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What does a CBT therapist do?
A CBT therapist is sometimes also known as a Cognitive Behavioural Therapist (CBT), behavioural therapist or talking therapist. They are professionals who work with clients with different mental health problems. They assess their needs and help them by using various talking therapies.
A CBT therapist can work with clients from various backgrounds, including children, adolescents or adults. They can deliver interventions to individuals or groups. They can work in general cognitive behavioural therapy or specialise in different areas, such as phobias, anxiety, depression, OCD, schizophrenia and other conditions. Therefore, what a CBT therapist does will depend on who they work with and their specialisms.
A CBT therapist aims to help people gradually change how they think, feel and behave to manage various problems. They identify negative thinking patterns and use tools to teach people how to break free from them so they feel better. Overall, they have an essential role in improving the health and well-being of individuals in our society and can even save lives.
A CBT therapist may receive referrals from doctors, or individuals needing help may contact them directly. CBT therapists will have many duties, including establishing relationships with clients, assessing clients, encouraging them to talk, listening carefully, discussing therapy plans, asking questions, teaching coping skills and techniques, etc. The role will also have an element of administrative work, such as maintaining confidential client records and writing reports.
CBT therapists can work alone with many different clients but may also work closely with their colleagues. They may also need to liaise with external stakeholders, including doctors, mental health nurses, clinical psychologists, psychological well-being practitioners (PWPs), psychiatrists, other specialists, GPs, other healthcare teams, parents/guardians, other family members, employment and education advisers, support staff, etc.
A CBT therapist can work for many different-sized organisations. They may work for large organisations, e.g. the NHS, or smaller companies, e.g. private clinics, occupational health providers and charities. Some more experienced CBT therapists may choose to have their own practice and become self-employed, do freelance work or work through employment agencies.
Cognitive behavioural therapy occurs in various settings, such as NHS or private hospitals, GP surgeries, clinics, healthcare centres, community venues, prisons and even a therapist’s own home. However, most CBT therapists will work in healthcare settings. They can provide face-to-face, online and over-the-telephone cognitive behavioural therapy.
A CBT therapist’s responsibilities will depend on many factors, including their role, who they work for, where they work and the area in which they specialise.
Some examples of their day-to-day duties may include (this list is not exhaustive):
- Assessing clients to identify whether CBT will benefit them.
- Holding group sessions.
- Establishing relationships built on trust and respect.
- Discussing therapy plans with clients.
- Implementing and evaluating therapy plans.
- Agreeing with clients on what will be covered in sessions and what they want to change.
- Encouraging clients to talk about their feelings and discussing any issues they may have.
- Listening carefully to clients whilst empathising with them and without bias.
- Asking clients questions and checking understanding.
- Assisting clients to understand how their thoughts, feelings and behaviours relate.
- Helping clients to see their problems more clearly or differently and finding ways to help them cope.
- Supporting clients to make choices that will improve their health and well-being.
- Following confidentiality and data protection laws and rules.
- Teaching clients various skills and techniques to help them cope.
- Talking with family members where necessary.
- Liaising with other healthcare professionals, such as doctors and community mental health teams.
- Keeping confidential records and writing reports.
- Managing referrals and signposting to other services where necessary.
A CBT therapist can expect to work 37-39 hours a week, usually 8am-6pm (Monday-Friday). However, some CBT therapists work evenings or weekends for events or appointments.
Flexible work is possible for some CBT therapists, e.g. part-time hours or a job share. There are even working-from-home opportunities or hybrid jobs with certain roles. Some may be self-employed or work freelance.
Travel may be necessary for some CBT therapists, i.e. those who work in the community. There may be a requirement to cover others in other areas, and there may also be opportunities to work overseas.
What to expect
Being a CBT therapist and helping people with mental difficulties is extremely rewarding. Individuals can go home at the end of the working day knowing they are helping make a difference in their client’s health, happiness and well-being. In some cases, their interventions can save lives.
The role would suit individuals who love to learn. They will need to keep up to date on current research and understand the needs of each client they see. Using knowledge learnt and seeing clients progress can be fulfilling.
There is no shortage of CBT therapist roles; jobs are available nationally, and there are many different areas in which to specialise. The salary is also good, especially if employed in the NHS or privately.
Being self-employed, working from home, and having control of your own clients can benefit some individuals if they decide to have their own practice. They can work around their own needs, and it reduces the need to travel. Also, being your own boss can be exciting and fulfilling.
Boredom will never be a problem for CBT therapists, as their clients and work can be varied. They will see and try to help many different people with various issues. One appointment may involve helping someone with anxiety, and the next, supporting someone with a condition such as OCD. Of course, this will depend on a CBT therapist’s specialist area.
