When you’re trying to choose a therapist, some of the therapy types and terms might seem confusing and contradictory. How do you choose the therapist that will be the best fit for you?
In this post, I’d like to explain the difference between one of the most common types of therapy in the UK (which is CBT, or Cognitive Behavioural Therapy) and the approach that I take with my clients (which is Integrative Psychotherapy). I’m not going to define every type of psychotherapy out there, but hopefully defining these two approaches and explaining the major differences between the two, will help you understand the heart of each therapy type and assist you in making the choice that’s right for you.
Let’s get started.
Cognitive behavioural therapy, or CBT, is a type of therapy treatment that takes a practical approach to treat issues and change behaviours. Here’s an excellent definition from PsychCentral: http://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/
“Cognitive behavioural therapy is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem solving. Its goal is to change patterns of thinking or behaviour that are behind people’s difficulties, and so change the way they feel. It is used to help treat a wide range of issues in a person’s life, from sleeping difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression. CBT works by changing people’s attitudes and their behaviour by focusing on the thoughts, images, beliefs and attitudes that are held….and how these processes relate to the way a person behaves, as a way of dealing with emotional problems.”
CBT combines cognitive therapy (examining what you think) and behaviour therapy (examining the things you do), and the goal of CBT is to help teach you coping skills so you can deal with specific problems. It focuses on your current therapy goals, and the “talk therapy” part of CBT mostly focuses on the present day, rather than talking about past events, traumas, or difficulties.
Here a useful article that gives more details on the CBT approach. It also includes a helpful little video: http://www.mind.org.uk/information-support/drugs-and-treatments/cognitive-behavioural-therapy-cbt
Integrative Psychotherapy, which is what I practice, takes a more holistic look when working with clients. Here’s a description of what “integrative therapy” means, from IntegrativeTherapy.com: http://www.integrativetherapy.com/en/integrative-psychotherapy.php
“Integrative Psychotherapy embraces an attitude towards the practice of psychotherapy that affirms the inherent value of each individual. It is a unifying psychotherapy that responds appropriately and effectively to the person at the affective, behavioural, cognitive, and physiological levels of functioning, and addresses as well the spiritual dimension of life.”
An integrative psychotherapist will incorporate elements of different models to help their clients. Instead of having one single approach that will treat all their clients in all situations, an integrative therapist will consider each individual as a whole, and use counselling techniques that are tailored to each client’s individual needs and circumstances.
I firmly believe that all individuals should choose the therapist (and the therapeutic approach) that is best for them in their specific circumstances. That said, I’ve noticed that CBT is sometimes referred to as the “gold standard” of psychotherapy practices, or the only “scientific” or evidenced form of therapy. This misconception has a damaging effect, because people think CBT is the best or only therapy that will help them, and will therefore miss out on other potentially effective therapies.
Right now, CBT is the most widely-offered and readily available type of therapy paid for by the NHS (the UK’s National Health Service). One of the reasons the NHS likes to recommend CBT is because they believe that type of treatment can achieve clinically-measurable results within a short space of time. They want clients to get in, fix the problem, and get back out – not have to do therapy sessions for years at a time. In CBT, clients are measured against outcomes that are controlled, and treatment fits into discrete categories or boxes on a form, to allow for empirical assessment.
The problem is, CBT doesn’t work for everyone – and many problems can’t be “fixed” using the singIe-issue approach favoured by CBT. In longer-term therapeutic treatment, progress is sometimes messy, non-linear, and inconsistent. It’s not something that can be measured on a graph, or fit into a pre-approved number of sessions with their counsellors.
Integrative psychotherapy is very effective, but its effectiveness is measured by subjective qualitative research, as opposed to empirical quantitative research. The claim I often hear is that quantitative evidence trumps qualitative evidence, which I simply do not hold to be true.
One of the fundamental differences between CBT and integrative psychotherapy is that a CBT practitioner takes on the role of being the “expert” in the relationship. Their job as a CBT practitioner is to tell you that your problem is caused by thinking the “wrong” way, and to explain how you need to change your thoughts. When you do that, you’ll be “cured.”
If you don’t get better, it’s not the fault of the CBT practitioner – it’s your fault, because if you are still depressed or anxious (or both), you are obviously still not thinking the right way. You are still giving authority to your maladaptive thoughts, which are in turn causing your depression or anxiety. This is oversimplified to make a point, and some of this is implicit in CBT, rather than explicit.
When it comes to trauma (which can show up in symptoms such as life just feeling empty, feeling flawed and unlovable, rage, or feeling “stuck” at work), CBT doesn’t go deep enough to actually make a difference for most people. Underlying trauma is something deeper than cognition or thinking, and it’s even deeper than language, so the short-term CBT approach of examining what you think and do will often fall short.
CBT is effective for certain things, but it is not a one-size-fits-all solution. That’s exactly why I decided to study integrative psychotherapy and meditation, so I could build trusting relationships with my clients in which I can follow my intuition and curiosity in the service of my clients.
The word “therapy” comes from the Greek “therapeia,” which means care, attention, and healing – so the most important thing I do is tend to my client.
Attending to my patient involves deep listening, with my embodied attention and mindful presence. I am always interested in who they are – in all of what they are telling me, and all of what is going on at the pre-verbal, embodied level, as well as at the level of language and conscious, intentional communication.
My clients need to know that I am attending to them with respect, care, curiosity, and with an intention to allow them space to be fully themselves, and to explore their territory of the hearts, minds, and souls.
Some of my clients have experienced significant or profound relational trauma. During our sessions together, I help my clients get to know themselves, feel more at home in their own skin, and have a sense of belonging in the world. I also help them discover and nurture a sense of autonomy, personal power, and self-compassion, which is often lacking in people who have been downtrodden or silenced by parents and/or partners.
As I’m working with a client, I notice whether the patient feels distant, or is keen to share. I’ll notice whether he seems shy, ashamed, aggressive, or agitated. I’ll notice whether she is making eye contact, or looking at the floor.
I’m interested in the quality of contact between us: What does it feel like, and what’s the quality of our interaction and connection? I’ll try to figure out what seems important, moment by moment, and what needs attention at that specific time.
Having the opportunity to explore your thoughts and feelings, your core emotional beliefs, your hopes and fears, your desires, and the whole situation of your life (historical and current) with a safe, empathic and experienced other person – one who is attuned to you – can bring about a crucial sense of awareness, which ultimately leads to lasting change in your life.
When I work with my clients, I do not take on the role of “expert.” I acknowledge that I have expertise in the therapeutic relationship, but I am very clear that my expertise is in exploring the processes of mind, heart, and body.
I am not an expert in what it’s like to be my clients, or in what they should think, how they should feel, or what they should do. My expertise is in being there as a supportive guide who has a set of maps. Those maps include psychological and emotional models from Western psychology, psychotherapeutic theory, and Buddhist psychology.
John O’Donohue once said, “One of the deepest longings of the human soul is to be seen.” It is my deepest wish that all human beings feel seen and valued, and that is one of the main reasons I became a psychotherapist.
If you decide you want to seek therapy, the most important thing is that you find a therapist (and a therapeutic approach) that work for you. Hopefully, the information I’ve given you in this article will help you make an informed decision by looking at different options.
(Originally written in 2018)