What is cognitive therapy?

I offer cognitive therapy at my private practice in north London – but what exactly is it and how does it differ from other approaches? Having trained in different schools of counselling and psychotherapy (including humanistic, integrative, cognitive and mindfulness-based therapies), in my work with clients I draw from the best of each. All the major schools of thought are full of wisdom and have a great deal to offer but – for the vast majority of psychological issues, including stress, anxiety, depression, problems with anger and assertiveness, low self-esteem, phobias, obsessive compulsive disorder and eating disorders – it seems clear from all the evidence that cognitive therapy is the most effective approach.

Having worked with dozens of clients, I also know from personal experience that cognitive therapy is an excellent way to help people feel better as quickly as possible. And when you're unhappy or unwell, that's clearly very important. Because cognitive therapy is designed to be a problem-solving, time-limited approach, its techniques are definitely best suited to short-term work but – as I explain below – they are also useful for longer-term therapy.

What are these techniques? Well, the central idea in cognitive therapy – which includes a number of different approaches such as cognitive behaviour therapy (CBT), mindfulness-based cognitive therapy, compassion-focused therapy, rational emotive behaviour therapy and schema therapy – is that it's our unhelpful thoughts and beliefs that lead to emotional problems. For example, when you are depressed you may think very negatively about yourself and your life. You may also have a lot of guilty thoughts, or regrets as you look back at your life and wish you had done things differently or made better choices. This type of thinking, which is called 'rumination', is not helpful because it lowers your mood and makes you feel bad about yourself. So the first task in cognitive therapy is to identify and change these 'automatic negative thoughts', replacing them with more realistic and positive ways of thinking.

The great thing about cognitive therapy is that it's based on common-sense ideas and is designed to be a 'DIY therapy'. So I will teach you how to use these techniques yourself, between sessions and whenever you feel stressed, anxious, down or otherwise unhappy. You can then become your own cognitive therapist, able to withstand stressful or challenging periods and maintain your mental wellbeing for the rest of your life.   

So is cognitive therapy purely a short-term approach?

No, this is a common misconception. Cognitive behaviour therapy (CBT), which is the main form of therapy offered on the NHS, is designed to be a short-term approach, with most patients offered anything from six to 20 sessions. For many people this is enough to address their presenting issue, relieve their symptoms and equip them to keep the anxiety, depression or other problem at bay. For other, more deep-rooted issues, once your initial symptoms have improved it's helpful to work longer-term. Newer approaches such as compassion-focused therapy or schema therapy have been designed to treat issues that have their roots in childhood and might take two or three years to fully address.

Schema therapy, in particular, has been designed to help adress both deeper-rooted issues such as recurrent bouts of depression, destructive relationships, eating disorders or addiction; and help people with 'personality disorders' such as borderline personality disorder or narcissistic personality disorder (for more about personality disorders, read this excellent guide on the Royal College of Psychiatrists' website). It combines cognitive therapy with psychoanalytic and Gestalt therapies to explore how maladaptive belief systems and patterns of behaviour, formed in early childhood, are recreated time and again in adult life, causing all sorts of problems.

Although I am happy to work either short or long-term, I find that most problems are best treated with a slower, more patient approach. For example, if you have low self-esteem, perhaps because your parents were overly critical and undermining when you were young, you will have struggled with feelings of inadequacy for decades. How easy is it then to change the way you feel about yourself, deep down, in six weeks? Not very. Tackling most issues requires persistence and hard work, coming at something from different directions, chipping away at it until we can effect deep, long-lasting change.

This means looking at the deeper issues that led you to become unhappy, which almost always points to difficult experiences in childhood or adolescence. I will then help you understand why these early difficulties still cause problems today and why you unconsciously repeat unhelpful or self-destructive patterns of behaviour in your work, family and romantic relationships. This will help you heal childhood wounds and become happier, stronger and better able to enjoy those relationships and your day-to-day life.

Isn't CBT just about filling out lots of forms?

Another common misunderstanding. Although it is very useful to record your feelings, thoughts and behaviour so you can begin to spot patterns and challenge/modify negative and unhelpful thoughts and patterns of behaviour, cognitive therapists value warmth, authenticity and a strong therapeutic relationship as much as other practitioners. In fact, in my opinion, the relationship between therapist and client is always the most important ingredient of any successful therapy. Making you feel safe, respected and valued is of great importance to me – any techniques must always come second to that.

And the most recent adaptations of cognitive therapy combine and draw from other approaches. For example, mindfulness-based cognitive therapy is a fusion of Western psychology with 2,500-year-old Buddhist meditative and psychological techniques. Compassion-focused therapy also draws heavily from Buddhism, adding the Tibetan Buddhist cultivation of kindness and compassion towards self and others to more mainstream cognitive therapy techniques.

As someone who has studied a number of different schools of psychotherapy, I believe strongly that an integrated approach, drawing from the best of each, gives the the best possible chance of helping each one of my clients, whatever their needs and current focus. I am also a certified cognitive-behavioural coach and offer a highly effective style of coaching which is based on CBT and approved by the British Psychological Society.

If you would like to find out more about me and the way I work visit the FAQ page, call me on 07766 704210, email dan@danroberts.com or use the Contact form.