Michael J Scott

  • Pseudo-diagnosis is rampant. Psychological therapists in NHS Talking Therapies are expected to generate a diagnosis for each client. But the Service states[Manual 2024)] that its’ diagnostic labels should not be used for medico-legal purposes! If they are not reliable enough for the Courts, how can they be reliable enough to guide treatment decisions? Confusingly, the Service states that its’ clinicians are not trained to diagnose.

    I have signed up to attend the BABCP annual jamboree in Scotland this September. I can confidently predict that the outcomes of much vaunted treatments will not be based on pre and post ‘gold-standard’ diagnostic assessments. Much less will they be based on independent blind assessment. Enthusiasm for interventions will greatly outstrip evidence. For whose benefit is the evangelical fervour for CBT?

    • those seeking employment as CBT practitioners
    • providers of NHS Talking Therapies Services
    • beleaguered NHS staff
    • politicians concerned to ‘prove’ ‘that at least they get some things right’
    • integrated Care Boards

    No one in their right mind is going to publicly dissent. The likelihood is that the deafening silence of the past 17 years will continue. “Repeat a lie often enough and it becomes the truth”, is a law of propaganda often attributed to the Nazi Joseph Goebbels.

    As with all propaganda, the losers are the person in the street. This is not to say that people cannot benefit from CBT but that they do not do so routinely [Scott (2018)].

    Dr Mike Scott

  • At a cost of £2 billion a year for adult and child mental health services. NHSE manages NHS Talking Therapies without any acknowledgment of a failure of governance. It is or should be aware that pychometric tests results provide, at best, circumstantial evidence of effectiveness.

    But it presses ahead with its conviction of a 50% recovery rate. It is akin to a person being convicted of an offence on the surmise of a policeman. The failure of NHS England and Talking Therapies has been going on as long as the Post-Office scandal, but with a determined blindness on the part of power-holders.

    Blood pressure monitors are a useful device, good for charting hypertension, but unlikely to be relevant to your knee pain. In a similar way, the two psychometric tests, beloved of NHS Talking Therapies, the PHQ-9 and GAD-7, are relevant only if the person is known to be suffering from reliably diagnosed depression or generalised anxiety disorder. No reliable standardised diagnostic interview is conducted in NHS Talking Therapies, in this context the questionaires are meaningless.  In NHS Talking Therapies clients complete these measures at the beginning when they are likely at their worst. With the passage of time, as crises subside, and with attention, scores improve. But test scores improve just as well when clients attend the Citizen’s Advice Bureaux. There is no independent evidence of recovery from any of the psychological disorders that are supposed to be the focus of NHS Talking Therapies.

    The reports of NHS Talking Therapies clinicians invariably quote PHQ9 and GAD7 scores and the improvement in them as evidence of effectiveness. As an Expert Witness to the Court for over 30 years, I have to regularly point out that the clinician’s reports cannot be relied upon. In a backhanded admission of the unreliability of clinicians reports, NHS Talking Therapies states that their reports cannot be relied upon for medico-legal purposes! Between NHS England and NHS Talking therapies there is a con going on here. The clinician is like a footsoldier in a totalitarian state, doing what he/she is told. The public are failed. The questionnaires are fake news. Perhaps the good news is that NHSE will be abolished in he next 2 years, but will the Department of Health and Social Care want to grasp the nettle?

    Dr Mike Scott

  • Nobody is asked whether they are back to their old self with treatments or of the duration of recovery. But these are the metrics that are most important to service users. It appears that evaluations primarily meet the needs of service providers and their academic fellow travellers. The NHS controls Service Providers and it is in their interest to use self-report measures, that give a positive spin to their ministrations. People present at their worst and so there is an inevitable seeming improvement with attention and time on a questionnaire. It is spin not to present apparently positive results in the context of what happens to those not given treatment. The reality is Talking Therapies clients does no better for clients than if they had attended a Citizen’s Advice Bureaux.

