Cognitive Behavioural Therapy for depression -- how best to approach it

[Dearthworm]

I've just had my fourth or fifth session. I don't know how to make best use of it, and the therapist is less focussed, less directional, than I had expected.

In the past I have had psychodynamic 'talking-cure' therapy, where everything is very free-flowing and spontaneous, and part of what I thought would be attractive and useful about CBT was the highly pracical, well-defined approach, where you take e.g. a negative thought, pick out the associated situation, mood, behaviour, and work out strategies for interrupting bad patterns, etc. etc.

This is what the therapist is doing at core, I suppose. But it is fluid and diffuse I suppose because depression is a diffuse, all-ecompassing thing. I can see clrearly how helpful the approach is with tightly defined unhappiness a phobia for example. But I am floundering with the shapelessness, the everythingness, of depression. And I wonder if the therapist is too (not because he is rubbish -- he isn't rubbish).

Today he said something (harmless in iteslf but a trigger of parts of my unhappiness) and I was so upset, so sobbing, that I couldn't think straight for any of the disciplined identification of problem thoughts, behaviours, etc, and the identification of alternatives.

And when I came away I thought that the best thing about the session had in fact been the disabling grief, the expression of sadness, which kind of calmed me, emptied me.

So I wonder if I should be having a completely diff sort of therapy -- the old free flowing talking cure again. But that didn't 'cure' me before.

[Dearthworm]

I just wondered how other people had experienced cbt for depression, and whether their therapy stayed very focused, or just ranged reactively over the whole stormy sea.

[Dearthworm]

Anyone?

I feel a bit wrecked by today's session, really ill, and I don't know what to do about making the sessions more constructive.

[whitecloud]

Dearthworm - am thinking of trying CBT. Maybe you are so overwhelmed with your feelings you are finding it difficult to focus on something so defined and you need other therapy as well. I find depression so frightening because you can feel so dreadful and then better - the mood swings are awful. You are also much more sensitive to everything when you are depressed, so maybe that's why you reacted so strongly to what therapist said.

Sorry I've no personal experience of CBT yet, but I feel it maybe should be used with other things. I am having other counselling as well. Just wanted to reply, so you don't feeel so alone. Thinking of you.

[Deathworm]

Thanks whitecloud. sorry you are low too. I just felt so overwhelmed by grief, and it was such a shapeless, everything feeling, and so disabling in terms of doing the work, but also cathartic. You are prbably right that we ought to have two kinds of therapy in tandem! I suppose resources wouldn't permit that though -- I already feel I've had more than my fair share of the NHS cake.

Other sessions have been less devastating. It might be becasue I have dropped my anti-depressants. I'll keep plugging on.

Sorry about your mood swings. That isn't so much a eature for me. It must be hard and disorientating.

[sb9]

I have tried both CBT and pyscodynamic and neither has worked for me so far. Felt the CBT was too clinical and a head than heart of thinking what you should do and pyscodynamic just made me think more of the past and get angry. No idea what im doing now either!

[Deathworm]

I'm sorry to hear that sb9

I found that at least psychodynamic therapy was cathartic and also interesting, even though not fundamentally helpful. Whereas CBT seems to give nothing. I'm sure it is v helpful for some conditions, but not depression, for me at any rate. Nor are pills, so I've ditched them. Exercise seems a good coping thing.

[HelensMelons]

Hi Dearthworm

I have just done a module on CBT and you have absolutely identified how effective it is in terms of working psycho-educationally with your counsellor. The practical strategies to identify mood, etc can work very well.

However, I think you have also identified its limitations - it sounds like you have personally identified grief and loss as your underlying difficulties, and although, CBT will can give you strategies to manage feelings/irrational beliefs associated with this - it won't necessarily touch on the trauma (?) itself iykwim.

There are other types of counselling available, bereavement might help but if you check out the BACP website a humanistic, integrative counsellor might fit best. That type of counsellor can utilise CBT strategies if needed, etc but can also meld other theories to work with each client to fit what they need.

Exercise is a fab way of coping, when I had pnd I became a gardening fanatic (I'm ashamed to say it didn't last!!).

Grieving is overwhelming and complicated x

[Deathworm]

Thank you v much Helen. I will look at the BACP website.

[HelensMelons]

You're welcome, you've changed your name?!

[Earlybird]

'Today he said something (harmless in iteslf but a trigger of parts of my unhappiness) and I was so upset, so sobbing, that I couldn't think straight for any of the disciplined identification of problem thoughts, behaviours, etc, and the identification of alternatives.

And when I came away I thought that the best thing about the session had in fact been the disabling grief, the expression of sadness, which kind of calmed me, emptied me.'

How did the therapist react when you began sobbing? Why not talk to him about what he said and how it triggered such a profound response for you? Is there a way to take your response and use CBT on that issue specifically?

Maybe you can also talk to him a bit more about CBT, how it can assist you (ie what you can 'expect'), and whether it is the 'right' therapy for you atm.

I've never had CBT, but those I know who like it usually have had years of more traditional analysis, feel 'talked out' and want some practical coping strategies rather than (as one friend put it) more 'navel gazing'.

[jabberwocky]

" those I know who like it usually have had years of more traditional analysis, feel 'talked out' and want some practical coping strategies rather than (as one friend put it) more 'navel gazing'. "

I'm one of those Earlybird. It worked wonders for my PN PTSD and I credit CBT for regaining my sanity and being able to have ds2.