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CBT - Cognitive Behavioural Therapy
The modern world can be a difficult place in which to live. Ever
increasing expectations of performance and efficiency in both
our personal and professional lives, coupled with the ever
decreasing resource of time in which to achieve these targets,
leaves us feeling squeezed from many directions at once. The
push to find more effective and streamlined processes to achieve
goals has not only been limited to business however. In the
world of counselling/psychotherapy, where one individual works
with another to assist in achieving greater peace of mind and
overall happiness, there exists a continuous effort to better
understand the nature of emotional unrest and to find the best
method of helping to achieve greater harmony with ourselves and
life.
Cognitive Behavioural Therapy (CBT)
comes from one such effort originally developed in the late
1950’s by the American psychologist Albert Ellis. Ellis was
disillusioned by the predominant Freudian psychoanalytic
thinking and methods of the day which usually involved as many
as 3 weekly sessions with an analyst. These sessions sometimes
lasted years without necessarily achieving any real practical
change within the person seeking help. Ellis wanted to move away
from traditional psychoanalysis and looked to develop a method
of working that could help others achieve practical behavioural
and emotional changes within a relatively short time frame. In
particular, Ellis was looking for a more time effective way of
helping those suffering from behavioural difficulties such as
addictions, OCD, extreme shyness etc, where the client stated
that there were things they were doing that they wanted to
modify, who yet seemed stuck in an endless cycle of behaviour
which they were unable to change of their own accord. Since that
original work, Ellis’s ideas and methods have been further
developed and streamlined to arrive at the particular method of CBT practiced within the NHS and by the majority of
Cognitive Behavioural Therapists in Britain today. In order to
appreciate the difference in the way I utilise CBT and the
experience you would have should you seek assistance with
myself, it is first important to understand the thinking behind
it and how CBT is currently applied across most of the country.
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Ellis’s ideas were inspired by the ancient Greek Philosopher
Epictetus who wrote “Man is not disturbed by things, but by the
views he takes of them”. When applied to Cognitive Therapies,
this translates into a way of working that focuses on the way we
perceive or think about (Cognitive) a particular
situation or event, and the manner in which these perceptions
determine our reactions (Behavioural) to that event.
A rather over simplified explanation of this concept can be
demonstrated by the following scenario:
Imagine a person walking into
a pub/restaurant they have never been to before and
just as they come through the door, there is a loud
burst of laughter from a table in
the corner. |
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This event, (a burst of laughter from a table in the corner
timed just as we walk through a door), might impact each of us
in different ways depending upon our mood on that day or other
cumulative factors that may have occurred throughout our lives.
Because human nature is to try and make sense of our world as
much as we are able at all times – something we’ve been doing
constantly since infancy - as new events unfold before us we
have a kind of internal running commentary of conclusions as to
what is happening around us. More importantly, we have our
conclusions about why they are happening. As we proceed through
life, we draw upon our existing beliefs about the world and use
them to inform our new conclusions about each further event we
experience as it occurs. We will, within seconds of an
experience, come to a conclusion as to what just happened and
why. In our example above, there might be a number of reasons
for there being a burst of laughter timed just as we come
through a door, but consider for a moment these two
possibilities at different ends of the spectrum:
Conclusion A). This is a fun
and friendly establishment where people feel comfortable to
freely laugh and joke with each other and are
having a great time.
Conclusion B). The people at
the table are laughing at the person coming through the
door - their laughter clearly demonstrating the
way they feel about how that person looks or is dressed.
As you can imagine, someone who comes to Conclusion A is going
to have a significantly different emotional reaction to this
situation than one who comes to Conclusion B. In addition, the
subsequent behavioural response would most likely differ
significantly with person “A” entering the establishment in
excited anticipation, while person “B” might slip away with a
deeply dented sense of self esteem. This (much over simplified)
example, shows how an individual’s emotional and behavioural
reactions to life will be determined, not by the events
themselves (a burst of laughter from a table in the corner in
this instance), but by our beliefs about why these events occur.
Without question, there is a fundamental truth to this concept
that all emotional reactions to life follow some type of
consideration and conclusion about what has just happened.
Despite this fundamental truth however, there are in my opinion
some distinct drawbacks and issues with the manner in which
these ideas are applied by the majority of Cognitive Behavioural
Therapists today.
