Let's talk about... going to CBT for the first time

We’re back! Let’s Talk about CBT has been on hiatus for a little while but now it is back with a brand-new host Helen Macdonald, the Senior Clinical Advisor for the BABCP.

Each episode Helen will be talking to experts in the different fields of CBT and also to those who have experienced CBT, what it was like for them and how it helped.

This episode Helen is talking to one of the BABCP’s Experts by Experience, Paul Edwards. Paul experienced PTSD after working for many years in the police. He talks to Helen about the first time he went for CBT and what you can expect when you first see a CBT therapist. The conversation covers various topics, including anxiety, depression, phobias, living with a long-term health condition, and the role of measures and outcomes in therapy. In this conversation, Helen MacDonald and Paul discuss the importance of seeking help for mental health struggles and the role of CBT in managing anxiety and other conditions. They also talk about the importance of finding an accredited and registered therapy and how you can find one.

If you liked this episode and want to hear more, please do subscribe wherever you get your podcasts. You can follow us at @BABCPpodcasts on X or email us at [email protected].

Useful links:

For more on CBT the BABCP website is www.babcp.com

Accredited therapists can be found at www.cbtregisteruk.com

Credits:

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Transcript:

Helen: Hello, and welcome to Let's Talk About CBT, the podcast where we talk about cognitive and behavioural psychotherapies, what they are, what they can do, and what they can't. I'm Helen Macdonald, your host. I'm the senior clinical advisor for the British Association for Behavioural and Cognitive Psychotherapies. I'm really delighted today to be joined by Paul Edwards, who is going to talk to us about his experience of CBT.

And Paul, I would like to start by asking you to introduce yourself and tell us a bit about you.

Paul: Helen, thank you. I guess the first thing it probably is important to tell the listeners is how we met and why I'm talking to you now. So, we originally met about four years ago when you were at the other side of a desk at a university doing an assessment on accreditation of a CBT course, and I was sitting there as somebody who uses his own lived experience, to talk to the students, about what it's like from this side of the fence or this side of the desk or this side of the couch, I suppose, And then from that I was asked if I'd like to apply for a role that was being advertised by the BABCP, as advising as a lived experience person.

And I guess my background is, is a little bit that I actually was diagnosed with PTSD back in 2009 now, as a result of work that I undertook as a police officer and unfortunately, still suffered until 2016 when I had to retire and had to reach out. to another, another psychologist because I'd already had dealings with psychologists, but, they were no longer available to me. And I actually found what was called at the time, the IAPT service, which was the Improving Access to Psychological Therapies. And after about 18 months treatment, I said, can I give something back and can I volunteer? And my life just changed. So, we met. Yeah, four years ago, probably now.

Helen: thank you so much, Paul. And we're really grateful to you for sharing those experiences. And you said about having PTSD, Post Traumatic Stress Disorder, and how it ultimately led to you having to retire. And then you found someone who could help. Would you like to just tell us a bit about what someone might not know about being on the receiving end of CBT?

Paul: I feel that actual CBT is like a physiotherapy for the brain. And it's about if you go to the doctors and they diagnose you with a calf strain, they'll send you to the physio and they'll give you a series of exercises to do in between your sessions with your physio to hopefully make your calf better.

And CBT is very much, for me, like that, in as much that you have your sessions with your therapist, but it's your hard work in between those sessions to utilize the tools and exercises that you've been given, to make you better. And then when you go back to your next session, you discuss that and you see, over time that you're honing those tools to actually sometimes realising that you're not using those tools at all, but you are, you're using them on a daily basis, but they become so ingrained in changing the way you think positively and also taking out the negativity about how you can improve. And, and yeah, it works sometimes, and it doesn't work sometimes and it's bloody hard work and it is shattering, but it works for me.

Helen: Thank you, Paul. And I think it's really important when you say it's hard work, the way you described it there sounds like the therapist was like the coach telling you how to or working with you to. look at how you were thinking and what you were doing and agreeing things that you could change and practice that were going to lead to a better quality of life. At the same time though, you're thinking about things that are really difficult.

Paul: Yeah.

Helen: And when you say it was shattering and it was really difficult, was it worth it?