    In routine practice service users are asked to complete a psychometric test, when their score falls below a cut-off they are discharged. But there is nothing in the process to guarantee:

    1. the test that was administered is appropriate to their diagnostic status 
    2. the score achieved is a surrogate for loss of diagnostic status as assessed by a blind independent rater using a standardised diagnostic interview
    3. that there has been an enduring change in the service users functioning that they would recognise

    But the same considerations apply to the assessment of the impact of antidepressants. A blog from John Read, Professor of Clinical Psychology at the University of East London shows that the focus has been on the impact of medication over 8-12 weeks and the experience of withdrawal symptoms such as nausea, dizziness as assessed on a scale. Notwithstanding that most patients have been on antidepressants for years and that the withdrawal symptoms are the least of their concerns, ‘I’m still bloody depressed’. 

    Dr Mike Scott

  • In Personalising Trauma Treatment: Reframing and Reimagining Scott (2022), I suggested that we can retrieve memories of extreme trauma, in our ‘Dr Who, Tardis’, and that  this may lead to the persistence of PTSD. But we also retrieve, lesser traumas such as bullying at work or being publicly-shamed, that result in ongoing debility. I argued that it is the centrality accorded to these experiences that produces dysfunction rather than the negative event per se. Such experiences may become the window through which the individual views themselves and their personal world. Treatment involves consideration of viewing the self and personal world through other windows, including the pre- trauma window.

    A just published study by Kredlow et al (2025), has found that negative autobiographical memories are also related to patient symptoms in the anxiety disorders and OCD. Nonresponse rates in CBT are estimated to be 34-50%. Thus, targeting negative life events that are related to an individual’s symptoms may improve treatment outcomes. Patients could be asked whether there are any key memories from their lifetime that they believe have contributed to their fears ( SNAMs, Symptom Relevant Negative Autobiographical Memories).The SNAM Event itself may not be as clinically relevant as to how an individual remembers and interacts with the SNAM.

    Formulations can be enhanced by an awareness of mental time travel. Examining in session how homework compliance may have been coloured, by ‘Tardis excursions’ since the last session.

    Dr Mike Scott

  • It was distressing this week to hear, at the opening of the Inquiry, of the ongoing traumatisation of children, which included reports of:

    • A child hiding under a table not wanting to go to school
    • A child constantly looking over their shoulder when outside
    • A child very frightened by loud noises or sudden movements
    •  The alarm of a parent that there was no adult around to assist their child

    About the same time as the murders, the 2nd edition of my self-help book ‘Moving On After Trauma’ was published by Routledge. In it I suggested that there is no need for victims to relive the trauma, rather to gradually behave as they did before the trauma. These can be seen as ‘dares’, and to most children are what makes life fun. It is ‘daring’ to get back to your old self. For both children and adults, it’s not possible to be your ‘old self’ without beginning to do what you did before the trauma. 

    The good news is that there can be ‘normal service’, but for many it feels ‘spoilt’ by the flashbacks and nightmares. The best that can be done is to insist that these intrusions don’t have the last word. Just blocking the memories, gives at most temporary relieve, the harder the memories are pushed away the stronger they return, as if on an elastic band. But the intrusions gradually lose their power if the person can say they are not relevant to what I’m doing today. The only purpose of the intrusions is to daily ask whether the memory is relevant to today, it is only the mind asking a question for possible protection. The vividness of the memories does not make them relevant. For a child they can be seen as a ‘bully’ who they are not going to get involved with ‘better things to do’. Or as a ‘sore’ that they mustn’t pick at, lest the inflammation becomes worse than the sore. 

    Parental guilt can get out of control when harm comes to your child, ‘my job is to protect them’. It can lodge in your gut even though you know you have done nothing wrong. Trying to cut it out seems to make it worse. It is a bogus guilt, unlike true guilt, were you can see the negative consequences of something and do it anyway. This bogus, trauma-related guilt is best dealt with as a ‘mental cold’, ignoring the discomfort as you would a cold when you have to work. Over time the guilt feeling fades but you can’t hurry it along. If you are not careful with this you can develop a ‘prejudice’ against yourself, which like all ‘prejudices’ gets in the way. Don’t become ‘bigoted’ against yourself.