Even though being a CBT therapist is rewarding, and there are many positives associated with the role, they may also face challenges, for example:
- Stressful working environment – some CBT therapists have multiple caseloads and will see many clients during the day. There is also a significant amount of administrative work involved in the role, e.g. writing or typing notes. A CBT therapist must juggle different demands, and work schedules can often be erratic.
- Mental demands – the role can be emotionally demanding, as they deal with individuals with high emotional demands and various mental health conditions. It is not easy seeing people struggling to cope with what is going on in their lives. CBT therapists may be exposed to trauma, and some clients may be challenging to deal with. It can also be frustrating if clients are not progressing as anticipated.
- Work-related violence – unfortunately, there is a risk of verbal and physical abuse working with people with mental health problems. It is usually due to alcohol and drug-related issues, but people can also lash out when in pain or emotional distress. Employers have a duty to reduce and manage the risk of work-related violence, so there are ways of prevention. However, CBT therapists must be aware of the risk.
Self-employed CBT therapists may have additional challenges, such as:
- Setting up a practice is not easy, and there will be additional costs.
- Loneliness when working from home, particularly between clients.
- Increased health and safety risks due to working alone with clients.
- Not receiving a regular salary, i.e. no guaranteed work and relying on clients paying.
- Managing your own business and ensuring compliance with the law will increase the workload.
Every career choice has pros and cons, and prospective CBT therapists must know what to expect before deciding whether it is a suitable role. Working in therapy is challenging, mentally demanding and stressful. However, there are many positives and helping people improve their lives is very fulfilling. In some cases, it can actually save lives.
When considering whether to be a CBT therapist, individuals should look at the pros and cons. They should also ensure they have the necessary personal qualities to carry out the role and responsibilities required.
Personal qualities needed to be a CBT therapist
Some of the personal qualities that a CBT therapist requires will include (this list is not exhaustive):
- A passion for helping people.
- Knowledge of healthcare, mental health and psychology.
- Knowledge of related legislation and standards.
- Knowledge of health and safety.
- Knowledge of equality and diversity.
- Knowledge of confidentiality, data protection and the GDPR.
- Having a caring attitude, sensitivity, empathy and understanding.
- Having confidence, patience, tolerance and a reassuring manner.
- Having a non-judgemental approach.
- Having self-awareness, including examination of own thoughts and values.
- Excellent interpersonal skills, i.e. able to deal with clients and other healthcare professionals.
- Excellent communication skills, both written and verbal.
- Excellent counselling and active listening skills.
- Good time management.
- Being motivated and committed to helping people.
- Being positive.
- Being open-minded.
- Being thorough and having attention to detail.
- Being flexible and open to change.
- The ability to work both in a team and alone using own initiative.
- The ability to look, identify and understand all behavioural problems.
- The ability to understand individuals’ reactions.
- The ability to challenge people positively.
- The ability to be resilient in emotionally demanding situations.
- The ability to gain people’s trust, respect and confidence.
- The ability to develop relationships with clients and build rapport.
- The ability to accept criticism.
- The ability to work well under pressure and remain calm in stressful situations.
- The ability to use IT equipment and software competently.
- The ability to follow policies, procedures, instructions and risk assessments.
Qualifications and training
There are many different routes to becoming a CBT therapist. Individuals could go to university or apply directly. They could also do other courses and work experience to help them enter the role.
An individual will typically need to undertake an accredited postgraduate degree in cognitive behavioural therapy to become a CBT therapist.
Some examples of courses include:
- A postgraduate certificate in CBT.
- A postgraduate diploma in CBT.
- A Master’s degree (MSc) in CBT.
The entry requirements will depend on each university; individuals should check before applying. They will typically need at least a 2:1 or 2:2 in an undergraduate degree in a relevant health and social care subject, e.g. psychology.
After completing an undergraduate degree, individuals should start applying for jobs in mental health, as this is a requirement to get a placement on an accredited postgraduate course.
They will need experience working in mental health in a registered core profession, such as:
- Art therapy.
- Clinical or counselling psychology.
- Education, health or forensic psychology.
- Mental health nursing.
- Occupational therapy.
- Social work.
Some institutions also invite applicants for an interview as part of the selection process.
If an individual has a professional healthcare qualification, there may be opportunities for them to train as a CBT therapist with the NHS.
They could apply directly to the NHS for the following roles:
A degree is required to become a CBT therapist. However, individuals could undertake a relevant college or private training course to help them gain knowledge and work towards their goals.