Paul: Oh God. Yeah, absolutely. I remember way back in about 2018, it would be, that there was, there was a fantastic person who helped me when I was coming up for retirement. And we talked about what I was going to do when I, when I left the police and I was, you know, I said, you know, well, I don't know, but maybe I've always fancied being a TV extra and, That was it. And I saw her about 18 months later, and she said, God, Paul, you look so much better. You're not grey anymore. You know, what have you done about this? And it was like, she said I was a different person. Do I still struggle? Yes. Have I got a different outlook on life? Yes. Do I still have to take care of myself? Yes. But, I've got a great life now. I'm living the dream is my, is my phrase. It is such a better place to be where I am now.

Helen: I'm really pleased to hear that, Paul. So, the hard work that you put into changing things for the better has really paid off and that doesn't mean that everything's perfect or that you're just doing positive thinking in the face of difficulty, you've got a different approach to handling those difficulties and you've got a better quality of life.

Paul: Yeah, absolutely. And don't get me wrong, I had some great psychologists before 2016, but I concentrated on other things and we dealt with other traumas and dealt with it in other ways and using other, other ways of working. I became subjected to probably re traumatising myself because of the horrendous things I'd seen and heard. So, it was about just changing my thought processes and, and my psychologist said, Well, you know, we don't want to re traumatise you, let's look at something different. Let's look at a different part and see if we can change that. And, and that was, very difficult, but it meant that I had to look into myself again and be honest with myself and start thinking about my honesty and what I was going to tell my psychologist because I wanted to protect that psychologist because I didn't want them to hear and talk about the things that I'd had to witness because I didn't think it was fair, but I then understood that I needed to and that my psychologist would be taken care of. Which was, which was lovely. So, I became able to be honest with myself, which therefore I can be honest with my therapist.

Helen: Thank you, Paul. And what I'm hearing there is that one of your instincts, if you like, in that situation was to protect the therapist from hearing difficult stuff. And actually the therapist themselves have their own opportunity to talk about what's difficult for them. So, the person who's coming for therapy can speak freely, although I'm saying that it's quite difficult to do. And certainly Post Traumatic Stress Disorder isn't the only thing that people go for CBT about, there are a number of different anxiety difficulties, depression, and also a wider range of things, including how to live well with a long term health condition and your experience could perhaps really help in terms of somebody going for their first session, not knowing what to expect.

As a CBT therapist, I have never had somebody lie down on a couch. So, tell us a little bit about what you think people should know if they are thinking of going for CBT or if they think that somebody they care about might benefit from CBT. What's it like going for that first appointment?

Paul: Bloody difficult. It's very difficult because by the very nature of the illnesses that we have that we want to go and speak to a psychologist, often we're either losing confidence or we're, we're anxious about going. So I have a phrase now and it's called smiley eyes and it, and it was developed because the very first time that I walked up to the, the place that I had my CBT in 2016, the receptionist opened the door and had these most amazing engaging smiley eyes and it, it drew me in.

And I thought, wow. And then when I walked through the door and saw the psychologist again, it was like having a chat. It was, I feel that for me, I know now, I know now. And I've spoken to a number of psychologists who say it's not just having a chat. It is to me. And that is the gift of a very good psychologist, that they are giving you all these wonderful things.

But it's got to be a collaboration. It's got to be like having a chat. We don't want to be lectured, often. I didn't want to have homework because I hated homework at school. So, it was a matter of going in and, and talking with my psychologist about how it worked for me as an individual, and that was the one thing that with the three psychologists that I saw, they all treated me as an individual, which I think is very, very important, because what works for one person doesn't work for another.

Helen: So it's really important that you trust the person and you make a connection. A good therapist will make you feel at ease, make you feel as safe as you can to talk about difficult stuff. And it's important that you do get on with each other because you're working closely together. You use the word collaboration and it's definitely got to be about working together. Although you said earlier, you're not sure about the word expert, you're the expert on what's happening to you, even though the therapist will have some expertise in what might help, the kind of things to do and so there was something very important about that initial warmth and greeting from the service as well as the therapist.

