This web site contains information about Cognitive Behavioural Therapy (known as CBT in the United Kingdom).

The site is provided by Louise Ritson, an experienced cognitive behavioural therapist in the North Cotswold region of the United Kingdom.

The information on this page is intended to apply specifically to Louise Ritson's CBT practice, although much of it may apply in a general way to the work of other CBT practitioners.

Cotswold CBT is a specialist private CBT practice providing a range of cognitive behavioural therapy services:

• Full-scope CBT
  Effective for a very wide range of emotional issues and mental illnesses, this is conventional CBT treatment (sometimes known as "high intensity" CBT in the NHS). Available face-to-face and by telephone.
• Guided CBT
  A low-cost form of CBT appropriate for less complex conditions. Available by telephone and online. (Face-to-face assessment is recommended where possible.)
• CBT assessment only
  A full CBT assessment including a brief written formulation and treatment plan for use by other health professionals, but without any commitment to treatment. You can use this to help you obtain appropriate treatment through the NHS or elsewhere, or you can choose to continue with Cotswold CBT's full-scope or guided CBT. Available face-to-face and by telephone.
• Formal assessment
  An extended assessment including case history, impact assessment, CBT formulation and a treatment plan, together with a full written report suitable for use in legal and other formal proceedings. Available face-to-face only.
• Couple therapy
  The application of CBT techniques to difficulties in relationships, where problematic emotional issues are shared. Available face-to-face only.
• Extended therapy
  In-depth exploration of life's issues using CBT methodology at a pace that you choose. Some people use this to understand and come to terms with their past, while others use it to help them process the stresses and strains of their present lives. Available face-to-face and by telephone.
• Supervision
  Professional supervision for other CBT practitioners. Available face-to-face and by telephone.

CBT is a way that a trained therapist can help people who have a wide range of psychological conditions, ranging from severe mental illness to mild feelings and thoughts that interfere with normal living.

CBT is called a "talking therapy", because when you are a patient in a session with your CBT therapist, you spend most of the time talking together.  But in CBT you are usually given specific tasks to perform between therapy sessions too.  For example, a common task between sessions is to write down significant thoughts that you have every day.

The word "cognitive" means that CBT is concerned with your thoughts, and the word "behavioural" means that CBT is concerned with the things that you do.  CBT is based on the way that your thoughts and behaviour influence each other.

The American psychiatrist A.T. Beck developed the basis for CBT in the 1950s to treat depression, although it was not until the 1980s that it became widely known.  Since then it has been used throughout the world, and recognised as an important and powerful form of therapy.

Some of the ideas underlying CBT have been known for centuries. They can be traced back at least to ancient Greece:

It is difficult to be precise about who can benefit from CBT, because every patient is different.

In the NHS, CBT is mainly used for psychological conditions like the ones in the following list.  Each medical term in this list describes a particular diagnosis by a doctor, but you do not necessarily need a diagnosis by a doctor in order to benefit from CBT.

• Post-traumatic stress disorder
• Depression
• Anxiety and phobia
• Eating disorders

CBT is also used for other conditions that are not psychological, but that can have a psychological component, like:

• Chronic pain
• Chronic fatigue
• Brain injury or stroke
• Chronic or terminal illness

Like any therapy, CBT can have very different results for different patients.

CBT begins with an assessment by your therapist.  If your therapist's assessment is that you would not benefit from CBT treatment, then your therapist will usually advise you about other forms of therapy that might be appropriate for your condition.

If your therapist's assessment is that you would benefit from CBT treatment, then you can expect positive benefits if you participate in your CBT treatment plan.

Many patients find that CBT enables them to overcome their condition and have a normal life, even when other kinds of therapy have not helped them as much in the past.

In general, medical professionals feel that CBT is effective.  For that reason, the Department of Health recommendeds CBT treatment for several of the conditions listed in the section above.

When you are having CBT treatment, you usually have regular weekly sessions with your therapist.  A session typically lasts for around an hour.

Your CBT therapist usually uses the first one or two sessions to make an assessment of your condition, and to formulate a treatment plan.  This assessment is different from any assessment that another therapist might have made in the past, so it is always needed.

The treatment plan will include an estimate of the number of treatment sessions required.  Between four and ten treatment sessions is typical. 

Some patients improve unexpectedly quickly, and need fewer sessions than was estimated.  Some patients improve more slowly than expected, and might be offered additional sessions.

After your treatment is complete, you might be offered some follow-up sessions at longer intervals, perhaps a few months, to ensure that the improvement has been sustained.

So CBT treatment usually takes at least several months, but it is rare for it to last more than a year.

The benefits of CBT can be ongoing, however, because during your treatment you acquire tools and skills that you can use throughout the rest of your life without involving any therapist.

Your CBT therapist can work effectively in partnership with your GP, and with other doctors and professionals.

If you are receiving another "talking therapy", like counselling or another form of psychotherapy, then it is unusual to receive CBT at the same time.  This is because these therapies involve you in a similar way, so they might be less effective if you have them together.

If you are receiving some other form of treatment, such as prescription drugs, then you may be able to benefit from CBT at the same time.  Your CBT therapist and your doctor usually work together.  For example, as CBT starts to take effect, your doctor might gradually decrease the dose of drugs that you receive.  You should not stop taking any drugs you have been prescribed just because you plan to have CBT.

If you are not having any other treatment, then in some circumstances your CBT therapist might recommend that you involve your GP.  For example, a short-term course of prescription drugs might help you to benefit more from CBT.

When you have CBT, you work with your therapist to develop ways to understand and control your own condition.  This work begins with an assessment by your therapist, who makes a plan for your treatment.  Then you proceed to explore and understand your thoughts and behaviour in more detail.  Finally, your therapist teaches you ways to be in charge of your own thoughts and behaviour so as to reduce the impact of your condition on your life.

From an early stage in your course of therapy, your CBT therapist assigns you tasks to perform between sessions.  These tasks are an important part of the treatment.  For most patients, improvements happen between therapy sessions.

Your CBT therapist usually spends some time with you understanding events in the past that might have contributed to your present condition, but this is not the main focus of the work.  The main focus is to allow you to have a normal life and be in charge of your own future.

Describing CBT in a few words like this might make it seem simple.  But the techniques of CBT are powerful.  They can have dramatic results in only a matter of weeks.

Louise Ritson is an experienced CBT therapist in the North Cotswold area of the UK, who specializes in adult mental health.

She works with a limited number of private patients, mostly from Gloucestershire, Worcestershire, Warwickshire and Oxfordshire, and she can provide treatment by telephone to private patients elsewhere, including patients outside the UK.  She has also worked with some NHS patients in Worcestershire and Gloucestershire.

She is an accredited member of the BABCP, and she is registered as a psychotherapist by the UKCP.  In her work as a therapist, she is bound by the codes of ethics of these organizations.  This guarantees, amongst other things, the confidentiality of your therapy.