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Remembering Why I Will Never Ever Have Cbt Again.


Fizzle

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For those of you who asked me:

Aaron Beck, one of the founders of Cognitive Behavioral Psychology was a psychiatrist in the psychoanalytic tradition. According to him, he discovered one day that it was often what a depressed patient was NOT telling him that was causing more suffering and distress than what his patient was telling him. So he decided to go beyond psychoanalysis and try to figure out what his patients were thinking that they were not sharing with him. He discovered that patients often had thoughts like: "I am just no good." "I am basically a failure." "I am shamefully weak and cowardly." "I am really stupid." "I am hopelessly ugly." "I'm lazy." "I'm really a bad son [bad daughter]" "I am evil."

When he began to discuss with his patients, these previously unspoken thoughts and show that they were not true and not fair assessments, he found that his patients began to show improvement and began to feel happier and more at peace. His patients told him that they felt better than they did from just analysis and depth psychology.

For those who asked me, this is probably the core idea of cognitive behavior therapy. Beck did not say that the thoughts caused depression or that CBT always worked to alleviate depression. In fact, he said that often depression got better on its own with time, or that talking to a sympathetic person or friend could be more helpful that CBT or that medicine was often key to improvement.

In relation to anxiety, Beck believed that "some" people for whatever reason, attach a sense of life-or-death importance and urgency to matters that are not really life-or-death and that some people can be helped by relieving unnecessary stress in their lives. Beck did not believe that CBT was miraculous or the be-all and end-all of therapy. He felt that it could be "helpful" to certain people with certain forms of depression that involved self-hate and certain forms of anxiety that involved artificial senses of life-or-death urgency in non life-or-death situations.

Edited by Epictetus
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I think CBT can be useful but it depends. I agree with Epictetus in that it is helpful in situations where a person is manufacturing their own crisis. In other words, there is no evidence to support their perceptions (irrational). I don't think CBT works as well when there is a marked neurological impairment OR when their is in fact clear evidence that sh*tty things are really happening to them.

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I was mostly helped by antidepressant chemotherapy. But I was also helped by CBT and other psychologies too. I think the chemotherapy and the psychology helped each other in my case. CBT did the most good for me personally [no disrespect at all for other psychologies, schools of psychology and\or traditions!]. If I felt like a "bad" person, a CBT practitioner would ask me: "How bad are you, really?" "Did you cause the Holocaust or some other atrocity that resulted in tens of millions of deaths?" This put my weaknesses and faults in perspective and helped me feel better.

Or, if I said: "I must do this," a CBT practitioner would ask: "How important is it that YOU do it?" "Are there alternatives to YOU doing it?" "If you were to suddenly disappear, would all the things you need to do simply remain undone, or would things somehow resolve themselves one way or another?"

If I felt stressed out, a CBT practitioner would ask: "Is this really of life or death importance and urgency?" or something like that. And I would calm down.

If I felt weak or cowardly or stupid or ugly or dumb or bad, a CBT practitioner would ask me: "Can a complex human being like you, made up of trillions of things and events and experiences, really be equated or "summed up" in a word like weak, lazy, stupid, ugly, dumb or bad without grossly over-simplifying your complexity and depth?" "Isn't it true that you do hundreds of brave, strong, ambitious, wise and good things every day?" And I might say: "Well, those don't count." And a CBT practitioner might say: "Could it be that they don't count because you don't count them?"

So for me, the experience of CBT was helpful. It offered me encouragement when I was discouraged, compassion when I was self-hating, consolation when I was sad and so on. And in addition, CBT taught me: "Hey, lets see if we can teach you how to encourage yourself when no one is around and how to comfort and console yourself when no one is available." And . . . "hey, lets see if we can teach you how to help yourself feel a little better when a med isn't working so well or there is no therapist available or when there is no one to talk to."

And it wasn't like the CBT therapist was saying to me: "Here is a perfect solution to all life's problems." No CBT therapist ever told me that CBT was going to be salvation or heaven on earth. LOL. It was never that dogmatic. It was always more like: "Here is some stuff that was helpful to some people. Would you be willing to see if it might be helpful to you."