Paul: Oh, absolutely. And you know, as I said earlier, I'm honoured to speak at some universities to students who are learning how to be therapists. And the one thing I always say to them is think about if somebody tells you their innermost thoughts, they might never have told anybody and they might have only just realised it and accepted it themselves. So think about if you were sitting, thinking about, should I put in this thesis to my lecturer? I'm not sure about it. And how nervous you feel. Think about that person on the other side of the, you know, your therapy room or your zoom call or your telephone call, thinking about that. What they're going to be feeling. So to get through the door, we've probably been through where we've got to admit it to ourselves. We then got to admit it to somebody else. Sometimes we've then got to book the appointment. We then got to get in the car to get the appointment or turn on the computer. And then we've got to actually physically get there and walk through.

And then when we're asked the question, we're going to tell you. We've been through a lot of steps every single time that we go for therapy. It's not just the first time, it's every time because things develop. So, you know, it's, it's fantastic to have the ability to want to tell someone that. So when I say it's fantastic to have the ability, I mean, in the therapist, having the ability to, to make it that you want to tell them that because you trust them.

Helen: So that first appointment, it might take quite a bit of determination to turn up in spite of probably feeling nervous and not completely knowing what to expect, but a good therapist will really make the effort to connect with you and then gently try to find out what the main things are that you have come for help with and give you space to work out how you want to say what you want to say so that you both got , a shared understanding of what's going on.So your therapist really does know, or has a good sense of what might help.

So, when you think about that very first session and what your expectations were and what you know now about having CBT, what would you say are the main things that are different?

Paul: Oh, well, I don't actually remember my first session because I was so poorly. I found out afterwards there was three of us in the room because the psychologist had a student in there, but I was, I, I didn't know, but I still remember those smiley eyes and I remember the smiley eyes of the receptionist. And I remember the smiley eyes of my therapist. And I knew I was in the right place. I felt that this person cared for me and was interested and, you know, please don't think that the, the psychologist before I didn't feel that, you know, they were fantastic, but I was in a different place.

I didn't accept it myself. I had different boundaries. I wanted to stay in the police. I, you know, I thought, well, if I, you know, if I admit this, I'm not going to have my, my job and I can't do my job. So a hundred percent of me was giving to my job. And unfortunately, that meant that the rest of my life couldn't cope, but my job and my professionalism never waned because I made sure of that, but it meant that I hadn't got the room in my head and the space in my head for family and friends.

And it was at the point that I realized that. It wasn't going to be helpful for the rest of my life that I had to say, you know what, I'm going to have to, something's going to have to give now. And unfortunately, that was, you know, my career, but up until that point, I'm proud to say that I worked at the highest level and I gave a hundred percent.

Now I realised that I have to have a life work balance rather than a work life balance, because I put life first. And I say that to everybody have a life work balance. It doesn't mean you can't have a good work ethic. It doesn't mean you can't work hard. It's just what's important in that. So what's the difference between the first session then and the first session now?

Well, I didn't remember the first session. Now, I know that that psychologist was there to help me and there to test me and to look at my weaknesses. Look at my issues, but also look at my strengths and make me realize I'd got some because I didn't realise I had.

Helen: That's really important, Paul, and thank you for sharing what that was like. I really appreciate that you've been so open and up front with me about those experiences.

Paul: So let's turn this round to you then Helen as a therapist And you talked about lots of conditions, and things that people could have help with seeing a CBT therapist because obviously I have PTSD and I have the associated anxiety and depression and I still deal with that. What are the other things that people can have help with that they, some that they do have heard, have heard of, but other things that they might not know can be helped by CBT?

Helen: Well, that's a really good question. And I would say that CBT is particularly good at helping people with anxiety and depression. So different kinds of anxiety, many people will have heard, for example, of Obsessive-Compulsive Disorder, OCD, or Generalized Anxiety Disorder where people worry a lot, and it's very ordinary to worry, but when it gets out of hand, other things like phobias, for example, where the anxiety is much more than you'd expect for the amount of danger people sometimes worry too much about getting ill or being ill, so they might have an illness anxiety. Those are very common anxiety difficulties that people have. CBT, I mean, you've already mentioned this, but CBT is also very good for depression. Whether that's a relatively short term episode of really low mood, or whether it's more severe and ongoing, then perhaps the less well known things that CBT is good for. For example, helping people live well if they have a psychotic disorder, maybe hearing voices, for example, or having beliefs that are quite extreme and unusual, and want to have help with that. It's also very good for living with a long term health condition where there isn't anything medical that can cure the condition, but for example, living well with something like diabetes or long term pain.

