CBT vs Counselling: my experiences of therapy for mental health

10th April 2018

It’s no secret that I suffer with my mental health. More specifically, I suffer from anxiety and depression.

Back in 2016 I decided to do something about it, and I spoke to my GP about my options. I decided to give therapy a go rather than jumping straight into taking medication.

Since then I’ve had CBT (cognitive behavioural therapy) and I’m currently having counselling. I’ve spent a lot of time thinking about the treatment I’ve had so far, and how these two different types compare. So I’ve decided to share my thoughts in a blog post. I hope that this post can provide some insight into having therapy for mental health problems.

Please remember that these are simply my opinions of my experiences in my local area. Your experiences might vary.

I also wanted to just point out that I realise how lucky I am as a UK resident to be able to get all of this treatment for free. But of course, it does come with its downsides. I of all people know the NHS is far from perfect!

Providers

In my local area, CBT is provided by the NHS and more specifically trained CBT therapists. However, counselling is actually provided by a charity called Age UK, and their therapists are trained volunteers. I always thought Age UK was a charity that just helped older people, but actually their counselling services can be used by anyone regardless of their age.

Of course, this might vary from area to area.

Waiting times

I think it was October 2016 when I went to see my GP about my mental health struggles. She gave me the details for the local mental health team and I called them about having therapy. I then had to wait until December 2016 for a telephone call with a therapist to decide what type of therapy would be best for me.

From this phone call it was decided that I would have CBT. I was told the waiting list for CBT was around 6 months, but it actually took 9 months. So altogether, it took 11 months from me talking to my GP about therapy to me actually receiving therapy. This is a hell of a long time when you are suffering, but this is the reality of the mental health services provided by the NHS. It’s simply not good enough.

In contrast, the wait for counselling was a lot shorter. I finished CBT in October 2017, and this is when my therapist referred me for counselling. I had my initial meeting about counselling in December and I started counselling at the end of January 2018.

Had I known that the waiting list for counselling was shorter, I probably would have requested to try that first as I felt desperate to talk to someone. However, I didn’t know about the difference in waiting times, and I was also just going with what the experts said.

Length of treatment

CBT normally lasts for 6 weeks, and each weekly session lasts about 30 minutes. With CBT, once those 6 weeks are up that’s it. You’re just let go, no matter how you feel. And I understand that this is because there are so many people on the waiting list for CBT.

After my 6 weeks of CBT ended I still felt like I had a very long way to go, and I was clear in expressing my feelings to my therapist. This is when she suggested that I try counselling.

When I had my initial meeting about counselling I was told that although most people have 6 sessions of counselling, I could have as many as I needed. Each session lasts for an hour, and we often overrun.

At the end of my 6th week of counselling I still didn’t feel ready to leave, but I felt like we were making great progress and I really wanted to continue. Fortunately, my therapist just asked if I would be okay for the same time next week, without asking if I wanted to carry on for more than 6 weeks which I felt would have been really awkward for me. It must have been obvious to my therapist that I needed more support, I’m so grateful that she didn’t have to ask me if I wanted to continue. I’ve had 9 sessions of counselling so far.

Treatment

CBT is a very structured. Each session we focused on a specific part of the CBT.

Firstly I was introduced to the concept of a worry diary; a place to document all of your worries. You have to write down the date and time, the situation, your worries, and how worried you feel on a scale from 0 to 10. Then you have to decided whether that worry is hypothetical (all in your head) or practical (something to actually worry about).

If the worry is hypothetical you have to save it for “worry time”. Worry time is a specific time of the day when you are allowed to worry. The idea is that you write down your hypothetical worry and save worrying about it until your worry time, rather than worrying about it right now.

If the worry is practical then you have to use problem solving techniques to come up with a solution straight away, rather than waiting until later.

And that’s it! That’s what I was taught during my 6 week course of CBT.

I really threw myself in to the treatment. I tried so hard to write down my worries and save them until later, but I found it impossible. And in fact I found myself getting upset because I couldn’t stop the worrying and save everything for a specific time.

I also found writing down my worries as and when they happened really hard because at the time I was working in an office, and I felt really uncomfortable getting my worry diary out in public. I tried to hide it, but I must have looked so suspicious. I also tried keeping a worry diary on my phone, but then it just looked like I was messing around on my phone all day.

Because CBT was so structured, I felt like it wasn’t very personal.  It was all about following the set protocol for the 6 weeks, and there wasn’t much opportunity to talk about the reasons why I was feeling the way I was.

I have nothing against my therapist because she was so lovely and I actually cried when the 6 weeks came to an end because I knew I was going to miss her, but the treatment just didn’t work for me. I wanted to talk about things that had happened in the past, but I felt like I had to stick to the structure of the course, so we only touched on the past very lightly.

After CBT I quickly fell back into my old ways. I kept persevering with the worry diary, but in the end I gave up. I just could not get my head around saving my worries until a specific time.

