What is CBT, and could it be the right approach for me?
In everyday communication, much use is made of initials and abbreviations. Although sometimes helpful, the overuse of initials can give rise to confusion. A careless reference can cause uncertainty as to what the initials represent. Alternatively, the introduction of initials may be seen as an almost deliberate ploy to disguise the true meaning of what is being described.
The counselling world is not immune from this frequent use of initials. Perhaps the most common set of initials appearing within the counselling setting is that of CBT. So just what is this CBT? What do the initials stand for?
CBT - cognitive behavioural therapy
The last question is the easy one to answer. CBT stands for cognitive behavioural therapy. It is a counselling strategy that looks to assist individuals who may be struggling with some form of emotional dysfunction, such as anxiety or severe stress. CBT encourages direct involvement with the thoughts, actions, and feelings that are linked to that emotion.
CBT suggests that it can be difficult to control emotions in the heat of the moment. Nevertheless, if we can stand back and find a safe way in which to review and then actively engage with our actions and thoughts, we can bring about a constructive variation in those thoughts and actions. This will have a beneficial impact on our feelings and emotions, positive change will quickly occur, and all will then be well!
Perhaps... or is that process just a little too simplistic? The reality, of course, is that there is much more to CBT than this brief description, although there is also a debate to be had on just how complicated the work needs to be. Some CBT concepts are presented as highly technical, with esoteric terms and even more initials which can only be fully understood by the trained CBT expert. An alternative, albeit more contentious view, is that much CBT is glorified common sense, just marketed within sophisticated packaging.
The CBT industry has spawned a variety of so-called 'tools' for use by clients. Many of these tools are simple paper or digital forms; these are intended to encourage the identification of specific harmful thoughts and to move the client in a structured and methodical way towards adopting more helpful or positive cognitions. That movement can occur during face to face discussions with a therapist, or through what is termed 'homework'. CBT that arose out of behavioural work also encourages clients to look at changes in behaviour and actions as well as thoughts.
For some practitioners, CBT work with clients will follow a very structured process, working to a set template with very little scope for deviation. That formulaic approach is more likely to be found in CBT sessions conducted within an organisational or agency setting, where therapists are expected to follow a well-defined treatment path with all clients. For others working outside of that rigid formality, those CBT processes can serve as a helpful basis for an informed discussion.
CBT is an approach favoured by bodies such as the National Institute for Health and Care Excellence (NICE). That preference is justified, as CBT is argued to be evidenced-based, offering a cure for conditions which have become medicalised such as stress and anxiety. Yet, despite the academic pretensions, the evidence presented, even in mainstream research journals, can sometimes be flimsy, with woefully small statistical samples. There is also a marked absence of substantial studies evidencing the longevity of any beneficial effect of CBT work. Some will argue that the NICE/NHS preference for CBT now rests increasingly more on cost considerations than evidence, per se.
Given the strength of the CBT brand, other counselling approaches now squeeze in under that umbrella and attach to the CBT label. Some techniques provide a good complementary fit, but others less so. The notion, for example, of combining mindfulness and CBT is seen by some to be a somewhat forced association rather than a natural fit for either approach.
Irrespective of whatever form of CBT is practised by the therapist, the work in the room is likely to focus on future change rather than looking back. CBT is more concerned with doing and resolving than understanding why. This has been promoted as a feature that sets CBT apart from some other strategies.
Nowadays, that differentiation can be exaggerated. In practice, most CBT therapists do try to understand why issues have arisen. As a result, that stretching of the CBT brand now includes work more commonly associated with other modalities such as person-centred work, psychodynamic counselling, and gestalt work. Similarly, many therapists practising these other counselling modalities may now also include aspects of a CBT approach as they work with clients to find a way forward, which will help resolve the immediate challenge.
So, given these candid observations on CBT, what conclusions might be proposed about this approach?
CBT is undoubtedly a helpful strategy which can yield very real benefits for many clients. It can provide a positive and transformative way of working with certain emotional challenges. It is, however, important to remember that CBT is ultimately based on rationality. Clients are seen as essentially logical beings whose thought processes have become distorted, for whatever reason.
That view may give rise to difficulties when the client present in the therapy room is struggling to understand a sense of self, and where there is fragmentation or obvious confusion over that cry of 'who am I'. A client who is having difficulty recognising or engaging with their internal world, or who is not able to easily engage with rationality, may not always benefit from the first intervention having such a structured, logical base as with CBT.
For those clients, alternative counselling approaches may prove to be helpful. This could include a pluralist approach which allows the client the freedom to explore and understand both themselves and the challenges that they are facing. This bringing together of different approaches (which can still include some CBT strategies) may encourage the client to develop deeper self-awareness. That may assist in working towards a more lasting change, rather than just adapting to whatever single 'quick fix' is being offered.
Perhaps a measured approach could be to see CBT as an effective modality when shown to be an effective treatment for certain identified emotional concerns. It may also be the right fit for those clients who always want to work in a very structured and formulaic way. If, however, CBT is the only strategy on offer, clients may want to remain a little cautious of an automatic 'one size fits all' application of CBT. That same caveat also applies to any other single strategy approach.
This highlights the importance of the first client/therapist meeting, which is critical to the long term success of any counselling work. That first encounter should ideally encourage the client to develop an outlined understanding of the various counselling options available and the support that is to be offered. It creates an opportunity for the client to be actively involved in considering with the therapist the right modality for the work, rather than simply submitting to the automatic engagement with just one counselling methodology.
In returning to the reflections on the overuse of initials which opened this article, it is perhaps, for this reason of encouraging informed consent that, dialogue using easily understood terms is always likely to be more helpful for clients than a conversation dominated by that plethora of initials.
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