Paul: interestingly, you spoke about phobias then, Is the work that a good therapist doing just in the, the consulting room or just over, the, this telephone or, or do you do other things? I'm thinking of somebody I knew who had a phobia of, particular escalators and heights, and they were told to go out and do that. You know, try and go on an escalator and, they managed to get up to the top floor of Selfridges in Birmingham because that's where the shoes were and that helped. But would you just, you know, would you just talk about these things, or do you go out and about or do you encourage people to, to do these with you and without?

Helen: Again, that's, that's a really good point, Paul, and the psychotherapy answer is it depends. So let's think about some examples. So sometimes you will be mostly in the therapist's office or, and as you've mentioned, sometimes on the phone or it can be on a video call. but sometimes it's really, really useful to go out and do something together.

And when you said about somebody who's afraid of being on an escalator, sometimes it really helps to find a way of doing that step by step and doing it together. So, whether that's together with someone else that you trust or with the therapist, you might start off by finding what's the easiest escalator that we've got locally that we can use and let's do that together. And let me walk up the stairs and wait for you and you do it on your own, but I'll be there waiting. Then you do it on your own and come back down and meet me. Then go and do it with a friend and then do it on your own. So, there's a process of doing this step by step. So you are facing the fear, you are challenging how difficult it is to do this when you're anxious. But you find a place where you can take the anxiety with you successfully, so we don't drop you in the deep end. We don't suddenly say, right, you're going all the way to the fifth floor now. We start one step at a time, but we do know that you want to get to the shoes or whatever your own personal goal and motivation is there's got to be a good reason to do it gives you something to aim towards, but also when you've done it, there's a real sense of achievement. And if I'm honest as a therapist, it's delightful for me as well as for the person I'm working with when we do achieve that.

Sometimes it isn't necessarily that we're facing a phobia, but it might be that we're testing out something. Maybe, I believe that it's really harmful for me to leave something untidy or only check something once. We might do an experiment and test out what it's like to change what we're doing at the moment and see what happens. And again, it's about agreeing it together. It's not my job to tell somebody what to go and do. It's my job to work with somebody to make sure that they've got the tools they need to take their anxiety with them. And sometimes that anxiety will get less, it'll get more manageable. Sometimes it goes away altogether, but that's not something I would promise.

What I would do is work my very hardest to make the anxiety so that the person can manage it successfully and live their life to the full, even if they do still have some.

Paul: And, and for me, I think one of the things that I remember is that my, you know, my mental health manifested itself in physical symptoms as well. So it was like when I was thinking about things, I was feeling sick, I was feeling tearful. and that's, that's to be expected at times, isn't it? And, and even when you're facing your fears or you’re talking through what you're experiencing. It's, it's, it's a normal thing. And, and even when I had pure CBT, it can be exhausting.

And I said to my therapist, please. Tell people that, you know, your therapy doesn't end in the session. And it's okay to say to people, well, go and have a little walk around, make sure you can get somebody to pick you up or make sure you can get home or make sure you've got a bit of a safe space for half an hour afterwards and you haven't got to, you know, maybe pick the kids up or whatever, because that that's important time for you as well.

Helen: That's a really important message. Yes, I agree with you there, Paul, is making sure that you're okay, give yourself a bit of space and processing time and trying to make it so that you don't have to dash straight off to pick up the kids or go back to work immediately, trying to arrange it so that you've got a little bit of breathing space to just make sure you're okay, maybe make a note of important things that you want to think about later, but not immediately dashing off to do something that requires all your concentration. And I agree with you, it is tiring. You said at the beginning it's just having a chat and now you've talked about all the things that you actually do in a session. It's a tiring chat and tiring to talk about how it feels, tiring to think about different ways of doing things, tiring to challenge some of the assumptions that we make about things. Yes it is having a chat, but really can be quite tiring.

