Charlie chats with Holly and Julie from our Mental Health and Wellbeing Team about the differences and similarities between CBT (Cognitive Behavioural Therapy) and Counselling. They talk about what to expect from your first session and also some hints and tips on how to get the most out of the experience.
The most important takeaway from this podcast/vodcast is that support like this of any kind is incredibly personal, and there’s no ‘one size fits all’ solution when mental health challenges pop up. Discuss with your healthcare provider what could be the best approach for you alongside other ways to support your wellbeing. Such as improving your physical health and social connections in ways that feel good for you, as well as gaining the other support you need for financial or housing security for example.
The other important factor is that many issues that can affect our mental health can be systemic, societal and based on discrimination or a threat to our safety. These are wider issues and cannot be denied in the way we discuss why you might be struggling. They are also harder to ‘think your way out of’, as some models of therapy can seem to ask us to do. Please be assured that you can have this discussion with your counsellor/therapist and there are other community spaces where these conversations are welcomed and supported too.
Below are some links to local and national resources that may help you instead of, while you wait, or alongside your journey in CBT and/or counselling.
Whatever your journey, TAWS wishes you safety, wellness and a positive route to stable mental health.
National
Mind – England & Wales: https://www.mind.org.uk/
Samh – Scotland: https://www.samh.org.uk/find-help
Mind Wise – Northern Ireland: https://www.mindwisenv.org/
The Hub of Hope – National directory of support services: https://hubofhope.co.uk/
Local
The Waiting Room – Directory of Birmingham support services: https://the-waitingroom.org/
Free tools
Anxiety UK – https://www.anxietyuk.org.uk/self-care-tools/
Birmingham and Solihull Mental Health Foundation Trust’s Self Help leaflets – https://www.selfhelpguides.ntw.nhs.uk/bsmhft/leaflets/selfhelp/Depression%20and%20Low%20Mood.pdf
Rethink Mental Illness – Information, guides and tools for life challenges: https://www.rethink.org/
Spaces to talk:
Andy’s Man Club- National and online meetings for men every Monday night: https://andysmanclub.co.uk/
The Mix – Messenger, email and counselling support for 11–25-year-olds: https://www.themix.org.uk/
MindOut – National online mental health chat support service for LGBQTIA+ folks: https://mindout.org.uk/
Black Minds Matter – Access to therapy for Black folks. Designed and delivered by Black folks: https://www.blackmindsmatteruk.com/
CHAPTERS:
00:00:00 – Introduction
00:01:39 – Main differences between CBT & Counselling
00:03:10 – Common misconceptions & understandable reactions
00:04:03 – What to expect from first CBT session
00:05:27 – What are common CBT exercises
00:06:50 – Lived Experience feedback – CBT
00:07:50 – Internal work vs ‘Paper’ based work
00:10:00 – Advice, ‘Cheerleading’ and Empowerment
00:12:28 – Lived Experience feedback – Counselling
00:14:20 – Social, systemic, other issues and impact on mental health
00:15:28 – Choice
00:17:00 – ‘Person-Centred Care’ and ‘Least-Invasive Approach’
00:18:29 – Free counselling resources
00:19:40 – Other models of therapy & specialisms
00:21:55 – Fears, anxiety and worries about starting CBT or Counselling
00:23:42 – Wrap up – You are not alone!
