Have you been considering seeking counselling or therapy recently and wondering will CBT work for me? When people think about seeking counselling or therapy, it can feel confusing and challenging to know what type of counselling to seek; there are so many models and approaches.
Before we address the question will CBT work for me, it’s important to first establish that there are different types of counselling therapies being practiced, all of which ultimately aim to help the client overcome a range of emotional problems. However this means it’s not surprising the waters can become muddied when taking the first step towards seeking support through couselling.
Cognitive and Behaviour Therapies are among the counselling therapies and psychotherapies that people usually seek. They are recommended by NICE (The National Institute for Health and Care Excellence) for anxiety disorders, depression and many emotional problems, because of the wealth of research that has demonstrated their effectiveness and efficacy.
The ideas that underpin each counselling model have a profound effect on the techniques we develop and the way we ‘do’ our work or the way we counsel. The model a counsellor uses, their ‘therapeutic bias or preference’, will even affect what is considered important or relevant during sessions. But just because there are different types, it does not mean one particular therapy is more ‘authentically’ counselling than the other.
Many models of counselling
There are many different theories of counselling available to choose from, whether as a practitioner or a client. Some of the most well-known include:
- Psychodynamic therapies, which includes Psychoanalysis, developed by Freud, are influenced by Freud’s ideas and direct the therapy to the past and childhood in order to make sense of their problems in adulthood. Emphasis is given to negative experiences of early development and the role of early parenting in the formation of the self and the other.
- Learning Theory Approaches, which include behavioural therapy which aims to eliminate unwanted and unhelpful behaviours as a way to solve problems. It is active and goal focused.
- Perceptual – Phenomenological Approaches which includes Transactional Analysis, Gestalt Therapy and Client Centred Therapy. Client or Person Centred is a non-directive form of talking therapy. The therapist remains non-directive, does not offer suggestions or solutions. It is not goal focused but rather focuses on the relationship between the client and the therapist. The idea is that the therapeutic relationship could lead to insights and lasting changes in clients.
- Existential Therapy is philosophical and focuses on free will, self-determination and the search for meaning. It emphasises the client’s capacity to make rational choices. It is non directive and the therapist does not offer suggestions or solutions.
- Cognitive and Behaviour Therapy which includes Rational Emotive Behaviour Therapy or REBT, Cognitive Therapy (also known as CT and CBT), and Cognitive Behavioural Modification. These are goal directed and state that our emotional disturbances arise from unhealthy unhelpful beliefs, attitudes and thinking and behaviours and that these can be changed so that we can free ourselves from being stuck in emotional pain. They concentrate on present problems and the current mindsets and behaviours that are creating them.
All of these are counselling theories. ‘Cognitive Behavioural Therapy (CBT)’ is an umbrella term for several different theories that share common principles, just as ‘Psychodynamic Therapy’ is also an umbrella term.
Will CBT work for me? Informed choice is key
When deciding on what type of counselling to seek, it is important to make an informed choice. It is helpful to do some research, speak to your GP and perhaps talk to your friends about what they have found helpful and whether they managed to free themselves from their emotional suffering. Prospective clients should ideally choose the model that they think best suits them, their strengths, experiences and ways of working.
But equally important is questioning perceived ideas or misconceptions about different models. So, some non-CBT counsellors think that CBT counsellors don’t pay any attention to the therapeutic relationship (the working relationship between the client and the counsellor), which is completely untrue. Of course, a CBT-counsellor will work hard to develop an open, trusting and relaxed working relationship. We are, after all, encouraging our clients to be frank and honest with their experiences and beliefs. How could we expect them to share these things if they did not trust us?
In Psychodynamic counselling, for example, the therapeutic alliance is viewed as the most significant condition or the central vehicle through which change occurs. In contrast, a CBT counsellor sees the therapeutic alliance as significant and very important, whilst believing that change occurs when a client changes their mindset and their behaviour. This process of change starts from understanding emotional responsibility, emotions, facing our past, present and future and developing skills of critical thinking and healthy behaviours. Without a therapeutic alliance effective change would be limited regardless of the counselling model used.
Even under the CBT ‘umbrella’ there can be differences. REBT, for example, can be described as philosophical CBT. In REBT, the process of therapy is an active and directive one but collaborative. The therapist and the client work as a team and focus on the client’s goal. It is a transparent process where problems and priority problems are agreed, goals set, and emotions assessed. Then the unhealthy beliefs that are at the heart of the client’s emotional problems are identified. Once this happens, the client learns to turn the spotlight on these happiness sabotaging beliefs so they can be questioned to check if they are realistic and helpful. Once this skill is learned, their healthy alternative beliefs are discussed and formulated. Then the process moves onto how to strengthen the healthy versions and weaken the current unhealthy ones through cognitive and behavioural exercise and homework. It’s like planting a seed for the healthy version and doing what’s needed so the seed can flower. The weeds that need to be kept in check are the unhealthy beliefs. The client learns this philosophy of change is universal. Once learned and applied to the initial problems, it can be universally applied to whatever we experience in life. REBT is an active-directive existential and humanistic CBT model that leads to consistent mental health and resiliency.
Avy Joseph is the author of Cognitive Behaviour Therapy: Your Route out of Perfectionism, Self-Sabotage, and Other Everyday Habits with CBT (third edition published by Capstone, April 2022). He is an experienced CBT/REBT Therapist and Director of the College of Cognitive Behavioural Therapies. He is a registered and accredited therapist with the British Association for Behavioural and Cognitive Psychotherapies (BABCP).