Philippe Jacquet is not a critic of cognitive behavioural therapy from the outside. He trained in rational emotive behaviour therapy in the early 2000s, and spent time in a Buddhist monastery where mindfulness practice — central to the third wave of CBT — was woven into daily life. He has worked within the CBT tradition and retains genuine respect for it.
Which is why what follows is not a dismissal. It is a clinical observation.
Why CBT is recommended
CBT is the most widely recommended form of talking therapy in the world, and there are good reasons for this. It is structured, time-limited, and produces measurable results. It works. For specific presentations — phobias, panic disorder, certain forms of depression and anxiety — the evidence base is strong and the outcomes are real.
Its other advantage is practical: it is short. In a world where healthcare systems are stretched and people want results quickly, a twelve-week intervention with a clear framework is attractive to commissioners, insurers, and patients alike.
The limitation — displacement of symptoms
A patient came to see Philippe Jacquet presenting with bulimia. In gathering her history, he asked a question he considers essential: had she had therapy before?
Yes, she said. CBT. An extraordinary experience. It had really helped her.
His first thought was practical: if it helped, and if she already had a relationship with that therapist, why not return? The therapist had retired. That made sense.
Then another question: what had she originally gone for?
Anorexia.
Philippe looked at her. But he didn’t treat you, he said. What you are describing is a mutation in the disorder.
The CBT had addressed the anorexia — the specific behaviours, the thoughts that maintained them, the immediate patterns. What it had not reached was the underlying structure: the relationship with food as a form of control, the use of the body to manage identity and emotion, the developmental roots of why this had formed at all. That structure remained intact. It found a new expression. Anorexia became bulimia.
When displacement is progress — and when it isn’t
This is not always a failure. Consider the person with severe agoraphobia who cannot leave their house. CBT works with them systematically until they can go outside. The symptom shifts: now they are afraid of flying, or the underground. They have gained considerably more freedom in their life. That is real. That matters.
But the anxiety has relocated, not resolved. The root that generated it is still there, now expressed differently. Whether this is acceptable depends on what the person needs — more functional freedom, or genuine resolution of what drives the symptom.
CBT, at its best, is honest about this. The question a person needs to ask before choosing a therapeutic approach is equally honest: am I looking to manage the symptom, or to understand and change what produces it?
Both are legitimate goals. They require different kinds of work.
“CBT has real value — I was trained in it, I respect it. But I have sat with a patient who told me her previous CBT had been extraordinary, transformative. She had come for anorexia. She was sitting in front of me with bulimia. The therapy had worked. The disorder had simply moved. That is not the same thing as healing.” — Philippe Jacquet
Book a consultation with Philippe Jacquet — psychotherapist and Jungian analyst, London.