What is CBT and how does it work?

Cognitive Behavioural Therapy, or CBT for short, is a short-term therapy, usually lasting for between 6 and 12 sessions,  which aims to help you overcome a specific problem.  Anxiety, depression, social phobias and eating disorders are all issues which can be worked on.  CBT encourages you to notice your ‘automatic thoughts’ which limit your freedom to feel relaxed, happy, and to do what you want in everyday life.  Your therapist will help you to challenge negative beliefs about yourself, and to risk making small changes, on a daily basis, which will put you, rather than that negative running commentary in your head, back in control.  The counsellor is not going to ‘dig deep’ into your past, but will instead look at how your issues are spoiling your enjoyment of life and help you to feel better in the here and now.  Any issue which is causing you to have negative thoughts about yourself, your life and your relationships can improve during CBT.  You and your therapist will agree on what you want to change and then draw up a plan for each week of the therapy.  Your goals will be small, measurable, realistic and form your ‘homework’ each week.  For example, if you are a client who has anxiety and has lost your confidence to look for work, you might look at ways of reducing your anxiety by cutting down on the time you have to think about it.  Your homework might be:

week 1 – find out  phone numbers of  voluntary organisations in your town

week 2 – ring or email them asking if they have opportunities for volunteers

week 3 – list the experience and skills you can offer

week 4 – practise mock interviews with a friend

week 5 – go for an interview

week 6 – work for half a day in a charity shop

Your therapist would encourage you to keep a diary of your thoughts and feelings and to notice if your worst fears actually ever happened- almost certainly they didn’t!

I hope I haven’t made CBT sound like ‘just a lot of goal-setting’; it’s not at all like that with a good therapist.  It is very organised, and you will look at how you behave as a result of your problems in a lot of detail, and work out different ways of behaving and thinking, but your relationship with the counsellor or therapist is still the key to your feeling better.  A warm, understanding, non-judgmental relationship is really important if CBT is going to help.

So, over the weeks,  you will together set  small, measurable goals, and then discuss how things went for you.  You will talk a lot about your fears and your feelings as well as how you coped.

CBT circle

I believe that our thoughts, feelings, beliefs and actions are circular, and we can begin to change at any point on the circle.  Sometimes, behaving differently helps us to see that our negative thoughts are untrue.  Other times, noticing ourselves being negative and deliberately changing the thought, repeating a positive statement instead, can help us change how we feel, and how we behave. As the therapist, I know that my role is to help you, the client, to make a commitment to change, by working out a detailed plan which I support you to follow, while listening and understanding your thoughts and fears. Just because it’s called cognitive-behavioural therapy, doesn’t mean that your feelings are any less important; in fact expressing them fully is vital for change.  An American study found that simply asking a group of unemployed workers to write down every week how they felt about being out of work, resulted in their getting jobs more quickly that those who didn’t put their feelings on paper.  Recognising how we feel about our situation, accepting that it’s not about our failings as a person, but rather the result of the situation we find ourselves in, somehow gives us permission to forgive ourselves, realise we are just another normal human being, who has ‘got a bit stuck’, and find the strength to move on, back to a happier place!




Will couple therapy help if I’m depressed?

The short answer is; it depends.  I often meet couples for the first time,  and one, or occasionally both partners are taking medication for the symptoms of depression.   It’s a difficult condition to define.  It can mean anything from ‘feeling a bit down’, to not being able to get out of bed in the morning,  to not feeling that life is worth living anymore. Some depression is better defined as grief, and is the natural consequence of loss or bereavement.  Being at home with a small baby who doesn’t sleep, losing your job, money worries, retirement, ill-health, can all make us depressed, and a relationship that is not working can have the same effect.

As a couple therapist,  I am happy to work with a couple on how the depression is affecting their relationship, but I need to check first of all that they have been to see their GP recently and that they feel well enough to look at their relationship issues.  If a client is already having individual therapy for depression, for example seeing a CBT therapist to work on their symptoms,  then I would suggest that couple counselling needs to wait awhile.   It may be that the couple relationship is contributing to the depression; it may even be the main cause of it, but a basic rule of thumb is that it’s better not to have two lots of therapy at once.  Couple therapy is always about how we negotiate the boundaries between our individual needs and the needs of the couple relationship, so if we are feeling better about ourselves, then we are better able to negotiate effectively with our partner.  It works the other way too; if we are starting to communicate better in relationship, then we mostly start to feel better inside, so sometimes clients say, half-way through their couple counselling, that they are no longer taking medication, because they are feeling better.  You can start with the couple work or with the individual work; the important thing is to ask for the help you need.