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As described earlier, CBT stems from work in the 1950’s which
was motivated by a desire to find a quicker, more streamlined
method of affecting change for those who might be struggling
with some aspect of life. Most CBT training courses in the UK
today teach a very specific thinking and methodology in which
clients are directed towards a concerted focus on what
conclusions they might come to about events, the emotions that
are then connected with those conclusions and the subsequent
behavioural choices they lead to. Unfortunately, this quite
often leaves many feeling that much of what is important to them
about their life experiences goes unheard in the counselling
room and they are left feeling that many of their problems are
their own fault for “thinking incorrectly”.
The nature of the typical CBT counselling session is to
concentrate on one specific set of emotional and
behavioural reactions to an event and then work through
the thought processes that drive them. Again, while it
may be true to say that the way we think about
situations determines the way we feel and act about
them, many people who experience |
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this type of CBT walk away with distinct feelings of inadequacy and failure.
They often feel that the therapist believes that they should be
able to “think better” about life and therefore behave better.
This can often lead to an individual feeling worse about things
than before they sought counselling!
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If you have received any kind of counselling through your local
GP surgery recently, you will most likely have encountered CBT
of this variety – whether through a computerised application or
face to face interaction with a counsellor. Quite possibly, you
have been told by your GP that you need to find a CBT worker and
undergo a course of CBT. This rise in the popularity of CBT with
those who direct funding within the NHS stems from carefully
selected studies showing that it does in fact often drive
certain, specific behavioural and emotional changes within a
relatively short time frame. The combination of cost
effectiveness due to its short term nature (rarely are more than
five or six sessions are offered) and its concentration on
behavioural change (getting people off sick notes and back to
work) makes it the ideal therapeutic intervention – on paper –
for those attempting to provided large scale healthcare on an
ever decreasing budget.
Of course it does need to be acknowledged that for some people
and/or some difficulties, this focused, pragmatic approach that
dives straight to the heart of one’s thinking processes is all
that is needed. I absolutely appreciate that there are those for
whom textbook CBT is entirely appropriate and even I use it in
this way with them. Having said this, CBT is not a “One Size
Fits All” therapeutic model and I also regularly encounter
clients who have recently received this type of short term,
concentrated CBT either from a GP surgery or other therapist and
have found it wanting. Sure, they understand the concept of how
the way we think determines the way we feel and act, but they
are looking for something more than practicality and logic from
a counselling experience. In addition, yes of course they wish
to achieve practical changes in their lives, but they wish for
this to happen in a supportive, understanding environment.
Unfortunately however, due to the strong focus on thinking by
many CBT practitioners, clients are often left feeling that
their counsellor neither had the time nor the concern to try and
understand the totality of their experiences and the things that
are important to them. In all likelihood this apparent lack of
concern was not personally true of the counsellor in question,
its just that because of the nature of CBT as practiced today –
particularly within the NHS – it does not allow much room for
counsellors to work outside the framework of a client’s belief
systems and how these drive feelings and behaviours.
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In 2008, I was awarded
an Advanced Post Graduate Diploma in CBT from the
University of Warwick. Significantly, this diploma does
not represent my primary training nor my experience in
counselling and psychotherapy. Rather, it is an
additional set of skills to add to an existing portfolio
of three other Post Graduate Diplomas in counselling and
over 15 years clinical experience. The manner in which I
utilise Cognitive Behavioural ideologies is to first
work in partnership with each individual client and look
at the whole of their particular needs and current
situation. Then, depending upon each individual’s
specific needs, Cognitive Behavioural ideas and methods
are gently intertwined with a much more humanistic style
of counselling/psychotherapy and personal relationship.
I believe that a client’s personal stories and a deep
understanding of their experiences are important. I also |
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recognise the importance
for each of us to feel understood at this deeper level
before attempting to consider how we might be able to
look at things differently. If changing the way we think
and using logic to determine life’s true meaning and
find emotional contentment were all that were needed,
many of us would not need counselling at all. In other
words, whilst I fully accept the fundamental truth of
Cognitive Behavioural ideas and how these can be helpful
in moving forward and making changes, I do not accept
that these are all that are needed. I hold a strong
belief in the importance of one person feeling fully
understood by another before trying to make those
changes. Stripping the therapeutic experience back to
the nuts and bolts might look good on paper, help with
the balance sheets, and even be very effective for some
people in some situations, but in my opinion it also
misses out much of what is fundamentally important about
the very human experience of one person helping another.
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If you would like to ask any questions about CBT and how
together we might be able to use it to make changes in your
life, I would be more than happy to discuss this with you by
telephone prior to making an initial appointment with no
obligation to you. Please feel free call me at my Bishops
Stortford office on 01279 83 44 67 at any time.
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