Whilst research evidence demonstrates that Cognitive Behavioural Therapy (CBT) is a highly effective treatment for a wide range of anxiety and depression related problems, it’s also important to ensure that a number of “Good Therapy” factors are in place before engaging in any form of talking therapy.
This article outlines our top ten “Good Therapy” factors and provides those considering therapy with a simple check-list to use when selecting a therapist or counsellor.
1. Professional Accreditation and Training
The first thing to check before booking therapy is that the therapist or counsellor is accredited with the relevant professional body and that they hold the recognised professional qualifications to practise as a psychotherapist. For Cognitive Behavioural Therapy, you should ensure that the therapist is accredited with the British Association of Behavioural and Cognitive Psychotherapy (BABCP). BABCP accreditation means that you can trust that the therapist has reached the rigorous standards of training and assessed practice laid down by the lead professional body for CBT. You can view the national CBT register at www.cbtregisteruk.com This allows you to check your therapist by name.
Other key accreditation bodies include the HCPC and BPS for Chartered / Registered psychologists as well as the UKCP and BACP for general counsellors and psychotherapists.
At Think CBT our therapists are accredited with the BABCP, hold professional indemnity, have completed a DBS assessment and are registered with most of the large private insurance providers. You can check our team profiles by visiting www.thinkcbt.com/psychotherapist-cbt-counselling. You can also search the independent UKCBT specialist registration here
2. Knowledge of the Research Evidence / Techniques for Treating the Problem
As a consumer, it’s important that you have confidence in your therapist and that the therapist has a clear understanding of the relevant research, established techniques and latest developments in the treatment of the problem. We have supported many clients who have previously wasted time and money working with unskilled therapists using irrelevant or inappropriate approaches.
We always recommend that clients follow the evidence and consult the published research data and NICE guidelines where possible. NICE publish a wealth of independently verified recommendations for the treatment of a wide range of psychological problems including depression, anxiety, PTSD, OCD, Social Phobia and eating disorders. You can check the NICE guidance by visiting www.nice.org.uk. therapist should be aware of the recommended psychological treatment for the problem and professionally trained in its application.
At Think CBT we will only work with a client if we are confident that we can help and if we have relevant subject matter training.
3. A Proven Track Record Working with the Presenting Problem
Having the relevant training does not in itself mean that you will get the best therapist to support you through the problem. Like most professions, having practical experience is also essential and you should always check that your therapist has successfully worked with similar issues. Whilst a therapist will not disclose confidential information about work with other clients, they are professionally obliged to declare relevant experience when asked as part of the initial contact. This is usually specified in codes of conduct and professional ethics. Don’t be afraid to ask your therapist for specific examples of whether they have worked with the same problems or conditions.
At Think CBT our therapists have over 250 years combined experience and hands-on exposure to a wide range of psychological, behavioural and emotional problems. All our therapists are additionally required to undertake a minimum of 90 minutes clinical supervision each month, to ensure that their practice is professionally focused and relevant.
4. An Initial Assessment and Assessment Report
Completing an initial assessment sets the foundation for undertaking good therapy. This usually involves a thorough and systematic assessment of the presenting issues and a clear set of recommendations on the proposed approach.
During CBT your therapist will also usually undertake a process known as formulation, which involves creating a model of past and current factors that trigger, maintain and influence your experience of the problem. Obtaining a written assessment report and talking to your therapist about their understanding of your problem is an important initial step before starting therapy. This ensures that you share a common understanding of the problem and that you agree with the proposed approach.
At Think CBT your therapist will always write to you following a structured initial assessment, confirming the problem and outlining the proposed approach and timescales.
5. Clear Goals for Therapy
Agreeing clear goals or therapeutic outcomes is an important initial stage in the therapy or counselling process. This helps to ensure that you have identified realistic expectations for therapy and that you have a basis for judging how therapy is working throughout the process. Entering into open-ended therapy without a clear set of goals encourages little more than passive exploration and can contribute to therapeutic drift. This is where the therapy process loses focus and a clear sense of purpose.
At Think CBT we tend to use a version of SMART goals (Specific, Measurable, Adaptive, Rewarding and Time-focused). In combination with work on personal values, this helps to ensure that therapy is targeted and relevant.
