Untangling

Thanks to Chouette for kickstarting this. In her post CBT: Completely Baffling Therapist she writes about seeing a therapist for CBT only to discover that there’s no real CBT on offer there. I’m not surprised that this kind of thing happens, but the reasons for it are somewhat complex and tangled.  To help untangle them, here are some indicators that might help you to find a therapist who can really do CBT.

The trouble is, CBT is a skill.  So some people have a natural talent for it. They don’t really need much training, just to be shown the ropes. Perhaps they have had therapy themselves, then read a couple of books, and it all makes sense to them. But other people struggle with it. They spend years of their lives and thousands of pounds in training, get master’s degrees and doctorates, and still they just don’t get the hang of it. As a prospective patient, how can you tell which is which?

Well, there’s no easy way! Some trial and error might always be necessary. Of course you might be lucky first time, but if you’re not, don’t hesitate to try someone else.

Strong indicators

Here are some strong indicators that a CBT therapist can really deliver:

• Personally recommended by a psychiatrist, a GP or a close friend.
  If your psychiatrist, your GP or a close friend can look you in the eye and tell you that a certain therapist has transformed people’s lives, then that therapist is certainly worth trying.
• Certified by the Academy of Cognitive Therapy.
  The Academy tries to evaluate whether a therapist really has the skills to be effective. Unfortunately it’s based in the US and expensive, so very few UK therapists seek certification, no matter how good they are.

Weak indicators

These indicators slightly suggest that the therapist might be effective:

• Accredited by the BABCP
  The BABCP accredits therapists who have a serious commitment to CBT and who meet a long list of criteria, but they don’t actually check whether those therapists have the skills to be effective.
• Collaborates with psychiatrists and GPs
  Effective therapists are happy to work in a medical setting and collaborate with other professionals, especially when treating serious illness. Some ineffective therapists are equally happy, so this is not a strong indicator.

Non-indicators

These non-indicators do not tell you anything at all about the therapist’s CBT skills.

• UKCP registered psychotherapist
  The United Kingdom Council for Psychotherapy maintains a register of psychotherapists, and many of them offer CBT. Unfortunately, a therapist can get on the register by being trained in something else entirely. So being on the register tells you nothing at all about the therapist’s CBT skills.
• Accredited by some other organization
  Many other organizations accredit psychotherapists, and a few of them promote treatments that are very close to CBT. But there is no general rule that links accreditation by these organizations with CBT skills.

Negative indicators

These negative indicators are warnings that a therapist’s CBT skills might be limited or non-existent:

• Advertises a range of therapies
  An effective CBT therapist is very likely a specialist who focuses on CBT alone. If a therapist offers other therapies, that suggests a lack of confidence in CBT. Amongst other therapies on offer, well-known complementary therapies like hypnosis and meditation are not such a bad sign, but alternative therapies you have never heard of are a very bad sign.
• Cheap and quick
  CBT is often in the news and there is a national shortage of therapists. You’d expect good therapists to have long waiting lists, and if they’re in private practice you’d expect them to be able to charge high prices. The internal NHS price for CBT is more than £100 a session, and waiting lists are typically measured in months. If a therapist can see you the day after tomorrow for £25, draw your own conclusions.

You’ll notice that none of these indicators is a hard and fast rule. There are no rules. It’s trial and error.

The first session

When you’ve decided to give a therapist a try, you can tell a lot from the first session.  I mean the first real talking session — sometimes you get questionnaires to fill in before the talking starts. At the end of your first session, the good signs are when the therapist:

• Really seems to like you
• Has told you almost nothing about himself or herself
• Is interested in the things that you find difficult to explain about yourself
• Seems to understand exactly how you feel
• Has asked you questions that no one else has ever asked you
• Hasn’t avoided discussing anything you wanted to talk about

These things are not specific to CBT, but they provide a good basis for CBT and an effective therapist will usually find them easy to achieve.