It’s been suggested more than once that CBT, or Cognitive Behavioral Therapy, might help me with some of my problems, including “depression, anxiety disorders, marital problems, and severe mental illness” (bipolar disorder, in my case), according to the American Psychological Association (APA). And I understand that it’s helped a lot of people, including some in my position, with some of the same problems I have. If it works for you, that’s great. I’m not saying that no one should ever use it or that it’s a rotten form of therapy.
I, however, dislike the premise of CBT and have never felt comfortable trying it. Here’s why.
One of the basic tenets of CBT is that the client’s thinking is faulty and the therapist helps the client to discover how and where. Then they work together to pinpoint the faulty thinking and replace it with healthy behaviors, or at least less destructive ones.
Again, according to the APA, “CBT treatment usually involves efforts to change thinking patterns” and examine “what is going on in the person’s current life, rather than what has led up to their difficulties.”
When I first got into therapy with the counselor who has helped me the most, what I needed was not someone to convince me that my thoughts were faulty. I had worked hard to reclaim my memories, validate them, and recognize that they really were damaging events. I would resist any attempt to undo that work by invalidating those memories, and my attempts to understand them, as “faulty.”
Despite all the times it has betrayed me, I think my brain is the most powerful weapon I have in moving forward, but that does not include denying the past or brushing it aside in favor of what the APA calls “learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.” Evaluating the memories and the thinking associated with them is a large part of what has helped me most, but calling them “distortions” would not be helpful. I needed to reclaim those memories and understand the feelings, accept them for what they were and how they changed my life, and then go on to rebuilding a new life – not one free from those memories and feelings, but one that validates them as part of my lived experience.
The methods used in CBT discomfort me as well. The idea of “homework assignments” and role-playing my future interactions does not appeal to me. I have gotten on much better with good ol’ talk therapy (and medications) than I believe I could with body relaxation and mind-calming techniques.
My problem largely involves confronting my memories and not denying them or downplaying them, but learning how to live despite having them in my past. It does me no good to deny a train-wreck as “faulty thinking” or to dismiss it as part of my past. Owning it as part of my past and realizing what it did to me is much more helpful. Validating my feelings and reclaiming my memories, then moving beyond them, is what I need. My therapist has helped me do that, without ever once suggesting that my thought patterns are faulty. We’ve worked on coping skills, sure – but never based on the premise that my past doesn’t affect my present or future.
CBT is also said (by NAMI, the National Alliance on Mental Illness) to be a short-term process (which I’m sure the insurance companies love) or one that can be carried out without a therapist guiding it. To me, this smacks of the “think away your troubles” idea. If I could have, I would have, without the help of long-term talk therapy.
My therapy has been a long and often painful process, but never one that attempts to make me think that my memories are invalid and that my progress will come by admitting that. Talk therapy is hard work, and I don’t believe there is any shortcut to mental health. Even now, after I have largely ceased therapy, I sometimes need a “booster shot” when my problems become overwhelming. Again, this comes from recognizing that my problems are real and that thinking them away rather than hard work is not the answer.
I am sure that people will tell me that I have misunderstood CBT, what it is all about, and how it is practiced. They may have many good experiences with it. But I don’t want to take a chance on a form of therapy that denies my reality and dismisses it as “unhelpful thoughts.” I need my reality heard and validated and examined. I need depth and breadth of therapy that recognizes my “train wrecks” and to what degree they have left me wounded. I need coping mechanisms that acknowledge my past as part of what going forward may mean.
I don’t trust CBT to do those things.
Comments on: "Why CBT Isn’t for Me" (5)
The furthest I’ve gone with “distortions” is my anxieties I know are false like my daughter didn’t text me back for a day so she must hate me and I extend it into I’m the worst dad in the world and I’m ready to suicide. I don’t think that is part of my mental illness. I just think my anxiety is sometimes worse than other’s and I am not good at calming myself. That is the most I will do in CBT. Unfortunately in my situation I don’t have a choice in my therapist. The best therapist I have worked with was the type you like. Another good one specialized in voice hearing and was excited she didn’t have to do CBT. She told me the voice I hear is real and I should listen to it and it can help me.
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I wish you all the best in your continuing treatment. I have anxieties too that threaten to overwhelm me.
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Thank you. I am glad you have or had therapy to help in the manner you like.
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I read a book years ago about “cognitive therapy” as it was then called and it really opened my eyes. At the time I had been depressed constantly for well over a year, weekly doctors appointments and all that… What this book said was that when you’re in a constant depressive mood you begin to make self-fulfilling prophecies along the lines of “I won’t even bother to do that because I will fail and it will be a disaster” as well as other negative thoughts along the lines of “I’m a bad person, I’m not worthy” that sort of thing. I’d never read a book like this before so at the time (in the early 1990s) it seemed like a big revelation to me.
On the other hand I do not believe that depressive moods are necessarily caused by this kind of thinking. If it were that simple then why am I depressed this week when my thinking was just as faulty a month ago and I wasn’t depressed back then? I don’t think it’s anything like as simple as that. But it does seem to be helpful for a lot of people. It’s more about self-esteem than anything else.
The most interesting therapy I’ve heard of was the dialectical behavioural one, but trying to get that in Britain is like trying to find a gold-toothed badger in the woods, it’s just not going to happen…
That last bit gave me a flashback to Captain Kirk in The Final Frontier (I think) where he’s yelling at Spock’s half brother. “I need my pain!” Which has always been one of my favorite scenes heh.