From the margins to the NICE guidelines: British clinical psychology and the development of Cognitive Behaviour Therapy for Psychosis between 1982-2002

Although histories of Cognitive Behaviour Therapy have begun to appear, their use with people with psychosis diagnoses has received relatively little attention. In this article we elucidate the conditions of possibility for the emergence of Cognitive Behaviour Therapy for Psychosis (CBTp) in England between 1982-2002. We present an analysis of policy documents, research publications and books, participant observation and interviews with a group of leading researchers and senior policy actors. Informed by Derksen and Beaulieu’s (2011) articulation of social technologies, we show how CBTp was developed and stabilised through the work of a variety of overlapping informal, academic, clinical, professional and policy networks. The profession of clinical psychology played a key role in this development, successfully challenging the traditional ‘division of labour’ where psychologists focused on ‘neurosis’ and left ‘psychosis’ to psychiatry. Following Abbott’s (1988) systems approach to professions, we identify a number of historical factors which created a jurisdictional vulnerability for psychiatry whilst strengthening the jurisdictional legitimacy of clinical psychology in providing psychological therapies to service users with psychosis diagnoses. The National Institute for Health and Clinical Excellence (NICE) played a significant role in adjudicating jurisdictional legitimacy and its 2002 schizophrenia guidelines, recommending the use of psychological therapies, marked a radical departure from the psychiatric consensus. Our analysis may be of wider interest in its focus on social technologies in a context of jurisdictional contestation. We discuss the implications of our study for the field of mental health and for the relationship between clinical psychology and psychiatry.

Information for Users of the Institutional Repository:

Users who receive access to an article through a repository are reminded that the article is protected by copyright and reuse is restricted to non-commercial and no derivative uses. Users may also download and save a local copy of an article accessed in an institutional repository for the user's personal reference. For permission to reuse an article, please follow our Process for Requesting Permission (https://uk.sagepub.com/en-gb/asi/process-for-requesting-permission).