In some ways, cognitive therapy is the victim of its own success. Since it was developed by Aaron Beck in the 60s, cognitive therapy (also known as cognitive behaviour therapy, or CBT) has become the dominant form of 'talking therapy' in numerous countries around the world, including the US and UK. This is mainly because it works so well – research consistently shows CBT to be the most effective form of therapy we currently have. But it's also about economics – the NHS has embraced it partly because it's cost-effective too. Many problems can be resolved in under 20 sessions, some (such as phobias) in five or six.
However, as I explain below, this is not how Beck intended cognitive therapy to be practised. His initial therapy model was a 20-session treatment for depression, which I think is about right for most people. I strongly disagree with the (financially-driven) short-term treatments many people receive on the NHS for anxiety, depression and other serious psychological problems. This is just one of the myths I try to bust with my clients, and when I am teaching cognitive therapy to students. Here are some more:
1. CBT is all about filling in forms
Not true. Although some CBT techniques do involve written work for clients (such as daily thought records), good cognitive therapy is based on the relationship between therapist and client. This should be warm, trusting and supportive, as with other approaches to counselling and psychotherapy. And many of the techniques I and other cognitive therapists use involve stories, metaphors, working with imagery, role-playing, mindfulness-based techniques, drawing, Gestalt-style 'empty-chair' work... none of which involve forms!
2. CBT is a short-term, quick-fix approach
Nope. In my own practice, I always tell people that there is no such thing as a quick fix for complex, highly sensitive problems; so our work will be slow and incremental. A few problems – especially 'specific phobias' – can be resolved quickly. Most others take time – somewhere between 10 and 20 sessions, in my experience; while deep-rooted, hard-to-shift problems might take a year or more.
3. Feelings are not important in cognitive therapy
Ironically, cognitive therapy is all about emotions. Despite the name (cognitions being all of the thoughts, values, beliefs, memories, etc that make up our minds) we only focus on changing unhelpful thinking because that has a powerful impact on feelings and moods. Nobody comes to therapy saying 'I want to think more rationally'! They come because they are hurting in some way; my job is to help them feel better on a consistent, long-lasting basis.
4. Cognitive therapy is all about positive thinking
A common myth, this one. In fact, cognitive therapy is all about rational, realistic, balanced thinking, which is not necessarily positive. If you are in a horrible job or relationship, thinking positively about it would be both impossible and unrealistic. Someone once said that cognitive therapy is all about seeing things as they really are. Life is full of pain, hardship, loss, struggle... as well as joy, wonder, love, delight. The key is to give both equal weight, rather than focusing purely on the negative (common to both anxiety and depression, in different ways).
5. CBT only offers superficial symptom-relief
A common criticism from my non-cognitive counselling/therapy peers. It's true that CBT can help people feel better much more quickly than other approaches. That's one of the reasons it's so popular and successful. But this is only the start. If you suffer from depression, say – which has a high chance of relapse – as well as helping you feel better in the short-term, my aim is to teach you new ways of thinking and behaving which protect you from depression in the long-term. Again, we have very good evidence to back this up, as well as my own experience of staying in touch with clients after therapy ends to see how they're doing.
So, hopefully you now have a clearer idea of what cognitive therapy is and is not. If you would like to book a session, email firstname.lastname@example.org