CBT and control

[seekingERPnorthwest]

I decided to end my 2nd attempt at CBT after 13 sessions - thanks so much to everyone who helped me come to the decision.  I can't sleep and was just reflecting on my 2 experiences of CBT.

It occurs to me that in my experience, the way the therapist controls the CBT sessions is quite different / the opposite to other therapies.  In counselling, it feels like a safe space to talk without being judged, whereas in CBT, the therapist comes across as the dominant person with the knowledge, who controls where the discussion goes.  This is maybe why I haven't liked it - because I prefer to be an equal rather than the inferior person in the room, and I'm not comfortable if someone is trying to be authoritative over me.  I can't stand it when they start trying to deny my experiences, and that is when I lose confidence in their ability to help me.  I'm happy to listen to suggestions and other viewpoints to my own - just can't hack it if someone attacks me when I'm trying to express myself / or if I don't agree with them, says it's because I'm not ready for therapy.

[snowbear]

I'm sorry to hear your experience of CBT wasn't a positive one, seekingERP.  Perhaps it will help you (and others who feel their CBT was unsuccessful) to review why this might be so.

A founding principle of CBT is it's a partnership of equals. It's possible you had a therapist who didn't sufficiently involve you in the process, or it's possible your perception of control was different to the therapists idea of how much control they were giving you. Either way, don't get the wrong idea about CBT. It's not about being told what to do, or an authority figure trying to dominate you and direct you.  

However, it is the CBT therapist's job to challenge your thoughts and beliefs.  Or rather, to show you how to challenge your own thinking. It's about making you aware that your current interpretations of thoughts and feelings isn't the only possible way to interpret things and that you're reacting the way you do out of familiarity and habit in preference to putting in the mental effort of considering other options.

Don't read 'putting in the mental effort' as criticism. Everybody does this shortcut of thinking, deciding how the world works and then basing our reactions on those ideas so we reach conclusions without having to work everything out from scratch and can make decisions quickly. It's normal. When you're recovered you'll still do this 'shortcut thinking' just using a different set of beliefs to direct how you react.

Getting you to challenge your thinking doesn't mean the therapist isn't listening to you, or denying your experiences. The therapist is (or should be) non-judgemental about what is under discussion. Sometimes though, we read judgement into people's reactions when what's really happening is we are judging ourselves and assuming the other person must be coming to the same conclusion. 

CBT isn't about teaching you right from wrong or trying to change your viewpoint. The therapist's job is to help you recognise what thoughts and beliefs you take for granted and then to challenge them. You're still free to choose what to think and how to react. But you can't change what you do in future if you aren't aware of what you're doing now. 

Consider these two different outcomes of therapy:

1. You say, 'I now understand I have several options on how to interpret my OCD thoughts, but after giving it due consideration I want to keep the set of baseline beliefs I've already got and carry on thinking as I do now. I understand that means I'll always have OCD and nothing will change.'

That would be evidence that therapy had been successful. Even though you'd not be walking away free of OCD you'd have grasped the principle that you can change how you see the world if you want to and you've made a free choice not to change. The therapist would probably be sad for you that you've chosen OCD over normality, but respect that it's your choice to make. You and the therapist part company on friendly terms.  

Now let's look at what you said above, or how it comes across:

2. 'How I see the world is the way the world is and I don't appreciate being challenged on that. I'll listen while you make suggestions, but if the other options don't suit me I'm not going to give them more than passing consideration while I stick firmly to my guns. If you disagree with my viewpoint then I interpret that to mean you think I'm wrong. That makes me feel under attack. That makes me feel I'm not allowed to express myself. Based on the way I feel after our therapy sessions (angry, upset, confused) I conclude that CBT doesn't suit me.' 

This is evidence that you haven't understood what therapy is about. You aren't there to offload how you feel without getting that mirrored back to you for further consideration. You haven't accepted you have options on how to interpret things and that changing your interpretation would result in you coming to a different conclusion on how the world works, with a different outcome.

