)

The only time when we can intervene in any religious or cultural beliefs is when it is believed that laws may be broken such as the FGM Act (Home Office, 2016) (Crown Prosecution Service, n.d.), in which case, we would refer the legal case to the necessary authorities and it would be down to the legal profession and not the therapist.

Strengths and Limitations of integrative approaches to counselling


Integrative counselling and psychotherapy can be seen as one of the most effective approaches within counselling. (The Counselling Directory, 2013) The idea behind the integrative approach is that no single approach suits every client and therefore you use different approaches and models of therapy to suit the situation and client. The article within The Counselling Directory cited also states that integrative therapy has four different categories:

  • common factors
    Looking at the common tools available in each approach that can be useful in the therapy. Therapist/Client rapport, therapist qualities – positive regard, and congruence etc. – emotional release, and clarification etc.
  • technical eclecticism
    The therapist looks at and selects the best interventions by relying on experience and knowledge of what has worked in the past for others, through theories and research literature.
  • theoretical integration
    The combination of two approaches with a common philosophy. The combined ideas are theoretically the same as each other. For example, cognitive behavioural therapy (CBT) is part of the theoretical integration category, as it is a combination of behaviourism and behaviour therapy, and cognitive theories and their application in therapeutic settings (Reeves, 2013), plus, cognitive analytical therapy is also a theoretical integration of psychodynamic therapy and cognitive therapy.
  • assimilative integration
    The therapist primarily sticks to one therapeutic approach, for example Humanistic or psychodynamic, but the therapist will use strategies and models from other therapeutic approaches as well. The combination of ideas will assimilate the pure form of the primary therapeutic approach.


The limitations of any integrative therapy depend on the category of integration.

Theoretical integration

One problem identified in theoretical integration is that it is difficult to integrate some theories; for example, it is difficult to integrate psychodynamic theory and behavioural theory. The psychodynamic approach suggests that our early experiences from birth onwards and their impacts lead to our psychological problems, where behaviour theory sees problems as much more agreeable to change (Reeves, 2013). These differences result in incompatibilities between these theories.

Assimilative integration

With this kind of integration, there is no balance compared to the other forms of integration. Where the therapist is primarily psychodynamic or humanistic, for example, they will pick and choose ideas from other approaches which may not be put forward by their primary approach, but can work very effectively and contribute to the treatment or treatment plan.

Technical eclecticism

This shares similarities and differences with assimilative integration, but it has no theoretical underpinning to the approach. (The Counselling Directory, 2013)

As CBT is a theoretical integrative model, and it is difficult to integrate some theories, CBT cannot and does not incorporate any psychodynamic theories. However, if you are going to work in a fully integrative manner, you need to bear in mind the theories within the psychodynamic approach too. If therapy seems to need some psychodynamic interventions, then you may need to drop CBT sessions sometimes and concentrate on the psychodynamic interventions, maybe through Cognitive Analytical Therapy instead, before continuing with CBT.

The basic concept of CBT

Cognitive Behavioural Therapy (CBT) was developed by [Aaron Temkin Beck][11], and as mentioned before, CBT is a combination of behaviourism and behaviour therapy, and cognitive theories and their application in therapeutic settings (Reeves, 2013). CBT helps to change how you think, hence the word *Cognitive*, and what you do, hence the word *Behaviour*.

A difficult life situation, relationship or practical problem can lead to:

  • Altered thinking
  • Altered emotions and feelings
  • Altered behaviour
  • Altered physical feelings or symptoms

Things can happen the other way too. Any of the above alterations can lead to a difficult life situation, relationship or practical problem (Royal College of Psychiatrists, n.d.).

CBT works by trying to get the client to think about a situation in a more helpful way in order to move forward using more helpful behaviours.

The basic concept of REBT

Rational Emotive Behaviour Therapy (REBT) has generally been put under the same umbrella as CBT, however although it has similarities, REBT is different. Where CBT was developed by [Aaron Beck][11], REBT was developed by [Albert Ellis][13] when he started to lose faith in the type of psychoanalysis he was using.

REBT is a practical and action-led model of therapy and personal growth. It doesn’t just focus on the client’s behaviours, but also allows the client to understand the behaviours of others and provide techniques that will help to solve future problems.

Although REBT looks primarily at our current beliefs and behaviours, it also looks at the cause and effect of past experiences and beliefs which create our present beliefs and behaviours. It does this whilst aiming to change irrational beliefs into rational ones quickly rather than slowly, however, one key point to note is that the therapist does not impose rational beliefs on the client, but accepts there are non-rational beliefs that may help people achieve happiness. That way, the therapist is accepting the client’s value system.

REBT, uses an A-B-C-D-E formula.

  • Activating Experience
    Also referred to by some as the Initial Sensitising Event (ISE), this is the root cause of our unhappiness
  • Beliefs
    Irrational self-defeating beliefs that are the source of our unhappiness, or come about as a result of the ISE
  • Consequences
    The neurotic symptoms and negative feelings and emotions that result from the ISE and/or Beliefs
  • Dispute
    We must dispute and challenge these irrational beliefs in order for the client to enjoy a balanced outlook in life
  • Effects
    The client must learn to enjoy the effects of the new rational beliefs and get used to the changes, letting them become the new norm.