Some examples of courses are as follows (this list is not exhaustive):
- Introduction to Counselling.
- Introduction to Cognitive Behavioural Therapy.
- Level 3 Certificate in Counselling.
- Level 3 Diploma in Cognitive Behavioural Therapy.
- Level 4 Diploma in Counselling Skills.
- Level 5 Diploma in Therapeutic Counselling.
- AS and A-level Psychology.
The entry requirements will depend on the course provider and level. Always check the entry requirements before applying.
It is advisable that individuals start with an introduction course, which lasts between 8-12 weeks.
It may also be worth enrolling on low-cost online, short CBT courses to see if the career would be of interest. That way, if not, it will save an individual a lot of time and trouble.
Courses and qualifications do not guarantee a role as a CBT therapist. However, it will demonstrate to employers and companies that an individual is keen on the job and may give them a competitive edge.
Relevant work experience in mental health, either paid or voluntary, can help individuals stand out and build their knowledge and skills.
- Work as a mental health care assistant, support worker, transport assistant, etc.
- Work with vulnerable people in other settings, e.g. care homes and the community.
- Work at or volunteer at a mental health charity, e.g. Mind, Rethink Mental Illness or Turning Point.
- Volunteer with the NHS.
Learning does not stop with experience or once someone becomes qualified. Attending relevant training courses and having additional certifications can help individuals enter the profession, enhance their employability, increase their client base and keep their knowledge and skills current.
We have many CPD & RoSPA approved Mental Health Awareness Online Courses that can be useful for individuals looking at a career as a CBT therapist, for example:
- CBT Awareness.
- Deprivation of Liberty Safeguards (DoLS).
- Mental health and capacity.
- Anxiety and depression.
- Eating disorders.
- Bipolar disorder.
- COVID-19 Awareness.
- Equality and diversity.
Health and safety training, e.g. work-related stress, violence at work and lone working, can also be beneficial.
Professional bodies and associations, such as the British Association for Behavioural & Cognitive Psychotherapies (BABCP), the British Association for Counselling and Psychotherapy, the UK Council for Psychotherapy (UKCP), The Association for Psychological Therapies and The National Counselling Society (NCS)can also advise on reputable training courses. Some also provide memberships, events and support to help individuals become CBT therapists and give those already in the profession the means to continue their professional development. Continuing professional development (CPD) is mandatory to remain on accredited registers.
The type of training required will depend on what employers are looking for, the CBT individuals want to offer and the CPD requirements for registration. As well as looking at professional body websites, it is also worth looking at several job advertisements to identify the courses required and other training needed for specialist roles. Jobs are on NHS Jobs, BABCP Jobs, BACP Jobs, Charity Job, HealthJobsUK, and other job sites, such as GOV.UK find a job service and Indeed. Also, look at recruitment agencies, e.g. Agency Central.
More relevant training and competence will open up more opportunities for CBT therapists. Refresher training will also be required, as it is a legal requirement, and it keeps knowledge and skills up to date.
If a person wants to work as an accredited CBT therapist, they need to be on a register accredited by the Professional Standards Authority. The BABCP has its own register, and they have applied for accreditation with the PSA.
Each register will require registrants to adhere to certain terms and conditions and conduct. Also, registration will need to be renewed, i.e. annually. The exact requirements will depend on the professional body.
There will be a cost to become registered and renew registration.
Other employers and even clients may check registers, so it is advisable that CBT therapists become accredited and registered.
Criminal records checks
CBT therapists must undergo a criminal record check, as they may have contact with children and vulnerable adults. A criminal record, caution, warning or conviction may put off prospective employers. However, employers should account for the seriousness of the crime, when it occurred and its relevance to the role.
The organisation that holds criminal records will depend on the country within the UK, for example:
- England and Wales – Disclosure and Barring Service (DBS).
- Northern Ireland – AccessNI.
- Scotland – Protecting Vulnerable Groups (PVG) scheme.
Some CBT therapists will drive as part of their role, especially when working in the community and at different healthcare centres. Therefore, they should have a full clean driving licence.
Where do CBT therapists work?
CBT therapists can work in many different settings, including (this list is not exhaustive):
- Schools, academies, colleges and universities.
- People’s homes and in the community.
- Hospitals, walk-in centres, therapy clinics and GP surgeries.
- Residential care homes, nursing homes and hospices.
- Children’s services.
- Advice and support centres.
- Offices and their own home, e.g. face-to-face, online or telephone.
They can work for public bodies and private organisations, for example:
- The NHS.
- Private hospitals, centres and clinics.
- Government agencies.
- Counselling service providers.
- Addiction agencies.
- Employee assistance providers.
