View Full Version : What do you think of CBT?


ClearConfusion
02-04-05, 10:18 PM
I started going to a CBT-therapist recently, but I stopped. Only went there twice. I thought that when I felt worse after the terapy than before it probably wasn't such a good idea. I don't know if it was the therapist - she misunderstood me a lot so I felt I needed to explain things more next time, or the method. It seems like it's all about "fixing things", "straighten oneself out". We were going to have ten sessions and it seemed to be all about changing my behaviour, like making plans for the whole day and stick by them. She said I would need to discipline myself a bit. As if it's all down to that.

The reason why I want to get therapy is first and foremost to have someone to talk to about more existencial things like my feelings of guilt. Of course I may need help to change things. But I want to bring it up myself, choose something that matters to me - that I feel I need help with. And I need someone who understands what I'm saying, who listens to me.

My mother actually raised her voice when I told her about this. She said: "She could at least listen to what you're saying!"

So, now I think that maybe a therapist with a more analythical (but not Freudian) approach, who's knowledgeable of ADD would be the right thing for me. Someone who is ADD would be great. I need someone who really understands me - and is willing to talk about the neurology of ADD as well, cause I think that's really interesting.

What are your experiences with CBT? What do you think of it?

exeter
02-05-05, 03:32 AM
CBT is appropriate and effective for certain conditions, and totally inappropriate for others, just like any other therapy or medication out there. It sounds to me like you're not quite ready to make the changes in your treatment plan just yet. That's ok, it just means that you probably need a different type of therapy at this time.

What I would do in this situation is talk to the therapist about reorienting the treatment. Certainly your original treatment goals are worth persuing (otherwise, you and the therapist wouldn't have made them), but if you're just going to be frustrated by the therapy sessions themselves, it doesn't seem to me like it's going to be very effective. I can remember having that type of experience with a previous therapist, and let me tell you, it sucked, a lot. I, too, consistently felt worse after the therapy sessions than I did before.

As far as CBT itself goes, I don't have experience with it with a therapist, but I can say that I use cognitive techniques on myself all the time. CBT is a very rational therapy designed to work from the inside out and from the outside in. The patient modifies his thoughts (cognitive) to change his behavior, while changing his behavior (behavioral) helps reinforce the new, positive thoughts he's introducing into his thought process. It's been shown to be effective in depression and, I believe, certain anxiety disorders.

I would think that there's some frustration inherent in this type of therapy, to be sure, but I don't think you should be leaving sessions feeling worse than you came in. Therapy isn't necessarily enjoyable, but it shouldn't contribute to your feelings of depression and guilt even more! (NB: I am not a therapist, so maybe this is a little shortsighted of me to say. If there's a therapist in the house, I'd appreciate a correction if I'm way off base here.)

Ian
02-05-05, 10:51 AM
I had a go at applying CBT myself and wasn't very successful. I had heard a number of people say how it had been good for them though and remain open to it.

Recently I spotted some posts by a new member here who goes by the user name of "allegro". She seems to have stumbled on CBT through her own trials rather than some external learning. If you are interested in what CBT might have to offer you might chase some of those recent posts with the search function and her user name. I found her posts tremendously encouraging.

I find exeter's comments pretty encouraging too. Thanks Ex. This gives me even more fuel to try again.

I have no qualifications in this field.
Ian.

KnittingJunkie
02-05-05, 01:59 PM
I think CBT might be a good thing. Might.

That said, it's sort of a trend lately (or at least, seems like it) for doctors to put people on it. Which could be good or bad. But if someone goes into the University of Iowa locked ward, chances are, any therapy they will get will be CBT. A friend of mine was Bipolar, and had to go in, and this Dr. (who I was informed by a colleague of his to be a total dumb@$$, and all the other doctors hate him), Dr. Black, who's since written some books (check the net for "Bad Boys, Bad Men"--that's the title of one of them. Almost checked it out of the library for a criminal psych class assignment, then went "Oh, crap--it's that guy.") yanked her off her meds (never, ever, ever should someone be taken off a substantial dose of Depakote, not to mention the others, without tapering, aside from all this--it's just asking for disaster, physically or mentally) crossed out her Bipolar diagnosis without talking to her psychiatrist slapped her with a diagnosis of Borderline Personality Disorder (oh, I also heard--from a doctor, not just patients--that everyone he sees gets diagnosed with a personality disorder) and stuck her in CBT with, well, pretty much the rest of the ward.