Have a look at the Links page for some suggestions.


Is marriage counselling the same as couple counselling?

Marriage counselling and couple counselling are both part of a relationship therapist’s work.  Is there any difference between them?  The answer is –  it depends.  If a  couple is in a long-term relationship, they live together, have joint financial obligations, know each other’s family, particularly if they have children together, then the practical and relationship issues that couples have to deal with are the same, whether they are married or not.  A married partner has greater protection under the law, however, so it is when a couple decides that they want to end the relationship that being married, or not, becomes the most significant; an unmarried couple can face greater uncertainty, and have even more need for legal advice.

So although I work with many married couples, relationship therapy is open to all couples, including, of course, same-sex couples, .  Each stage of life presents different challenges.  I see a surprising number of couples who have been together for five or six years, but have only recently married.  Many have a small child.  They thought that committing themselves to marriage and children would heal the cracks in their relationship, but after the initial euphoria of the wedding or the birth, the opposite has happened.  Expectations of married life, and the fear of failure have increased.  Differences that were forgotten during the excitement of planning the future have resurfaced in the cold light of routine, and can’t be ignored any longer.

Good counselling supports you to find out why your relationship  isn’t working,whether you have been together a life-time, a few years or just a couple of months.  It helps you to communicate your feelings and your needs better,  and to discover what has to change if you are to stay together.  Individuals also come for relationship therapy; you may be struggling to get over a relationship that has ended, unsure whether to continue with your partner, or wondering why your relationships never seem to last.

I don’t think there’s any such thing as a ‘normal’ marriage or a ‘traditional’ relationship.  I come across couples who are living together, and are far more ‘married’ than those who have done the whole big white dress, expensive party thing.  A good marriage is about comfortable, shared commitment to the same values and goals.  Saying vows in front of your friends and family can help you to achieve that, but if you don’t listen to each other, or understand each other properly, then that legal piece of paper won’t help a bit.  My job is to give you the time, the space and the support to do some honest talking and listening. Many couples don’t look for help until it’s almost too late.  So if you are starting to struggle, ring a Relate-trained or BACP registered counsellor. The research shows that the sooner you get support, the better your chances of staying together.  Married or unmarried, it’s the commitment to making your relationship work that makes the difference.

How do I know we have built a good counselling relationship?

I’ve worked with them for months, watched them argue, defend, then start to listen and understand each other.  I’ve seen them slowly turn more towards each other, to talk together, rather than just  angrily through me.  They have told each other what they really need, begun to negotiate different ways of talking and communicating… and suddenly the work is done, they are ready to take over, to ‘go it alone’.  I have got to know them and to like them.   I have thought about their problems, looked for different ways of working with them, been a mediator, a listener, a curious friend, a reflector of all that they have told me and each other; and now it’s time to let them go.

I always have mixed emotions when clients move on.  It’s a great feeling if a couple want to stay together and look as if they will make it happen now.  It’s a  privilege to help a couple separate in a way which causes the least hurt and misunderstanding for them and their family, but it’s also important to acknowledge the sadness that both are feeling, even if they know they can’t go on living together.  If we have built a good counselling relationship, I am bound to feel attached to a couple, to hope things go okay, to feel curious about ‘what happens next’.  But the counselling relationship is a professional one;  I am often a container for a couple’s emotions, I can support them to  to deal with them better, but I know the work is done when they are able to understand and contain feelings for each other, or, sadly, when they recognise their partner can’t do that for them, and their future is not together.

So if we have built a good counselling relationship, I will feel sad to see a couple move on, but hopeful that it is an ending which holds the seeds of new beginnings for them both.

How can you help your child to be happy at school?

It’s a couple of weeks into the new school year now.  Most children will have settled back into class with a new teacher and will look forward to the school day, but it is the time of year when some parents start to notice that change is affecting their child’s behaviour negatively,  and it’s no bad thing to be aware of what help is out there for mums and dads.

