CBT-Why Counseling is Challenging

When people begin CBT counseling they understandably hope that things will gradually improve in a smooth and upwardly linear way. However, the changes that you will be attempting to make through CBT counseling are challenging particularly if you are working to change behaviours that helps you to cope in the short term (e.g. eating disordered behaviours, alcohol/drug abuse). Added to this is the fact that in order to resolve a problem you must focus on it, an increased awareness of your problem will make it feel more significant.

Instead what happens when you begin to resolve a problem is that you may feel worse and this initial rise in discomfort and distress can make you doubt the process of change. However, as you begin to understand more about your problem, why it developed, why you are now so stuck and what you can do to change things you will start to feel that things are improving. You will still have bad days but the bad days will become less frequent and when they do occur, they will be less intense.

Below the short and long term advantages and disadvantages of resolving a problem are outlined. This highlights why the process of change is so challenging. In the short term the many disadvantages of change have to be tolerated with few, if any advantages to balance these. It is only as the process of change continues that the long term benefits that come with resolving problem can be enjoyed.

Short term Advantages of Change:
1. Hope that things will change in the future

Short term Disadvantages of Change:
1. Increase in distress
2. Time (& money)
3. Outcome is uncertain
4. Giving up familiar for unfamiliar
5. Hard work
6. Have to prioritise it

Long term Advantages of Change:
1. Health & happiness will improve
2. Positive impact on relationships
3. Positive impact on career
4. Reduction in stress
5. Increase in self esteem

Long term Disadvantages of Change:
NONE

The Coast of South America
One way to think about the process of recovery is to think of a trek along the coastline of South America. You had initially hoped to travel from coast to coast by car, taking a smooth road across the centre of the country, but you are told at the last minute that there is no such road and instead you must walk, setting off in what intuitively seems like the wrong direction (the equivalent of starting in southern Chile and then dropping down to the southern most tip of South America). As you round the headland you begin to feel as if you are starting to go the right way (beginning to trek up the coast of Argentina) but from time to time the coastal path will take you inland away from the coast line and you will feel as if you are diverging from the correct path. However, if you keep moving, following the signs pointed out by your guides you will eventually reach your desired destination.

Becoming your own therapist
The trek along the coastline of South America can also be used to think about the core goal of Cognitive Behavioural Therapy (CBT) currently recognised by the National Institute of Clinical Excellence (NICE) as one of the most effective types of counselling; becoming your own therapist. During the first phase of your trek your Guide (your therapist )will teach you the various skills you need for your journey, taking the lead through the sometimes challenging terrain. However as you become a more accomplished trekker/therapist you will begin to feel more confident about taking the lead. Although when you have finished your treatment you will not have completely resolved your problem, you will feel in a much stronger position to continue your journey along the coastline to recovery independently.