Social power: Some implications for the theory and practice of cognitive behaviour therapy

Practitioners of cognitive behaviour therapy (CBT), are faced by real dilem mas when having to take into account the consequences of unequal power rela tions in society. Whilst a perspective on social power is not new in psycho logy, its implications for therapeutic practice have yet to be fully worked out, The problem becomes most acute when clinicians have to confront the s hortcomings of individually focused therapeutic models in, for example, inn er city Community Mental Health Teams (CMHTs), where a majority of clients face real and corrosive adversities in their lives. Exploring the effects o f juxtaposing the individually focused school of CBT (Beck, 1976) with one which explicitly focuses on power relations, e.g. in community psychology ( Smail, 1997), is one way to shed light on these issues. Attention is drawn to core differences in the perspectives, e.g. the main focus of CBT on idio syncratic beliefs and the insistence of community psychology on the social structuring of such beliefs. Ways in which real adversity has been discusse d within the CBT literature are outlined and a clarified view of the proble m presented. A clinical case example is used to illustrate what a focus on social power could add to case formulation in practice. The aim of this pro cess is to assist clinicians in practice to make the best use of the skills they have acquired within a theoretically coherent framework. Copyright (C ) 1999 John Wiley & Sons, Ltd.