This guide contains some personal opinions about CBT therapy, based partly on speaking to therapists (in real life, not at 7 Cups) and partly on Internet research.
CBT
CBT was originally developed in a hospital setting to treat severe depression. It is now widely used for depression of any severity, and also for anxiety and some other related mental illnesses.
As originally developed, CBT is a brief, high-impact treatment. Treatment times are measured in weeks for simple cases, or in months for complex cases. However, the severity of symptoms doesn’t tell you anything about how simple or complex your case is—that requires an expert clinical assessment.
As originally developed, CBT works by investigating the underlying cause of the problem, forming a treatment plan, and then carrying out the plan. The goal of treatment is not to suffer from the problem any more. For example, if you have depression, the goal of treatment is not to have depression.
In technical jargon, the outcome of investigating the cause of the problem is known as the “formulation” (or sometimes, “conceptualization”).
Coping
However, some therapists use a different approach. They teach a collection of well-established coping techniques and strategies that help you to live a more normal life while remaining ill. This approach is also widely used for a great variety of mental illnesses.
This approach is not necessarily time-limited, because as you face new challenges in life you may need new coping techniques. Treatment times may be measured in years or decades.
The goal of treatment is to cope with life better. For example, if you have depression, the goal of treatment is to live a more normal life while still having depression.
Confusingly, this approach is also called CBT.
Recovery
The word “recovery” is also used in a confusing way.
Some therapists use the word “recovery” to mean you don’t have the illness any more.
Some therapists use the word “recovery” to mean you still have the illness but you can cope with life better.
Unfortunately, this means you need to clarify what the word “recovery” means with each person you talk to. Alternatively, avoid using the word at all.
Other approaches
In addition to these two approaches, there are other approaches to therapy. Some of them are called CBT, even though they are nothing like the approaches described above. Most of them have other names.
Some therapists specialize in a single approach. Some therapists use different approaches with different clients. Some therapists use more than one approach with the same client.
Choosing a therapist
All this makes choosing a therapist very challenging.
For depression, anxiety, and related conditions that can be treated using CBT, a reasonable goal is that one day you will not have the condition any more. It is often possible to find a therapist who specializes in brief, high-impact treatment based on a formulation and a time-limited treatment plan, in order to achieve this goal.
To ensure that your therapist will try to help you in this way, you have to ask the therapist explicitly, before you start treatment: “Do you specialize in using a formulation and a time-limited treatment plan.”
Then, in early therapy sessions, expect to see the formulation in writing, or in the form of a diagram. Also expect to be clearly informed about the treatment plan and how long it is likely to take. (The length of time might not be exactly predictable, but it should not be open-ended in this type of therapy.)
Qualifications
Therapists’ qualifications do not always tell you what kind of treatment they specialize in, or how effective they are. In particular, I do not know of any national or state scheme for licensure or accreditation that provides this information.
I only know of one professional organization that checks therapists’ ability to provide CBT using a formulation and treatment plan. That is the Academy of Cognitive & Behavioral Therapies. It’s based in the US, but it has a few therapists in other countries.
A second organization is developing something similar, but at the time of writing it doesn’t seem to have a directory of therapists yet. It’s the Beck Institute for Cognitive Behavior Therapy.
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