Perhaps you haven't grasped that you're not there to be told the right way to think. Perhaps you've not understood that the therapist isn't starting from a judgement standpoint that how you think in the throes of OCD is 'wrong'. For the therapist your OCD thinking is just one way of interpreting the world and it isn't helping you to live the life you want, which is why you're there. The therapist views their job as helping you to find a way to think that benefits you more. It's not about 'fixing' you. (Bad therapists fall into the trap of believing they can fix people instead of remembering the sufferer has to make changes himself/herself.) 

Your interpretation, your choice, you directing you - that's the aim of CBT.

When you understand the aim of therapy then you'll be 'ready' for therapy. Then it stands a chance of being successful. When we go into therapy with false expectations of what it's supposed to achieve, or fixed ideas about what it should and shouldn't do, we'e already on an uphill struggle that's likely to fail. 

Sometimes a break in therapy is useful while we absorb the information we've already been given. Take some time to reassess what you learned from these sessions and don't write it all off as failure. You might be surprised how you've absorbed more than you realise by being uncomfortably challenged. In the coming months, as you continue the battle against your OCD, some of that thought-challenging may come back to you in beneficial ways.

I've had both counselling and CBT and the way I see it is this:

Counselling makes you feel better immediately (you feel heard and understood and validated), but it doesn't change how you think. Just as reassurance never reassures for long with OCD, the feeling better doesn't last and OCD persists or returns. 

CBT challenges you to think differently and (if you pick up the gauntlet and run with it) OCD recovery occurs and you feel much, much better in the long term.  

[seekingERPnorthwest]

Thanks, Snowbear

[Gary.p]

3 hours ago, snowbear said:

I'm sorry to hear your experience of CBT wasn't a positive one, seekingERP.  Perhaps it will help you (and others who feel their CBT was unsuccessful) to review why this might be so.

A founding principle of CBT is it's a partnership of equals. It's possible you had a therapist who didn't sufficiently involve you in the process, or it's possible your perception of control was different to the therapists idea of how much control they were giving you. Either way, don't get the wrong idea about CBT. It's not about being told what to do, or an authority figure trying to dominate you and direct you.  

However, it is the CBT therapist's job to challenge your thoughts and beliefs.  Or rather, to show you how to challenge your own thinking. It's about making you aware that your current interpretations of thoughts and feelings isn't the only possible way to interpret things and that you're reacting the way you do out of familiarity and habit in preference to putting in the mental effort of considering other options.

Don't read 'putting in the mental effort' as criticism. Everybody does this shortcut of thinking, deciding how the world works and then basing our reactions on those ideas so we reach conclusions without having to work everything out from scratch and can make decisions quickly. It's normal. When you're recovered you'll still do this 'shortcut thinking' just using a different set of beliefs to direct how you react.

Getting you to challenge your thinking doesn't mean the therapist isn't listening to you, or denying your experiences. The therapist is (or should be) non-judgemental about what is under discussion. Sometimes though, we read judgement into people's reactions when what's really happening is we are judging ourselves and assuming the other person must be coming to the same conclusion. 

CBT isn't about teaching you right from wrong or trying to change your viewpoint. The therapist's job is to help you recognise what thoughts and beliefs you take for granted and then to challenge them. You're still free to choose what to think and how to react. But you can't change what you do in future if you aren't aware of what you're doing now. 

Consider these two different outcomes of therapy:

1. You say, 'I now understand I have several options on how to interpret my OCD thoughts, but after giving it due consideration I want to keep the set of baseline beliefs I've already got and carry on thinking as I do now. I understand that means I'll always have OCD and nothing will change.'

That would be evidence that therapy had been successful. Even though you'd not be walking away free of OCD you'd have grasped the principle that you can change how you see the world if you want to and you've made a free choice not to change. The therapist would probably be sad for you that you've chosen OCD over normality, but respect that it's your choice to make. You and the therapist part company on friendly terms.  