MUSIC: Pixabay – The Trance Beats
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hello I’m Holly I’m part of the mental health and well-being team here at the Active wellbeing Society I have about 10 years of experience working in mental health ranging from supporting people who are in hospital struggling with their mental health right up until working with people with depression anxiety NHS talking Therapy Services and within tours I help support with our mental health and well-being programs out in the community hi I’m Charlie from the virtual well-being project here at the Active wellbeing Society for a number years I was a lived experienced peer support worker and then I gained some qualifications in mental health which meant I could move into support work moved on to project leadership including leading projects for the NHS supporting people as they move back into independence from our psychiatric boards um I now lead the virtual evolving project here at the actual eving Society supporting people in virtual spaces to lead happy and active lives hi I’m Julie I work for the active well-being Society in the mental health and well-being team um I’ve been working in mental health for around about 30 years now um and I came into it from engineering because I myself experienced mental health issues I’ve had family history also and then that’s really kind of giving me the passion for the work that I do now supporting people with complex emotional trauma and various um mental health issues this video is about the differences between CBT and counseling for anyone you might be waiting for different kinds of therapy this might be a handy video to get to know about what to expect um and also know what questions to ask that kind of thing so Polly do you want to talk us to the differences between CBT and counseling yeah there’s a lot of differences but I would say kind of the main ones to be aware of um first of all CBT is quite a Here and Now sort of treatment so we focus on you know what is going on for you right now uh whereas counseling has the capacity to look at current difficulties and things you might be going through but also dve a little bit more maybe into past uh difficult experiences um so that’s one big distinction um another might be kind of the element of structure So within CBT it’s quite structured you’ll have a lot of guidance and be given some strategies whereas with counseling it’s quite self-led so it’s more exploratory um and by that I mean the um counselor might ask a few questions but really it’s up to you what you want to bring to the session um and what you want to add on to the agenda and and another difference would be kind of the main presenting problem that we deal with in CBT and counseling so for counseling much of the time if the main problem that you’re experiencing is anxiety based counseling won’t be offered to you it’s much more focused on um alleviating depression um and depressing depression symptoms um and that’s because there’s not as much research to suggest that counseling helps with anxiety so if you if you are experiencing anxiety Then CBT is something that could work really well um more so than counseling it’s it’s really helpful to know the differences because I think often you’re prescribed CBD and it’s not necessarily explain to you what what to expect have you found people that you’ve supported that maybe found a bit of a confusion as to what to expect from what’s been offered to them yeah um I mean I tend to lump all of the CBT C into one and I’m getting therapy type thing um and they are they’re quite different in how you work with it so for someone like to see beat it the more you put into it the more you’re going to get ahead of it it’s very much about doing the work in between the sessions whereas as counseling’s probably a little more laidback from that but and there’s different ways to kind of prepare yourself for it I have to say to people um with counseling you’re going to open up some Old Wounds and stuff like that so you can actually sometimes feel worse before you start feeling better and working through it so that’s just something to be really aware of um and again with with the CBT unless you do the work nothing’s going to change and it it is about taking the suggestions of of the person who working and actually doing that homework and putting something into it brilliant thank you so looking back on kind of your experiences when you’ve been delivering CBT if you were talking to somebody who’s maybe waiting for CBT and they’re thinking about their first session what are they going to expect they might have been waiting for a while they might have their hopes up as as to what’s going to happen and you got someone at home who been watching this and they’re thinking like what can I do to prepare or um how can I kind of mentally prepare emotionally prepare um what is that for a session with going to entail I mean first and foremost it’s getting to know each other you know and getting to know your practitioner or therapist and and then you um there may be um C you know kind of room to explore what’s brought you to that session um and a bit of background and an overview um but quite quickly you might find that you start talking a little bit more about what CBT is and the practicalities so together you may look at what we call a vicious cycle so that could be identifying difficult thoughts feelings and behaviors that are cropping up for you um and really starting to drill down into an understanding a shared understanding of what’s going on for you at the moment so whil there will be space and there should be space to talk about kind of the the situation and what’s What’s led you to get in touch often it will be quite quickly that you can delve into more solutions right how can we understand this um and doing some exercises together U kind of written exercises or talking through that cycle and what what do those kind of written exercises entail because I’m I know from the support work that I’ve done and I imagine it’s a similar experience to you there can be a little bit of a push back initially from from that kind of homework exercise where particularly if you were maybe expecting more of a counseling model if you don’t know that that’s something you’re going to be asked to do what what what does that usually entail particularly in those initial first few weeks what could somebody expect from that it’s a good question I think it will it will