CBT is Not the Only Talking Therapy: A point of view

It's tough finding a counsellor that suits every individual and any one counsellor will not suit every client. Also, the increasing medicalisation of mild to moderate mental distress does not always help the individual to get better.  This is why properly qualified independent counsellors need to be allowed to offer a range of alternatives.

Wide spread ignorance in general practise leads to the belief that CBT is the only model of talking therapy that works and that it must be administered only by the NHS. As powerful as CBT is, the widespread dismissal of psychoanalytic theory by many of its practitioners means that it does not always provide lasting relief from emotional distress, especially with the strict rationing number of sessions allowed. It is effective for rapid symptom relief and does work over the long term for many, but not all. The medical model of "treatment" means that the client is seen as a "patient" with a set of "symptoms", and the client is reduced to a set of problems and any failure in the client to improve can be seen as a failure in the commitment of the client.

It is interesting that in many areas of the country that those providing treatment for mental illness under the IAPT (Improved Access to Psychological Therapies) schemes specifically exclude those with training in counselling in favour of those more accepting of a strict medical model. They also make high demands on their practitioners in terms of numbers of clients they must see. This can often result as the patient being seen in terms of outcomes that favour, or not, the practitioner and the genuine relationship between them becomes strained.

By contrast, integrative counselling is founded on the intersubjective relationship between the client and counsellor and offers a talking therapy that truly respects the individuality of the client. It provides an holistic approach to counselling that embracing humanistic, psychoanalytical, and cognitive psychological theories and encourages a detailed exploration of phenomena and from this exploration the meaning underlying a client's distress. Any development of negative regard by the client of the counsellor are seen as just one phenomenon which can usefully be explored to reveal the underlying meaning and how this meaning is played out in the present, often to the detriment of the client's relationships.

There are many well regarded colleges and institutions that offer well-founded training to degree level and beyond, ensuring that their graduates are fit to practise as counsellors and psychotherapists.  With advent of the voluntary regulation by the Professional Standards Authority (PSA) for Health and Social Care, GPs and potential clients can have confidence that those included in the approved registers of accredited counsellors maintained by the BACP, UKCP and other ethical bodies have proper training and experience and are subject to a complaints procedure designed to protect the client.

CBT has many virtues and is a model I use in my own practise when requested, but it is not the only talking therapy. Let's please keep it that way.

Listening is hearing, right?

During a counselling session a while ago, a young female client looked at me with a quizzical look and said, "I told my boyfriend that you wear hearing aids and yet you seem to be the only person ever to have heard me!"

It seems to me that this illustrates perfectly the difference between hearing and listening. Having severe hearing loss in both ears, I need some pretty expensive technology to help me hear clearly which, thanks to our dear old NHS, I have. But that's only half of it. In order to "hear the other" I have to "listen", to give that person my undivided attention and to switch off the noises of prejudice and preconception in my own head.

Paradoxically, in counselling, listening actually involves some speaking. Not in an uncontrolled way and not with the intention of imposing your own thoughts or seeking those moments of gratification that you get when chatting with friends, but to explore the thoughts, ideas and fears of your client. The mutual, intersubjective understanding that arises from this is the bedrock of the counselling relationship in which trust and attunement develop allowing the client to feel heard. This, then, allows the client to feel safe enough to explore the roots of their unhappiness. Over time, this act of listening is experienced as therapeutic and allows the client to heal.

What I have learned from this is that listening is really an act of loving kindness and that when talking to friends and family if you take the time to listen, you may hear so much more and may even find it deepens your relationships.