    Hope this helps

    Dr Mike Scott

  • Is usual care worth a monkey? Or more precisely the £2bn per year spent on NHSTalking Therapies for Adult and Children’s mental health?

    Cuijpers et al (2024) anticipated that the response rate of treatment as usual would have improved as a result of the dozens of RCT’s conducted over past decades. Regrettably there has been no percolation. Remission rates and pre- post effect sizes did not significantly improve over time. In primary care the remission rate for care as usual was 27%. The pre-post standardised mean difference in care as usual in primary care was 1.11. But this is no different to that found in NHS Talking Therapies, suggesting that the latter confers no added value. Interestingly the remission rate using independent assessors  in care as usual in the Cuijper et al (2024) analysis was found to be just 14%, Almost 80% of patients in routine care do not respond to treatment.

    This tip of the iceberg response is identical that found by myself Scott (2018) assessing litigants with a standardised diagnostic interview with regards to their psychological treatment either before or after personal injury. (In specialised mental health care the response rate was 20%). In the rcts the response rate to psychological treatment was 41%.

    Dr Mike Scott

  • Why then is the Health Secretary, Mr Sweeting – wasting £2bn a year on NHS Talking Therapies.?

    The professional groups providing psychological services are a powerful lobby. It was announced on the June 25th, 2025 that BABCP (British Association for Behavioural and Cognitive Psychotherapy) and the British Psychological Society (BPS) would welcome into their fold:

    • Mental health well-being practitioners.
    • Psychological well-being practitioners.
    • Education Mental health practitioners.
    • Children’s well-being practitioners.

    The president of BABCP , Dr Stirling Moorey said that this is a. “Significant step forward in quality assurance, public protection and professional recognition’.

    But in what way will ‘quality assurance be increased?’. Better than AI? The AI advocates have used the same flawed methodology as NHS Talking Therapies, neither have looked at the proportion of clients who have returned to their old selves post-treatment for what they sees as a meaningful period as assessed by independent assessors. There has been no real listening to clients.

    An AI Chatbot (Therabot) appears to do just as well as NHS Talking Therapies for clinically significant symptoms of depression and GAD [Heinz et al (2025)]. The study used the same outcome metric, changes on psychometric tests.  Results were compared with a waiting list control. The Therabot intervention lasted 4 weeks, and there was a 4 week follow up. Average use of the intervention was greater than 6 hours. The authors claim that participants rated the therapeutic alliance as comparable to that of human therapists. For depression an 8-point change in score by the follow up, compared to a 4-point change for those on waiting list. For GAD a change of 3.2 compared to a change of 1.1 for those on the waiting list. 

    Psychological Wellbeing Practitioners (PWPs) arrived on the scene 15 years ago as part of the IAPT Service , welcomed by BABCP/BPS. However there has been no evidence of an added-value of their ministrations over and above what was on offer before. Whilst it is the case that there has been increased access to ‘psychological interventions’ there has been no evidence of this making a real-world difference to clients lives beyond that which obtained pre IAPT . Most parsimoniously the new designations looks like an exercise in empire building, gifted by NHS England.

    The Government is set to abolish NHS England within 2 years. It seems that this body and its’ products are not fit for purpose.  Mr Sweeting has vowed to make a bonfire of quango’s but hasn’t yet lit the blue touch paper, the AI study may encourage this.

    Yet doubtless BABCP/BPS will struggle strenuously to ensure that £2bn a year continues to be spent on these service. Mr Streeting, Health Secretary , should ask why?

    Last year the Spanish Society for Clinical Psychology published my paper ‘The UK NHS Talking Therapies Fantasy’ it should be on the required reading list of the Health Secretary.

