Like any clinical practice, Cognitive Behavioural Therapy (CBT) participates in societal networks of power relations. This chapter explores one aspect of this, by posing the question of how its success and widespread recognition may be a function not of its effectiveness per se, but of its comfortable integration with existing cultural and institutional power arrangements. Our Enlightenment heritage calls for a rationalist ordering of the therapies, in accordance with narrow and pre-constructed values that correspond with those of society's most powerful institutions. It is in this context that we should understand CBT's overwhelming emergence as the therapy of choice. The risk of its institutional success is the establishment and legitimisation of a therapeutic hegemony, and the gradual diminishment of a once rich landscape of therapeutic possibilities.