- The Evidence
The most important distinguishing feature of CBT is the evidence that supports it. The National Institute of Clinical Excellence (NICE – the government body responsible for providing national health care guidance on the promotion of good health and the prevention and treatment of ill health) recommends it as the treatment of choice for a range of mental health problems including Anxiety, Depression, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder and Eating Disorders. CBT’s effect has been proven time and time again in randomised control trials (the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome) and a wealth of published research studies exist supporting its efficacy (e.g. Cochrane Review – a group of over 10,000 volunteers in more than 90 countries who review the effects of health care interventions tested in biomedical randomized controlled trials). CBT is the only psychotherapeutic approach with such a robust evidence base across a range of mental health problems.
- A Short Term Treatment.
CBT is frequently presented as a ‘short term treatment’ and although in comparison to other types of ‘talking therapy’ it is certainly time limited, it is important to dispel the myth that it offers a quick fix. CBT is used to treat problems that are interfering with a person ability to function in one or more areas of their life. These problems are real, significant and often long standing and so it stands to reason that to resolve such problems a certain amount of time and energy is going to be needed. A problem that is quick and easy to resolve would not need a course of therapy from a highly trained professional. The number of CBT sessions that a person needs depends on the severity and chronicity of symptoms but an average minimum is between 15-20 sessions. Many other psychotherapeutic programs (e.g. psychodynamic psychotherapy) can continue for years.
The features that enable CBT to be a ‘short term’ treatment are also important in distinguishing it from other psychotherapeutic approaches.
2.1 Problem Focused And Goal Oriented
CBT focuses on resolving specific problems. During the initial assessment (first 1-3 sessions) the therapist will develop a Problem Formulation which will enable both therapist and patient to understand how the problem has developed and why (up until this point) it has not been resolved. This formulation is then used to guide treatment towards specific goals (identified collaboratively by therapist and patient) that when reached will signify the resolution of the presenting problem. Throughout treatment the initial problem formulation will be reviewed and updated to included additional information that may come to light and treatment is reviewed at regular intervals to ensure that progress towards the end goals is being made. This shared understanding of the problem and a clearly defined end goal ensures that treatment is as effective and efficient as possible.
2.2 Becoming Your Own Therapist
The ultimate goal of CBT is for the patient to become their own therapist. In some types of counselling the therapist is set up as the ‘expert’ who imparts knowledge of a seemingly inaccessible nature which can leave the patient feeling dependent upon the therapist and can undermine their confidence in their own capacity to resolve problems. In CBT therapist and patient work together so that the patients can learn a set of skills (practical and psychological) which can be integrated with their existing a knowledge so that they are eventually able to independently resolve not only current problems but tackle future ones without the need for additional counselling. This means that usually only one course of treatment is necessary thus reducing the likelihood that ‘longer term’ input will be needed. The following analogy illustrates this goal:
"An oyster creates a pearl out of a grain of sand. The grain of sand is an irritant to the oyster. In response to the discomfort, the oyster creates a smooth protective coating that encases the sand and provides relief. The result is a beautiful pearl.
For an Oyster, an irritant becomes the seed for something new. Similarly (CBT Counselling) can help you develop something valuable from your current discomfort. The skills taught… will help you feel better and will continue to have value in your life long after your original problems are gone". Greenberger & Padesky 1995
2.3 A ‘Here and Now’ Therapy
CBT is often described as a ‘Here and Now’ therapy however it is important to be clear about what this means as this term is frequently misunderstood and used to imply that CBT is not suitable for resolving complex problems. In the initial phase of CBT the focus is on alleviating the symptoms that the patients is currently experiencing (e.g. panic attacks, low mood) by addressing the factors that are maintaining them. This is done not only to bring relief to the patient but where appropriate (i.e. for severe/long standing problems) to release some capacity for the patient to focus on exploring and resolving the factors that have contributed to the problem developing in the first place. In this second phase of treatment (often thought of as the domain of longer term psychotherapeutic approaches) an extended (but less popularised) version of CBT is utilised (Schema Focused CBT) which has been specifically developed to ensure that ‘here and now’ improvements are consolidated and to protect against future relapse. Although this second phase extends the length of treatment, as it continues to utilise the feature outlined above it represents a significantly more time efficient way of resolving long standing problems than other types of counselling traditionally used to tackle such issues.