Paul: And I think that the one thing that you said in there as well, you know, you talk about what would you recommend. Take a pen and paper. Because often you cannot remember. everything you put it in there. So, make notes if you need to. Your therapist will be making notes, so why can't you? And also, you know, I think about some of the tasks I was given in between my sessions, rather than calling it my homework, my tasks I was given in between sessions to, I suffered particularly with, staying awake at night thinking about conversations I was going to have with the person I was going to see the next day and it manifested itself I would actually make up the conversations with every single possible answer that I could have- and guess what- 99 times out of 100 I never even saw the person let alone had the conversation. So it was about even if I'm thinking in the middle of the night, you know, what I'm going to do, just write it down, get rid of it, you know, and I guess that's, you know, coming back again, Helen to put in the, the ball in your court and saying, well, what, what techniques are there for people?

Helen: Well, one of the things that you're saying there about keeping a note and writing things down can be very useful, partly to make sure that we don't forget things, but also so that it isn't going round and round in your head. The, and because it's very individual, there may be a combination of things like step by step facing something that makes you anxious, step by step changing what you're doing to improve your mood. So perhaps testing out what it's like to do something that you perhaps think you're not going to enjoy, but to see whether it actually gives you some sense of satisfaction or gives you some positive feedback, testing out whether a different way of doing something works better. So there's a combination of understanding what's going on, testing out different ways of doing things, making plans to balance what things you're doing. Sometimes there may be things about resting better. So you said about getting a better night's sleep and a lot of people will feel that they could manage everything a bit better if they slept better. So that can be important.

Testing out different ways of approaching things, asking is that reasonable to say that to myself? Sometimes people are thinking quite harsh things about themselves or thinking that they can't change things. But with that approach of, well, let's see, if we test something out different and see if that works.

So there's a combination of different things that the therapist might do but it should always be very much the, you're a team, you're working together, your therapist is right there alongside you. Even when you've agreed you're going to do something between sessions, it's that the therapist has agreed this with you. You've thought about what might happen if you do this and how you're going to handle it. And as you've said, sometimes it's a surprise that it goes much better than we thought it was going to. So, so we're testing our predictions and sometimes it's a surprise. It's almost like being a scientist. You're doing experiments, you're testing things out, you're seeing what happens if you do this. And the therapist will have some ideas about the kind of things that will work. but you're the one doing, doing the actual doing of it.

Paul: And little things like, you know, I, I remember, I was taught a lovely technique and it's called the 5, 4, 3, 2, 1, technique about when you're anxious. And it's about, I guess it's about grounding yourself in the here and now and not, trying to worry about what you're anxious about so you try and get back into what is there now. Can you just explain that?

I mean, I know I know I'm really fortunate. I practice it so much. I probably call it the 2-1 So could you just explain how what that is in a more eloquent way than myself?

Helen: I think you explained that really well, Paul, but what we're talking about is doing things that help you manage anxiety when it's starting to get in the way and bringing yourself back to in the here and now. And for example, it might be, can I describe things that I can see around me? Can I see five things that are green? Can I feel my feet on the floor? Tell whether it's windy and all of those things will help to make me aware of being in the here and now and that the anxiety is a feeling, but I don't have to be carried away by it.

Paul: And there's another lovely one that, I, you know, when people are worrying about things and, it's basically about putting something in a box and only giving yourself a certain time during the day to worry about those things when you open the box and often when you've got that time to yourself.

So give yourself a specific time where you, you know, are not worrying about the kids or in going to sport or doing whatever. So you've got yourself half an hour and that's your worry time in essence. And, you know, I use it on my phone and it's like, well, what am I worrying about? I'll put that in my worry box and then I'll only allow myself to look at that between seven and half past tonight. And by the time I've got there, I'll be done. I'm not worrying about the five things. I might be worrying slightly about one of them, but that's more manageable. And then I can deal with that. So what's the thought behind? I guess I've explained it, but what, what's the psychological thought behind that? And, and who would have devised that?

I mean, who are these people who have devised CBT in the past? Because we haven't even explored that yet.

Helen: Well, so firstly, the, the worry box idea, Paul, is it's a really clever psychological technique is that we can tell ourselves that we're going to worry about this properly later. Right now, we're busy doing something else, but we've made an appointment with ourselves where we can worry properly about it.

