- 31 August 2017
- 14 min read
How I made Cognitive Behavioural Therapy my career
Charlotte Rhian Lowe explains everything you need to know about becoming a Cognitive Behavioural Therapist.
When did I decide I wanted a job as a Cognitive Behavioural Therapist?
I always knew I wanted to work within a caring environment, even writing on my personal statement at school that I wanted to become a Counsellor or Psychologist.
I initially went down the Psychology route by completing my BSc and MSc in Psychology, receiving a first-class honors and a masters degree with distinction.
It was whilst undertaking these degrees that I was initially introduced to Cognitive Behavioural Therapy (CBT), progressing to work as an Assistant Psychologist in two services which offered CBT.
This furthered my knowledge and understanding of this individual therapeutic approach, and provided me with first-hand experience of witnessing the benefits CBT can have on an individual’s life.
During my time working as an Assistant Psychologist at Lancashire Traumatic Stress Service (LTSS), I had a CBT research article published which enabled me to obtain a more in-depth understanding of this therapy.
My research explored service-users’ experiences of receiving trauma-focused CBT after suffering from post-traumatic stress disorder.
Seeing the positive results of CBT throughout my work experiences facilitated my decision to train as a Cognitive Behavioural Therapist.
What qualifications does a Cognitive Behavioural Therapist need?
I believe a Cognitive Behavioural Therapist would need to gain experience in the field of mental health, which could be through either paid or voluntary employment.
To obtain the relevant experience, for many years I carried out voluntary work in a variety of services; MIND, Barnardo’s, Youth Offending Team, Prince’s Trust and Bipolar UK.
I began working voluntarily from the age of eighteen and whilst studying Psychology at college. There are also plenty of opportunities to acquire paid employment, and in the early stages of my career I worked as a Support Worker and a Nursing Assistant on the psychiatric wards.
The next step to a career as a Cognitive Behavioural Therapist would be to undertake a degree in a relevant subject area; Mental Health Nursing, Social Work, Art Therapy, Occupational Therapy, Psychology or Psychotherapy.
It is essential individuals read up on CBT to ensure it is an area of interest they wish to pursue.
In addition, following the completion of their professional degree, it would be wise to obtain some work experience in a service offering CBT. This would further an individual’s knowledge of CBT, and confirm it is the career path they wish to take.
I also completed an online diploma in CBT which provided me with a secure knowledge base for this therapeutic approach before embarking on my career.
The final step to becoming a qualified Cognitive Behavioural Therapist would be to complete a post graduate diploma in CBT.
This can be carried out over a year on a full-time basis or over two years on a part-time basis.
Numerous universities across the country deliver the Post Graduate Diploma in CBT and further details can be obtained online.
Finding a job as a qualified Cognitive Behavioural Therapist
You would be unable to find or apply for a job as a Cognitive Behavioural Therapist with no experience as experience is vital to practice effectively as a Cognitive Behavioural Therapist.
Please see the qualifications section for details on obtaining relevant mental health experience.
Additionally, to successfully qualify as a Cognitive Behavioural Therapist trainees are required to complete many clinical and supervision hours involving direct contact with clients.
It is therefore impossible for trainees to qualify as a Cognitive Behavioural Therapist having little or no experience.
What was your first job in the industry like?
For me personally, my career starting as a Cognitive Behavioural Therapist was more of a gradual process and therefore it is difficult for me to recall my first day on the job.
As I was already very much aware of the CBT approach and related principles, I did utilise these when working therapeutically with students in school.
This meant that I was fortunate to already be working in an environment which allowed me to effectively make use of CBT techniques prior to beginning the CBT training.
Although I do not remember a specific first day, I do remember my initial period of working as a Cognitive Behavioural Therapist.
As is typical of a newly qualified trainee, I felt apprehensive about beginning my new role, but this soon diminished and I began to feel more confident.
Like any job, it was about practising the skills I had acquired on the course, learning from any mistakes made and asking for help where necessary.
Therefore, regular supervision and a discussion of the sessions with clients is crucial to a Cognitive Behavioural Therapist both during training and once qualified.
What to expect from your job
Cognitive Behavioural Therapists can work in many different settings, but generally the role they carry out is very similar.
Practising as a Cognitive Behavioural Therapist involves working with clients suffering from mental health difficulties by carrying out mental health assessments, developing a formulation of a client’s difficulties to then subsequently deliver CBT.
Therapy involves working with clients to help them change the way they think and act, with the aim of improving the way they feel.
Some of the day to day tasks I expect to face during my job as a Cognitive Behavioural Therapist include:
• Carrying out mental health assessments,
• Developing formulations of my client’s problems,
• Identifying goals to work on during therapy,
• Setting ‘homework’ tasks for the clients to complete between sessions,
• Involving a client’s family wherever possible,
• Providing advice and training to other health professionals,
• Running therapeutic groups,
• Writing reports and maintaining accurate records.
There is therefore an eclectic range of tasks to complete, and no one working day is the same as another.
Although it is not an expectation, what I do find is that working as a Cognitive Behavioural Therapist is especially rewarding.
Working in the private sector
There are many private organisations which recruit Cognitive Behavioural Therapists, and examples include private hospitals or occupational therapy services.
Similarly, there are several agencies which frequently recruit Cognitive Behavioural Therapists, such as TPP Recruitment or Pulse. However, often they only offer short-term contracts of between 3-12 months which is not always practical for some people.