It was then that she went really, really, really...well, I'm sorry for using the word, but crazy. Far worse than when she'd checked in. Can't even stand to think about it. She just got worse.

So what do I think of CBT? When I tried to kill myself 5 years ago and was put on it inpatient (state committed for a month because of the way I tried to do it--long story) in a hospital, it didn't do jack.

To review:

It's really popular, and sometimes it's used by doctors as a cure-all for pretty much anyone, and
It didn't do jack for me, except make me go "What on earth is the point of this?"
If you get the wrong doctor, who's an egomaniac and thinks he knows everything, all heck can break loose and people who will not benefit from CBT whatsoever might be stuck on it for kicks. (Wait, maybe that was covered at that first "revew" part.)
But that's all I know.

Chrys

Ian
02-05-05, 05:53 PM
That's why I thought "allegro" had such an interesting spin because it was all outside the formal input that would normally have been the case.

I'm sure the CBT is not appropriate in all situations but it sure has caught my attention as being appropriate for some of the things I am interested in changing.

The first time I tried to get started with CBT type habits I could not seem to make a good start.

After a bit of reading I am going to start by trying to collect the thoughts that go on in my head that are negative. So far I have two. Not a great start maybe but a start.
Cheers! Ian.

KnittingJunkie
02-05-05, 07:30 PM
Yeah, I know, and maybe my distaste for CBT is excessive since it's just based on two separate incidents and one was involving a total jack@$$. I don't know, you get it, don't you?. If it works for you, then that's awesome! Rock on.

Having it shoved down my throat in a crappy state hospital I'd been packed and shipped to for a month just didn't go so well, and obviously I have absolutely no objectivity about that method of therapeutic counseling, just because of my bad memories + the inappropriate use of it on my bipolar chica. I think part of CBT, principle wise, is that the person going through it has to be at least somewhat interested or agreeable or open to the possibility that it could be good. And upon being introduced to it, I wasn't really impressed, anyway. I felt like they were trying to train me--like a dog adopted from the pound who needs to be re-programmed to be well behaved or something. Kind of like a spray on the nose or a "bomp" on the head, with a "Bad girl! Don't ever, ever jump several stories and break both your feet when you really wanted to kill yourself ever again and are now disappointed in your failure! Baaaad!"


Hopefully when I'm starting out as a therapist, my reluctance to use it won't be a problem--and if it is, and someone wants an explanation of why...I don't really want them knowing I was state committed when I went through CBT! :rolleyes: Might not go over very well...

Chrys


p.s. I did, however, have to pretend that it was working miracles...that was the only way they'd sign me out at the "shall we let her out or keep her longer?" meeting at the end of that month. Somehow I managed to grit my teeth and play along. In reference to the "dog" metaphor, when I was nice and faked improvement and interest, I almost expected to get a pat on the head and a milkbone for compliance and good behavior...

p.p.s. Should mention that I was 18, and wasn't quite as grown up as I thought I was at the time. Could potentially be part of my combativeness to the whole shrinky thing in the first place, logically, no?

Ian
02-05-05, 08:39 PM
p.p.s. Should mention that I was 18, and wasn't quite as grown up as I thought I was at the time. Could potentially be part of my combativeness to the whole shrinky thing in the first place, logically, no?


If you were anything like me.. yes. :)

KnittingJunkie
02-05-05, 09:06 PM
If you were anything like me.. yes. :)
Yeah...funniest thing happened the other day...I'm embarrassed to admit it, but @ 23 years old, I'm still mooching off my dad. He's a doctor, and my husband's...well, he works his butt off but doesn't make a ton of money.

Anyway, I was apologetically and embarrassingly saying how I would really really super-appreciate it but it's not my money and I don't work for it and if he doesn't really want to give me money I totally understand and...etc.

