Cognitive Therapy is based upon the principle that the way we perceive situations influences how we feel about them. It involves learning how to identify and replace distorted thoughts and beliefs, ultimately changing the associated habitual behaviour towards them. It is usually focussed on the 'here and now' and is a problem-solving orientated treatment. 

Cognitive Therapy was first developed in the 20th Century by American psychiatrist Aaron Beck who realised what usually held his clients back most were negative thoughts and beliefs such as "I'm stupid" or 'I can't do that". Beck initially focused on depression and developed a 'list of errors' in thinking, which he believed could maintain depression. The list included errors such as magnification (of negatives), minimisation (of positives) and over-generalisation. 

Albert Ellis, another therapist,came to similar conclusions about his clients' negative beliefs and their tendencies to 'castastrophise' or 'awfulise'. Ellis's work also became known as a form of Cognitive Therapy, now referred to as Rational Emotive Behaviour Therapy (REBT). When individuals are distressed they often cannot recognise that their thoughts are distorted, so Cognitive Therapy helps them to identify these thoughts and reassess them. For example, if an individual makes a small mistake they may think "I'm useless, I can't do anything right." Strongly believing believing this may cause them to avoid the activity where they made a mistake which leads to confirmation of this belief. Addressing these thoughts, and reassessing them can lead to more flexible ways of thinking, allowing the individual to feel more positive, be less likely to avoid situations and be able to challenge their negative beliefs.

The cognitive approach came into conflict with the behavioural approach at the time, which focused solely on assessing stimuli and behavioural responses to it. However, during the 1970's behavioural techniques and cognitive techniques joined forces to create Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) combines Cognitive Therapy, and Behavioural Therapy and involves changing the way you think (cognitive) and how you respond to these thoughts (behaviour). CBT focuses on the 'here and now', reflecting on where it came from, and breaks overwhelming problems into smaller parts to make them easier to deal with. These smaller parts can be described as thoughts, emotions, physical feelings and actions. Each of these has the ability to affect the other, e.g. the way you think about things can affect how you feel emotionally and physically, and ultimately how you behave. 

CBT is based on the principle that individuals learn unhelpful ways of thinking and behaving over a long period of time. However, identifying these thoughts and how they can be problematic to feelings and behaviours can enable individuals to challenge negative ways of thinking, leading to positive feelings and behavioural changes. It is possible for the therapy to take place on a one-to-one basis, with family members or even as a group depending on the issue and how the individual feels most comfortable. 
CBT is widely used within the NHS (although waiting times can sometimes be long), is evidenced based and supported by the National Institute for Health and Clinical Excellence

CBT can be useful for dealing with issues such as:

  • Anger
  • Anxiety
  • Depression
  • Drug or Alcohol Problems
  • Eating Disorders
  • Insomnia
  • Obsessive-Compulsive Disorder
  • Phobias
  • Post-Natal Depression
  • Post-Traumatic Stress Disorder
  • Sexual and Relationship Problems

The emphasis on cognitive or behaviour aspects of therapy can vary depending on the issue. For example, the emphasis may be more towards cognitive therapy when treating depression, or the emphasis may be more towards behaviour therapy when treating obsessive compulsive disorder. 

CBT is a practical therapy, which is likely to work best treating a specific issue as it focuses on particular problems and how to overcome them. 

CBT sessions may consist of a number of activities, including:

  • Coping skills
  • Assessments
  • Relaxation
  • Challenging certain thoughts
  • Thought stopping
  • Homework projects
  • Training in communication

Behavioural Therapy is effective for individuals who require treatment for some sort of behaviour change, such as addictions, phobias and anxiety disorders. Based on the principle that behaviour is learnt, and can therefore be unlearnt, or reconditioned, Behavioural Theraphy concentrates on the present without focusing on the past to find a reason for the behaviour.

The most famous examples of conditioning are those of Ivan Pavlov and B.F Skinner.

An experiment conducted by Pavlov demonstrated how ringing a bell close to dinnertime caused dogs to associate the ringing of the bell with the expectation of food, which made them salivate even if no food appeared. The importance of this experiment is that the coniditoned response (the dogs salivating) decreased in intensity the more times the conditioned stimulus (ringing the bell) occurred without the appearance of food.

A similar technique can be used to treat phobias, for example, where an individual can gradually be exposed to the stimuli that triggers the phobia, and recondition their behavioural response to it (i.e reduce their fear of the phobia in question)

B.F Skinner conducted an experiment that associated reconditioning with rewards. The experiment involved feeding a rat via an automatic dispenser until the rat learnt to associate the noise of the dispenser with the arrival of food. Once the rat had learnt this behaviour, a lever in the wall was raised so that when the rat touched it accidentally with its paw, the food was dispensed. The rat then learnt to associate the lever with the arrival of food and continually pressed it.

A similar technique can be applied to individuals by reinforcing desired behaviour, or not reinforcing undesired behaviour.