And like you've said, if we reassure ourselves that actually, we are, we're going to deal with what's going on through our mind. It reassures our mind and allows it not to run away with us. And then when we do come to it, we can check, well, how much of a problem is this really? And if it's not really much of a problem, it's easier to let it go.

And if it really is a problem, we've made space to actually think about, well, what can I do about it then? so that technique and so many of the other techniques that are part of Cognitive and Behavioural psychotherapies have been developed in two directions, I suppose. In one direction, it's about working with real people and seeing what happens to them, and checking what works, and then looking at lots of other people and seeing whether those sorts of things work. So, we would call that practice based evidence. So, it's from doing the actual work of working with people. From the other direction, then, there is more laboratory kind of science about understanding as much as we can about how people behave and why we do what we do, and then if that is the case, then this particular technique ought to work. Let's ask people if they're willing to test it out and see whether it works, and if it works, we can include that in our toolkit. Either way, CBT is developed from trying to work out what it is that works and doing that.

So, so that's why we think that evidence is important, why it's important to be scientific about it as far as we can, even though it's also really, really important that we're working with human beings here. We're working with people and never losing sight of. That connection and collaboration and working together. So although we don't often use the word art and science, it is very much that combination

Paul: And I guess that's where the measures and outcomes, you know, come into the science part and the evidence base. So, so for me, it's about just a question of if I wanted to read up on the history of CBT, which actually I have done a little. Who are the people who have probably started it and made the most influence in the last 50 years, because BABCP is 50 years old now, so I guess we're going back before that to the start of CBT maybe, but who's been influential in that last 50 years as well?

Helen: Well, there are so many really incredible researchers and therapists, it's very hard to name just a few. One of the most influential though would be Professor Aaron T. Beck, who was one of the first people to really look into the way that people think has a big impact on how they feel. And so challenging, testing out whether those thoughts make sense and experimenting with doing things differently, very much influenced by his work and, and he's very, very well known in our field, from, The Behavioural side, there've been some laboratory experiments with animals a hundred years ago.

And I must admit nowadays, I'm not sure that we would regard it as very ethical. Understanding from people-there was somebody called BF Skinner, who very much helped us to understand that we do things because we get a reward from them and we stop doing things because we don't or because they feel, they make us feel worse. But that's a long time ago now. And more recently in the field, we have many researchers all over the world, a combination of people in the States, in the UK, but also in the wider global network. There's some incredible work being done in Japan, in India, you name it. There's some incredible work going on in CBT and it all adds to how can we help people better with their mental health?

Paul: and I think that for me as the patient and, and being part of the BABCP family, as I like to, to think I'm part of now, I've been very honoured to meet some very learned people who are members of the BABCP. And it, it astounds me that, you know, when I talk to them, although it shouldn't, they're just the most amazing people and I'm very lucky that I've got a couple of signed books as well from people that I take around, when I do my TV extra work. And one of them is a fascinating book by Helen Macdonald, believe it or not on long term conditions that, that I thoroughly recommend people, read, and another one and another area that I don't think we've touched on that. I was honoured to speak with is, a guy called, Professor Glenn Waller, who writes about eating disorders. So eating disorders. It's one of those things that people maybe don't think about when they think of CBT, but certainly Glenn Waller has been very informative in that.

And how, how do you feel about the work in that area? And, and how important that may be. I know we'll probably go on in a bit about how people can access, CBT and, you know, and NHS and private, but I think for me is the certain things that maybe we need to bring into the CBT family in NHS services and eating disorders for me would be one is, you know, what are your thoughts about those areas and other areas that you'd like to see brought into more primary care?

Helen: Again, thank you for bringing that up, Paul. And very much so eating disorders are important. and CBT has a really good evidence base there and eating disorders is a really good example of where somebody working in CBT in combination with a team of other professionals, can be particularly helpful. So perhaps working with occupational therapists, social workers, doctors, for example. And you mentioned our book about persistent pain, which is another example of working together with a team. So we wrote that book together with a doctor and with a physiotherapist.

Paul: Yeah, yeah.

Helen: And so sometimes depending on what the difficulties are, working together as a team of professionals is the best way forward.