That was my experience with CBT. It was like a cooking class: "Here is a spatula, a rolling pin, a blender, a big spoon. Here's how to use them when they are helpful. They are not always helpful. Its okay if they sit in the drawer. Some, you will probably never use in your own cooking."

Edited by Epictetus
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Among the self blame and self hate and extreme emotions, making everything a life or death emergency is something I did as well. Coming here has really opened my eyes to the fact I was pretty blissfully ignorant to the extent of my mental health issues. That said, I do see that I have made some progress in overcoming some of them, the anxiety and urgency, so that is good. But man this stuff is hard. Well this place is doing a good job helping me see all the pieces of my life coming together. That's a good thing.

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I've read that CBT may be helpful for ADD/ADHD, but I think I'd have to be willing to make the changes in my brain and trust that the process was sound.

Like Epictetus, I believe I've benefitted immensely from my anti-depressants. Without them working, I'm pretty sure I wouldn't be able to tell a sound suggestion from an insane one! In fact, I'd be more likely to listen to the insane one.

Thanks Fizzle, for starting this thread.

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Bigmike, I should clarify the numbers I mentioned are for an out of network provider of DBT not CBT who does not participate with insurance (I have gotten anthem to authorize and cover supposedly at in network levels with the huge catch of using their in network customary amd reasonable caps).

Icarus, tahmks for mentioning the song I like it

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Ok, I will share a little more. I had an extremely brief experience with it and probably wasn't long enough to determine if it was right for me but I was referred by my counselor to try a site called mood gym. Took me a while to remember but eventually I went and tried it out. I log on and create and account. I didn't know really what to expect but tried to keep an open mind during it. The site asked me questions on a rating scale. Being asked questions like this wasn't new but I felt turned off because I could see right away what the "correct" healthy answers were and what answers were "wrong." When you finished section one you were chosen as a character based on your answers. To my surprise, there was a "correct character" and every other character was flawed. It basically said you need to be like this character and change. I didn't like that too much. And the questions were too simplified. I took methods last semester and learned the term mutually exhaustive and mutually exclusive which meant that only one answer can be chosen and at least one answer has to be chosen. There were some where I could pick 2 out of the 4 answers shown. Some of them I couldn't narrow down to just one. It was frustrating. The testing was too rigid and didn't allow for flexibility, therefore, I couldn't give the most accurate information. So after 30 mins I just quit and never tried again. I felt sad and since I wasn't the "chosen" character I felt bad. I have a history of comparing myself with healthier, better people. I did later get referred to try DBT which I will have to talk with my counselor the next time we meet. I was told CBT isn't for everyone but can be very useful if you have certain conditions.

Icarus21, I tried MoodGym back in 2006 (I was 14/15) and I remember thinking the same thing! I didn't like how the tests implied there was obviously a "correct" way to think/be and overall the methods were oversimplified. I remember my self esteem actually got worse because I wished I was cheerful and upbeat like the "ideal" character but I just wasn't. The site's methods seemed generic and generalized.

Edited by KayElle
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Such a great discussion going on here!

Icarus that program sounds awful!

Thanks Gandolfication yeah I'm with a good therapist now. I liked what you said about how when we love and accept ourselves we are more able to find a balance between encouraging and pushing ourselves. Silly example but at the gym last night I went to do my last set of squats and thought "I can't do another 15" so I said to myself "that's ok i'll just try 5" and then ended up doing 10. To me that was really nice as I can struggle in finding that balance between being too harsh vs lazy hehe.

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A therapist told me that in CBT they teach you to replace negative thoughts with positive thoughts, in DBT they teach you to shift your focus to something else. I know logically why a lot of my thoughts are unreasonable but knowing that hasn't helped me stop thinking them that much. I think some of them have been helped by CBT though. A lot of my thoughts are reasonable but my emotional response is to strong. DBT gave me tools to help me calm down.

That makes total sense because when I am not having an extreme emotional reaction I can catch and shift my thoughts pretty easy but when the emotional reaction is out of control the shifting is not going to happen. I just hang on and try not to hurt myself or anyone else and then have to spend a lot of time digging myself out of the dark mood it puts me in. So I really need to look at it as two different approaches based on how I am behaving in the moment. Very helpful for me. Thanks.

