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A principled negotiation approach to assisting clients with their relationships
Dr Michael Free
Cognitive Behaviour Therapy (CBT) is a relatively short term, focused approach to the treatment of many types of emotional, behavioural and psychiatric problems. The application of CBT varies according to the problem being addressed, but is essentially a collaborative and individualised program that helps individuals to identify unhelpful thoughts and behaviours and learn or relearn healthier skills and habits. CBT has been practised widely for more than 30 years. It has been researched extensively, and has demonstrated effectiveness with a variety of emotional psychological and psychiatric difficulties. It is also continually evolving, and third wave CBT therapies such as Mindfulness Based Cogntiive Therapy (MBCT), Acceptance and Committment Therapy (ACT), Dialectical Behaviour Therapy (DBT), Schema Therapy and others are increasingly being used for a variety of emotional, behavioural and psychiatric problems.
CBT is one of the most established and researched psychological therapies for emotional, psychological and psychiatric dysfunction. For some problems, such as anxiety and depression, CBT is as effective as medication and can also enhance the effects of medication. The results of CBT are long-term, and you can keep using what you have learned in therapy to approach other problems in your life.
In particular, CBT has demonstrated effectiveness with individuals experiencing the following problems:
CBT is particularly useful in treating the problems listed above where you request a practical method of treatment for a specific problem rather than “wanting to understand yourself better”; are able to consider psychological causes of problems; and are able to be actively involved in the therapy process and will practice skills between sessions.
CBT has been extensively investigated in rigorous clinical trials and has empirical support. Broadly, CBT has evidenced the following outcomes:
In a broad sense, as its name suggests, CBT involves both 'cognitive therapy' and 'behaviour therapy'. Cognitive therapy focuses on an individual's pattern of thinking while behaviour therapy looks at associated actions. When combined skillfully, these two approaches provide a very powerful method to help overcome a wide range of emotional and behavioural problems in children, adolescents and adults. Depending on the problem, CBT may involve a mix of both therapeutic modalities, so some issues are better treated with more behavioural methods and some with more cognitive methods. One of the strengths of CBT is that it aims not just to help people overcome the symptoms that they are currently experiencing, but it also aims to teach the person new skills and strategies that they can apply to future problems. It focuses on the 'here and now' whilst developing an understanding of past styles of thinking and behaviour that have developed over time.
CBT examines all elements that maintain a problem, including our thoughts (cognitions), feelings, behaviour and the environment. It is a structured therapy, which involves a partnership between you and your therapist. You are fully involved in planning your treatment and the therapist will always let you know what is happening. Usually you will have a thorough assessment in the first session or two. Each session will involve discussion, explanation and practice of skills and techniques. Often you will be required to practice those techniques in between sessions.
In the first session, your cognitive behaviour therapist should:
CBT is a well-planned therapy focused on outcomes. There are a range of techniques and styles in CBT, but regardless of their approach, each session your therapist should:
CBT is an active therapy - sometimes described as a 'doing therapy' rather than a 'talking therapy'. So, individuals will be expected to be active participants in their own therapy. This means that you can expect to be fully involved in your sessions and to develop with your therapist some tasks to practice in between sessions. Sometimes these tasks are called 'homework'.
A typical CBT program could last anywhere between 5 and 20 weeks depending on the problem, the client and the therapist. In some cases, you can expect to see an improvement in just a few weeks; however, it might take longer if your problem is very entrenched.
CBT sounds like quite a simple therapy, but it takes a skilful therapist to be effective. A competent cognitive behaviour therapist will have had substantial training and experience in the area. Most professionals using CBT (i.e. Psychologists, Psychiatrists, Mental Health Nurses etc) should be registered with their relevant professional registration board, which oversees professional training and competence. AACBT provides a national accreditation system for CBT practitioners.
Your cognitive behaviour therapist should never
a) you specifically authorise in writing the release of information; or
b) the release of information is to protect you or others from harm; or
c) the release of information is required by law.
A qualified therapist would be expected to practice the code of ethics applicable to their profession. Be sure to contact relevant regulatory bodies if you are concerned about the practice of a therapist.
The Australian Association for Cognitive Behaviour Therapy is the national association for practitioners of CBT.
The Accredited Practitioner List provides a list of members who are Accredited in CBT and can assist with referrals. You may also check with your local GP.