Counselling has been a lot more personal. My therapist really tailors each session to me and my needs. I’m allowed to go off on a tangent and talk about something completely random. I’m also allowed to switch between talking about something that happened 20 years ago, and then talk about something that happened last week. She puts two and two together and helps me to understand the reasons why I feel the way I feel, so then I can start working out how I can feel better about things.

My therapist for counselling encourages me to look at things from a different angle, and she often sets me little challenges each week. I’ve been very proactive with these challenges, and I’ve noticed that they’ve had a massive impact on the way I feel.

Counselling is a lot more about releasing those feelings I have. It’s more about talking and figuring out how I can help myself. There’s no structure or protocol. It’s a lot more freeing that CBT, and I feel like it is working.

Although both my therapists have been fantastic and have both made me feel comfortable, I’ve definitely felt more comfortable with my counselling therapist. I’ve been able to cry in her sessions. Where as when I was having CBT, I often felt like I needed to cry, but I held it back. If I had cried about what I wanted to cry about, I would have over run my sessions every week.

To summarise…

It’s clear to me that counselling has been significantly more beneficial for me that CBT. And I even think that the people around me have seen this too, especially Tyrone.

Saying that, I don’t think my 6 weeks of CBT were a complete waste of time. I learned a lot of techniques for dealing with anxiety, and maybe, with a lot more practice, I might find them beneficial.

One thing I wanted to mention that might have affected the outcome of these treatments is timing and what was going on in my life while I was having treatment.

For instance, when I was having CBT I was still working full-time. At this point I really wasn’t enjoying my job and I did discuss the prospect of leaving with my therapist. She made me feel like my feelings were valid, and she helped me deal with the fear of leaving my job. And even as I wrote my letter of resignation I thought about my therapist and her words of encouragement. I will be forever grateful for that.

In contrast, by the time I  started counselling I had left my job, and I was dealing with the fall out from that. I still had a lot of thoughts in my head related to my reasoning for leaving that job, and a lot of anxiety about the future.

But either way, counselling has been the only type of therapy that has allowed me to talk about the past (more specifically my hip dysplasia and being a victim of medical negligence), which is one of the main causes of my depression and anxiety.

If you’ve made it to the end of this post, well done! I know it’s been a long one, but there’s a lot of thoughts I wanted to share with you. 

If you are struggling with your mental health, please talk to your GP, or even just someone you feel safe talking to. There are lots of helplines you can call and speak to someone if you feel like you have no one.

You are not alone. Your feelings are valid. You are loved. 

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  1. I think counselling is amazing. But, well, I should say that considering that I’ve graduated Psychology. It’s great you’ve tried both and now you have some ideas of how to cope in some situations. I’m really happy for you.

    For me, even with the very long wait, having these for free on the NHS is remarkable. In Romania, these consultations were never free. Actually the price made them inaccessible for many people, even those on middle income, similar to the ones at private practice here in the UK. I should also point out that even GP consultations are now partly paid by patients, from 2015. NHS might not be perfect, for me, the system but it’s pretty close to being perfect. That’s also because I’m comparing it with another system I’m familiar with.

  2. 🤗 Thank you for writing this Holly. I feel like I really learned something about CBT, as well as counselling – things I didn’t really try before I took medication for my depression a while back. I think I was very uncomfortable speaking about myself to someone in person, I had a counsellor for a short period of time. Bit weird given I can be so open on my blog sometimes. That was the other thing I wanted to send you 💕 for – being open about mental health. I’ve seen what being open about mental health can do to help people and let them know they are not alone. So I appreciate you so much, adding to the discussion. ♥️

    As I was reading, and before I read your sentence about CBT being structured, I was thinking exactly the same thing. And yeah, it didn’t sound very personal and felt like a temporary “connection” to your therapist for CBT. I felt really bad for you when I read about the worry diary! I can imagine it’s hard to hide something like that at work or in public when you need to write in it. But I am really glad you still found the experience valuable even though you had to wait for so long. I’m also glad that your counsellor now is working out for you! Good thing you didn’t have to bring up that odd six week limit at all 😉

    So glad you’ve been seeing better days 🌼

  3. Thank you for writing this post. My experiences with CBT were very similiar with you – very structured, and with strict deadlines and no room to deviate. (and keeping diaries is SO hard at work! I had that same problem and kind of had to wait until lunch or after work to fill them out which maybe defeated the purpose but what else to do?) i am really looking forward to trying counselling as my next step too, although unfortunately there are no free services in my area so I am currently having to sort my finances out first. I agree that in many ways the NHS is brilliant, and in many other ways, not enough. I have also dealt with waitlists, though not as long as you, and eventually i accepted medication as it does seem to help, and it gives me something to do when I can’t access other forms of help. the side effects aren’t great though 🙁 I’m glad that counselling is working for you and you are feeling a lot better. 🙂


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