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gandolfication , CBT sessions cost between $140 - $180. I am lucky to be paying the lower rate. My employer's insurance does not cover it. I complained to my union and they said to me, "You should tell your employer." I told my union they are the ones who agreed to this in their contract. My union did not disclose the agreement until eight months after the contract was signed and sealed. My employer and union are in bed together.

Now back to the CBT discussion.

I picked up a book form my local library called "Mindful Way Through Depression."

We will see how if it helps.

Edited by duck
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Epictetus, you had a really good therapist. I like the way you put it.

""" It was like a cooking class: "Here is a spatula, a rolling pin, a blender, a big spoon. Here's how to use them when they are helpful. They are not always helpful. Its okay if they sit in the drawer. Some, you will probably never use in your own cooking.""""""

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I think CBT can be useful but it depends. I agree with Epictetus in that it is helpful in situations where a person is manufacturing their own crisis. In other words, there is no evidence to support their perceptions (irrational). I don't think CBT works as well when there is a marked neurological impairment OR when their is in fact clear evidence that sh*tty things are really happening to them.

afflicted, you are absolutely correct.

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Such a great discussion going on here!

Icarus that program sounds awful!

Thanks Gandolfication yeah I'm with a good therapist now. I liked what you said about how when we love and accept ourselves we are more able to find a balance between encouraging and pushing ourselves. Silly example but at the gym last night I went to do my last set of squats and thought "I can't do another 15" so I said to myself "that's ok i'll just try 5" and then ended up doing 10. To me that was really nice as I can struggle in finding that balance between being too harsh vs lazy hehe.

Mellabella,

I really like that simple example - and I find it a little hard to articulate exactly in words, but that's it. It has to do with perspective, self-compassion, self awareness and possession and still pushing ourselves within what we can, in a world that (as I see it) is still essentially socially darwinist and competitive, and where we must eat and have clothes and shelter and hopefully some other comforts.

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Generally speaking, If some type of psychotherapy helps a person, I am all for it. I would guess that most therapists are eclectic and consciously or unconsciously borrow what they regard as helpful wisdom from whatever source. And as others have pointed out so beautifully, the personality of the therapist can have a major impact on the outcome of therapy.

I come from an academic philosophical background, so CBT was a good fit for me. I can see how others would be turned off by it or disagree with in on a deep level. When I was in a graduate program for philosophy, almost every professor was someone who profoundly disagreed with every other professor. But we all got along more or less and challenged each other in the good sense.

If I were to look at CBT from a "philosophical" point of view, I would tend to think one of its greatest strengths in relation to depression is its understanding of "over-simplification." We are finite beings and cannot cope with the near infinitude of data flooding our minds without recourse to simplifications. At the same time, we are capable of rising above simplifications at times and recognizing that they are simplifications of substantial, dense, deep and complex realities. It would be easy to "sum up" a person with a label like: lazy, weak, cowardly, ugly, stupid, no good. A lot of depressed people do that to themselves every day. But a part of us can rise above this and recognize that a real human being cannot really be equated with a simple label without gross misrepresentation of their depth and complexity. So over-simplification can be seen "from above" so to speak as 1] untrue [half-truth, 100th of a truth] and 2] unfair.

CBT practitioners are often characterized as promoters of positive things. But most CBT practitioners disagree with this. Positive thinking is not helpful if it is untrue or unfair. So it is not that a person is no good and just tells himself that that is an over-simplification that doesn't do justice to their being. The positive must be true and fair. So CBT practitioners wcould say they advocate realistic thinking.

The idea is to get a well-rounded picture. For example, an aircraft crashed today. A fact. But as many as 40,000[?] aircraft did not crash today. Also, perhaps a fact. In depression, negative facts seem to pile up in a person's mind. CBT never denies a negative fact. It just asks whether it is also a fact that there are other facts [to counter over-simplification]. Often in depression a person paints a portrait of themselves that lacks most of his or her features. It would be like asking someone to draw a portrait of them but only allow them to draw the nose. Maybe they draw the nose quite well, but the portrait would be incomplete. What about the eyes, the mouth and so on?

For me personally, just the CBT idea of the dangers of over-simplifications in causing or contributing to people feeling bad, is huge and profound. At the same time, I recognize that a others would disagree. People disagree about things. That doesn't mean we have to "assume" they lack insight or good-will. Perhaps I am wrong.