The behavioural approach came into conflict with the cognitive approach at the time, which focused on identifying and replacing distorted thoughts and beliefs. However, during the 1970's behavioural techniques and cognitive techniques joined forces to create Cognitive Behavioural Therapy.

The person-centred approach views the client as their own best authority on their own experience, and it views the client as being fully capable of fulfilling their own potential for growth. Person-centred therapy began formally with Carl Rogers in the 1930's an 1940's. Rogers affirmed individual personal experience as the basis and standard for living and therapeutic effect, He considered that individuals have within themselves vast resources for self-directed behaviour. These resources can be tapped if a definable climate of facilitative psychological attitudes can be provided. 

Roger's consider's that there are three conditions that must be present in order for a climate to be conducive to growth and therapeutic change. The core conditions are:-

  1. Unconditional positive regard (UPR) - this means that the Therapist accepts the client unconditionally and non-judgementally. The client is free to explore all thoughts and feelings, positive or negative, without danger of rejection or condemnation. Crucially, the client is free to explore and to express without having to do anything in particular or meet any particular standards of behaviour to 'earn' positive regard from the Therapist.

  2. Empathic understanding - means that the Therapist accurately understands the client's thoughts, feelings, and the meanings from the client's own perspective. When the Therapist perceives what the world is like from the client's point of view, it demonstrates not only that that view has value, but also that the client is being accepted.

  3. Congruence - means that the Therapist is authentic and genuine. The Therapist does not present an aloof professional front, but is present and transparent to the client. There is no air of authority or hidden knowledge, and the client does not have to speculate about what the Therapist is 'really like'.

    In essence, as persons are accepted and prized, they tend to develop a more caring attitude toward themselves. As persons are empathetically heard, it becomes possible for them to listen more accurately to the flow of inner feelings and experience. As a person understands and prizes himself or herself, the self becomes more real, more genuine. These tendencies, the reciprocal of the therapist's attitude, enable the person to be a more effective growth-enhancer for him or herself.

    Together, the three core conditions outlines above are believed to enable the client to develop and grow in their own way - to strengthen and expand their own identify and to become the person that they 'really' are independently of the pressures of others to act or think in particular ways.

    Person-centred theory takes these core conditions as both necessary and sufficient for therapeutic movement to occur, i.e. that if these core conditions are provided by the Therapist, then the client will experience therapeutic change. Notably, person-centred theory suggest that there is nothing essentially unique about the counselling relationship and that in fact healthy relationships with significant others may well provide the core conditions and thus be therapeutic in themselves, although normally in a transient and short-lived sort of way, rather than consistently and continually.

Solution-focused therapy (SFT) was developed in the 1980s by Steve de Shazer and Insoo Kim Berg in the USA. It focuses on what clients want to achieve through therapy rather than on the problem(s) that led them to seek help. In essence, the approach does not focus on the past, but instead, focuses on the present and future. 

There are a number of differences between SFT and traditional psychotherapy. Central assumptions are that the client will choose the goals for therapy and that they themselves have resources which they will bring to the sessions. Part of the solution-focused practitioner's task is therefore to discover whatever a person is already doing which might contribute to the resolution of the problem with which they have come.

SFT is not about obtaining a detailed personal history in the same way as other therapies. 'Problem talk' and speculation about motives or 'purposes' of symptoms are avoided. Expert 'jargon' is not used.

The Therapist invites the client to imagine their preferred future and then together they start to move towards it, sometimes through small steps and sometimes by making large changes, To encourage these changes questions are asked about the client's story, strengths and resources, and about exceptions to the problem.

Solution focused practitioners ask many questions about what life might be like if the problem was solved. As the answers to these questions gradually become clearer, both practitioner and client begin to get a picture of where they should be heading. The clearer this becomes the greater the possibility of it beginning to happen. By helping people identify the things that they wish to have changed in their life and to attend to those things that are currently happening that they wish to continue to happen, SFT Therapists help their clients to construct a concrete vision of a preferred future for themselves. 

The SFT Therapist helps the client to identify times in their current life that are closer to this future, and examines what is different on these occasions. By bringing these small successes to their attention, and helping them to repeat these successful things they do when the problem is not there or less severe, the therapist helps the client move towards the preferred future they have identified. 

Goals are defined in practical and recognisable ways. Talk about pre-session changes, exceptions, scaling tasks and the 'miracle question' keeps the focus of effective solutions. Like CBT, homework tasks are offered to continue the process of change between sessions. Individual, couples or families may be seen and joint sessions are not uncommon even where one individual may be the main focus. 

An important research finding is that SFT is equally effective for all social backgrounds whereas some other psychological therapies sometimes seem to favour the well-educated and affluent. In practice those with few resources are the ones often most in need of effective therapies. Another advantage is that results are usually achieved within 3 - 6 sessions. Research indicates that SFT is considered to be effective in 65-83% of cases in an average of 4 - 5 sessions.