Cognitive Behavioural Therapy

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Scallywag
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Aug 16 2018 18:23
Cognitive Behavioural Therapy

Does anyone have any experience with cognitive behavioural therapy and did you find it useful?

I’ve recently started CBT and its too early for me to write it off, but I do feel like I have some problems with it and I am wondering if this is going to be useful for me or if there is anything else I should try.The CBT I am doing involves working through workbooks with a counsellor which contain checklists and thought experiments which try to get you to identify your thoughts and behaviour and whether they are rational.

I don’t like using these workbooks though. I don’t mean to be insulting to those that they do help, but they personally make me feel rather stupid and that my problems aren’t being taken seriously. It is also information that I already know, it’s just that applying it is easier said than done.

I also don’t like being challenged on my thoughts/feelings and having to prove that it is rational to think that way about myself or a situation. It doesn’t change the fact that whether its rational or not the experience is still real for me and that fact is kind of being ignored.

I’ve searched around before for leftist perspectives on counselling and a common criticism seem to be that it has an individualist outlook, ignoring the social context of mental health, blaming the individual for their mental health problems and making them fix themselves to better fit society, rather than changing society. I agree with these views, but at the same time there is kind of the risk of saying or coming to believe that mental health is all societies fault, therefore there is nothing I can do to help myself, and I don’t want to get stuck with that thought either.

Sorry that this post is a bit of a rant, would really like to hear some thoughts on this though.

What are your experiences with CBT, have you found it useful and if not have you found something else that works for you?

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shug
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Aug 17 2018 07:15

Your scepticism is refreshing given how hegemonic CBT (and its bastard offspring, Mindfulness) has become in the NHS. William M. Epstein's 'Psychotherapy as Religion' looks critically at CBT and the supposed evidence of its efficacy. I'd recommend it. It's pricey at about £20, so get your library to order it.

Fluffy
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Aug 17 2018 11:13

I guess it depends on what you're using CBT for. My partner used to swear by CBT in general but found EMDR (Eye movement Desensitization and Reprocessing) to be the most effective remedy for her PTSD.

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jef costello
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Aug 17 2018 11:43

I thought that I did CBT but I didn't have a workbook or anything.

The idea of CBT, if I remember rightly is to look at your automatic reactions and try to identify them and try to counter them if they are having negative effects. I think it can help some people and not others.

I don't see anything wrong with being challenged, I hvaen't seen the books so they might be terrible, but the idea is not to tell you that you are wrong for feeling something, but more to help you to ask yourself why you are feeling a particular way and if you can do something to change that if it causing a problem.

It also depends on what is being treated, for example I don't think a lot of mental illnesses are behaviour, in that sense, so can't necessarily be treated in that way. To be honest I think it is something that works if you have a professional trying to help you, if they are just shoving one size fits all workbooks at you then it is not as likely to have an effect. Just being asked how you feel has a beneficial effect, they control for it in medical trials, because just the fact of filling in forms to say how you are improves mood etc.

You can also check out this, but I think you know about it already

Scallywag
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Aug 17 2018 20:29

The workbooks are not terrible. They are self-help guides written by a psychiatrist and used to treat issues like anxiety, depression, low confidence and negative thoughts. You work through parts of them yourself at home, but also go over it with a counsellor. They are supposed to be helpful, but I think they are also used partly to save time by using them to guide counselling sessions and asking patients to complete parts of them at home. It is CBT that the workbooks use.

There are things I don’t like about them though. The workbooks direct the counselling sessions which I think is kind of restrictive and I feel I would prefer not to use them at all and instead talk about whatever I want with my counsellor and uncover issues as I bring them up
.
Its also kind of frustrating as I feel the workbooks contain a lot of information I already know. I know what unhelpful thoughts or extreme thinking is for example but preventing myself from doing so is easier said than done. I also don’t like that my mental health problems are being rooted in me just being pessimistic or thinking negatively. To me that seems dismissive of my experiences and I’ve been struggling with things for years, if it was so easy to solve I would have already done so.

I guess I need to give this a chance though, but I am just wondering if this is going to work and if this what counselling is like for everyone dealing with issues like anxiety and depression, or if there are alternatives to it.

PeterTCA
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Aug 25 2018 17:07

CBT is a therapy reflecting current/social organisation.

1950's followed behaviourism and Psychoanalysis

Humanistic therapies reflected the 60's.

CBT is replete with long waiting lists, targets, tick boxes
and therapists who are not required to undergo their own therapy.

All therapy, whatever system it uses, depends on the quality of the therapist.

Humanistic therapies are still available.