Edited by Epictetus
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Gandolfication: Glad you liked the song! Was it the one from Michael Caan??

KayElle: Wow. That is surprising. I thought I was overreacting a little when I excited out but It is reassuring to know I wasn't the only one who that that. Thank you! Yes! And you are correct! The correct one was the upbeat cheerful one. I felt like crap afterwards.

Mellabella: It was very simplified and every question felt loaded. It wasn't the best on my self esteem.

I didn't know it was so expensive for all of these treatments. Why wonder people struggle with throwing in the money for something that isn't totally guaranteed. I was very fortunate with having very good insurance and my mom paying most of it when I was younger.

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Hi Everyone! Soo many thoughts. A really good discussion. Thanks to everyone contributing. Epictus I am glad you commented and hoped you would as I didnt want people reading this thread and then being influenced away from CBT when it helps so many people. I hate it for myself but as i said to start I really do see its value in a bigger context. Not EVER EVER again for me thank you very much but I do know how many people it helps.

I dont have time to do justice to answering now but shall be back! I have spent years trying to prise apart what exactly it is that makes it not work for some and help others. What factors are there that support each. I am obsessed about understanding these things about people for certain reasons of my own. Even after years I feel my theories on it are half baked. I sometimes wish I had professional level knowledge (education) briefly just to aid me being able to think it through in the way I want to.

Behavioural therapy of any sort was not what I needed at a certain point. Talk therapy isnt for everyone by a very long shot but it makes me sad to see it sidelines so much these days.

Will come back with my half baked ideas.

Edited by Fizzle
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Fizzle,

What you said about hating it for yourself while also recognizing that it helps many reminds me how profoundly unique and complex we are to respond differently to different forms of therapy and treatment and even different practices or approaches to ourselves. We are not one size fits all and it is easy to say that, but there is so much commonality in experience even in different varieties of depressions and human experience, that once one has been at this thing for a while, that can tend to get lost. I find great hope in this, even if it also complicates the matter.

It also reminds me that one of the principles that I think every therapy should and probably seeks to adhere to is doing what is effective in accomplishing the desired goal (in DBT most broadly of building a life one wants to live). DBT makes it an explicit principle that runs throughout it, and is one reason I like it (I think it does too on a more granular scale at least).

"I have spent years trying to pry apart what exactly it is that makes it not work for some and help others. What factors are there that support each. I am obsessed about understanding these things about people for certain reasons of my own. Even after years I feel my theories on it are half baked."

I think this is normal for anyone who's been at this for a while, especially a deep thinker, which most of us with too many eyes are. I have this impulse in great quantity, and I have to try to be a bit equanimical about it, appreciating and accepting myself for the way I am (and part of me genuinely does like this boundless impulse to analyze everything to death), while also seeking to detach, move away from obsessing and just live more simply in acceptance.

Anyhow, I've much enjoyed this discussion - thanks for starting.

-g

Edited by gandolfication
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I think it is good that Fizzle and others call into question the assumptions, premises and conclusions of Cognitive Behavior Therapy. And I mean that! Although CBT helped me enormously, I myself have many questions about its philosophical presuppositions. I don't regard it as final and authoritative. It is a finite, very limited vision. It contains some truths but not the Whole of Truth by any stretch of the imagination. Even when it states something that is either self-evident or reasonable, it is inadequate to the vastness and near infinity of its subject matter both in form and content. I tend to approach it point by point and ask: is this true or false . . . is it certain or probable or possible or doubtful . . . and if it is true, how is it not the full truth . . . what has it not said and what has it left out? So while I am profoundly grateful with what it has helped me with in depression, I am not its cheer-leader or praise singer. I wouldn't want anyone to feel bad about disagreeing with CBT and disagreeing deeply!

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Epictetus, I hope you didn't get the impression I was against CBT. I hear it helps many people and I'm very glad about that. I feel it is like a medication where it will work for other types of people and not others based on their diagnosis. I love that you added to Fizzle's topic!

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Thanks Icarus. I agree with you.