Little ones starting school wet the bed for the first time in ages, they don’t want to go because ‘my tummy hurts’ or as one five year old said to me after her first day ‘I’ve been to school, it was nice, but I won’t go again’.  In that hour when they come home from school, or when you first see them after school, it really helps to just sit down with them if you can, while they have a drink and a biscuit, giving them time to talk and unwind; small ones, in particular, may sit and draw while they talk to you; it  allows them to make sense of their day to you while it’s fresh in their minds.

After tea  they are often so tired that they are practically asleep standing up, and older children get very tired too, but when it comes to bedtime they are wound up and can’t settle.  Clients are initially very sceptical when I suggest the mini-meditations for children on the Calm for Kids website, but they really do work, and after a couple of evenings, parents have told me that they find even noisy, ‘fighty’ boys reminding them about the CD, because they help them feel relaxed as they lie in bed.  The CD costs about the same as a pizza, but its benefits last a lot longer.

There’s a lot of pressure on teenagers at school, but there’s also evidence that teenagers, particularly teenage boys, have a different body clock from the rest of us; they find it hard to go to sleep, and i-pads, x-boxes and televisions in bedrooms really don’t help.  It won’t be popular; they will tell you that, ‘nobody else’s parents do it!’, but it does make sense to ban all technology from bedrooms at night.  Teenagers also find it hard to get out of bed in the morning;  the research tells us they need huge amounts of sleep, but winning the battle of the i-pad on school nights, allows you to be more lenient at weekends, and improves your chances of seeing  them safely out of the house in the morning as you go to work.  If you sit down and negotiate a ‘win-win’ with them, and their wishes and feelings are also being taken into account, they will usually see the benefits of a compromise.

Sometimes a child doesn’t settle down at school, and this can happen when you least expect it; it may be after happy years in nursery, in the first year of junior school,  at age eleven, and even post-16.   Children and teenagers often don’t want to say, or don’t know what’s wrong, and they show it by being defiant, reluctant to do things, rude, or fighting with their siblings. Occasionally school gets in contact to say a child is not settling, or is being difficult.  What do you do?

The first point of contact is the class teacher.  You may well find that your child is being dreadful at home, but is fine at school.  That usually means there’s no problem.  Most children express their tiredness and feelings of pressure at home; it’s the natural place to release their emotions, and so long as you have basic ground rules about what’s acceptable, and keep talking and asking if they are okay, there’s unlikely to be much wrong.  There’s a great book to help you understand how your child’s brain works, and to improve how you talk to each other,  and it’s useful with all ages, from two year olds to teenagers.  I know some adults who have understood themselves a lot better after reading it too.  It’s The Whole-Brain Child by Daniel Siegel and Tina Payne.  It’s a practical, up-to-date, hands-on guide to getting on with your child and helping them grow.  I recommend it frequently to parents, and they quote it back to me and tell me how it’s improved their relationship with their children and with each other.

If you are seriously worried about your child’s progress, and feel you need more advice or support, the teacher in charge of special needs, or SENCO,  is your next port of call.  There’s no shame in your child needing extra support; sometimes it’s really able children, who find it hardest to settle to routine tasks in a new class.  The phrase I always keep in my head is, “The child’s behaviour is giving us a message; it’s our job to work out what that message is”  Children often can’t put into words what’s wrong; some children withdraw when they don’t feel good, others ‘act out’.  It’s up to us, as adults, to recognise that if a child, or teenager’s behaviour changes, there’s something they need to talk about.

If you are seriously concerned about your child’s behaviour or progress, you can ask school for an assessment with an Educational Psychologist.  There’s often a long waiting list, but they really do know their stuff, and will usually get to the bottom of what’s wrong.  Don’t forget how useful your GP can be; they are experienced with children and frequently a good source of advice too.  I’ve added some resources and contacts that many parents have found useful to my links page.

And what about you, the parents?   Suddenly, after eighteen years of giving them your time and your love, maybe forgetting to nurture your own relationship, because teenagers need so much attention, they are gone; off to university, communicating mostly when their bank card doesn’t work or they need to know how to make  ‘spag bol’……..That means you’ve done a really good job, but it’s not always the dominant feeling as you are left behind.  It may feel brilliant to have an empty house, to not be treated like a free taxi-driver anymore,  to become a couple again, but often it doesn’t.  I’ll talk about it another time.