And he went, "You know...other than in the obvious ways, you've really grown up an awful lot. Maybe it was marrying Jeremy..." (my husband grew up kind of poor, and has taught me a few things...probably responsible at least in part for my "de-spoiled-brat-ification") "...or maybe it was having a child, or maybe it was both. Whatever it was, I don't know if you remember, but you used to just expect me to give you whatever amount of money you wanted whenever you wanted it! Now you look for coupons and sales, and act all embarrassed when you have to call and ask for help...it's so odd to think of then and compare it with now."

(He sent me a check with a post-it note on it that said, "I love you and I'm proud of you" with a heart...how cute is that?)

Needless to say, growing up was hard to do...

Chrys

mctavish23
02-06-05, 12:51 AM
Hans Eyesenck discovered many years ago that all psychotherapy has some impact in and of itself;as opposed to any one particualr type of therapy being somehow "better" than others. Subsequent research has consistently shown that the relationship/rapport between the client/therapist is (and remains) the most important variable for change.
That's why therapy is more of an "art" than science and why "good therapists are born, not educated.":)

Ian
02-06-05, 01:17 AM
Needless to say, growing up was hard to do...


Chrys, the very hardest. Grace, humility and all the other fundamentals are hard won prizes worth having. You inspire!

mctavish23 this is my experience. I'm lucky to have a coach/therapist that is so well suited to my needs. She knows almost nothing about ADHD but she certainly isn't done learning. What a treat to have a free thinker on staff!

KnittingJunkie
02-06-05, 04:19 AM
Well, we never admit or are cognitively aware (yes, I freely said that word, of all things, in this forum, completely apart from the therapy) that we are truly immature until, older and wiser (in my early 20s, that is), looking back, we go..."What the heck was I thinking/doing/etc.?" It's just inarguably a looking-back thing, I think. I'm sure Sam will do something stupid and insist that it's an adult decision because, I don't know, he's begun shaving every single day instead of once a month or so, and is now a grown man.

Later, he will look back and go, "Man, that was pathetic."

Chrys

casper
02-06-05, 01:19 PM
What is CBT?

Stuck
02-06-05, 01:41 PM
Casper-

I'm thinking this means "Cognitive Behavioral Therapy".

Stuck
02-06-05, 01:48 PM
[QUOTE=exeter]

As far as CBT itself goes, I don't have experience with it with a therapist, but I can say that I use cognitive techniques on myself all the time. CBT is a very rational therapy designed to work from the inside out and from the outside in. The patient modifies his thoughts (cognitive) to change his behavior, while changing his behavior (behavioral) helps reinforce the new, positive thoughts he's introducing into his thought process. It's been shown to be effective in depression and, I believe, certain anxiety disorders.

QUOTE]


Is this like self enforced tough love?

Something like changing the self defeating mantra in your head?

Enquiring mindless person who wants to know.....

Coral Rhedd
02-06-05, 04:07 PM
My current therapist is CBT and my previous therapist was Client Centered (Carl Rogers type) and there is a vast difference between them. With my first therapist I got to vent a lot and she was always reflective and mirroring or my thoughts. Very validating. Yes, I know it is a technique but she did it well and I began to feel more like a normal person. But after awhile we weren't really moving forward. Everything felt like going over old ground.

My current CBT therapist admits she is "not psychodynamic." Right now she is good for me because she won't just let me stay in one place and whine. Even I get sick of my whining. She focuses on automatic thoughts. Yes, I can discuss the past a little but really only as it relates to triggering automatic thoughts. Sometimes I feel frustrated. I want to explore something that I think will give me insight and she is all focused upon present time strategies. Sometimes I feel she doesn't really listen, that she rejects my own view of myself and this makes me angry. But overall, I am doing better and accomplishing more.

I think the reason CBT is more popular has to do with funding and the bottom line. CBT advertises itself as short term therapy that gets results. It's an HMO world and few insurance companies are willing to let us navel gaze at their expense.

Mctavish contributed something really important here. It is the fit between the therapist and the client that really makes therapy work. If you don't feel comfortable with someone -- for whatever reason -- then find a therapist you do feel comfortable with.