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Lucky Black Cat
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Sep 1 2018 17:06

It sounds like you should be in regular talk therapy where you can have more validation, empathy, and support for your pain and struggles. I do think it's important to be challenged, too, on your thoughts, beliefs, and emotions. So hopefully it's possible for you to do both CBT and talk therapy? Ideally there is a balance between validation and being challenged.

Quote:
I’ve searched around before for leftist perspectives on counselling and a common criticism seem to be that it has an individualist outlook, ignoring the social context of mental health, blaming the individual for their mental health problems and making them fix themselves to better fit society, rather than changing society. I agree with these views, but at the same time there is kind of the risk of saying or coming to believe that mental health is all societies fault, therefore there is nothing I can do to help myself, and I don’t want to get stuck with that thought either.

This is a dilemma I have, too. It's so hard to find the right balance between these two ways of thinking. I don't think I'll ever stop being confused about it.

I try to take a practical approach to this dilemma. Even if it is mostly society's fault, I can't just change society to be a better mental health environment for me. Of course as libertarian-communists, we are trying to change society, but that ain't gonna happen soon enough. So when it comes to mental health, I focus on changing myself and my life since that's what I have more control over (even though it's not total control).

Quote:
What are your experiences with CBT, have you found it useful and if not have you found something else that works for you?

I've not done CBT with a therapist but have used workbooks. I did find it somewhat useful in changing some of my negative self-talk. But like you say, though it may be easy to identify better ways of thinking, it's a lot harder to change your thought patterns. Constantly monitoring and adjusting your thoughts is tiring, and leaves you with less mental focus for learning or engaging in other activities.

Because of this, I don't keep up with CBT practice. However, learning CBT has left me with better mental habits than I had in the past. So although I'm not rigorous about it, I generally have healthier thought patterns than before, even though they can still be pretty fucked up. Also, if I get into a particularly fucked up place mentally, I'm somewhat better equipped to find my way out of it.

I do find, though, that changing your conscious thought patterns, as CBT teaches, only has limited ability to change your underlying beliefs and emotions.

Basically, CBT has been useful in improving my mental health, but on its own it hasn't nearly been enough. I do think it's worth learning, though. Even if what you learn seems obvious, it's about developing healthier mental habits.

Black Badger
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Sep 1 2018 19:06

We can leave aside the question of why the abject alienation of the individual that happens under capitalism necessitates an institutionalized system of professional listeners and counselors (in my more cynical moments I have called this "rent-a-friend").

Quote:
All therapy, whatever system it uses, depends on the quality of the therapist.

This is what I've found as well. Some therapists don't converse with their clients, others intervene quite a bit. Some use particular techniques they like, but may not be the best practitioners of them. Because therapy is so personal, you need to find a practitioner who is self-aware as well as being at least professionally empathetic. It also helps if they aren't throroughly bourgeois in their outlook -- my therapeutic process does not need to include justifications of my politics.

I have done CBT, EMDR, talk therapy, and various combinations. The best therapist for me was one who used to work in the same field and then moved into psychology to assist her former coworkers. I didn't have to spend any time explaining the jargon or the acrynyms or the unhealthy attitudes of my coworkers -- she already had that as part of her history. From the beginning it didn't matter that much which techniques she used.

Wordwizard
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Sep 2 2018 01:14

I have used CBT, and found it helpful, truthful, though hard to come to terms with. You might want to look at the variety of stress reduction techniques, as well as the challenging of false thinking.

Scallywag
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Sep 12 2018 17:01
Lucky Black Cat wrote:
This is a dilemma I have, too. It's so hard to find the right balance between these two ways of thinking. I don't think I'll ever stop being confused about it.

I try to take a practical approach to this dilemma. Even if it is mostly society's fault, I can't just change society to be a better mental health environment for me. Of course as libertarian-communists, we are trying to change society, but that ain't gonna happen soon enough. So when it comes to mental health, I focus on changing myself and my life since that's what I have more control over (even though it's not total control).

Yeah I think you have the right approach here, thanks very much for sharing this.

Some of the things that cause me massive worry are things like finding a decent job or career, and doing well in studies and with that avoiding this dilemma is very difficult. I often end up getting into conversations with my counsellor about work, and are met with responses like there is so much freedom to do any kind of job you want, and questions like what would I like to do, whats my goal/ambitions?

That is frustrating and I am like fuck all of that, I am anarchist and all I want is to live as a free individual in a social / collectivist, decentralised, libertarian society.

I've not brought up political things like that with my counsellor, I am not so sure that's a good idea, but it gets hard to avoid it.