The shortfalls of CBT

As mentioned before, One of the ideas put forward about CBT is that it is a suitable form of therapy for all human problems. This idea can be damaging in some respects, as CBT is not suitable for all psychological conditions.

Interestingly, whilst researching the overall efficacy of CBT, I came across a few items of note.

  • Carl Rogers emphasised the quality of the therapeutic relationship as a necessary and sufficient condition for successful therapy (Rogers, 1957) whereas CBT therapists tend to see the alliance as more instrumental in ensuring the patient’s adherence to the treatment protocol (e.g. Dunn, et al., 2006) (Goldsmith, et al., 2015)
  • The Countess of Mar in the House of Lords suggested the results of a trial into the effectiveness of CBT and GET (graded exercise therapy) had been artificially inflated (BACP, 2013)

The fact is that, as opposed to the spin that accompanied the publication of selective results, only 15% of patients improved with CBT and GET, leaving 85% with no benefit from those interventions. Furthermore, of the combined CBT/GET groups of 321 people, 91% experienced adverse events
[The UK Medical Research Council] PACE trial PIs [Principal Investigators] changed the primary outcome measures with the intention of artificially inflating the success of CBT and GET—treatments they promoted for more than 20 years—and that, consequently, they are guilty of scientific misconduct. (UK Parliament, 2013)

…CBT is ‘probably effective’ with major depression, general anxiety disorder, panic disorder and social anxiety disorder, but not as effective as has been claimed, due to publication bias, poor quality of studies, and the use of waiting list control groups as a comparator. (BACP, 2016)

  • CBT is as much based on the development of a therapeutic alliance as it is in a psychodynamic and humanistic approach. The success of therapy will be, at least partly, informed by the nature of the therapeutic process, and not simply the application of particular theoretical ideas, as some suggest (Reeves, 2013)
  • Recent literature provides fairly strong evidence that CBT in addition to antipsychotic medication is effective in the management of acute as well as chronic schizophrenia (Rathod & Turkington, 2005). However, I would stress that CBT was not used alone in any of these studies from what I have seen. It was used carefully in conjunction with psychiatric help and antipsychotic medication.

An alternative to CBT called Metacognitive Therapy (MCT) has been touted to be better than CBT. But it was developed by Manchester University (Addelman, 2020) and studied by Manchester University (Wells, 2019) so more independent studies are needed.

Either way, if the client is not able or willing to challenge their thoughts and behaviours, then CBT will not be effective.


Addelman, M. (2020). *New therapy more effective than cognitive behavioral therapy for depression.* Retrieved from: https://medicalxpress.com/news/2020-05-therapy-effective-cognitive-behavioral-depression.html

Babilonia, S. (2015). Challenging religious privilege in public life. Retrieved from: http://churchandstate.org.uk/2015/10/the-problem-with-faith-11-ways-religion-is-destroying-humanity/

BACP. (2013). Policy. Therapy Today, 24(2), p. 52.

BACP. (2016). News. Therapy Today, 27(8), p. 6.

Crown Prosecution Service. (n.d). Female Genital Mutilation Legal Guidance. Retrieved from: http://www.cps.gov.uk/legal/d_to_g/female_genital_mutilation/#a02

Cuijpers, P. et al. (2016). How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry, 15(3), pp. 245-258. https://doi.org/10.1002/wps.20346

Dhami, S. & Sheikh, A. (2000). The Muslim family: predciament and promise. The Western Journal of Medicine, 173(5), pp. 352-356. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071164

Dunn, H., Morrison, A. P. & Bentall, R. P. (2006). The relationship between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive therapy for psychosis. Clinical Psychology & Psychotherapy, 13(3), pp. 145-152. https://doi.org/10.1002/cpp.481

Goldsmith, L. P., Lewis, S. W., Dunn, G. & Bentall, R. P. (2015). Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis. Psychological Medicine, 45(11), pp. 2365-2373. https://doi.org/10.1017/S003329171500032X

Home Office. (2016). Mandatory reporting of female genital mutilation: procedural information. Retrieved from: https://www.gov.uk/government/publications/mandatory-reporting-of-female-genital-mutilation-procedural-information

Pink Therapy. (2016). Why I am resigning from the British Association for Counselling and Psychotherapy. Retrieved from: https://pinktherapyblog.com/2016/02/17/why-i-am-resigning-from-the-british-association-for-counselling-and-psychotherapy/

Rathod, S. & Turkington, D. (2005). Cognitive behaviour therapy for schizophrenia: a review. Current Opinion in Psychiatry, 18(2), pp. 159-163. https://doi.org/10.1097/00001504-200503000-00009

Reeves, A. (2013). An Introduction to Counselling and Psychotherapy: From Theory to Practice. London: SAGE Publications Ltd..