I think there is also a simple form of CBT and a deeper one. The deeper form of CBT seems to me to be more helpful than the simpler form. Maybe I'm wrong about that. I think the simpler form is a step towards the deeper form. In the deeper form, concepts, judgements and discourses are seen as maps. A good map is designed to do two things at least: First, it must truthfully show what it intends to show. And second, it must be simpler than what it depicts. A map of a forest that showed every tree and pine needle would fail because it would be as hard to navigate the map as it would be to navigate the forest! LOL.

A map also serves certain goals: a geographical map, a hiking map, a geological map, an aeronautical map . . . all are simplifications, but are interested in different kinds of things. So one map can leave out things that would be crucial in another sort of map. And that "leaving out" is intentional. A geological map can be good and helpful but perhaps not to an airline pilot.

It is important to remember that a map is a map and not the terrain! ! ! This is a good thing to remember about concepts, words, propositions, judgments and even entire discourses. All of them leave out tons of details. I guess one of the deeper insights of CBT is that words are always in a sense over-simplifying substantial, deep, rich and complex realities. It is different to spend one's day in a map of a forest and spending one's day in the real forest! I would say that is almost a mystical aspect of CBT. It has a love/hate relationship with words, especially words as labels.

A label is a kind of over-simplification. Someone says: "She is fat." Fat can be a label. We can overcome an over-generalization or over-simplification sometimes by being more specific: She is 5 feet tall and weighs 240 pounds. CBT is leery of labels: He is weak. She is dumb. He is cowardly. She is lazy. He is a failure. She is ugly. He is no good. A label can make a person feel bad when a more accurate statement would not.

Why not just forget all the thinking and go with intuition? Many great sages have had a vision and asked their followers to just believe, just follow, don't ove-rthink, don't give in to the monkey brain jumping around." That sounds great. But the problem is that without thinking, how can one praise the vision of a sage and criticize the vision of say, Adolf Hitler? People with visions often say: "You will see it when you follow my vision." But that can be dangerous. Sometimes we need data and logic.

Even a truth is part of the whole of truth. Even a truth has a history which is open to the future, open to being enriched or not. Something can be both true but inadequate to the Whole of truth. It is impossible to say everything all at once. I can say that 2 + 2 = 4. The statement can be both true and inadequate. It also seems like mystery grows with knowledge instead of decreases. Truths do not abolish the mystery, they make it bigger. Every answer leads to more questions. And often something that can be said, can be said better.

I think if someone from the future were to look at CBT, they would see partial truths, errors and an incompleteness that didn't know it was incomplete because it was too caught up in its own history. So maybe being fair minded involves always having some humility. I don't know. That's just what I am thinking at this time in my life. What I don't know is infinite compared to what I do know! ! !

Edited by Epictetus
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Hi Epictus!

I don't call into question it's assumptions and premises as such. I see it as one weapon in a potential arsenal. I do think it has certain failings when it comes to helping some people. Like me!!! And I do think it's focus is limited and a little simplistic at times. (yes I think when it goes into schemas then some of that is filled in). Which is fine when treatment providers recognise and are open to that but can potentially cause more difficulties when they aren't.. I have come across so many therapists (socially)who are incredibly rigid and dogmatic about CBT. And generally as people. Very narrow and judgmental in general and not in response to me discussing the topic like I am here. CBT does seem to attract a certain amount of people who are this way inclined from what I have seen. People who are very different to you Epictus as you are the opposite and I am glad it helped you love your wonderful little brain. I love your far from little brain too. :)

Shall be back folks as I need the time to put down something I find complex!

Edited by Fizzle
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  • 2 weeks later...

Still coming back to this guys!. Its just a hard topic for me and I am also finding certain things difficult at present. I didnt want anyone to think I didnt read or appreciate their response.

Edited by Fizzle
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I don't hate CBT, know it helps most people, understand it's value and the concepts that it embraces. I also don't want to put anyone off. It just really really really isn't for me. Never ever again thank you very much. Actually from a personal perspective I do hate CBT.

Whiling away the time through the night I came across old reruns of a series called Celebrities in Therapy and it reminded me of everything I hate about CBT. Its brought up a whole lot of old feelings and memories. I so wish that I had never had it when I was young and desperately needed someone to support me in a way that would help me.

It's not for me either. My behaviors are intact, it's my nerves and anxiety that are a mess. Hopefully my meds won't fail me anytime soon, but if they do, I'll have to just plug along.

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