Cognitive Behavioural Therapy (CBT) is rational, practical, and often happens step by step. It’s founded in experiment and aims to be scientific. It calls thinking “cognition” and doing “behaviour”. So if CBT therapists are like guides, they’re like guides who’ve been trained as engineers or surveyors. If you want to get somewhere specific, like “out of depression” or “away from anxiety” they’ll measure exactly where you are compared to other people, they’ll offer you a step by step route which has been shown in studies to work, and they’ll measure how far you’ve got at the end of therapy. It’s not that they’re cold: CBT therapists will remind you that studies say they have perhaps the warmest relationships with their clients of any approach to therapy. But they’re friendly in a businesslike way, with agendas, plans and Things To Do. They’re reassuring if you like to know that the place you’re at has been systematically mapped and the route you’re being offered is the best that science has come up with so far.
CBT has come up with lots of treatments for particular “Mental Disorders” or “Mental Health Diagnoses”. In the landscape of life, a mental health diagnosis is an area like, say, France. If you’ve got that diagnosis then they reckon they know where you are likely to be at the moment. It’s like having a nationality. There are validated CBT treatments for depression, treatment resistant depression, bipolar disorder, low self-esteem, panic, agoraphobia, other phobias, generalised anxiety, social anxiety, OCD, PTSD, tinnitus, anger, insomnia, chronic fatigue, chronic pain, compulsive gambling, weight loss, smoking and many more. I’ve learned those treatments and use them regularly.
CBT treatments tend to follow the same basic sequence: first you’re introduced to the problem and you learn about who has it, when, where and why. Then you learn how various triggers for the problem produce the unpleasant outcomes, and why the problem doesn’t go away by itself. You’re asked to investigate how you think about the problem, what you feel and what you do about it. Then you’re shown how important it is to change your thinking, because it’s your thinking which produces the unpleasant feelings and unhelpful doings. You’re asked to make a commitment to change how you respond to your feelings, and you’re shown what to do differently in future. Lastly you’re encouraged to monitor your progress and keep going until your behaviour changes.
CBT, like engineering, has developed a lot of tools, schools, and specialisms for different situations. For example, there’s Schema Focused Therapy which is for going back into your past and digging down to your underlying assumptions. There’s Metacognitive Therapy for going up into your thinking about your thinking, in case you’re getting anxious about being anxious or depressed about being depressed. There’s Acceptance and Commitment Therapy (ACT) for those nasty feelings that you have to accept whilst you commit to making your life better. And there’s Mindfulness Based Cognitive Therapy for staying with and watching a problem until you get used to it or it changes in its own time. I use all these tools at various times.
CBT is very useful, particularly for problems with medical names, and it’s nice to know that there are established routes with set stages for getting out of difficult place of life. CBT becomes trickier if, as happens most of the time in therapy, you have several problems going at once. It’s easy to end up going “off-piste” when each week you meet your therapist, you’re in a different unpleasant place. It’s difficult to keep facing in the right direction, and doing the right things in the right order in therapy.
CBT tends to assume that you don’t want to be where you are, and that you are sure where you want to get to instead. But that’s often not the case. If life is a journey, then a person is often like a squabbling family which can’t agree which way to go. Each of us has conflicts between different parts of ourselves. In life we grow up, we play different roles, and in each of those roles we develop parts, just as an actor does, so that we can do what seems best in each situation. Some of those parts are more grown-up; others are more childish. They want different things which lie in different directions. If you’re feeling like that, the therapist’s role as guide is to get everyone in your inner family on the bus, to help them decide where to go, and to help you put your grown-up self at the driving wheel. You can then drive the bus to the different places you want to go, and get the various things you need in life.
CBT is also a matter of taste. Some people don’t want to take a practical, scientific approach to their problems. They don’t want to be measured, they don’t like plans, they’re not interested in “problem solving”, and they don’t want to take the same route as everyone else. They may be more interested in another important approach I use, namely Psychodynamic Therapy. Or they may be interested in my own approach, which combines CBT with Psychodynamic Therapy. I call it Journeybuilding™.