I'm a CBT therapist AMA

[FeelingsAreNotFacts]

I work as a CBT therapist for an IAPT service. I know there are lots of misconceptions around what CBT is and what IAPT can help with. AMA!

Please tell me your route to getting there

is it true that people with autism don't respond well to CBT?

How much personal therapy did you have to do, while training?

What mental health conditions do you think CBT is most helpful for?

Have you ever used CBT for Pseudodementia? Was it successful?

It depends on the difficulty the client has and to some extent the skill level/adaptability of the practitioner. If someone presents with textbook, say, health anxiety and simply happens to have autism alongside this, no problem. I've done some training on adapting CBT interventions for clients with autism which was really helpful.

However, sometimes somebody comes in flagged as needing support with social anxiety or OCD etc but when you delve in a bit more detail the problem is actually difficulties with social communication due to ASD or their 'compulsions' are actually a form of emotional regulation rather than OCD compulsions proper. This sort of case is where there are going to be problems: we'll be encouraged to try and work with them anyway but the training doesn't equip us to work with ASD difficulties specifically. It's frustrating for both therapist and client and a crying shame there aren't more specialist support services for this demographic.

Do you feel lots of people get fobbed off with "6 weeks of cbt" that could do with deeper counselling. A plaster/band aid if you will?

When I knew I wanted to work as a therapist, I did some counselling skills training and gained relevant voluntary experience in the 3rd sector (mentoring disadvantaged young people, then manning a domestic violence helpline). I then trained in a core profession (won't say which as outing but think nurse, social worker, OT etc) and worked in a community mental health team for a bit. I then applied for the NHS High Intensity CBT training which is a fully funded postgraduate course that pays you at Band 6 for a year while you learn. Once qualified, you move up to Band 7.

I had cbt. I dont felt it made any difference.

Does it annoy you when people won’t help themselves and just appear to want to moan about their situation?

I've actually had a huge amount of personal therapy across a range of modalities (including CBT!) and feel I'm a better therapist for it but this was previously - I didn't have any specifically for my training. Personal therapy isn't a requirement for CBT training. It's tricky to see how it could be mandated because the IAPT CBT training teaches you interventions for specific mental health disorders (eg. panic disorder, body dysmorphia etc), as opposed to counselling training which teaches people to work with a huge range of 'life' issues (childhood abuse, grief, divorce, etc). So unless a CBT trainee actually had one of the conditions, it wouldn't really be possible to do CBT themselves iyswim? In my experience though, it's quite rare for an IAPT CBT therapist to have no personal experience of therapy.

In my personal clinical experience, I have the most success with body dysmorphia, health anxiety and panic disorder - I think the interventions for these are hugely effective and it's a joy to watch people get better over the course of treatment. I also think it works really well for mild to moderate depression (ideally first or second episode) and OCD, though less well in severe cases or where there's a long history of trauma or recurrent depression.

What's an IAPT CBT Therapist? (One of the things I think is hard in therapy is the endless acronyms!)

I wonder what questions you are expecting to be asked and what misconceptions you are thinking of primarily?

I had to look this up as I'd never heard that term before - every day's a school day! I've not, no and I've never heard any colleagues speaking about it either. I'm not sure if you'd work with it using the depression intervention or if it would require specialist adaptations. I'll be on the look out now!

As an autistic CBT therapist, actually we do respond well to CBT because it's logical, there's clear rules to it and it can be adapted to suit the individual.
I know I'm not the OP here but couldn't read and not reply to you!
And @CupOfCoffeePlease yes I feel way too many people are fobbed off with 6 sessions when they likely require longer or a different approach. CBT is a time limited intervention but that can be 18-24 weeks plus, depending on the presenting issues.
Good luck OP, and sorry for jumping into your thread!

This is what I was going to ask. Struggling massively with invasive thoughts. I’m a ‘high-functioning’ ASD/ADHD woman (have a career, single parent and managing - well, ish). My counsellor suggested CBT but I’m skeptical about it helping because of these issues and we agreed EMDR might be better.

How many clients do you see in a normal day? Do you get a break between each client? Is your job stressful?

I think people are often offered CBT when counselling would be more helpful, yes but I don't think they're being 'fobbed off' so much as there isn't anything else. In my service, there is almost no counselling on offer and what there is is for very limited circumstances and even then only for up to 12 sessions. So yes, we assess people who definitely need long-term counselling but it's not that we're withholding it, unfortunately, we simply don't provide it. I always explain the difference between CBT and counselling to clients at their assessments and if I feel they would benefit more from counselling, offer to signpost them to local providers but these all charge. Ideally, the NHS would offer masses more holistic/person-centred counselling alongside CBT and other talking therapies.

I'm sorry to hear that. It doesn't suit everyone in every circumstance. I hope you manage to find the help you need

I was also going to ask about autism. I had CBT for depression, and I told them about stuff I don’t do because people are mean to me because of my autism. They spent ages convincing me that my thoughts were distorted and actually I could do those things. So I tried - and people were mean again. Which means I don’t see how CBT can help, because the premise is that your thoughts are faulty. But what if your thoughts aren’t faulty, they’re actually true and correct?

1.how long was the iapt training and how 2.many modules?
3.how many weeks in uni and how many in training / practice?
4.what percentage of your clients are actively self harming or suicidal ?
5.do you know any one who is working privately and managing a small caseload of , say 5 a week?
thank you so much…. 🙂

Is doesn't annoy me so much as make me wonder whether CBT is the right therapy for them at this time or if there are some unhelpful thought processes interfering with engagement. So I'd draw it (kindly!) to their attention and we'd clarify what they're hoping to get out of therapy. If they want someone to listen to them vent and validate their experience, that's absolutely fine but it's a job for counselling rather than CBT and I'd signpost them elsewhere. Sometimes though, there might be thoughts there about fear of failure or feelings of hopelessness about never getting better which are stopping them from engaging properly. It's always good to drag these to the light and do a bit of gentle exploring/challenging to hopefully get things moving in the right direction!

Do you think CBT just doesn't work on some people?

I've had it twice (once for anxiety and once for depression) and it just didn't work. I really tried to engage, did all the homework, did extra reading etc. but to me it felt like I was being told to "think happy thoughts" - not putting down what you guys do. I am referring literally to the idea of changing my thoughts.

I am well aware of cognitive distortions and very aware that my thoughts are irrational. But I was never able to actually change them in a way that changed my mood.

For example if I text someone and they don't get me back, I can easily identify my thoughts of "I bet they don't like me. I wonder if I've done something to upset them". And no matter how I try to spot that thought and try to change it and replace is with "Maybe they are busy" or whatever, I simply don't believe it.

I believe that they're angry at me. Even though it might not be rational. It's not likely but it's not impossible. And every bit of me believes it's true. Even after weeks of practising it.

All the "rational" thoughts I try to replace with are just basically lies to me. It's like thinking "I have blonde hair" and I don't. It doesn't make me think it's true. I am just saying something I don't believe in my head.

I'm asking this because I have a couple of things going on currently which I have not sought help for as I know I will be given CBT again. Is it possible that I'm just not understanding or doing it right or does CBT just not work on some peoples brains?