What is cognitive therapy?
I offer cognitive and schema therapy at my private practice in East Finchley, North London and via Skype – but what exactly is cognitive therapy and how does it differ from other approaches? Having trained in different schools of counselling and psychotherapy (including humanistic, integrative and cognitive 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 problems, including stress, anxiety, depression, problems with anger, assertiveness and low self-esteem – it seems clear from all the evidence that cognitive therapy is the most effective approach.
Having helped many people with their problems, 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. Cognitive therapy works well as a short-term approach – typically 10 to 20 sessions – and schema therapy is extremely effective longer-term work, from 25 sessions to a year or more. Schema therapy is designed to help people with longstanding or hard-to-treat problems. It will be helpful if you have tried other approaches but nothing has worked; or your problems are very wide-ranging, affecting your work, relationships or family life.
How cognitive therapy works
The central idea in cognitive therapy is that our unhelpful thoughts and beliefs strongly influence the way we feel and behave. For example, when you are depressed you may think very negatively about yourself and your life. You may also feel guilty or hopeless, and be consumed with regrets as you look back at what hasn't worked in your life. This type of thinking, which is called 'rumination', is not helpful because it brings your mood down and rarely leads to effective solutions. So one of the first tasks in cognitive therapy for depression (or any other problem) is to identify these 'negative automatic thoughts' so you can begin to seek more constructive and realistic 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 the stressful or challenging periods we all must face throughout life.
So is cognitive therapy purely a short-term approach?
No, this is a common misconception. Cognitive behaviour therapy (CBT) is a highly effective short-term approach - many problems can be significantly improved with a course of therapy lasting between 10 and 20 sessions. But it's worth noting that cognitive therapy was originally designed by Aaron Beck as a 20-session treatment for depression; and for more long-lasting issues a longer-term approach is necessary, which will take as long as you need.
For example, if you have low self-esteem, you may well have struggled with deep feelings of insecurity or a lack of confidence for decades. So it's very difficult to change the way you feel about yourself in a few weeks or even months. It's better to be patient, helping you feel better in the short term before tackling the deeper-level beliefs that fuel low self-esteem.
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 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 in 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 make some changes, 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.
Some people find it very helpful to write down their thoughts; others less so. So any good cognitive therapist will be flexible and find the approach that best suits the person in front of them. It's also important to remember that cognitive therapy is a collaborative approach. This means that we will work as a team, first figuring out what caused your problems in the first place and then which factors might be maintaining it. We will then agree on the best ways to solve those problems in each session and over the course of your therapy.
Of course, I am happy to explain more about how CBT works when we meet. You might also want to read up on CBT - if so, I recommend the Overcoming... series of books, which focus on different problems. So for depression, read Overcoming Depression: A Self-Help Guide Using Cognitive Behavioural Techniques, by Paul Gilbert; for anxiety, try Overcoming Anxiety... by Helen Kennerley; for self-esteem problems, read Overcoming Low Self-Esteem... by Melanie Fennell.