Hermeneutical injustice in CBT: towards an enactivist paradigm in psychiatric practice

Cognitive Behavioral Therapy (CBT) is widely presented as an empirically grounded, value-neutral “gold standard” of psychotherapy. This paper challenges that assumption by arguing that CBT is underpinned by substantive philosophical commitments that shape what counts as legitimate knowledge and therapeutic change. Excavating cognitivism and hierarchical objectivism as core concepts which have shaped the historical development of CBT, I will demonstrate how the approach constrains the therapeutic encounter within narrow explanatory frameworks that privilege cognitive correction. Drawing on Fricker’s concept, I argue that CBT’s dominance contributes to hermeneutical injustice in psychiatry by limiting patients’ interpretive agency and restricting pathways for psychological healing. As an alternative, I propose enactive psychiatry as a more suitable paradigm for understanding mental distress and guiding psychotherapeutic practice. Enactivism offers a pluralistic, relational, and participatory model that better addresses epistemic power asymmetries while remaining committed to scientific inquiry as a means of alleviating psychological suffering.