What is a clinical psychologist?
A clinical psychologist is a psychologist with extra (three years minimum) training in the practical application of theoretical knowledge about the mind and behaviour to people's problems in living. The current qualification for this is a doctoral degree, though in the past it was a masters, both in clinical psychology. There are many other kinds of psychologist, including educational and industrial. The only other kind of psychologist who specialises in therapy for problems is a counselling psychologist.
Therapists are those who practise therapy, usually with a particular orientation, such as psychoanalytic or personal construct or person-centred. Clinical psychologists receive basic training in a range of therapies and with a range of client groups including older people, people with a learning disability, children and adults with mental health problems. They also usually adopt a particular therapeutic orientation, but may often borrow extra ideas and techniques from other approaches.
The main aim of a clinical psychologist's intervention is to develop a formulation, or suggested explanation, of the development and maintenance of a problem, this then leads on to plans to change the situation. The formulation and action plan are developed jointly with the client, so that the client has choices and contributes ideas at all times. In other words, the problems aren't sorted out for you, but by you, with assistance.
What is CBT?
Cognitive behavioural therapy (CBT) is a collaborative, evidence-based treatment. It involves therapist and client agreeing on definitions of the problems and the goals of treatment, and then making a formulation of how the problems keep being maintained. The language is all about thoughts, behaviour, feelings and physical reactions. There are treatment protocols for many problems, but these are always modified to apply to the client’s pattern of difficulties.
Homework tasks allow the client to overcome fears, practice new skills and challenge their unhelpful thoughts in between sessions. Practice is vital for this approach to work. Tasks should be stretching but not impossible to carry out.
Thought diaries allow the client to develop awareness of how they feel and think about problematic situations and what they do to try and cope. They also allow the therapist to learn about these patterns and monitor progress.
This form of CBT, delivered by email, is unsuitable for people who self harm, are suicidal or aggressive to others, or who have serious mental health problems.
What if I fail in CBT?
There is always a reason why a given approach is not working for you. Your therapist will engage you in discussion about possible reasons for lack of progress and you will plan to address these together.
The reason is never that the client fails (in any case this is a judgement, not an explanation). Any therapy is a complex interaction between at least two people and all of the environmental and internal factors that affect their behaviour.
It may be that a major life event occurs and knocks you for six before you’ve been able to consolidate your gains, it may be that some of your own thinking patterns affect progress (for example, thinking you’re a failure and so avoiding doing homework in case you get it wrong).
What if CBT doesn’t work for me?
As above, there are many, usually complex reasons, why therapy might not help or might only partially help. It is vital to stay non-judgmental about yourself and the therapy in order to give it the best chance of helping you.
The outcome studies to date show that the majority of clients (60-80% depending on the problem) benefit to the extent that they no longer have the problems they started with.
If you happen to be in the minority the first time, you will find you have learned some helpful things about yourself and this will increase your chances of success next time around.
Should I look for help elsewhere while having this treatment?
Getting involved in another therapeutic approach whilst participating in CBT is generally unhelpful and confusing.
Enlisting the help of family and friends, for example to prompt you to do homework or fill in diaries, or even to carry out tasks with you if appropriate, is a good thing to do.
Reading about your problem, educating yourself about CBT, checking out other internet sites, are all helpful.