CBT vs counselling: how the two talking therapies differ

Both CBT and counselling are talking therapies delivered by trained practitioners, usually for around an hour a week, and both can help with low mood, anxiety and stress. The difference lies in what happens in the room. CBT is a focused, problem-solving therapy with specific techniques and practice between sessions. Counselling gives you time and space to explore feelings and experiences with someone who listens without judgement and helps you reach your own decisions.

Neither is better in all situations. The NHS says the type of therapy you can get depends on what you need it for and what is available in your area, and an assessment will usually recommend which fits.

The NHS describes CBT as a type of talking therapy where a therapist helps you to change how you think and act. It is a recommended treatment for many problems, including depression, anxiety (such as social anxiety, phobias and OCD), PTSD, eating disorders, bipolar disorder and personality disorders, and it can also help with sleep problems, long-term pain, irritable bowel syndrome and chronic fatigue syndrome.

In a typical session you will talk about situations you find difficult and discuss how they make you think, feel and act, then work out different ways of approaching them. This may include questioning unhelpful thoughts and beliefs, noticing emotions and physical feelings without reacting to them, and changing what you do, such as doing activities you have been avoiding. You will usually be asked to practise between sessions and may record progress in a worksheet or diary. CBT can be done as guided self-help, one to one or in a group, in person, online or by phone, with usually 5 to 15 sessions.

The NHS describes counselling as a type of talking therapy where a counsellor listens to you and helps you find your own solutions to problems. It can help with difficult emotions such as stress, low mood, worry or anger, with life events such as illness or bereavement, and with problems in relationships, at school or at work.

Sessions usually last 50 to 60 minutes and can be in person, over the phone or online, on your own, as a couple or family, or in a group. In a session the counsellor listens without judgement, tries to see things from your point of view, encourages you to talk about your thoughts, feelings and life experiences and helps you find your own solutions. The NHS says counsellors do not usually give advice or tell you what to do. On the NHS you will usually have 8 to 16 sessions.

People often find CBT suits them if they have a defined problem such as panic attacks, a phobia, OCD or persistent negative thinking, and want a practical plan with techniques to use between sessions. Counselling may suit those who want to talk through a difficult life event or relationships, to feel heard, and to reach their own conclusions at their own pace. These are general patterns rather than rules, and many people benefit from either.

The NHS says that after a referral for CBT you will have an assessment with a therapist, who will recommend a type of therapy, which may be CBT or another type depending on what you need it for. The same applies if you refer yourself to NHS talking therapies for anxiety and depression: you may be offered counselling or another talking therapy.

For many problems such as anxiety and depression, you can refer yourself to NHS talking therapies without speaking to a GP, if you are 18 or over (or 16 in some areas). For some conditions, including eating disorders, bipolar disorder, personality disorders or psychosis, the NHS says you will need a GP to refer you for CBT.

You can also choose to pay privately. The NHS advises finding an accredited CBT therapist through the UK CBT register, and for counselling, checking that a private counsellor is on a register accredited by the Professional Standards Authority, such as the British Association for Counselling and Psychotherapy (BACP). Free options may be available through an employer, school, university or charity. If you are under 18, the routes differ.

If you are in crisis or have thoughts of harming yourself, do not wait for therapy: contact NHS 111, a GP, or call 999 if in immediate danger.