vary on what kind of um problems or difficulties that you’re bringing to the session but generally it will be firstly about filling in what might be referred to as a five areas diagram so again it’s different boxes where you put down what are your thoughts what what am I doing that might be on helpful or um is bothering me at the moment how am I feeling um and and trying to use that framework to understand what’s keeping the depression or anxiety alive kind of thing um and then from that it might be filling a diary you know every every day so what have you done or any difficult thoughts that you’ve had um again you know for some people writing things down and a lot of written work isn’t something that they feel comfortable with and that’s fine you can adapt it however you need to we can draw you can do a voice message on your phone you know whatever it is that helps you it’s mainly about just logging and noticing the thoughts and the behaviors so it be something along those lines so just from a little experience Julie um what has the feedback been in terms of the most profound change for people and in their experiences of those kind of um practice that homework style yeah for me and it it’s been that kind of getting the jumble out of your head and being able to over write it down put it down in some way that you can actually work with it in a logical order so for me personally when I had SE be it it’s kind of all been really overwhelming the stuff that’s in there and not knowing where to start so by kind of putting it down bit by bit I could go right I’m choosing to work on this and then perhaps the next session I’m going to choose to work on that so it just gives you some leeway into doing it and some way in without feeling totally overwhelmed absolutely sometimes when you’re looking at all the issues and there can be so many sometimes in life count there particularly when you can Ling at social issues Financial issues emotive issues all those kinds of things sometimes it can be good just to take that beat and go right we’re going to focus on this area and this is what we’re going to we’re going to do the work on what can the work look like in CBT when it actually kind of comes down to it um because we’re talking about the homework and that can sometimes be the the eye roll um because we all feel that a little bit like we just we just want to get to the feeling not this bad anymore on stage um and sometimes being given homework can be but actually the the doings of the work is sometimes a bit more internal than the writing stuff down thing so what what can that feel like or be like from the in session work and the out of session work what is that like during CBT it it being completely honest it can be challenging you know a lot of the time what we’re trying to do with CBT is ask someone to confront something that they might have been avoiding so it could be actually some anxiety that I’m really worried about XY Z and I’ve just been ignoring it I’ve been putting it off um so what CBT will do to break that cycle is encourage someone to in a in a supported way confront those fears or anxieties and that’s going to bring up some difficult emotions it might be that if we’re feeling really low or you know we’ve got not got a lot of motivation the work looks like taking really small manageable steps towards achieving a goal but again that requires us to to to push through what we kind of are inclined to do which is kind of shy away from it so I would say that’s the the main thing um that can be challenging is actually confronting difficult emotions but you know I tell people it’s like taking medication for a physical illness if you like you know if you don’t take your medication every day and you don’t do it consistently it’s probably not going to be as effective as if you just take it once a week when you turn up to the doctor’s appointment same thing with with CBT you know if you only ever do the work when you get the session you’re probably not going to feel the benefit from it as you’ve said Julie um it’s you get out what you put in so the the work really is about using the strategies that the therapist or the practitioner has given to you and doing it consistently um despite the difficult feelings it might bring up um and that’s something to talk through if it is challenging talk about it with your therapist and think how how that might be able to be a bit easier you know can you break it down can can there be something that can be changed to make it easier to do the initial stages before you build up to something a bit more difficult are they likely to give you advice like would you find um if you were to you know set set down U these um these Cycles break down the issues are they going to guide you through that to make decisions and choices or is that that on you to to find those Solutions and find those those new new ways of being I would say it’s a combination of of the two a lot of the especially at the beginning it might be a bit more guided and and and definitely in terms of the types of strategies that we can use CBT therapists and practitioners will offer you you know this is the strategy this is how you might want to manage a difficult thought or a worry um but actually the best Solutions are often within us anyway and so any any therapist or practitioner is going to really welcome if you can see something that might help you bring that to the table um and hopefully they’ll be asking you questions that that lead you to discover those things that are already there and the things you already know um and and just support you emotionally and give you a bit of a bit of cheerleading really to go on and do it yeah and that that’s kind of one of the the core differences isn’t it between CBT and counseling is there’s kind of less of that within the counseling space yeah counseling is much more um it’s just a space to to start to understand your thoughts and feelings um you won’t be advised by a counselor in fact often you know part of the discipline and and the the training towards becoming a counselor is you know you should be leading anyone you shouldn’t be given advice um but that SP often allows people to again come to their own conclusions and their own Solutions rather than having um strategies per se and and advice given to them of how to manage the feelings um and the thoughts absolutely sometimes it can be really powerful just to have a a structured and permissive space to have what some