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Lucky Black Cat
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Sep 12 2018 20:13

CBT and other therapy stuff tends to have a liberal streak a mile wide. Individualistic and overly optimistic. Most commies/anarchists will naturally recoil from that. But as the saying goes, don't throw the baby out with the bathwater.

At times when exploring CBT or mindfulness, I would get angry and just want to dismiss the whole thing as garbage. But I resisted the temptation. Instead, I search for what makes sense to me, discard what I don't like. A lot of the time I edit or amend the advice to suit a more realistic, politically aware world-view.

I try to be a realist, but an optimistic skew on realism, rather than a pessimistic skew. Optimism and pessimism can become a self-fulfilling prophecy, to some extent. There are many other factors that I have no control over, but a realistic level of optimism will have a positive influence on my actions.

Sadly, we will most likely never live in the society we want, and thus never have anything close to the life we want. The next best thing is to live a life where we work hard to make that possible for future generations. And try to make as decent and happy a life for yourself as you can.

I wish you all the best in figuring that out... and do keep us posted on this thread with updates. grin

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Lucky Black Cat
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Sep 12 2018 20:14
Scallywag wrote:
I've not brought up political things like that with my counsellor, I am not so sure that's a good idea, but it gets hard to avoid it.

I wish there were more commie consellors!

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sherbu-kteer
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Sep 15 2018 15:22

This is a very interesting thread, thanks to all for contributing. I thought I might add a bit from the other side of the chaise longue... I've studied a bit of CBT. I haven't had the opportunity to use it yet with any clients, so no experience in that regard but from a directly theoretical point of view there are plenty of downsides to it.

I don't want to get into a whole long spiel, but the neoliberal tsunami of the late '80s led to a shift in the way mental health care was delivered in most western countries. Efficacy (defined as 'value for money') became the order of the day and the newly-empowered layer of managers made it clear that all social support should be structured around 'evidence-based practise'. Methods that could not be clearly validated by empirical research, like psychoanalysis, lost ground to methods that could, like CBT.

From a researcher's point of view, CBT has a lot going for it; studies consistently show that it is particularly effective in the treatment of anxiety disorders. But it doesn't work for all clients, and it contains some philosophically questionable assumptions (for more on that, I recommend these two blog posts: 1, 2 -- sadly mental health researchers and practitioners do not study philosophy anywhere near as much as they should). The reason it's so ubiquitous is because how handy it is from a neoliberal POV -- it (usually) has a defined time-frame, its predefined outcomes are easily measurable, there's an endless backlog of studies and meta-analyses that show it gets results, it's fairly cheap, easy to grasp, you don't even need to pay a therapist to deliver it (as you mentioned, there's the workbooks, and there are even CBT websites and apps that can do it all remotely), etc etc. You put money in, you get a functioning human out.

There's also a background ideological bonus in the way it -- rightly or wrongly -- centres the patient as the main problem. In other words, it's not the external stimuli that make the anxious man anxious, it's the anxious man's cognitive patterns. And once you change the anxious man's cognitive patterns, the anxious man is no longer an anxious man. And I'm not calling that notion wrong! But you can see how it's so attractive for the neoliberal politician, or the manager of a clinic; you don't have to change a thing structurally, you just have to change the person. It's purely individualised. If work is making a person anxious, you don't have to change their shoddy working conditions, you just have to teach them to respond to those shoddy conditions without getting anxious.

Hopefully this made sense and I wasn't just rambling. There is a lot of critical literature about this, I know in the field of social work it's discussed mainly by people interested in 'critical social work', not sure what the equivalent might be for other fields. Unfortunately 90% of it is trapped behind paywalls, obscured by needless jargon, or seemingly written by crackpots, but it's there. I will try and find some readable open access stuff for you if you are interested.

gbcr
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Sep 23 2018 01:57

I believe the root issue of most mental health issues is the fundamental alienation and trauma from abuse in our society. If you live in an actual community where people actually care about each other and are honest, you probably wouldn't really need therapy. However, the system teaches us not say or express what we really feel. Labor and life gets very alienating.

Therapy provides a way to help overcome at least some of the negative feelings from this. You can find a way to express all the ways you've fucked over and abused, and at least pretend you have some actual connection with another person. It doesn't solve the broader issues of society, but when you have live the system, it be useful. Protests and direct actions may also be useful in this regard to some extent.

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shug
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Jan 2 2019 12:56

This is a useful account of how the 'cognitive approach' to illness/disablement/unemployment functions as an attack on our conditions. (Towards the end gives the impression that it's all down to them nasty Tories, though the writer corrects this in the later comments..)

https://kittysjones.wordpress.com/2016/11/29/rogue-company-unum-had-a-pr...