My second article looking at the different types of counselling, looks at CBT.
Cognitive Behavioural Therapy, or CBT for short, is a form of goal-oriented, systematic psychotherapy that brings together two previously separate schools of therapy (the cognitive, and the behavioural, as you might expect!). At a basic level it is about changing how you think (the cognitive side) and what you do (the behavioural side). Putting these two together, it can look at how the way you think affects what you do, for example the way you think about things/yourself can affect your emotions and that in turn affects the choices you make in how to act. Of course, if you think-feel-act negatively this can produce a negative feedback loop and reinforce the negative feelings. CBT therapists work to explore such “helpful” and “unhelpful” thinking patterns. CBT often involves “homework” such as keeping a journal to observe how thinking patterns are affecting elements of daily life, and to work out different ways of thinking that might be more helpful.
Currently, in the UK, CBT seems to be the therapy of choice in the NHS, but personally I wonder whether this is down to its effectiveness, or simply the fact that it is brief, and somewhat cost effective in the short term. We have seen schools, for example, gearing themselves towards shaping children who can pass “SATS” rather than whole, happy, well rounded children, and my worry is that CBT, while it may be effective at treating symptoms in a way that looks good on balance sheets, may not be the holy grail of solving mental health issues. I liken it to a sticking plaster – CBT will cover up the wound on the knee and let us carry on, but it will not help us discover why we fell over and hurt our knee in the first place. My worry would be, long term, that more and more sticking plasters would be needed. So many times have I heard people say “I’ve done CBT and it really helped… But now I seem to be having problems again…” I think CBT can certainly be enormously useful, but I have heard enough people say they did not find it helpful to come to the conclusion that it is not the universal panacea CBT evangelists might like to claim it is. There are people who will respond very positively to CBT, and some who will respond much better to person-centred, or Gestalt, or other types of therapies (always with the caveat that it is often the therapuetic relationship itself which is the key determiner of success) – on the whole, a one size fits all approach to therapy and mental health is something which I find disturbing.
One positive thing, however, about CBT, is that due its nature, it is something you may be able to “try at home” to a certain extent, and perhaps even starting to think about how we may think negatively, and how that may be affecting our emotions and actions, is something a lot of us can do for ourselves, and maybe the first step into a more wide ranging encounter with therapy of whatever kind we may ultimately choose. There is a selection of books on CBT below which may prove useful as a further introduction to this form of therapy.
A Selection of Cognitive Behavioural Therapy books in the UK:
A Selection of Cognitive Behavioural Therapy books in the USA:
Although this is a blog about self help, there are always times when we do need to look for others for help. For mental health, this often means counselling or therapy, a much misunderstood field. So I have decided to write a series of articles exploring different types of counselling and therapy, what they mean, how they work, and some of the pros and cons, together with some links to titles to read further about the different kinds of counselling.
First up, I decided to look at Person Centred, or Client Centred, therapy, from the humanistic school of thought. I am going with this first, because I have personally benefited from this type of counselling, and am indeed training to become a person-centred counsellor!
Person-centred counselling originated in the thinking of Carl Rogers, an eminent American psychologist. He believed that each individual human being had more knowledge and resources to promote their healing and growth than any therapist could ever have – so that the therapist’s job was to create conditions whereby the client could begin to explore and uncover these resources in themselves, rather than directly influence the client from a position of “expertise” or “greater knowledge”.
These conditions, often referred to as the “core conditions” for therapeutic change, are Congruence, Empathy, and Unconditional Positive Regard.
Congruence refers to a quality of “realness” or “genuiness” on the part of the therapist within the therapeutic relationship. In a world where people wear masks, the congruent therapist is not an actor, but a real person, someone who is self aware, has knowledge of their own person and individual issues, but who is not confused or anxious about being and expressing their true self as it is in that moment. In a world of facades, it is vital for the client to see the therapist as someone who will be true, who will be real, who will have the courage to honestly be and express who they are.
Empathy refers to the quality of the therapist being able to move around in the client’s frame of reference, to understand the client’s unique position and perspective. Not simply on a “I know how you feel” level, but by sharing the client’s feelings, by identifying what is going on for the client, by communicating this understanding to the client. Rogers considered it vital that this understanding was communicated to the client, so that the client knew they were being understood. This part of the therapeutic relationship is, like congruence, something that the client may rarely have experienced before.
Unconditional Positive Regard refers to the therapist’s ability to “prize” the client as a uniquely valuable person in their own right, without applying conditions of worth. Conditions of worth refer to the unfortunate tendency in society, and when growin up, to feel that one is only valuable when certain conditions are met. For example, “If I am a good boy, I have value; if get into a fight, I am bad and have less value.” or “If I like blue and everyone else likes red, I have less value than everyone else, because I am different.” or “If you are calm, that is more valuable than if you get angry.” In the therapeutic relationship, unconditional positive regard allows the client to start moving away from these conditions of worth, to start becoming a person in their own right, and stop being the person others want them to be. At some stage in the therapeutic process, they will learn that the therapist prizes them in spite of what they reveal about themselves, and this often leads to greater courage in expressing and exploring who they really are.
Combined, these conditions help the client to begin to trust themselves more, to move from a state of incongruence, towards congruence, and become more fully functioning.
Person-centred counselling is not without criticisms, one of which is that it might not be as effective for serious mental illness and is therefore a bit of a luxury for the “worried well”. Carl Rogers would disagree. To an extent, the outcomes of Person centred counselling are difficult to measure, whereas something like CBT (Cognitive Behavioural Therapy) are favoured by, for example, the Uk NHS as proving a more measureable outcome. Client Centred therapy can take longer, but I am not convinced measurability is always key.
Personally, I have benefited hugely from person centred Counselling. I have moved from rigidity to fluidity, from anxiety to calm, from shyness to confidence. All thanks to experiencing the core conditions with my therapist. My next few years of studying Rogerian counselling/therapy are going to be a fantastic journey.
A selection of UK Person Centred Counselling Books:
A Selection of US Based Client Centred Counselling Books: