So, CBT isn't working for you? These are your next steps

Cognitive behavioural therapy (CBT) is often the go-to form of therapy offered on the NHS.

Sometimes, it’s hard to get much else in the way of psychological help that isn’t CBT, counselling or medication.

These things are offered regularly as they all have tons of potential to help, but if you’re here reading this, the chances you feel like CBT isn’t working for you.

The talking therapy is designed to help you manage your problems by changing the way you think or behave. It generally focusses on your present issues, rather than your past, but therapy isn’t a one-size-fits-all, so the reality is, CBT doesn’t suit everyone.

When you’re at this point, it can feel hard to know what to do next.

While going private is an option, it won’t be accessible for everyone – either financially or simply because of how overwhelming the admin can feel (in which case, visit British Association for Counselling and Psychotherapy for a list of people.

So, what else can you do?

Dr Sarah Bateup, a cognitive behavioural therapist and chief clinical officer at Oliva, shares her recommended next steps if you’re hitting a wall with CBT.

Seek a different therapist 

The reality, as Dr Sarah puts it, is that ‘some therapists are better than others.’

‘So, beyond checking that your therapist has the necessary qualifications (CBT practitioners need a post-graduate diploma in CBT to be accredited by the BABCP), your ability to connect with them is a good measure of how well placed they are to support you,’ she says.

‘The most effective therapists will adapt their communication style, so you should always feel that things are explained in a way that you can understand, and that you can open up.

‘If your therapist doesn’t feel like the right fit, don’t give up hope. 

‘There are plenty of different CBT therapists with plenty of different skills and styles – and plenty of really brilliant ones, too.

‘So make the most of trial sessions, and set up intro calls to help establish whether a different CBT therapist might be a better match for your individual needs, preferences and personality. Just remember that this can take time and even multiple attempts.’

If you’re on the NHS system, you can ask to be reassigned to a new therapist.

This might mean an additional waiting time, but if it means you get a therapist you click with better, then it’s worthwhile.

Explore different types of therapy

It might be the type of therapy, rather than the therapist themselves, that isn’t a good fit.

CBT often involves people doing practice tasks or exercises between sessions, which doesn’t suit everyone. It can also be to be quite structured. 

Other types of therapy such as counselling or relational therapy tend to be less structured and there is less focus on between-session tasks.

‘If you are looking for a type of therapy that will help you explore past events and relationships, examine how they have impacted how you feel and how you relate to others, then you may prefer psychodynamic therapy,’ Dr Sarah says.

‘This type of treatment is aimed at helping people deal with the influence of the past on their present behaviour and feelings.

‘Art and music therapies offer alternative methods of communicating our feelings. There are also types of therapy designed to help people navigate very specific experiences, such as bereavement counselling or couples therapy.’

Reliable resources like the NHS website or Royal College of Psychiatrists website give clear information about different types of therapy, including who they’re designed for and what’s involved in the treatment.

‘The important thing to remember is that, just because CBT wasn’t suitable for you, doesn’t mean to say there isn’t an alternative therapy out there that is,’ she adds.

Look to your workplace mental health provider 

If CBT isn’t for you, and you’re struggling to access alternative therapies via the NHS, it’s worth investigating whether you can access private treatment through your employer. 

Dr Sarah says: ‘Workplace mental health support can widen access to a broader range of treatment options without any additional cost for employees.’

You can also use any services you find to trial therapy styles outside of CBT – for example, you might come across relational therapy styles, which might suit you better and give you more confidence in pursuing a private therapist.

Dr Sarah adds: ‘If you don’t feel ready to start therapy again just yet, that’s ok, too. Guided meditation, mindfulness practice and breathwork can all offer effective mental health support in the meantime.

‘It’s worth checking whether relevant classes, apps or resources are available through your employer.’

Give CBT a second chance

If you’ve tried and struggled with CBT in the past, this doesn’t mean to say that it will never work for you.

Dr Sarah says: ‘Your receptiveness to CBT therapy depends on your individual circumstances, mood and ability to engage with the treatment at a particular time.

‘It also depends on the therapist too, as not all therapists are the same.

‘So, if you find yourself wanting to try CBT again, it’s worth giving it a go. A change in circumstances, a different therapist,  or even your attitude towards treatment could mean that you respond differently and succeed with CBT the next time. 

‘It’s also worth remembering that CBT is an umbrella term for a range of different types of talking therapies. So, if one type of CBT doesn’t work for you, a different style of CBT may be more effective.

‘The NHS website provides a helpful overview of the different types of CBT that are available.’

Consider medication 

There is no shame in taking medication, so it’s worth considering if it’s recommended by your GP.

‘Antidepressants are the most common type of medication used in the treatment of mental health conditions, such as clinical depression, generalised anxiety disorder, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD),’ explains Dr Sarah.

‘They work by increasing the levels of neurotransmitters (chemicals) in the brain.’

Medication can also help support any work you may make in therapy, of any kind.

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