To tell my counsellor no I can't do the bloody homework?

[sorryihaventacluetoo]

I'm having phone CBT for postnatal anxiety and depression (both heavily interlinked, tough to unpick). It's my second session tomorrow and all I can think about is that I haven't had a chance to do the homework she emailed to me after our first session. She emailed me a 98 page booklet to read through and wanted me to complete two pretty substantial worksheets - ironically about what I get up to during the day.

I have a husband that works away a lot, a 12 week old baby and a four year old with ASD. They're full on. And I have no family help. DS is settling at a new nursery so theoretically he'll be gone for 15 hours a week but at the moment he's only managing half that, so I'm up and down to nursery a lot. What I would very much like for that one hour a week is a chance to talk through the stuff that's crowding my head and doesn't get any outlet at all. Giving me homework just adds to the workload.

AIBU to just not do the homework and tell her this? I don't feel a CBT approach is particularly useful in this circumstance. But I know I'm lucky to get this chance to have it.

Just explain why you can't do it.

She's following a set format, which, in your case, doesn't work for you, so she needs to change it.

She's looking for patterns, to work on, to change.

She'll be glad to hear how much you are out and about.

My therapist for PND etc told me that I had too much time on my hands and that was the issue. I had a similar age gap to you, with a DH who worked away and abusive childhood memories that had come back. I had gone NC with my Mother during my Pregnancy.

Some don't have a clue.

What I would very much like for that one hour a week is a chance to talk through the stuff that's crowding my head and doesn't get any outlet at all. Giving me homework just adds to the workload.

Tell her exactly this. She may be able to refer you for something that is what you feel you need, or your GP may be able to refer you for counselling instead of CBT. Other ways to access counselling include privately or via an employer's "Employee Helpline" (yours or your DH's).

The fact that you didn't / couldn't do it will be important for her to know. Perhaps you could do it with her during the session.

However, what is the point in doing counselling if you aren't even going to try what she suggests? At least give the homework a go for a 2-3 weeks before you declare it pointless.

Are you afraid of what the homework will uncover?

From what I can gather, CBT is pretty much the only type of free counselling you can access around here. Probably because it's cheaper and short term.

I'm not saying it doesn't work btw. I'm just saying I don't think the approach works for me in this situation.

@RabbitsAreTasty No, I'm not afraid Rabbits. I can see what the homework is driving at - showing me that I don't have enough time to do things that I find pleasurable. But at present because I have no way of changing that what's the point in doing the exercise? My baby will still be a baby next week. My son will still have ASD. I'll still be knackered.

I've had CBT and was given homework but it was just some thought sheets, not 90 odd pages. Perhaps at your next session ask for an alternative, more light weight version. The worksheets I had did help with the therapy so I do recommend them but I only spent a very small amount of time to doing them so there are alternatives that take far less time that are also effective.

I did CBT for similar reasons to you when DD was about 6 months old, I had done it before and not done the homework and this time I was determined it was going to work so I made myself do it, just for an hour one night a week and what I didn't get done in that time didn't get done but it worked 1000x better doing the homework than not doing it so I would advise if you possibly can do it to do it because it does make a difference.

Interesting to hear @Pickleypickles - thanks for sharing

I have PNA and although CBT is the recommended treatment- I found psychotherapy worked much better for me- and psychotherapy has 0 “homework” generally- it’s all about what you do in the time

I feel a bit like CBT is a sticking plaster... research on it seems to support my view.

I agree that you need to communicate this.

But my other thought was this:
When my counsellor gives me 'homework', it's something that I value doing. I find it useful to do and it has meaning. I don't "enjoy" it necessarily, but it has a useful purpose (and its never as bulky as what you have either, by the by!)

If you find the tasks she sets an inconvenience or unwarranted (as opposed to valuable but you just don't have the time?), then I wonder if it is the task or the approach or even the counsellor that isn't right? This is for your benefit, not hers, so its important that it works for you and your lifestyle.

It's tricky about CBT because for some people it really does work - and is demonstrable - but because its effects are demonstrable, it gets all the funding while alternative forms of therapy (whose outcomes are less demonstrable or predictable) aren't facilitated. I'm a huge fan of the NHS but this is a flaw in its system, that certain treatments become absolutely relied-upon and chances aren't taken on other options that might be more beneficial to individual patients' needs. I'm so grateful that my university provided talking therapy; I'd never have been able to pay for it myself.

