How to Choose the Right CBT Therapist

How to choose my own Cognitive - Behavioral Therapist

Aaron Beck, one of the pioneers of Cognitive Behavioral Therapy, had been trained in psychoanalysis in 1956 when he decided to study the dreams of depressed patients in an attempt to convince his academic colleagues in the psychology departments at that university, who at that time were very skeptical of psychoanalysis.

Beck himself, in an interview, states that he felt an obligation to try to show them the real truth. And so he began to investigate the dreams of his depressed patients, which did indeed confirm some of the psychoanalytic beliefs about depression. Typically in a depressed person's dream, they would see themselves as the victim of unpleasant circumstances in a way that seemed to relish their need to suffer... possibly due to a hostility towards themselves that they had repressed into their unconscious... thus producing all the associated symptoms, including slowing down, feeling rejected, suicidal desires, and so on.

And he continues, “Then I thought that to prove the above, I should use some of the experiments that had been developed by cognitive and other psychologists by designing a series of experimental studies to test the hypothesis that depressed people were indeed characterized by a need to suffer. To my great surprise, it turned out that people who suffered from depression actually had a very strong need to receive approval and some kind of vindication for themselves, and not because of some impulse to punish themselves. At this point, I began to review everything I had done up to that point... And it seemed to me a very logical approach to think that in these depressive dreams, the fact that they saw themselves as victims of circumstances, as losers, and so on, was because this was a basic perception of themselves!”

The motivation was therefore not self-punishment on an "unconscious" level but the way they perceived themselves in terms of perception and processing of information on a conscious level. In other words, the research of a psychoanalyst confirmed the saying of Epictetus, who more than 2000 years ago proclaimed that "It is not things that disturb people, but the doctrines beyond things" i.e. that what disturbs (worries/disquiets, etc.) people is not the situations themselves, but the way they interpret them. Thus the dominant position of psychoanalysis began to be overthrown since according to Occam's Razor this new approach better explained the phenomenon of depression without the need for further speculations such as the hypothesis of the existence of the unconscious. And so began Cognitive Therapy, which later, embracing the evidence-based contribution of Behaviorism to the field of Mental Health in the last half of the 20th century, resulted in the Cognitive-Behavioral Therapy (CBT) that we know today. In the years since then, CBT as an evidence-based treatment has proven effective in a multitude of disorders such as...

anxiety disorders,
phobias,
panic attacks,
obsessive-compulsive disorders,
addictions,
mood disorders such as depression and bipolar disorder, etc.

In addition, for difficult mental health cases, the combination of CBT and antidepressants has been shown to effectively treat severe or chronic depression, while a number of studies show that CBT, on its own, is more effective in common disorders such as social phobia, panic disorder, etc. than medication. It is worth noting that Cognitive-Behavioral Therapy is the most studied form of psychotherapy... No other form of psychotherapy has been shown to be systematically superior to CBT, while in cases where there are systematic differences between psychotherapeutic approaches, these usually favor CBT. Furthermore, it is relatively low-cost, which facilitates its adoption by the National Health Systems of many countries (England, America, Germany, etc.) and their insurance providers.

For example, 18-24 sessions are sufficient to cure a common depression, provided that there are no other underlying disorders that create the depressive episode. Otherwise, potentially, it could reach 24 months due to comorbidity and other idiosyncratic characterological peculiarities of the patient's personality. As almost always happens with something that gains popularity - and not without reason -, many mental health professionals have rushed to benefit from its spread... declaring themselves Cognitive-Behavioral therapists without even a basic training in it.

They have heard something here and there, they have read a book or two about it, and they think that this gives them the right to introduce themselves as Cognitive-Behavioral Therapists. They may even cite schools in their resumes where they supposedly received their training, but a careful look will show the informed prospective client that they have nothing to do with a systematic, purely Cognitive-Behavioral approach.

So the $1,000,000 question is: how can one spot a Cognitive-Behavioral therapist?

In principle, a certification is a strong piece of evidence, although after graduation, there is a possibility that some of them will slip into other “psychoanalytic” approaches and their own methodologies, outside of the official therapeutic protocols of the GST.

Therefore, I would say that at least two years of proven theoretical and practical training are necessary in order for someone to be entitled to apply the methods and tools of the GST with relative success. Incidentally, let us mention that a clinical protocol is a series of steps/selection of specific methods and techniques that has been proven through clinical trials to be effective for the treatment of a specific mental disorder. It should be noted here that there are also general-purpose effective CBT protocols that adhere to the structure and basic techniques of Cognitive-Behavioral Therapy, which with minor variations are applied to a multitude of common disorders. Another key indicator that you can use to determine that your therapist is working Cognitive-Behavioral is a process called “Case Formulation”.

This consists of a summary of the patient's history that is consistent with the patient's symptoms and behaviors that maintain the problem he is facing. It is a working hypothesis that concerns the how and why of the problems the patient is facing, their causes and psychological mechanisms. So when he arrives at a concise formulation, he should show it to you and after you agree, the formulation of your treatment plan can begin. In addition, another key characteristic of a Cognitive Behavioral Therapist is the use of reliable and valid psychometric tools such as the Beck Depression Inventory, which is used on the one hand to create a quantified reference point at the beginning of the treatment, and on the other hand to be used as an indicator that the treatment is progressing in the right direction. Psychometric questionnaires are for a Cognitive Behavioral Therapist what a thermometer is for a doctor!

Finally, a Cognitive-Behavioral therapist does not give advice or if he does, it remains at a minimum level. The important element here is that the therapist should skillfully guide the patient to discover things that will help him see things from a different perspective... If someone were to get well with advice, he should have managed to do so by buying a self-help book... But one thing is I feel good, and another is I get well! Such books serve, in my opinion, on the one hand to sensitize and prepare someone to "enter" a cognitive-behavioral psychotherapy process, and on the other hand to function as potential workbooks since it has been proven that the repetition and friction of the patient with his treatment in the interval between two sessions has positive and faster results. This is another key indication of a Cognitive-Behavioral Psychologist-Psychotherapist.

In conclusion, in addition to reading a little about the history and learning a little more about the basic elements of Cognitive-Behavioral Therapy, you should now also know how to recognize a mental health specialist who recommends you as a Cognitive-Behavioral Therapist. It is up to you to choose the one who suits you so that you can entrust your problem to him and ask him to help you solve it with his scientific knowledge, with art and method and patience but also with humor and oddities. Collaboratively...