There is also the possibility of setting up in private practice by working independently with clients as a Cognitive Behavioural Therapist.
Although setting up privately allows individuals to work much more flexibly, there are also some challenges to this.
No guarantee exists as to whether practitioners will refer enough clients, and the number of clients will fluctuate at times.
When setting up privately, initially it is therefore sensible for individuals to maintain another job which provides them with a steady income to cover their living costs.
Working In The NHSSince the introduction of the Improving Access to Psychological Therapies (IAPT) programme in 2008, there have been an increased number of opportunities to work as a Cognitive Behavioural Therapist within the NHS.
Similarly, since a lot more money has recently been invested into CBT, the amount of jobs available will continue to rise.
The IAPT service was established to increase provision of evidence-based treatments for common mental health problems, with it now being estimated that approximately 900,000 adults access this service each year. Although I have never worked as a Cognitive Behavioural Therapist in the NHS, I know many people who have done so or still do.
Furthermore, I have worked as an Assistant Psychologist within the NHS so I have experienced many of the same frustrations faced by Cognitive Behavioural Therapists.
Examples include having an extremely large case load of clients to see, or being limited by the number of sessions available to offer clients.
The importance of supervision whilst practising as a Cognitive Behavioural Therapist
Receiving supervision from an accredited supervisor is an essential component in the practice of CBT, as well as during training.
The aim of supervision is to support and develop practitioners, and therapists subsequently learn new skills and techniques from their supervisors. Supervision can be delivered face-to-face, within a group setting, online or over the phone. However, it is recommended for CBT therapists to make use of audio and video recordings of their sessions during supervision, therefore face to face contact with a supervisor is preferred.
Supervision offers a safe environment for CBT therapists to discuss any concerns, casework or other professional issues in a structured way. Supervision sessions can make use of the Cognitive Therapy Scale Revised (CTS-R), which is a 12-item scale with each item reflecting one important competence in CBT.
Competencies range from agenda and homework, to more complex CBT competencies, such as eliciting negative thoughts and emotions. Audio and video recordings are used to determine whether the trainee meets the competencies listed.
For accreditation purposes, the British Association for Behavioural and Cognitive Psychotherapists (BABCP) require trainees to make use of the CTS-R during their CBT training.
The amount of supervision sessions required will depend on a therapist’s workload, and the number of clients they have on their caseload.
A full-time CBT therapist will require at least one hour of face-to-face supervision each week.
Why do I enjoy Cognitive Behavioural Therapy?
There is still so much more to be discovered. A large number of individuals do not benefit from CBT, so research is continuously being carried out in this area.
I feel excited by the ‘third-wave’ of CBT which incorporates mindfulness and more compassionate based approaches.
I have an interest in compassionate based approaches and have found these to be helpful when standard CBT protocols are not proving effective on their own.
Another branch of CBT which I am excited about, is the increased recognition of the benefits of this evidence based treatment for children and young people.
Since 2011, the Children and Young People’s Improving Access to Psychological Therapies Programme (CYP-IAPT) has been delivered by NHS England with the aim of improving existing Child & Adolescent Mental Health Services (CAMHS) working in the community.
This programme has recently been extended further so many more Cognitive Behavioural Therapists are set to be trained.
I especially enjoy working with children and young people, so I am enthusiastic with the current plans to try to improve mental health provision for this age group.
What kind of person is a Cognitive Behavioural Therapist?
I believe a Cognitive Behavioural Therapist needs to be a ‘people person’ and enjoy working with others.
It is vital that they are caring and wish to make a positive difference to the lives of others, ideally feeling passionate towards mental health.
I consider there to be a need for a Cognitive Behavioural Therapist to exhibit several key qualities:
• Good communicator,
• Good interpersonal and listening skills.
What are the career opportunities for an experienced therapist?
There is the possibility for a CBT to go on to supervise other CBT practitioners. This would involve them completing an accredited supervision course attached to a relevant university.
There is also the option for an experienced Cognitive Behavioural Therapist to specialise in teaching or research in CBT.
This would involve them being employed by a college or university and it is likely they would be required to supervise student’s research projects in addition to carrying out their own research.
As already mentioned, experienced Cognitive Behavioural Therapists also have the option of setting up privately and working independently with clients.
• Experience in the field of Mental Health.
• Degree in a relevant area: Mental Health Nursing, Social Work, Psychology, Psychotherapy, Occupational Therapy or Art Therapy.
• Accredited Post Graduate Diploma in CBT.
• Exceptional communication skills
• Strong interpersonal and counselling skills
• Excellent listening skills
• Skills in assessment and formulation
• Empathy and the ability to deal with people in distress
• Problem solving and decision making skills
• Ability to maintain confidentiality
• Report writing and presentation skills
• ICT skills for recording information
• Understanding of all therapeutic approaches
• Good time management and organisational skills
Cognitive Behavioural Therapists working within the NHS can expect to receive a salary of between £26,500 and £41,500 per annum. A similar rate of pay is usually paid when working as a Cognitive Behavioural Therapist in a private organisation.
Cognitive Behavioural Therapists who practice privately typically charge clients anything between £30 and £80 per hour.
I believe it is necessary for an individual to highlight any mental health experience they may have from working with different client groups in a variety of settings.
It would be wise to focus on any therapeutic experience they may have, and discuss how this may be related to CBT.
As well as an individual focusing on their experiences and qualifications, I think it is important for them to discuss their qualities as a person and how these are deemed necessary for the role of a Cognitive Behavioural Therapist.