The four stages of CBT should always produce beneficial results. This fits in with many research findings. CBT has been tested in a similar way to other therapies like drug therapy. These tests generally show that CBT is effective.

There have also been reports that CBT does not work so well in some cases. It is not yet clear why this is. For example, in one reseach study CBT was used to treat depression. Some patients got better and some did not. No one completely understands the reasons for this. One possibility is that some CBT therapists leave out one or more of the four stages.

For example, in that research study there were five therapists. Three of them seemed to get good results, but two of them did not. It has been suggested that the two therapists whose results were poor did not spend time getting to know their patients and allowing their patients to get to know them. They left out Stage 1.

A patient once told me that her previous therapist had not discussed any thought processes, but had gone straight from the assessment to behavioural activities. The therapy did not work very well, and the patient was referred to me. That therapist seems to have left out Stage 2.

When a stage of the CBT process is left out, it does not mean that the therapy is completely useless. A limited form of therapy can be useful for some people. But CBT probably works best when it is used in a complete way, as it was originally designed.

See also: What to expect from your CBT therapist