What is CBT? Reflections of a practising Cognitive Behavioural Therapist
The words Cognitive Behavioural Therapy undoubtedly evoke different thoughts and feelings for different people. For some it may represent what the NHS now describes as the therapy of choice for many psychological problems. For others, it may bring up frustrations or annoyances as it reminds them about how other therapy modalities have been ‘stepped over’ when it comes to free and accessible provision. For others, it may not represent much at all. For me, the words together are very familiar as it is describes my chosen profession.
Cognitive Behavioural Therapy or CBT as it is commonly referred is a talking therapy. The word cognitive refers to the mental processes that occur in our minds such as thoughts, images and memories. CBT stipulates that cognitions are central to the ways in which we experience events. The content of a person’s thoughts shape how they interpret an event, which then affects how they feel emotionally and physically. For example, if I was walking down the street and another person walking towards me whilst looking the other way was going to collide with me unless I took evasive action, I might interpret this in different ways. I might think “why doesn’t this person look where they are going? Honestly, people just don’t have any respect”, I would be likely to feel angry. I might even react aggressively and say something critical or confrontational. Similarly, I might be thinking differently, such as “this person is obviously distracted and perhaps has a lot on their mind. I can move out of their way, because I can see what is going to happen.” With these thoughts, I would be likely to feel less angry and I could probably carry on without reacting to what has just happened. The ways in which we think during different situations influences how we feel and how we react.
Now this is a familiar introduction to explaining the nature of CBT. Unfortunately, it can give the impression that all a person need do to feel better and get on with others is to think positive. However, this is not what CBT purports. Realistically, our reactions to events are influenced by how we are already feeling during an event. For example, if I was already stressed by circumstances in my life, I might react more quickly and negatively to that person in the street than if I was walking along without many cares in the world. Feelings then, also affect how we think and it is important to recognise at the end of the day that we are all human beings who are affected by life and what it throws at us. Having sympathy and understanding for ourselves and others in this way is no less a component of CBT than it is of other theoretical approaches.
Techniques as well as the relationship are important in CBT. The model emphasises collaboration, two-way feedback and interpersonal effectiveness. It is built on the core conditions of counselling that underpin professionalism and humanness in all therapeutic relationships. Yes, it is true that CBT training focuses on strategies to manage thoughts, feelings and behaviours more so than it does therapeutic encounters. Its emphases on problem-solving, goal-setting, cognitive challenging, emotional expression, behavioural experimentation and exposure to fear are what most people associate with CBT. The focus on strategy is one of CBT’s strengths as is the value of homework to promote practice of what has been learnt in the sessions. A proficient Cognitive Behavioural Therapist recognises that both the techniques and the therapeutic relationship are central to the success of treatment.
Does CBT just focus on the here and now? Well, the short answer is no. It does emphasise that work begins in the here and now in order to reduce the severity and frequency of symptoms. This is one of the reasons that CBT can be time-limited as people can achieve what they were looking for in a specific number of sessions. However, this is not possible for everyone as their symptoms are heavily influenced by experiences from earlier life that caused them to develop very rigid negative core beliefs about themselves, others and the world around them. In these circumstances, CBT most definitely explores the past. It does so, because it recognises that the strategies people are using today were developed whilst they were growing up. Therefore, there is a need to understand the origins of current problems. Again, a proficient therapist will do this with understanding and sympathy for the child who had to adapt to their environment.
The misunderstanding that CBT does not focus on the past may in part occur, because once the origins of present problems are understood the therapy chooses to focus on how they can change. It looks at assessing the both accuracy and the helpfulness of current beliefs and strategies. It asks people to consider adopting less rigid ways of seeing themselves, others and the world. It aims to increase flexibility within a person’s coping strategies so that they can learn to choose how to react to that person in the street, rather than doing so in the same old way. CBT helps a person know thyself better so that they can become their own therapist.
Discussions about CBT can often elicit strong points of view. It has had increasing exposure in the media since the NHS commissioned its provision nationwide in 2008.
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