More and more health authorities are using CBT as a preferred treatment for a number of different mental health issues and that number is set to rise. As a therapist who primarily uses CBT techniques as a main approach, I know just how effective they can be.
The basic assumption behind Cognitive Behavioral Therapy (CBT) is that one’s thoughts influence one’s emotions and behaviors, and that if negative thoughts are altered, negative emotions and behaviors can be altered as well. We are what we think, so to say. By using a series of practical and easy to use methods, CBT looks at changing the “here and now” which means that less time is spent on delving into a clients’ past. This has a direct effect on a client’ s daily life and his ability to handle dysfunctional thought patterns that tend to affect mood and happiness. In a therapeutic alliance, the therapist and client explore and try to change these thought patterns. CBT has a strong educational element to it in the sense that the relationship built up in therapy serves as a model for other relationships. The therapist helps the client to formulate problems in cognitive terms, and is constantly inviting feedback from the client to ensure that he/she feels understood and can learn to contribute jointly with the therapist to the treatment. It is very much a problem – solving approach. Central to this approach is the use of Ellis’s ABC model which charts the relationship between a triggering event, the resulting behavior and how dysfunctional thought patterns complicate the issue. The use of homework assignments is used to consolidate what takes place in the session. Goals are set in behavioral terms and potential solutions are tested out in practice: clients are encouraged to explore options for change and evaluate outcomes by comparing progress with previous experience and hence are encouraged to take an objective, scientific, view of their problems. In this way, clients are taught, in theory, to become their own therapists and are thus prepared to deal with relapse and problems if and when they arise in the future.
Even though many studies have suggested that CBT is an effective treatment for a range of issues ¹, there are still dissenting voices who believe that other methods should be considered. For example, A.S Petridis PhD² wrote an article in 2009 questioning the evidence that CBT is any more effective than any other method and came to the conclusion that “there is clear evidence from studies that no one method is any better or worse than any other”. Also, John M. Grohol, PsyD, cited a study that directly compared psychoanalysis with CBT on study groups, a first of its kind, and wrote that the study revealed no real difference in effectiveness.³ Additionally CBT methods have been criticized, most notably by Dr Oliver James who started a debate among the medical community when he claimed: “There is not a single scientific study which supports that claim ( that CBT is effective),” says Dr James.”Being cheap, quick and simplistic, CBT naturally appeals to the government. Yet the fact is, it doesn’t work,” added Dr James. This was quickly countered by other professionals.
However, the future development of CBT seems assured. A recent study by the Psychiatric Clinics of North America claimed that CBT is the method with the greatest amount of scientific evidence backing it but that evidence also said that CBT needs to evolve and a number of new methods that could add to its effectiveness hold promise. This was widely discussed in a study cited in Psychiatry News in 2006 *. Authors noted that several studies had revealed CBT is being used more often for bipolar and other severe mental disorders. There was also mention of drugs being developed to increase the efficiency of CBT techniques and the methods being used in a group therapy session. It is also becoming the treatment of choice for the justice system as well if an article from the Office of Justice** programs is to be believed . They stated the concept of taking responsibility and working on perceived entitlement as two areas where CBT is highly effective. All of this says that CBT has a bright future and will most likely become widely practiced in all areas of mental health care.
As a therapist with many years of experience, I tend to see myself as integrative . I have always considered the ability to use more than one method beneficial for the client. This has been borne out in many therapeutic situations I have found myself in. I first came across CBT about ten years ago and have been a keen supporter ever since. Despite the criticism aimed at the method (see last section), I find it the most effective treatment for the widest range of issues available. I have used it in various situations over the years from depression to bipolar to clients with low self – esteem and interestingly also clients who have lost a purpose in life due to job loss, grief or separation . In contrast to other methods, CBT really does make a difference in a clients daily life and as most sessions are based on dealing with present issues, one can say that it also goes a long way towards keeping clients in therapy. I once heard it described “CBT sessions mostly aim at making sure clients have a good week”. I believe this sums it up perfectly. It is truly amazing to see people have that “aha” moment when they fill out the worksheets or realize by being challenged how they had been thinking wrongly over the years. I have also found that CBT can be easily locked together with other therapies to give the client an individual solution. Those therapists trained in, for example, CBT and psychoanalysis can create a “package” that provides a solution for dysfunctional thinking in the present with a deep analysis of the origin of the client. Even though advocates of these therapies often seem to be at odds with each other, I actually believe they can form a working alliance for the good of the client. I have often done this in an integrative approach when needed and had good results. In these cases, engaging in psychoanalysis actually helped strengthen the CBT methods by helping to put the past in perspective.
Dr. Nicholas Jenner is a Counseling psychologist in private practice working with individuals, couples, groups and companies. Apart from seeing clients face-to-face, Dr Jenner also runs a thriving online therapy business bringing help to those who are housebound or located in rural locations where therapy is difficult to find. For more information , follow the link to his website HERE
² http://soultherapynow.com/articles/cbt – effectiveness2.html
³http://psychcentral.com/blog/archives/2009/08/09/psychodynamic-therapy – vs-cbt-smackdown- for- anxiety/
** http://www. nij .gov/journals/265/therapy.htm