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  • Dr Emily Barney

Talking Therapies Explained: CBT v Counselling v Solution Focussed Hypnotherapy

Updated: Jun 24

There are dozens of talking therapies available today and it can be confusing to know what they are and which is going to be the most effective at reducing any unwanted symptoms. This is especially confusing because talking therapies use conflicting methods based on different ideas of how people change. For example, some therapies want you to feel more (e.g. Psychodynamic /Psychoanalytic), others want you to feel less and think more (e.g. traditional Cognitive Behavioural Therapies - CBT). The former views difficult emotions as something that needs to come out and be "worked through" and you can expect the therapist to say very little in the sessions, the latter considers difficult emotions as something to be controlled through conscious re-assessment of negative thought and you can expect sessions to be highly structured.


This short blog focuses on the two most popular talking therapies that you will come across when reaching out for help with your mental health (CBT and Counselling) and then a description of a new, modern and very effective form of therapy, not currently available on the NHS, called Solution Focussed Hypnotherapy.

You have decided you need help, now what? .....

Ok, so you think you might be depressed or have a problem with your anxiety, for example, and decide you need some professional help. If you decide to go to your GP hopefully you will be signposted to the fabulous services NHS professionals offer in Primary Care called IAPT services (stands for Improving Access to Psychological Therapy - although service providers are different depending on area). IAPT services will predominantly offer CBT, usually in a range of formats, initially in group or telephone and then 1-1 if needed and you will likely have around 6 sessions of these.

However, maybe you don’t want to wait or go to your GP, what do most people do then? Most likely we google "local counsellors" or ask around for recommendations.


Counselling


What it means to “go to a counsellor” is generally well understood. For example, if you decide this is the option for you (maybe you're having difficulty coping with a loss/bereavement, for example) you can generally expect to talk about your feelings or your problems openly and freely. The counsellor will provide a ‘safe space’ with no judgement and a listening ear for you to talk about what is on your mind. The idea being that as you talk about your thoughts, feelings and problems that you will start to make sense of them and feel heard and understood and you can start to un-complicate the contents of your mind and make better decisions. Counsellors can offer helpful reflections or observations and provide support as you ‘work through’ difficult emotions. Depending upon your reason for accessing counselling, the counsellor might ask you to talk about your past.

Counselling can be very helpful for people who want to talk about their problems in a less structured way or feel they need to “get things off their chest” to someone who doesn’t know them so that they don’t have to feel guilty that they are burdening someone else with their problems. It can also help to make sense of what is going on by getting an alternative perspective on the situation.

This type of therapy can sometimes take a long time and can create a dependancy to the therapist for some people and is generally unlikely to be effective for people who don’t believe talking about their problems is going to help them.

CBT


Originated in the 1960s, the bottom line / aim of traditional CBT approaches is to reduce symptoms of anxiety, for example, by changing the way you think about your feelings and situations in life and hopefully prompting positive behaviour changes. The therapy focuses on the current situation and you are rarely required to talk about your early experiences.

CBT therapy is ‘content’ focussed, meaning sessions will focus on the content of your current negative thoughts/beliefs with an expectation that you analyse a problem or thought pattern and break it down into detail. For example, you will likely be expected to keep thought diaries and do behavioural experiments, gradually exposing yourself (with support) to situations that make you feel uncomfortable/create anxiety. The idea of this being that you habituate/become desensitised to that situation in the end and stop avoiding it. This approach requires a lot of effort on behalf of the person but can suit people who feel they need to talk in great detail about their problem, people who like structure and who believe they have to work hard to get better.

There is a modern version of CBT that is becoming more widely available the NHS but it depends on your area. Modern CBT is sometimes referred to as “Third-Wave” CBT, these are therapies like “Mindfulness-Based CBT” or “Acceptance and Commitment Therapy.” Essentially what you will experience from these therapies is a shift in the process of how negative thoughts and emotions are handled in sessions. Traditional CBT will encourage you to challenge negative thoughts and beliefs, whereas mindfulness based/ACT approaches teach a path of least resistance and will encourage you to adopt a position more akin to a curious, non-judgemental observation towards your internal world. The effectiveness of mindfulness approaches is

now well understood by research and this is one of the most effective talking therapies available in the NHS, particularly for reducing symptoms of anxiety.


Solution Focussed Hypnotherapy (SFH)


Originated in the early 2000’s, this therapy is arguable the most modern form of therapy available today because it is designed on a neuropsychological understanding of how the brain works. SFH is essentially a structured stress reduction therapy, stress being a key factor in causing all mental health problems (as well as many physical health problems).

As technology advanced in the millennium we learned more about the mind and how negative emotions are processed as well as, perhaps more importantly, what is happening when the brain is working at its best. SFH was designed based on this knowledge. For example, we now know the brain is highly active during a stage of sleep called REM (Rapid Eye Movement) and that it is doing something very important in this stage… it is processing emotional build up from the day. We have learned that the trance state in hypnotherapy replicates this stage of sleep and also quietens a brain region down called the Amygdala - which detects threat and is highly excitable when stressed out. We now also know that the mind has a vast resource and capacity for innovation and creativity and can find solutions to adapt and grow even from the most traumatic and difficult of situations.

SFH is a structured therapy and each session is structured exactly the same because we know the brain doesn’t like change. The first half of every session is a set of exercises designed to connect you to the resources in your brain that will help you to find solutions and then the second half is hypnotherapy.

If you decide to try SFH you can expect to not talk about your problems (apart from in the initial meeting where you’ll tell the gist of your story). This is because we now understand that the more the brain focuses instead on what has been good and focuses on positive thinking, acting and interacting, the more serotonin builds up in the brain. Over time (not a long time usually somewhere between 8-10 weeks) a constant flow of serotonin will start kicking in and we know that when we have a constant flow of serotonin this creates a feeling of calmness and certainty and a general feeling that you can cope with life and its problems.


This therapy is very effective for a wide range of problems such as stress, panic, anxiety, depression, phobias, PTSD/trauma, OCD and more. It is a nice form of therapy, going against the notion that ‘hard work’ is needed to produce change.


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