I’m a Cognitive Behavioural Therapist (CBT), ask me anything

[BeaPerry]

I’m a Cognitive Behavioural PsychoTherapist (CBT) AMA ?

Definitely
in my experience across mental heath services, the needs of people with neurodivergence’s have been not recognised and not met
in recent years, services are recognising that people with neurodivergence are more likely to require mental health services, and more likely to have poorer outcomes within mental health settings,

the responsibility of the therapist is to develop a shared understanding with the person of the psychological difficulties and tailor the CBT to the individual with adaptations for the impact of the ND - when this happens it can be very effective

Yes, it can be, if the person with dementia is experiencing a psychological problem that there is a CBT treatment protocol for - such as depression, panic disorder etc ..
it would require adaptations for the individual and would need the Individual ro still have ability to learn new information and retain it, or it would be the wrong approach

I trained in CBT a few decades ago when mental health services were more multidisciplinary-
psychdynamic / cognitive analytical /
etc etc

it is not good that CBT has become the ‘little bit will help / fix most things” that the NHS has set up, in recent years

I work with disorders that will benefit from CBT -
there are psychological difficulties that I do not work with because CBT is not appropriate-

it is not good that access to good quality other modalities of psychotherapy are hard to access

Thank you for your thoughtful reply.

I'm wondering about this too. I have huge frustration that, in our local NHS at least, whatever your issue, the first "hoop" to jump through is 6 weeks of CBT.

I had to go through this whilst coping with a dire family situation where all the reframing in the world wasn't going to change it. If I mentioned this the CBT practitioner was clearly a bit stumped - and it felt as though they actually didn't care and were hired to read me a script.

Once I proved this "hoop" didn't work I got put on the waiting list for a counsellor, who was genuinely helpful.

But the point is it's left me with a really negative view of CBT and means that I refuse any CBT type interventions from my otherwise very good therapist. I've also heard a lot of negative things about CBT from others who have been through this NHS path. So I do wonder if you feel this NHS model is doing your specialism a real disservice?

Does CBT help with trauma?

I was surprised to find out that CBT practitioners don’t actually diagnose anything. Apparently it’s just “working with the client on areas where they would like to focus”.

Troubled teen was referred and had 30+ sessions, was told she was depressed, was strongly encouraged by therapist to change her whole life (e.g. drop out of uni), but when asked for any supporting evidence e.g. to give to the uni she was told the above. Is this normal?

which issues won’t you take on as CBT might not be the best therapeutic approach for them?

I did this through the NHS for my postnatal anxiety back in 2018. I had a young graduate trainee as counsellor who had her supervisor watching remotely (which was already anxiety-inducing in itself). She suggested, based on this idea, that I should record my voice describing all the terrifying scenarios in my head and then listen to them multiple times a day to desensitise myself.
It didn't work as I got obsessed by my non-British accent while listening back and couldn't focus on the content.
So she told me to write them down and she would read them while I recorded on my phone.
It didn't work either and 1 year sessions were absolutely useless until I actually started medication.
Is it possible that with some personalities CBT simply doesn't work?

a therapist should be happy to write a supporting letter/report for University if they’ve spent 30 session with a client. Did they refuse to?

Could CBT help me with constant and worrying thoughts about being alone in old age? My worry stems from the fact that I have no children and am an only child myself.

I suspect that CBT is a therapeutic approach which requires an extremely high level of readiness and willingness to change from the client at the beginning , which is unrealistic in many cases and definitely with children and young people.

Yes - CBT : reframing your thoughts can look like gaslighting and the therapist has to make sure they are not gaslighting-
e.g. Person struggles with self critical thoughts - therapist says change that to I am good enough - person feels gaslighted -

therapist should dig into the specific thoughts/ meanings/ behaviours reinforcing the beliefs and hep the person to step back, look at the evidence and form their own reasoned response to the critical voice

And yes to your 2nd question
CBT delivered on the cheap devalues CBT and people

Yes 👍 definitely-
the therapist should facilitate the person to develop an acceptance of their authentic self -
if that means they can’t achieve the things they want to do - such as go into a cinema, we can look at how they can manage their needs in space where there may be challenges and find a way to achieve their goals without masking -

I have seen some studies showing CBT has limited positive effect for autistic people and actually, in many cases, causes harm. Do you have links to studies supporting your opposite view that you can share?

Not that I’m aware of sorry,
but the Mental Health in schools teams often employ CBT practitioners so the ones in your locality should advise

Thank you. That's very helpful.

But this presupposes that the problem is the person’s thought processes and within their control, when often if there is a biological cause of their difficulties or it is due to difficult life circumstances they may already be doing everything possible that could be expected to cope and CBT is effectively just blaming them for the situation.

Is it worth going private? I hear people have more success with it I assume because use sessions aren't limited as they are with the NHS?

How would you sum up CBT in a few sentences?

what conditions/ issues /ilnesses does it work the best for?

I have a very vague notion of it and I could google it but would like your take on it as a practitioner

He told her he could write a letter to say how much she had improved, but the university said they needed an actual diagnosis to be able to make any adjustments.

Of course, part of this might have been (young adult) teen’s interpretation, hence my question.

There is no doubt that CBT definitely helped though, at least in the short term.

a therapist should look at reasonable adjustments with the client and write suggested reasonable suggestions in any letter or report. They can’t formally diagnose, that’s a job for a clinical psychologist or psychiatrist.

A psychology degree can be a gateway to many careers -
look at the various psychologist roles
PWP
MHWP

No, there are good evidence based treatment protocols for trauma with CBT
EMDR is also a good treatment for trauma
it depends on the person and the trauma
however there are other modalities of psychotherapy outside of CBT and EMDR that can help with trauma
trauma is a very broad area