Cognitive Behavioural Therapy
By: James Foley
Cognitive Behavioural Therapy
Most counsellors will in some way bow the hat to Cognitive Behavioural Therapy (CBT) as being part of their skill set. Most lay people will also have heard of it. In fact CBT and mindfulness are perhaps the most often talked about counselling buzz words.
Despite its apparent popularity do we really know what CBT is?
Why is there a difference in how CBT is practiced by different counsellors?
Ultimately the real question for you is, will it help you?
What is the reason for its popularity and is it merited?
To finish, what role does CBT have in Prevail?
What exactly is CBT?
A view from history
CBT is part of the evolution of modern psychotherapy. Sigmund Freud and others got the ball rolling with their psychoanalytical approach in the early 1900s. From the the 1940s onward less analytical and more interpersonal approaches were being used. From the 1960s onward two men, Albert Ellis and Aaron Beck separately developed what became CBT. Not surprisingly CBT has not remained static. Acceptance and Commitment Therapy (ACT) is a more recent version.
For the sake of this blog I will focus on Beck’s version of CBT.
Where did CBT come from?
CBT is a union of two therapeutic approaches, behavioural and cognitive. Behavioural therapy has its basis in how people learned to behave. It states if we are to change our behaviour we have to learn new responses to the situations that cause us stress. Cognitive therapy believes the work of change in counselling begins with changing our cognition’s. Cognition’s are our thoughts, beliefs and interpretations about the situations that are upsetting us.
To put it more simply CBT says our stress is not due to the event that is happening to us but how our learned behaviour and our cognitive responses make us respond to it.
So the next time you walk into dog pooh on the street and get annoyed, remember it is not the pooh that is making you angry. It is a combination of your memory of learning from your Mother that you should be more careful and your belief that the pooh should not be there to start with. It’s not the pooh’s fault.
The effect of negative thinking?
CBT teaches that Negative Automatic Thoughts, (NATs), are a common reason for negative responses. Examples of NATs are, “..I can’t…This is so unfair…This is impossible…I will never let them do this to me again..”, etc. These self defeating thoughts just pop into our head when we believe a situation is against us. More often than not these thoughts are false, not based in the real world. Even if they are true it is still not helpful to make decisions based upon them. Truth based negativity still breeds negativity.
When such thoughts are continuous and even reinforced by external forces they may form part of your core beliefs. These are often formed in childhood. Core beliefs are deep rooted. Counselling work may take some time to expose and replace with new beliefs.
Principles of how CBT works
The success of any CBT approach depends on the therapeutic relationship established between the client and the counsellor. Trust in the other is essential for both counsellor and client. Relationship is the framework for every human interaction and has particular importance in the professional context of all counselling therapies.
CBT is often described as directive in style. That means that the counsellor will guide the client through their own self discovery. Information on the client’s behaviour and thought patterns during their stressful periods may be collected through reflective diaries and self recording charts. These same methods can be used at review periods to see if the counselling work is helpful.
Problem identification and formulating of the details of the work to be done regarding them is fully agreed between the client and counsellor.
A counsellor using a CBT approach will tend to use a structured approach. He/she will focus directly on your problems, how it is affecting you and what change you want to bring. It is common for goals to be set and reviews to be held at agreed times. This work is mostly based in the present but may involve looking at past experiences.
As part of the here and now approach of CBT the client is encouraged to practice new beliefs in the real world after these beliefs have been developed and learned in the safety of the counselling room.
A goal of CBT is for the client to learn how to counsel themselves. That they will be able to challenge their own beliefs and past learning in a similar way as they did in the sessions. Over time, with frequent practice, the client will automatically work through identifying harmful NATs and core beliefs. They can then develop safe and appropriate new beliefs that they can adapt to their situation.
Why do different counsellors practice CBT differently?
CBT has almost become a generic brand in counselling therapy. Practically all college courses teach it in various ways. It is usually a stand alone module in a general academic course. There are some who take on specific training in CBT, even to Masters level.
The counsellors practice of CBT is greatly influenced by how their tutors viewed it. Also some counselling schools have a bias for or against CBT.
The relationship between each client and counsellor is unique and therefore their practice of CBT will be unique to each counselling relationship.
Will CBT help you?
This question could be asked of any model of counselling. As is the case with all counselling it is in many ways down to you.
How much do you want to change?
How much work are you prepared to put into it, and with CBT there can be a fair amount of work, both in the session and at home?
A half hearted involvement in any approach to counselling will always result in mediocre results.
It could be said that if you are a person who likes structure and learning, then CBT maybe for you. If you believe a direct challenge is what you need CBT can provide this for you if you agree this with the counsellor first.
If you are someone who prefers a more gentle approach in a more free flowing environment perhaps you will not choose CBT.
The truth is that a counsellor who takes on to do CBT with you will be competent in their knowledge and skill to be able to adapt CBT to you. It really should not matter what your felt preferences are.
The appropriateness of CBT for the client will be part of the initial assessment between the client and counsellor. A client may ask specifically for CBT. More often the counsellor will assess the type of therapeutic approach that would fit for the client. Establishing trust with the counsellor early in the work enables the client to trust the counsellor to choose which therapeutic approach will work best for both of them. The counsellor gains this trust by showing commitment to adapt to the client’s own personality and with maintaining confidentiality.
Why is CBT so popular?
In an era where funding is based on proven research CBT will always win over other methods of counselling.
Here are just three such examples of research into CBT:
- Evidence-Based CBT for Anxiety and Depression in Children and Adolescents: A Competencies Based Approach
The HSE and private providers are more likely to employ CBT practitioners than other practitioners because of its researched structured approach. It is likely to be shorter than other models of counselling which makes it a popular choice with funding organisations. Public and private funding of counselling may demand frequent reviews using structured rating scales. CBT is very amenable to this and can easily incorporate such rating scales as part of CBT reviews.
in its own right CBT is like a research project based on one person. Data is collected, analysed, recommendations are made, and put into practice. It is not surprising that a counselling model which inherently values a researched based approach would in itself be thoroughly researched.
CBT at Prevail Counselling Therapy
CBT is part of the service that I provide at Prevail. Coming from a psych nurse background I have experienced it as the primary therapeutic approach. I believe it can be used as part of an overall approach with a client or as the primary method of counselling therapy.
I have completed two cert courses separate from my training in the area of CBT. One of those was on Reality Therapy which is considered part of the broad church of Cognitive and Behavioural therapies.