people would call like a a brain fart almost like where where where where you can kind of have have that permission to have that space to explore difficult stuff but also just kind of unwrap and unravel some of the complicated like that that that KN you were talking about earlier it just gets a bit a bit kind of confused in in your head space and and just have that space to explore that with someone who knows how to how to unot those those things with you but not for you say and what’s the feedback been like from from folks that you’ve been supporting or from your own Journey when when youve when you’ve been through counseling yourself or when you support others who’ve been through counseling has it been different to people who’ve been through a CVT very much so um kind of the counseling it it takes a while to kind of set in and as I said often it feels worse at first um and it it tends to be longer term um from what I day but people find it useful some but not everybody because different ways of treatment was was support different people and work for those but for those that it does work for it works very very well for those that don’t like that then it doesn’t work so well so it’s it’s also very important to find a CER that you’re comfortable with um and sometimes the feedback will be that actually I didn’t feel comfortable with this this sort of coer and it’s actually okay to to request a change of coer because that’s going to be a key part to actually working with it comfortably being comfortable with the person that’s sat opposite you so it’s it’s don’t never be afraid to to ask those questions and say actually I don’t think it’s working between you and not we can do it so yeah generally for for people it works well it’s a process though and it’s not a quick fix and often people like well I’m going to go and get this stuff appear in two weeks on I feel brilliant not the case generally it does take longer and again you know feeding into it you you’ve still got to action stuff that you’ve talked about and got to go away and then do those actions so not everybody always recognizes that it’s often that people like I’m going to go in I’m going to have a chat with some and they’re going to fix my brain and unfortunately much as that would be nice doesn’t work that way again there’s still a process behind it that you have got to take responsibility for it and work through absolutely and there’s there’s also the the hard facts which are often emotional issues or um you know issues of kind of um you know those behavioral cycles that we get stuck in can be linked to social issues or environmental issues or financial issues and all those other things are a little bit harder to unpick than just saying I’m going to challenge that thought when it comes up because if you are in financial distress or if a living situation isn’t great it’s a little bit more difficult than going to a counselor and just talking it through um so it’s it’s always worth acknowledging that those systemic issues aren’t necessarily going to be deconstructed by having a conversation with the counselor but a good counselor will acknowledge that with you and support you through validation of that as part of the issue that you’re facing yeah absolutely there’s often extra things that that need to be looked at because it’s it’s not just about the unraveling of what’s going on a bit it is kind of looking at all the social aspects and you know is my life in order in all of these things to enable me to feel better and I think I would add to that you know in acknowledging that um it it might not be that either CBT or counseling it’s not one or the other sometimes it’s a bit of both for that reason you know if there are things that are more practical and um social things that need to be resolved before someone can you know really address the underlying low mood or the underlying experiences it might be that a bit of CBT to support with motivation and problem solving could be really useful to then go on you know to be in the right um sort of Foundations to go on to explore perhaps some deeper um past experiences within a counseling setting so it’s not always necessarily an either or it could just be you know this and then something else um so again yeah just just talking through that with the therapist will’ll be hopefully quite insightful and and get a bit of guidance and advice on it and yeah I think that kind of that that point about um that not being either or and also choice is part of this as well and I think um particularly when NHS is your only option you can feel like I have to take what I’m given and this is the only thing that I’ve got and while there is an El of Truth in that it’s also worth saying you can ask for other things you can say I have tried this and I’d like to try something else um and you can also say I’ve tried this practitioner i’ like to try another one um there are other other things you can pursue it just you know you might need to have a few different conversations but that’s happen um but yeah how how has that been navigated in services that youve you’ve worked in the past when people had other questions or if they wanted to try the things was there an ease of movement in that or did that take time does that part of the process that you were involved in at all yeah no absolutely I mean it it does take time and I think we always um want to work in a a person centered way um a big um ethos really though within an HS talking therapies is going with the least invasive or least intrusive intervention first is is what you might hear it referred to as and what really that means is if somebody maybe helped through something that is going to take less of their time be less emotionally tax in perhaps or um you know yeah just kind of the lightest touch option if you like first if that’s going to be useful then we would always prefer to go with that um and then kind of build on that if we find that that perhaps hasn’t done the trick if you like we can always then layer on more intensive forms of therapy um so there will be again as you say an element of needing to follow that model um however I think it’s really important that people feel empowered to ask questions to understand why decisions are being made about their care and to be as involved in those decisions as possible um and I think you know for me certainly where somebody has tried one thing and it hasn’t been helpful for them there’s always scope to explore