Ian
02-07-05, 12:52 AM
Is this like self enforced tough love?
Something like changing the self defeating mantra in your head?
Enquiring mindless person who wants to know.....


I'm no expert on this and am only really interested loosely in the principles I might exploit for my own use. What I'm taking away from it is that it's a way of recognising the negative messages I give myself then deliberately replacing them with messages that might be more conducive to a better me.

The nutshell version by someone not very familiar with it all isn't going to be the best so please flush this out with others more knowledgeable.

Currently I'm finding that often I have little messages going off in my head that I hadn't heard before just because they are so familiar to me. I've had them most of my life I expect. Mostly I give myself heck for some blunder or another. I caught myself once yesterday saying "I wish I was dead". It was a little strong for the circumstances and I'm pretty sure I don't need to be saying that to myself. I'm convinced that those types of habits aren't helping my feelings of self worth!

So I'm trying to make a list of the things I can hear go off in my head so that I can at least own up to them. I can choose to practise some other more positive habit of some other more appropriate message and learn to be more of my own best friend. :D Anyway that's the theory I'm going on.

Coral Rhedd
It's a fine line between finding a therapist that I'm comfortable and finding one that will not put up with my bad habits. I suppose it depends on what it is I'm after.

I think I put trust ahead of comfort when I look at my therapist. I know change doesn't come without discomfort but without an environment of trust I can't even begin.

You sound as if you have a dynamite session going on with your therapist. I'd love to hear what you think are the essentials of what's working for you in this vein.
Thanks to all.
Ian

Coral Rhedd
02-07-05, 02:48 AM
Coral Rhedd

You sound as if you have a dynamite session going on with your therapist. I'd love to hear what you think are the essentials of what's working for you in this vein.

IanIt's strange. Most of the time she seems to really believe in me and believe that I am an intelligent person who has the capacity to make my life better. That's very empowering. She is also warm, funny, and focused. Since I am so unfocused, this truly helps. It probably also helps that her husband is ADD so she has some insight into the frustration and the confusion it can cause.

Another thing probably helps: She has a great personality. Very charismatic. I am not the type who easily drifts into transference. In fact, I can be fairly wary. What gets past my defenses is that we share many of the same values -- political: left, religious: non, educated: over. :D

Ian
02-07-05, 11:17 AM
It's strange. Most of the time she seems to really believe in me and believe that I am an intelligent person who has the capacity to make my life better. That's very empowering. She is also warm, funny, and focused. Since I am so unfocused, this truly helps. It probably also helps that her husband is ADD so she has some insight into the frustration and the confusion it can cause.

Another thing probably helps: She has a great personality. Very charismatic. I am not the type who easily drifts into transference. In fact, I can be fairly wary. What gets past my defenses is that we share many of the same values -- political: left, religious: non, educated: over.


Well there goes the transference troubles.. :D

Thanks Coral. I appreciate the details on just what makes up a close match for you. Those same things apply to me and my professional help.
Cheers! Ian.

shinobi
02-15-05, 03:48 AM
no no no no no no. never ever again ever. bin that $hit in the place where lost socks, old jewlery and loose change seem to dissapear to.

KnittingJunkie
03-12-05, 05:04 AM
There was something here. Now there's not. Please don't ask.

Thank you.

Ian
03-12-05, 11:37 AM
I've tried but I just can't get going with this. I would expect it to work for me but I'd need a bunch of help.

When I was in a twelve step program for 14 years I read a "Daily Reflections" reading every morning and the frequency of a positive message did influence my thinking. It was a very effective way to eat away at a lot of negative messages. I didn't really even know it was happening until years into it.
Cheers! Ian.

mctavish23
03-19-05, 02:24 PM
I believe that no therapy should be "forced" on anyone.The setting in question has a real bearing on that though.