There are other areas which I haven't mentioned for example people with personality issues which again can be seen as quite severe but there is help available and at the moment there is more training available for people to be able to become therapists to help with those issues. And whether it's in primary care in the NHS or in secondary care or in hospital services, there are CBT therapists more available than they used to be and this is developing all the time. And I did notice just then, Paul, that you said about, whether you access CBT on the NHS and, and you received CBT through the NHS, but there are other ways of accessing CBT.

Paul: That was going to be my very next question is how do we as patients feel, happy that the therapist we are seeing is professionally trained, has got a, a good background and for want of a phrase that I'm going to pinch off, do what it says on the tin. But do what it says on the tin because I, I am aware that CBT therapists aren't protected by title. So unfortunately, there are people who, could advertise as CBT therapist when they haven't had specific training or they don't have continual development. So, The NHS, if you're accessing through the NHS, through NHS Talking Therapies or anything, they will be accredited.

So, you know, you can do that online, you can do it via your GP. More so for the protection of the public and the making sure that the public are happy. What have the BABCP done to ensure that the psychotherapists that they have within them do what they say it does on the tin.

Helen: yes, that's a number of very important points you're making there, Paul. And first point, do check that your therapist is qualified. You mentioned accredited. So a CBT psychotherapist will, or should be, Accredited which means that they can be on the CBT Register UK and Ireland. That's a register which is recognised by the Professional Standards Authority, which is the nearest you can get to being on a register like doctors and nurses.

But at the moment, anyone can actually call themselves a psychotherapist. So it's important to check our register at BABCP. We have CBT therapists, but we have other people who use Cognitive and Behavioural therapies. Some of those people are called Wellbeing Practitioners that are probably most well known in England.

We also have people who are called Evidence Based Parent Trainers who work with the parents of children and on that register, everybody has met the qualifications, the professional development, they're having supervision, and they have to show that they work in a professional and ethical way and that covers the whole of Ireland, Scotland, Wales and England.

So do check that your therapist is on that Register and feel free to ask your therapist any other questions about specialist areas. For example, if they have qualifications to work particularly with children, particularly with eating disorders, or particularly from, with people from different backgrounds.

Do feel free to ask and a good therapist will always be happy to answer those questions and provide you with any evidence that you need to feel comfortable you're working with the right person.

Paul: that's the key, isn't it? Because if it's your hard-earned money, you want to make sure that you've got the right person. And for me, I would say if they're not prepared to answer the question, look on that register and find somebody who will, because there's many fantastic therapists out there.

Helen: And what we'll do is make sure that all of those links, any information about us that we've spoken in this episode will be linked to on our show page.

Paul, we're just about out of time. So, what would you say are the absolute key messages that you want our listeners to take away from this episode? What the most important messages,

Paul: If you're struggling, don't wait. If you're struggling, please don't wait. Don't wait until you think that you're at the end of your tether for want of a better phrase, you know, nip it in the bud if you can at the start, but even if you are further down the line, please just reach out. And like you say, Helen, there's, there's various ways you can reach out. You can reach out via the NHS. You can reach out privately. I think we could probably talk for another hour or two about a CBT from my perspective and, and how much it's, it has meant to me. But also what I will say is I wish I'd have known now what, or should I say I wish I knew then what I knew now about being able to, to, to open myself up, more than, you know, telling someone and protecting them as well, because there was stuff that I had to re-enter therapy in 2021.

And it took me till then to tell my therapist something because I was like disgusted with myself for having seen and heard it so much. But actually, it was really important in my continual development, but yeah, don't wait, just, just, you know, reach out and understand that you will have to work hard yourself, but it is worth it at the end.

If you want to run a marathon. You're not going to run a marathon by just doing the training sessions when you see your PT once a week. And you are going to get cramp, and you are going to get muscle sores, and you are going to get hard work in between. But when you complete that marathon, or even a half marathon, or even 5k, or even 100 meters, it's really worth it.

Helen: Paul, thank you so much for joining us today. We're really grateful for you speaking with me and it's wonderful to hear all your experiences and for you to share that, to encourage people to seek help if they need it and what might work. Thank you.

Paul: Pleasure. Thanks Helen.