    085280

    Dr Mike Scott

  • In March 2025 the government announced the end of NHS England within 2 years, with a move of staff and function to the Department of Health and Social Care. Integrated Care Boards, who oversee much of mental health provision, are being asked to achieve a 50% reduction in costs. Jobs are likely on the line. The pressure will be to avoid any ‘talking’ in favour of digital ‘solutions’ such as Silver Cloud. A recent exchange on Twitter highlights the extreme dissatisfaction with NHS Talking Therapies attempt to do things on the cheap! The paradox will be ‘talking therapies, don’t talk’.

    Psychological treatment is following an ‘entropy trajectory’, where energy becomes progressively available in a less useful form. The process starts off reasonably well, with randomised controlled trials showing CBT treatments are better than active control conditions, but a paucity of evidence on how long gains last. Further it is not clear what this means in the real-world.I have found it impossible to discover what proportion of those given CBT would say that they recovered in the sense of being back to their normal selves for what they would see as a meaningful period. When the rcts have been evaluated in routine practice , there has usually not been independent assessment. Thus whilst a case can be made that ‘efficacy’ is proven, not so for ‘effectiveness studies’. When it comes to routine practice the energy is further degraded, it is only the Service providers who claim a 50% recovery rate. My own independent analysis as an Expert Witness to the Court suggests a tip-of-the iceberg rate of recovery. Most likely explained by giving people simply time and attention rather than anything to do with CBT.

    Unfortunately, Service providers and lead organisations for CBT are likely to push as far as possible f or the retention of the status quo. But in w hose interest?

    Dr Mike Scott

    • The dropout rate from trauma focused treatments (TFTs), in randomised controlled trials is 1 in 4
    • With a 50% recovery rate, but in routine practice only the tip-of-the iceberg recover
    • TFTs are not user-friendly for clinicians or clients, as the latter rarely want to re-live their trauma
    • But there is a new way forward – gradually daring the client to think and behave as they did pre-trauma. At the same time challenging the relevance of the intrusive memories to what they might do today. That is, changing the window through which they view themselves and their personal world.

    The Powerpoint presentation below highlights this different pathway:

    https://www.dropbox.com/scl/fi/zh3owqemrdh4vcac7j14o/Reconceptualising-Trauma-Treatment-2025.pdf?rlkey=0rwfvr5djghnag5tt8n5zu49m&st=qk09aany&dl=0

    Scott, M.J (2022) Personalising Trauma Treatment: Reframing and Reimagining London: Routledge and

    Scott,M.J (2024) Moving On After Trauma 2nd Edition London: Rutledge

    Dr Mike Scott

    • Subscribe

      Sign up for our newsletter and stay up to date

      *

      Across countries, Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Spectrum Disorder (ASD) have become the ‘go to’ explanations for:

      • difficult or unusual child behaviour
      • an unresponsive partner
      • a difficult employee or manager
      • long term dysfunctions

      Before the millennium very different explanations would have been proferred. Are there really more casualties? Are we now any better at resolving these issues?

      Difficult to assess true prevalence because there are no biological markers for ADHD/ASD. This comes as a surprise to most users of the terms. It should generate caution when a child is placed on a ‘pathway’ for one and sometimes both of these disorders. Or when a person re-interprets what they see as long-term dysfunction in terms of one or other of these labels. Due consideration should be given to alternative simpler explanations and treatments. But mental hypochondria rules, the equivalent of seeing a headache as signs of a brain tumour, which would evoke a ‘not impossible but really….’ response.

      Propelled by pharmaceutical companies and designated specialist Units, the ADHD/ASD juggernaut has acquired such momentum that it may be regarded as ‘churlish’ and ‘unprofessional’ to question it. Defenders of these constructs, can rightly point out that there are no biological markers for any of the psychological disorders. But this does not seem a sound basis for multiplying diagnoses. Curiously these disorders do not figure in the NHS Talking Therapies lexicon, nor where they a focus in the most recent meta-analysis of the efficacy of CBT treatments Cuijpers et al (2025). In subsequent posts I will look at the validity, utility and authority behind the supposed treatments of ADHD/ASD.

      Dr Mike Scott