the possibility of something else um it’s just about having the conversations um and I think hope you know hopefully being satisfied with the answer then as to why something can’t happen if it can’t happen um I let that answers your questions it does absolutely thank you and I think the other thing as well is that um NHS isn’t the only option I think that’s the other thing as well is that NHS is a wonderful resource and we’re incredibly fortunate to have what we have um but in terms of free therapy um Services it’s not the the only access the only point of access um across the UK we’re very lucky that we have various Charities and various organizations um that offer Counseling Services whether that is through your faith community um whether that is through local community support Charities um sometimes it can be through domestic violence charities um or other kind of specific support organizations so if you for example might be having a barrier to access via a GP for whatever reason um there are other routes that you can pursue and there are usually um like kind of um geographical Geographic uh directories of where you can find free or lowcost or subsidized Therapy Services in your area um so that’s always thing that I would always mention to people um because there specialist other therapies therapy models if you’re looking Beyond things like CBT and counseling that it might be worth looking into as well and I think on on that you know it’s a really good point that you make and even within the counseling sort of um modality if you like or kind of type of therapy um it might be that the the type of past experiences that someone needs support with needs a much longer term kind of input as you’ve said than what the CH talking therapies are able to provide and perhaps a little bit more of a specialist knowledge and and background so you know for example things like um sexual violence and and things of that nature um it would be much more it would be kind of safer for somebody to have a longer term intervention with someone that has a specialism within that type of experience and that might not be something that’s offered within your location at your NHS local service and you may be offered some you know kind of um details somewhere else that could provide that so even within counseling there might be certain things that need to be um explored elsewhere outside of the NHS that could be a conversation that the practitioner has with you as well just to set expectations around that absolutely and that those kind of expectations management thing is is so important because you are giving so much of yourself when you go to counseling and you are offering that little piece of your soul with along with a big bundle of hope when you go to counseling whether it is CBT or straight up counseling and um knowing that that is a shared um shared agreement that you have with that person um and that understanding that they’re also invested in you too whether that is being able to say to you your specialism isn’t my my area but I can SL push you to someone who is I think that’s a really honest C is on the table approach and is really really valuable a lot of people so we’re speaking about expectations of the first session and a lot of that is ing anxiety about um worries about judgment or kind of fears about sharing some quite personal details what would you say to somebody who’s coming to their first session whether it’s counseling or CBT about um what they’re they’re bringing and things they’re going to be saying in that first session I mean absolutely it is it is a racking as you you said before you bring in something that’s really personal on part of you to really a stranger let’s be honest you know um but whether it’s CBT or counseling the person that’s sat in front of you or is on the phone with you is is going to it will not be judging any part of what you’re saying um it is a safe space it’s confidential I think that’s another big thing you know no matter whether you’re in the NHS you’re at another organization um they will respect your confidentiality so you really can be open um and you won’t anything you say I’m sure will not shock people um mental health and all difficulties Associated are so much more common than people want to talk about often that’s unfortunately part of the stigma around mental health um but actually it’s quite probable that who you’re talking to has heard this before um and so you don’t need to be worried about any kind of judgment or criticism in that respect I think following on from that it’s you’re going to need to be vulnerable and put yourself in that vulnerable position and and from experience of going through counseling CV and from supporting others doing it you are safe to do that and it is okay it’s going to feel un comfortable it’s you’re going to feel very out there but these are the trained professionals that that we’re working with that are are there to hold that and to help you through that so yeah you’re going to feel themable but that’s okay that that kind of space to be your authentic self this is the space to do that really is absolutely because you know as you said nothing’s going to shock the people that you’re working with because because of that kind of train in the background behind it um you know in the work that I’ve done I’ve had with all sorts of things and it’s like okay let’s work with that it’s never like oh my gosh that that sort of thing so you are safe in the hands of the people doing that as long as they are accredited yeah absolutely thank you both so much this has been really really really helpful to get both of your perspectives from both the lived experience and the Press side as well I mean both of you have so much wealth of experience years of doing this and it’s really really valuable so thank you so much thank you when whether it’s CBT or counseling that you’re waiting for please be assured that you are not alone mental ill health is really common and so is seeking help um we’re going to pop some details in the description below of things like National Services that might be useful to you and other resources that might answer sing more questions we hope we’ve answered some questions today um but do get in touch drop us some comments if you have any more thank you again to Holly and Julie for their time today and yeah we hope to see you again in another video soon take care bye thank you bye
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