The Mechanics of Cognitive Behavioural Therapy (CBT)
Cognitive Behavioural Therapy (CBT) is a time-limited, structured therapeutic endeavour that is supported by an extensive body of clinical and research evidence. The therapy is guided by the problems and goals, which are mapped out using a formulation, agreed upon between therapist and client. The therapeutic relationship places the client at the centre of the intervention using the principles of teamwork and collaboration to drive the therapy forward.
CBT is not about changing beliefs but about exploring the evidence underpinning the belief. Essentially, it is about understanding the person.
Central Features of CBT
The number of sessions of therapy is agreed at assessment and provides a time frame for the work undertaken. Anything between four and twenty sessions of therapy is recommended. The severity of the presenting problem and the client’s ability to work with the therapist and treatment methods will be taken into consideration when estimating the number of sessions required. National Institute of Health and Care Excellence (NICE) has issued guidance in relation to specific mental health conditions, e.g. PTSD, Social Anxiety, depression etc. providing a framework of the treatment options available. CBT is the talking therapy of choice in most of the guidance issued thus far.
The setting of an agenda at the beginning of each session of therapy provides a structure to optimise the time available.
Sessions will be 45-60 minutes long but can be amended in accordance with the person’s mood state and ability to focus on the therapeutic work.
The focus of the work primarily deals with the ‘here and now’ but has the flexibility to consider key events in the past whilst understanding the impact on the present.
The goals identified at assessment will provide the focus for the interventions. The goals can evolve as the therapy progresses and requires regular evaluation throughout the intervention. Generally the effectiveness of the treatment is reviewed against progress towards attaining the goal.
The interventions undertaken in therapy will be guided by an individual formulation. A shared understanding usually in the shape of a formulation enables both the therapist and client to understand the presenting problems and interventions designed to overcome this.
The formulation will, wherever possible emphasize strengths and resilience, as opposed to solely targeting difficulties and negative consequences. Disorder specific interventions will be considered and implemented if the assessment findings and formulation supports this.
A collaborative partnership is at the core of the work undertaken, using the principle of teamwork to drive the therapy forward. The therapeutic relationship is an on-going process that is fluid and not fixed, it requires energy, effort and commitment from both the therapist and the client.
The therapy is not static and the interventions employed will be creative, flexible and adaptive to meet the needs of the individual.
Therapy places the client at the centre of the process, acknowledging the client as being ‘the expert’. This expertise is combined with the therapist’s knowledge and skills to drive the treatment process.