Rogers, C. (1957). The Necessary and Sufficient Conditions of Therapeutic Personality Change. Retrieved from: http://www.shoreline.edu/dchris/psych236/Documents/Rogers.pdf

Royal College of Psychiatrists. (n.d.) 5 Areas Assessment. Retrieved from: https://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/cbt/5areas.aspx

The Counselling Directory. (2013). Integrative Psychotherapy as an Effective Form of Counselling. Retrieved from: http://www.counselling-directory.org.uk/counsellor-articles/integrative-psychotherapy-is-the-best-approach

UKCP. (2015). Memorandum of Understanding (MoU) on Conversion Therapy in the UK. Available at: https://www.psychotherapy.org.uk/wp-content/uploads/2016/09/Memorandum-of-understanding-on-conversion-therapy.pdf

UK Parliament (2013). PACE Trial: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis - House of Lords Grand Committee Available at: https://hansard.parliament.uk/lords/2013-02-06/debates/130206114000195/PACETrialChronicFatigueSyndromeMyalgicEncephalomyelitis

Wells A (2019) Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health. Frontiers in Psychology, 10(2621). https://doi.org/10.3389/fpsyg.2019.02621

  • 2
    $\begingroup$ Wow! Jaw-dropping answer $\endgroup$ Jun 1, 2017 at 7:13
  • $\begingroup$ Could you please tell in a sentence what's essential about "psychatric help" as opposed to cognitive and/or behavioural therapy? In which respect is psychatric therapy not cognitive and/or behavioural and goes beyond it? $\endgroup$ Jan 15, 2020 at 12:07
  • $\begingroup$ @Hans-PeterStricker - Therapists trained in talking based therapies such as CBT are not necessarily trained in the psychiatric help required to deal with psychotic mental health disorders such as Schizophrenia. These kind of psychotic disorders require the help of psychiatrists who can support their therapy and prescribe the necessary medication which will help to mediate the hallucinatory aspect of the problem. Psychotherapists cannot prescribe medications whereas psychiatrists can. $\endgroup$ Jan 15, 2020 at 12:41
  • $\begingroup$ So the main role of psychatrists is to prescribe medication? I haven't been aware of this. But I stumbled over your formulation "psychatric help and antipsychotic medication" which I understood to be two different things. $\endgroup$ Jan 15, 2020 at 12:48
  • $\begingroup$ @Hans-PeterStricker - Prescribing is not the main role of psychiatrists, but one of the roles they can fulfill. nhs.uk/conditions/psychiatry may help to define what a psychiatrist does. Low level psychiatry for PTSD etc. can be provided by a general practitioner or primary care physician, but if there is a severe disconnect from reality in any way, more specialised help is required, hence the need for a psychiatrist. $\endgroup$ Jan 15, 2020 at 12:57

Generally, therapy is more successful, the more resources a patient brings to the therapy.

For example, a generally healthy person will recover quickly from a flu, while an old person with fragile health may even die from it. The same goes for psychotherapy.

The more "functional" a person was before he or she developed a psychological disorder, the more friends they have, the more functional their family was when they were children, the better educated that person is, and so on – the more likely it is that this person's psychological health can be restored through treatment.

Moderators of therapy success are the same as for the absence of a disorder in the first place. That is, the more likely it is for someone to develop a disorder, the less likely it is that treatment will be successful.

  • 2
    $\begingroup$ There is a lot of opinion in this answer from what I can see. Have you got any references to the statements you have made such as "The more 'functional' a person was before he or she developed a psychological disorder, the more friends they have, the more functional their family was when they were children, the better educated that person is, and so on – the more likely it is that this person's psychological health can be restored through treatment." $\endgroup$ May 17, 2017 at 16:57
  • $\begingroup$ @ChrisRogers: I agree that you ask for references. On the other side: Isn't there some deep truth in the claim - even without references? Should I deny the correlation if it's not proven or perfect? Am I supposed to believe any reference that would tell me that there is no such correlation - against my very strong beliefs? $\endgroup$ Jan 15, 2020 at 15:23
  • $\begingroup$ And to be honest: I would doubt any study that tells me the opposite: "there is no such correlation". $\endgroup$ Jan 15, 2020 at 15:25
  • 1
    $\begingroup$ @Hans-PeterStricker - You may support this and doubt any scientific study which refutes it, but this is a scientific stack and we require supporting evidence to back claims made in answers no matter what the answerer's background in order for readers to read further and check claim validity. $\endgroup$ Jan 16, 2020 at 9:44
  • $\begingroup$ @ChrisRogers: To be specific it would be great to have a study at hand that claims that there is no such correlation but instead: Whether a person's psychological health can be restored by CBT does not depend on how "functional" the person was before he or she developed the disorder, how many friends they have, how functional the family was, and so on. Do you know of such a study? $\endgroup$ Jan 16, 2020 at 10:22

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service and acknowledge you have read our privacy policy.

Not the answer you're looking for? Browse other questions tagged or ask your own question.