My internship back in 1975 was at the Broughton State Hospital in Morganton,N.C. I worked 4 days a week on the Token Economy Unit and then tested all day on the Neuroscience Unit one day a week. As you know, token economies are behavior modification settings. The thing that I liked the most about it was the reason behind it. The residents (instead of "patients") were chosen ( They were not forced.They didnt have to do this if they didn't want to.This also meant they were high functioning enough to decide for themselves.) to help them ultimately move out of the hospital and live on their own or in some group type setting. If not for that opportunity, most all of them would have remained in the hospital for the rest of their lives. Many of these people were in my opinion, under "chemical restraint" by way of years and years of antipsychotic meds.Back then it was strictly "old school" meds like Thorazine .Haldol, Prozac, etc.These were the real "heavy hitters, with lots of serious side effects,etc. In short, the Token Econmy helped these people work on their Adaptive Daily Living skills (ADL's) to the point where they could move from the unit to an apartment setting on the grounds.From there they could move off campus to one of several settings, depending on how well they were doing. I saw no problem with helping them learn good self care skills and then rewarding them or paying them to do those things as well as their respective other jobs they might have outside the unit. I get a paycheck every 2 weeks for doing my job.That's how the real world works.

I know for a fact that it helped several people who were at risk to become "institutionalized" make it out of there. I don't know how these folks got into the hospital or who put them there.Our goal was to see that they could live a productive life on their own.

Having said all that, I am not hard core behavior mod in my practice.I use a variety of techniques and styles to fit the particular situation.Having only one approach to anything is not a good idea. Please remember that I'm as hyper as most of the kids I see, so I have to keep it fun and exciting for them as well as me. If I had to sit there and say "And how did that make you feel?" I'd have a stroke.One thing I do though is to give each parent of a new client a handout on Informed Consent that I developed on my own 10 yrs ago.It goes above and beyond the info given to them during the Intake and paperwork part before I see them.We don't have to do that and I'm grateful. What it does is describe what I do and how I do it.In it, I outline the types of techniques I use and discuss their origin and saftey,etc.I think it helps a lot and I keep tweaking it as I go to more workshops, etc.If a kid doesn't want to be there I certainly don't make them come back.Most of the time though we hit it off and they want to come back

.Good rapport is really the key to any therapeutic relationship and not the type of therapy used.It's not about the therapist or their "style", it's about helping the client. With kids that also includes their families .

mctavish23
03-19-05, 07:11 PM
One of the things I forgot to mention has to do with Cognitive - Behavioral therapy and how it's classified. In spite of the name(s), CBT, as well as Rational Behavior Therapy (RBT) and it's off shoot Rational Emotive Therapy (RET) , are actually classified as Experiential and not Behavioral. I think Exeter put it very well in describing it as a therapy from the inside out or something like that.I apologize if I got that backwards.
The essence of CBT is "How you think effects the way you feel." With RBT and RET the core is "Everything is as it should be." That used to drive me up the wall but I've come to grips with it...lol.
The "behavior" part of it is related to what's called "ABC thinking." That breaks down like this:
A= antecedant (what triggers the negative thought or behavior the client wants to work on,i.e. presenting complaint )

B = behavior that occurs as a result of or in reaction to the "trigger"

C= consequence(s) of those actions

Some of the most common techniques within CBT are the use of guided visual imagery, deep muscle relaxation training and thought stopping. The latter has to do with interrupting negative thoughts that might trigger other problems.The most common of these are imagining either a stop sign or a red light.The reason for this is that they are 2 of the only things in the world that you only have to learn once. Then for the rest of your life you (and your brain..lol) automatically know what they mean.

One of the other types of therapy that goes well with all of the above is (Ericksonian) hypnotherapy.The late Milton Erickson is an icon in the field and is considered the father of modern hypnotherapy. He redefined how hypnosis was viewed (and conducted). One of his favorite techniques was to pattern his breathing and tone of voice with that of the client. He was able to show through his many years of research and clinical work that this helped the client calm down and relax. In the process they were then able to express themselves better, as well become more receptive to feedback, etc.One of the best books he wrote was My Voice Goes WIth You.

Behavior modification on the other hand would use techniques like operant conditioning, shaping, flooding, systematic desensitization and over correction and positive practice to name a few.


