What is the difference between Cognitive Behavioural Therapy (CBT) and counselling?

What is CBT?

CBT is an evidence based talking therapy that suggests that changing unhelpful thinking patterns and behaviours can make us feel a whole lot better. CBT prefers a ‘here and now’ approach, such that thoughts and behaviours that are maintaining the problems can be tackled, although there is some reflection on the past and how this may have started the difficulties for the client. CBT has protocols to guide CBT therapists on how to help clients with certain difficulties, which have been rigorously tested and are shown to be effective. However, we know that clients are all individuals and as such all have their differences, so CBT therapists use some flex with these approaches to adapt them to the client.

There are two types of CBT: low intensity and high intensity. Low intensity CBT is often offered as the first step in the NHS and is usually only 4-8 sessions, which are delivered weekly or fortnightly, over the telephone, videocall, online or occasionally face to face. These sessions usually focus on one or two key techniques due to the limited time of the treatment. These sessions are delivered by Psychological Wellbeing Practitioners (PWPs), Children Wellbeing Practitioners (CWPs) or Educational Mental Health Practitioners (EMHPs), who have normally trained for 6-12 months at a graduate/postgraduate certificate or diploma level at university. These positions are not currently accredited by the governing body.

By contrast, high intensity CBT is offered as a first step in the NHS only for certain issues, e.g. Post-Traumatic Stress Disorder (PTSD), or if a client doesn’t feel better after low intensity interventions. It tends to be 8-12 sessions in the NHS (but longer if needed in the private sector). Sessions are delivered weekly by a fully trained CBT therapist, who has trained for a number of years and is hopefully accredited with the British Association of Behavioural and Cognitive Psychotherapies (BABCP). A word of warning: be careful of therapists who claim to offer CBT but have not actually completed a postgraduate/graduate diploma or masters, or do not hold accreditation with the BABCP.

What is counselling?

Counselling is a form of talking therapy designed to help people overcome their difficulties. Counselling can take the form of general discussions or use some specific strategies to help the client. Conversations can be about all sorts of different things, e.g. relationships, childhoods, thoughts, feelings, difficult situations, etc. There are many types of counselling, e.g. person-centred or gestalt counselling, all of which work in slightly different ways to support the client.

Therapists usually train for a number of years in counselling, and then become accredited with the British Association for Counselling and Psychotherapy (BACP). Again, be careful of therapists who claim to offer counselling, but have not actually completed a qualification or hold accreditation with the BACP.

Similarities and differences between CBT and counselling

As you can imagine, there are many similarities and differences between CBT and counselling. A lot of people use the terms interchangeably and some therapists seem to offer both, so it can get very confusing! Below is a summary of the similarities and differences:

Similarities:

  • Both CBT and counselling are usually one to one sessions between the therapist and the client; however, other people can be involved as and when necessary with the client’s consent. Certainly, there are CBT groups out there to help people meet others in a similar position, which provides great peer support.
  • Sessions are usually 50-60 minutes and occur weekly (or sometimes fortnightly if needed)
  • Both counselling and CBT have been shown to be effective for low mood or depression, and thus both are offered on the NHS. The client could choose either treatment depending on the main problem and the approach the client prefers.
  • Both CBT therapists and counsellors need to train to do their role over a number of years and can become accredited with their own governing bodies.

Differences:

  • CBT is much more protocol-led than counselling, which prefers a more fluid approach. Therefore, CBT has more structure and a general plan for sessions.
  • CBT is much more based in the ‘here and now’, whereas counselling looks at the past and present.
  • Research shows that CBT is effective for anxiety, whereas counselling is less so, and as such counselling for anxiety is not offered in the NHS.
  • There are two main forms of CBT, e.g. low intensity and high intensity, and many types of counselling, e.g. person centred, gestalt, humanistic, integrative, etc.
  • CBT is quite an active therapy, in that sessions will include discussing current ways of coping and looking at new, more helpful ways. Sessions tend to use a mix of discussion, little experiments, worksheets, writing on whiteboards, roleplays, etc. In comparison, counselling utilises more discussion, with some additional elements of drawing things out such as family trees and other active techniques.

What’s right for me?

It depends on the difficulties you have. As above, part of your decision should be based on what the research evidence suggests. The go-to place to check this out is the National Institute of Health and Care Excellence (NICE). Here you can search for different difficulties and the recommendations for treatment from NICE. However, this can be a bit tricky to navigate, so there will be a blog that outlines the recommended treatments in more detail soon.

Another part comes down to you as an individual and what you want to get out of therapy. If you’re after some techniques and new coping strategies, CBT is probably better suited for you. If you’re looking for a space to explore your past and how that’s impacting on your future, counselling is probably more up your street.

Most therapists are happy for you to contact them and find out a bit more about their way of working (watch out for future blogs about choosing the right therapist!). At Brighter Life Therapy, you are welcome to book in for a free initial consultation to see if the CBT we provide is what you need. If not, we can put you in touch with other professionals and services in the area who might be better suited for your needs. Get in touch via our general enquiries form below, or by calling 0118 40 50 108.

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