Favouring cognitive behavioural therapy (CBT) over counselling is not a new thing.

The NICE guidelines for Depression already recommends CBT as its frontline therapy. While they ask therapists offering counselling to discuss with their patients how uncertain the effectiveness of counselling can be.

What’s the difference between CBT and counselling?

Both CBT and counselling are used to support people with similar issues like anxiety and depression. And they’re both forms of talking therapy and can be used for short term work.

But while CBT therapists and clients work together to change a client’s behaviour or thinking patterns, counselling is less directive and through listening, empathy, encouragement and challenge counselling hopes to help the client to better understand themselves and find their own solutions to cope with the issues that face them.

Arguably someone could equally benefit from being supported by both interventions at different stages of their lives.

What does the NHS currently offer?

The NHS currently runs the Improving Access to Psychological Therapies (IAPT) programme which offers CBT first and counselling after.

First a patient is assessed by a psychological wellbeing practitioner who mostly go on to treat patients using CBT. It is only then if patients are severe at referral or if they do not respond to CBT are they stepped up to receive counselling.

Two years before IAPT was rolled out the Depression Report argued that services were not implementing therapies according to NICE guidelines.

IAPT was brought out to fix this. It purported to be cost effective and evidence-based. At the time there was also a huge need for quick return on investment, with savings on benefits hoping to balance the costs of any programme.  

What’s so good about CBT?

CBT is easy to prove and also easy to prove that it’s cost effective.

The benefits of counselling are harder to show. Counselling is collaborative and non-directive so benefits can appear long after sessions have finished. Patients may suddenly start to make links and gain insights at a later date, making it harder to prove its effectiveness.

Research into counselling is catching up

There is plenty of evidence out there that shows the benefits of CBT for treating anxiety and depression. But research looking into counselling is starting to catch up.

A recent analysis of data collected from 33,243 patients across 103 IAPT services in the journal BMC Psychiatry this year found that the type of therapy someone attended did not predict an improved PHQ-9 score, a screening tool for mental health. 

The researchers Jo Pybis et al said: “It is apparent from the findings presented here that counselling is not inferior to CBT.”

What if counselling was removed from the NICE clinical guidelines?

The British Association for Counselling and Psychotherapy (BACP) say that the impact of removing counselling from the NICE guidelines for depression could be ‘disastrous’, adding that it could lead to counselling no longer being offered on the NHS and restricting patient choice and depriving people of a proven intervention.  

Julia Britton, Director of charity Open Door, a community service for young people, said: “Easily accessible counselling and psychotherapy has been essential to the Open Door service over many years and we have helped thousands of young people through evidence-based interventions.

“There is ample evidence to suggest the efficacy of counselling in the treatment of depression and anxiety and it would be a huge loss to young people if it were to be removed from the NICE guidelines and their access to counselling diminished.”

Michaela McCarthy, MBACP, Managing Director of The Awareness Centre that provides NHS IAPT programmes said: “If NICE did downgrade, or remove, counselling from their guidelines for treating depression it would seriously restrict the range of help available to people.

"Counselling is not necessarily a “quick fix” but a lot can be achieved for a client with depression in six or 12 weeks, such as psych-education and reducing feelings of isolation, or of being unheard and unseen, which can help people to adjust their mood for the better and recover.

"If NICE did downgrade or remove counselling for depression from the services offered it would be denying a client group, which is already seriously under-resourced, of a valuable way of managing their mental health.”

With evidence for counselling catching up with CBT it doesn’t make sense any more to pit one type of therapy against the other. Both can help people and Mental Health Today believes that both should be invested in.

What are your thoughts? Do you agree?