I hope this helps some in understanding what's involved in CBT and the other therapies mentioned.

mctavish23
03-19-05, 07:19 PM
I needed to clarify a mistake I made in describing the "old school" meds I mentioned in the thread on therapy being "forced'. I just realized I listed Prozac.Man is that wrong...lol. I meant Prolixin. Sorry.

Ian
03-19-05, 10:14 PM
The image of your the attitude you describe of your approach with the kids you see, makes my hair stand on end in all the right ways. My hair stands on end frequently with exposure to all sorts of music, theatre, writing, and authenticity of all kinds when it sticks a chord in me.

I've always loved kids with more fire than other (non-ADHD) adults find tasteful. I think I'm doing the wrong type of work. My youngest has been struggling ever since she went to school. She's not diagnosed but will be tested in the next few months. She's not medicated and recently I've taken to not being medicated when she gets home from school. This way I can join her on her own level. We are very much alike and we are having a ball together. We rev at the same speed. :)

Kids are a gift. I'm so grateful to have the benefit of your perspective. It confirms that I'm finally on rails with my youngest which I feel in my bones regardless. She's headed into puberty just now and she'll need all the friends she can get as she descends into hormonal grief.

I've used the desensitising to get better control over my anxiety with the dentist and doctor. The rest I'm a little vague on how it is that I'd implement. I know positive messages would be helpful but tossing them back at myself is beyond any suspension of belief I might have to muster.

In your experience what might yield the biggest bang for the buck in this realm of treatment if one was willing?
Cheers! Ian.

mctavish23
03-19-05, 11:22 PM
Thank you. For a second I wasn't sure what you meant about your hair standing on end (Whew :) ). The type of therapy that will have the most impact on a person can't really be predicted beforehand; or at least I can't do that. I really believe it has more to do with the personality of the therapist and their ability to relate to the client.If you can find a creative person who is well versed in many different techniques, then it doesn't matter so much which one they use.

Personally, I don't do group therapy for example.I don't have the patience. I also don't do a lot of traditional non directive work, largely because I'm hyper and can't shut up for that long. Everyone has their niches.Learning which ones are the best for you will pay dividends for therapists and their clients. The same applies for everyone else as well.
Good luck and thanks again.

Ian
03-20-05, 01:13 AM
I've been gifted with a good coach/therapist. She's just like you describe, in that she's well versed in the art, and creative enough to roll with it and improvise. She's been off sick for a month or so. I am tardy in sending a letter and as usual I'm full of shame about putting it off, but that's a deep pot hole in need of a new thread! :)

My question wasn't clear.
I was wondering if within the realm of CBT there was any stronger likelyhood of successes with any particular common technique within CBT?

Maybe that makes the water muddier yet. If that's the case just pretend you missed the post.. :*)

It's terrific to get to bend your ear. Thanks.
Cheers! Ian.

mctavish23
03-20-05, 01:20 AM
I don't know of any particular technique within the therapy that has more impact per se' than others. There may be but I simply am not aware.

Ian
03-20-05, 02:22 AM
Gracias

KnittingJunkie
03-20-05, 06:41 AM
Uhh...no one in here would have any idea which specific behavior mod therapy might be best for drug/alcohol rehab (in their personal opinion, having substantial scholastic knowledge on the topic) by any chance, would they? RET? CBT? Other? Wouldn't be in need of a lengthy and time-consuming explanation on the part of the person with apparently vast knowledge of behavior therapies...just in need of an acronym, if anyone's kind enough to provide one. :o (Homework.)


Chrys

Ian
03-20-05, 06:57 PM
I don't think I can offer up any acronyms but instead a little experience.

For many years I attended 12 step meetings. I no longer qualify for them.

I had read the AA book of daily reflections every morning for a long time. I attribute that habit to much of how I came to "check" some of my impulsivity.

That would be a strain of CBT no?

mctavish23
03-20-05, 07:33 PM
Perhaps. I keep 2 daily meditation books on my desk at work and find them helpful. It's good to start the day off with humility and gratitude.

Ian
03-21-05, 12:42 AM
Here here.

KnittingJunkie
03-22-05, 02:44 AM
Danke. CBT then...hmmm....noted. Thanks! (in English this time!)

Chrys