There is much debate over the value of CBT (Cognitive Behavioural Therapy) especially since primary care counselling is now provided nationwide by the IAPT (Improving Access to Psychological Therapies) Service. The IAPT Service promotes mainly the use of CBT for depression and anxiety, as recommended by NICE (The National Institute for Health and Care Excellence) largely because of the CBT core features of strong evidence-base work and concrete measurement of outcomes. CBT targets negative thoughts, with a set structure to sessions involving sheet work and between sessions homework. The idea is that change in thinking will lead to change in /reduction of/elimination of connected negative feelings and behaviour(s).
I received training in CBT in 2011 on a Post-Qualifying Certificate course run by The Iron Mill Institute, Exeter. Since then, I have incorporated my CBT skills into my counselling work when it seems appropriate and each time in a flexible, individual way. I am an integrative counsellor, using various approaches, and the importance of the therapeutic relationship is fundamental whichever approach I use, including CBT. My CBT work with clients is collaborative and I believe empathy, warmth, non-judging, valuing and accepting are vital for establishing a strong working relationship with the client. The CBT work is embarked upon sensitively with the aim of empowerment for the client.
However, there are difficulties in using CBT as experienced by clients and observed by me. The force behind CBT is applying logic using an evidence-base. In the pursuit of tackling negative thinking, there is a risk that feelings may be left behind, not given space to be properly expressed and explored. Clients can come up with new/alternative balanced thoughts and as an intellectual exercise give a new lower rating of connected negative feelings, but this can be no more than a paper-exercise when a client says “but I don’t feel any better/different”. This clarifies the underlying need to explore the client’s feelings and experiences using a different, Person-Centred approach.
Using CBT can feed a client’s issues rather than resolve them where the client’s comfort zone is his/her head rather than heart. Those who find it easier to express thoughts rather than feelings may well through CBT be able to escape the more difficult but arguably more important realm of exploring and working with distressing feelings.