- Occupational health providers.
- Not-for-profit community-based organisations.
They can also be self-employed and work for themselves or an agency.
How much do CBT therapists earn?
If a CBT therapist decides to work for the NHS, their salary is subject to a band pay system (agenda for change pay rates).
For example (these are a guide only and are subject to change):
- Newly qualified (band 5) – £27,055–£32,934.
- Trainees (band 6) – £33,706–£40,588.
- Qualified (band 7) – £41,659–£47,672.
The exact salaries for CBT therapists will depend on the role, location (London supplement), specialisms, qualifications and years of experience. As individuals progress in their careers, there may be opportunities to enter more senior positions, and the band will increase.
There is potential for CBT therapists to earn more if they work in other settings, e.g. private practice. Experienced CBT therapists may also earn higher salaries if they combine their role with specialisms, such as teaching, research or consultancy.
What self-employed CBT therapists will earn is variable, as most will set their own rates. It will also depend on how many clients they have, their hours, their qualifications and specialisms, and the expenses they have to pay, e.g. utilities and training. Most charge between £60 to £100 per session. They should agree on rates with clients based on their circumstances.
Some CBT therapists may work voluntarily, e.g. helplines, or combine unpaid work with paid CBT work.
Types of CBT to specialise in
Individuals can choose to work in general cognitive behavioural therapy, or they can specialise in different areas, such as (this list is not exhaustive):
- ADHD – specialising in people who have attention deficit hyperactivity disorder (ADHD). It helps those with ADHD with their symptoms and executive function difficulties.
- Adults – helping people over the age of 18 years old.
- Children and young people – specialising in individuals under 18 years old.
- Eating disorders – sometimes known as CBT-ED. This area specialises in people with eating disorders such as anorexia, bulimia or binge eating disorder.
- Insomnia – sometimes known as CBTi. It helps people identify why they are having sleeping problems so they can overcome them.
- Long-term health issues – specialising in helping people cope better with symptoms of long-term health conditions, such as irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), fibromyalgia, cancer and chronic pain.
- Psychosis – sometimes known as CBTp. This area specialises in people experiencing psychosis.
- Trauma-focused – specialising in post-traumatic stress disorder (PTSD). CBT therapists use various psychological techniques to help people deal with a traumatic event.
CBT therapists can also offer therapy for various mental health disorders, such as depression, anxiety, OCD, bipolar disorder, addiction, self-harm, hoarding, phobias, schizophrenia and many others. They may decide to specialise in one area, such as depression or addiction, or many.
CBT therapists may also specialise in using specific talking therapies, such as cognitive therapy, behaviour therapy, mindfulness, dialectical behaviour therapy (DBT) and many others. The Royal College of Psychiatrists has further information on these types of CBT on its website.
All different CBT therapist roles will require differing knowledge, skills, experience and qualities. Some may need specific qualifications and additional training for specialised areas, e.g. children and young people postgraduate diploma if working with these individuals.
Most CBT therapists will need to know how to build relationships with different people, actively listen, ask questions, use various talking therapies and help people manage their problems by changing how they think, feel and behave. Any additional areas of expertise will depend on what an organisation is looking for and the type of work a CBT therapist wants to carry out.
If CBT therapists do not do their role effectively, it can put clients (and others) at risk. In worse cases, it may even cost lives. Therefore, whatever the type of role, they must have the necessary competence (knowledge, skills and experience) to carry out the work professionally and safely. They should also know the limits of their competency and not use therapies, techniques and tools if they are not trained and competent.
CBT standards, techniques, tools, therapies and laws are updated regularly. Therefore, CBT therapists must keep ahead of the latest developments and changes in legislation to remain legally compliant and carry out their roles effectively and safely. CPD gives CBT therapists the knowledge and skills to keep up to date with these changes and understand their responsibilities. It also helps them stay registered with an accredited body and allows them to progress in their career.
Joining a professional body or association, covered earlier, can help prospective and current CBT therapists enhance their skills and overall career. They can offer different levels of membership, CPD, advice and support, access to industry contacts and networking events.
There is ample opportunity for career progression. With more qualifications and experience, a CBT therapist can enter more senior roles, such as a supervisor or manager. They can also decide to focus on a specific therapy area, such as long-term health problems, eating disorders or addiction. Alternatively, they may become self-employed and set up their own practice.
Knowledge, skills and experience in cognitive behavioural therapy can also lead to a career in different areas. For example, a therapist may want to work in education, training, research or supervision. They may want to work in other areas, e.g. occupational health, mentoring or mental health services. Finally, they may decide to combine CBT with other roles.
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