Now let's look at what you said above, or how it comes across:

2. 'How I see the world is the way the world is and I don't appreciate being challenged on that. I'll listen while you make suggestions, but if the other options don't suit me I'm not going to give them more than passing consideration while I stick firmly to my guns. If you disagree with my viewpoint then I interpret that to mean you think I'm wrong. That makes me feel under attack. That makes me feel I'm not allowed to express myself. Based on the way I feel after our therapy sessions (angry, upset, confused) I conclude that CBT doesn't suit me.' 

This is evidence that you haven't understood what therapy is about. You aren't there to offload how you feel without getting that mirrored back to you for further consideration. You haven't accepted you have options on how to interpret things and that changing your interpretation would result in you coming to a different conclusion on how the world works, with a different outcome.

Perhaps you haven't grasped that you're not there to be told the right way to think. Perhaps you've not understood that the therapist isn't starting from a judgement standpoint that how you think in the throes of OCD is 'wrong'. For the therapist your OCD thinking is just one way of interpreting the world and it isn't helping you to live the life you want, which is why you're there. The therapist views their job as helping you to find a way to think that benefits you more. It's not about 'fixing' you. (Bad therapists fall into the trap of believing they can fix people instead of remembering the sufferer has to make changes himself/herself.) 

Your interpretation, your choice, you directing you - that's the aim of CBT.

When you understand the aim of therapy then you'll be 'ready' for therapy. Then it stands a chance of being successful. When we go into therapy with false expectations of what it's supposed to achieve, or fixed ideas about what it should and shouldn't do, we'e already on an uphill struggle that's likely to fail. 

Sometimes a break in therapy is useful while we absorb the information we've already been given. Take some time to reassess what you learned from these sessions and don't write it all off as failure. You might be surprised how you've absorbed more than you realise by being uncomfortably challenged. In the coming months, as you continue the battle against your OCD, some of that thought-challenging may come back to you in beneficial ways.

I've had both counselling and CBT and the way I see it is this:

Counselling makes you feel better immediately (you feel heard and understood and validated), but it doesn't change how you think. Just as reassurance never reassures for long with OCD, the feeling better doesn't last and OCD persists or returns. 

CBT challenges you to think differently and (if you pick up the gauntlet and run with it) OCD recovery occurs and you feel much, much better in the long term.  

Good morning snowbear,

im about to embark on my cbt journey in a weeks time, and your above statement has clarified my mind as to what I need to do to succeed.

I have had cbt before, but that was about 13 yrs ago, and I would say in the long term it was pretty successful. What makes me angry and frustrated is that I was referred to my CMHT over a year ago and they just talked about medication. Then I had crisis intervention and that was basically the same thing.

Surely CBT should be tried initially with people and then try medication? I'm just sounding off because people with OCD are not getting the intervention they deserve.

 

[Avo]

Hi ERP,

I am sorry you felt the need to end your therapy early, I too have been in a position where I feel I didn't get along with my therapist and it effected how I responded to therapy. I was given the impression and of course it was my interpretation and not necessarily fact that my first therapist was looking down on me, almost revelling in his own  knowledge of the condition and enjoying the sound of his own voice.  He may have had the theoretical knowledge of OCD but for me he had not got the people skills to relate to me. I could tell it was not going well as towards the end of our sessions he said something along the lines (and I am paraphrasing here)

"this is not your first course of CBT and it may be that if you don't respond and put in the effort that you may not be able to access further CBT in the future".

This for me was not a professional thing to say even if it's what he was thinking. Coupled with the fact that my dad died of cancer during the sessions and he knew this.

3 years later I am back with a different therapist in the same location  who is firm with me put I feel has that bit of empathy for my situation without offering re-assurance. I feel as a result I am learning more and responding better to the CBT this time around. She has in my opinion a firm but fair approach and I respect her more for that.

Snow bear I think has given some excellent advice - as she always seems to do, I find myself nodding in agreement almost every time I read one of her posts. I would not give up on CBT, if you get the right therapist it can make a big difference.

 

 

[Fender]

I think I get what you mean. When I had cbt I found some things did really help me but I was never totally satisfied with how it was going. Maybe it was like you said, the therapist lead everything.