Mind you, I have found CBT to be really beneficial to me in terms of dealing with my anxiety. A 98-page booklet sounds a lot though; see if you can come to some other solution with the therapist before jacking the whole thing in.

I had CBT for PND and anxiety, and found it useful. Before that, there were so many tasks I'd just put off, days I wouldn't leave the house etc.

But it's not a talking therapy. Before the CBT started, I had a few weeks where the CPN would drop by my house for an hour just for a chat. It wasn't "therapy" as such, it was just a chance for me to offload what I was finding particularly hard. Could you ask your GP if that would be available?

I have had very successful cbt and this is nothing like what I had to do. This is far too much and overwhelming for anyone. Let alone someone with mental health issues.

Tell the counsellor it is too much.

CBT is about changing your mindset and giving yourself the tools to cope with the anxieties you experience. It’s not about changing your lifestyle it’s about helping you deal with your life stressors. It’s the type of therapy that’s supposed to benefit you long term instead of a shoulder to cry on at the moment you’re struggling. If you have anxiety and depression then you really need something that will help you in the long run, you don’t want something that will help you for 8 sessions and then leave you in the same predicament as before.

I think the time has to be right for CBT, it wasn’t for me in the past (similar reasons to you op) and back then, counselling would have worked better I think. A few years later CBT did work very well for me, but I was able to do my worksheet and phone sessions while my kids were at school and nursery and that made all the difference.

When I did my CBT (fairly recently) I was given the option to choose either counselling, or CBT. It seems unfair that you were not given that choice.

That said, the print outs, probably about 98 pages tbh, were to go along side the CBT sessions as notes to refer back to. I don’t remember being to,d to read them all.

You need to be honest with her as to why you haven't done the homework, that in itself should give you both something to talk about and work on. Don't give up on the support though. However, it's worth trying to make a few minutes after the kids have gone to bed to read a few pages or start on the paperwork as that'll will also give something to work on.

It's one of my big bugbears in life that CBT is the only type of therapy available on the NHS. Yes it's helpful for some, but what about everyone else?

CBT has been proven, in a lot of cases to have a positive impact. It is the first port of call for the NHS because it can give the patient substantial benefit in a short space of time. The only way to benefit is to do the homework as it's to change your thoughts process and coping mechanisms.
I agree that a ninety odd page booklet is overwhelming and difficult to find time to get through and this needs to be discussed with your therapist. I only had a few sheets a week to work through.
It deals with day-to-day issues but if there are underlying issues then having talking therapy along side this can be beneficial. Unfortunately mental health funding has been cut so you may have to look at charities for this.
I was lucky. I had CBT through the NHS and counselling through works occupational health. After a relapse, my doctors surgery had an in house counsellor through relate.
If I were you I'd look into charities that deal with pnd to see if they can offer anything and try and continue with the CBT.

CBT isn't the only type of therapy available on the NHS. I had 2 and a half years of psychodynamic psychotherapy weekly sessions with a clinical psychologist. Most areas will have a secondary psychological services department that provides more in depth support to those they think need it-the issue is getting access as it's usually pretty heavily guarded. It does exist though.
In terms of the OP, it does sound like you would benefit from counselling rather than CBT. Was the referral through your GP or through IAPT?

We were given homework of a similar length for dd's phobia. We didn't do that but just used the essence of what she had advised (gradually exposing her to her fear) It did work

Explain why you haven't been able to do the homework.

CBT is short term therapy for acute issues. In my opinion, PND is more than just an acute issue. You may need better, long term therapy so don't be afraid to ask your GP to refer you somewhere else if you need it.

On the other hand, the PND and anxiety may lift naturally. I do hope so.

Just be completely honest with your counsellor. Some work between sessions is useful, but giving you a 90 page book and complex worksheets shows a poor understanding of your situation and of patient compliance in general.

Ask your counsellor how the course of treatment can be adapted to suit your individual situation.

I got cbt for schizophrenia. It was NICE guidelines.
It worked on rationalising delusions and hallucinations.
It isnt just bog standard shit for minor issues at all.
Depends who you get imo. Sometimes wallowing with the shit stuff makes things worse.

Has she got a baby and a child with ASD.
Quickly jot down a days work. That should give her a bit of an idea and make you feel better. Tell her you didn't have time to complete it and you have realised this maybe part of the reason you are stressed.
If she hasn't had any children she won't understand.

It is a ridiculous amount to be given to read and would put most people off.