6. A Structured Therapy Plan
Having a therapy plan helps to ensure that you will follow a transparent and well-ordered process. This means that you can be confident that therapy is being planned and prepared in advance and that your therapist is applying techniques in a well-integrated and logical manner. Having a therapy plan helps to avoid ad hoc approaches and unplanned sessions.
Therapy plans do not negate the need for responsive and innovative sessions; a good therapist can hold the balance between adapting and improvising in real-time during the session and following a sound therapy plan.
At Think CBT clients agree their therapy plan and discuss proposed techniques with their therapist at an early stage in the process. This helps to ensure a collaborative approach to therapy; it's easier to engage in the process when you understand and contribute to the planned approach.
7. Feedback and Monitoring
Regular two-way feedback throughout the therapy process is essential to ensure that therapy remains relevant and on course. You should check that the therapist has a clear basis for monitoring feedback and that agreed measures are in place to assess progress at the end of therapy.
At Think CBT we use a wide range of recognised psychometric measures and personalised monitoring processes to ensure that the client is provided with regular feedback on progress throughout the therapy process.
8. Lapse Planning
In the final stages of therapy, your therapist should spend some time discussing how potential lapses might be triggered and how this could be managed in the event of something going wrong. It’s important to remember that therapy is not a magic bullet and that life can often throw up unexpected or negative events. The purpose of good therapy is to equip you to manage potential problems in a healthy and sustainable manner. Therapy is not a basis for stopping bad things from happening, it’s about developing the personal insight, skills and resilience required to bounce back effectively. A good lapse plan provides a personalised backup in the event of future problems.
At Think CBT we provide our clients with a therapy journal to document progress throughout the process, to act as a primer for key tools and techniques and to provide the basis for developing a good lapse plan at the end of therapy.
9. Post-Therapy Follow-Up
The therapy plan should normally be organised to space out the last few sessions, so that the client has more time to practice and test-out the new techniques and approaches learnt during therapy. Similarly after the completion of therapy, clients can benefit from follow-up at agreed intervals to ensure that the new approaches are continuing to prove effective and that where necessary, any booster sessions can be agreed.
At Think CBT, your therapist will agree follow-up intervals with you and you will be provided with the opportunity to maintain email and telephone contact where relevant. We are also interested in post-therapy feedback to ensure that we continuously learn and improve on our approach.
10. A Good Therapeutic Relationship
Whatever form of therapy you decide to engage in, the quality of the therapeutic relationship is key in determining successful outcomes. Finding the right therapist is paramount and working with someone that you can get on with and trust will significantly influence your progress. Therapists often refer to the “Core Conditions” for good therapy. These are empathy, congruence and unconditional positive regard. This basically means that your therapist demonstrates a sense of connection, a shared understanding of the problem and a willingness to support you without judgement. The initial stages of therapy can sometimes feel clunky or awkward, but you should use your own common sense in deciding on whether you can work closely with the therapist.
Like all people, therapists possess their own personality and interpersonal style. We have worked with some clients who described their previous therapist as difficult to get on with, overly directive, not very good at listening and sometimes just plain odd. Make sure that you can connect with and feel confident about your therapist.
At Think CBT we always organise an initial free telephone consultation, to ensure that the basic relationship is right, that the therapist has the relevant experience and to undertake some basic fact finding before the first paid session.
If you choose to work with a Think CBT therapist, you can confidently rely on all ten points in our good therapy check-list, however always talk to your therapist about any issues or questions that you may have before starting the process.
The Good Therapy Check-List
To summarise and simplify our Good Therapy recommendations, we have produced a simple ten point check-list that you can use to help find the right therapist. This checklist can be downloaded here or you can copy it from the following list:
1. Is the therapist professionally qualified and accredited by their lead UK body?
2. Does the therapy offered follow the published research and NICE recommended treatment for the problem?
3. Does the therapist have specific practical experience of working with the problem?
4. Does the therapist provide a structured initial assessment and written assessment report?
5. Are therapy goals and measures used to guide and monitor progress?
6. Will there be a structured therapy plan and timescales?
7. Is there an agreed feedback process to refine the approach / address problems during and following therapy?
8. Does the therapist offer a lapse plan at the end of therapy?
9. Are there follow-up / contact arrangements / booster sessions available following the completion of therapy?
10. Do I feel confident, supported and comfortable with the therapist?
To find out more about our services or to talk to a BABCP accredited Cognitive Behavioural Psychotherapist, contact info@thinkcbt.com or view our website at www.thinkcbt.com.
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