Am I doing CBT wrong or expecting too much?

[nodogz]

Right, come on here to get put straight. I don't know if I'm being a sensitive flower or not!

TLDR
I'm doing CBT for self esteem and I'm put out because the therapist said I need to try more
AIBU - try harder and do the work they suggest
YANBU - that sounds different to my experience of CBT, maybe it's not a good fit with this therapist?

I'm doing NHS CBT work as I've had an awful year and trying anything to feel better. I've got some sessions to try and unpick my very low self-esteem.

But I never seem to have the right answers for the therapist. Like she asked me to set goals for the week to do something I'd never tried before or want to do and I said I have no idea what I could do? I have no hobbies or real interests and haven't ever (always putting myself last). She suggested something that didn't appeal (couch25k) and I said no thanks and gave some mitigating factors. But then she said I have to want to change in what I took to be an exasperated way.

I do seem to spend my time saying "I don't know" throughout the sessions and just upsetting myself going over painful feelings. I don't know the answers to the questions asked and I feel lost in the process - like I'm doing feelings "wrong". I'm trying hard to be honest with her and myself and be open to new stuff but I'm getting the vibe she thinks I'm a bullshitter or quitter (I'm not, I'm genuinely afraid and worried about breaking forever if another bad thing happens). I expected to be coached more through the process or guided toward achievable goals.

I feel like quitting the whole thing tbh. I can commit to a coffee with a friend once a week as a nice thing to do but can't see what that will achieve if I'm never honest with my friend in the weekly meeting. I could do it for the rest of my and still never believe that my friend genuinely likes me or wants to spend time about with me or would want to hear how I really am. I thought we'd be tackling why I'm like that rather than just doing more pretending?

That doesn't sound like the CBT I did... it sounds like her approach us around motivating you (or trying to) towards a desired end point - which only works if you where you want to end up.

My CBT was more about moving away from my default reaction to life experiences - eg why I always assume the worst when it comes to myself...

For what it's worth, mine was for anxiety/depression and I did online self guided, so maybe not directly comparable?

Therapist sounds inexperienced to me. Is this NHS?

I'm not sure CBT is really the right thing for self esteem issues.

CBT is a relatively "light" short term therapy. It's not really a talk therapy.

It gives you ideas/tools to help change your thought patterns. It does require a lot of your own input and work away from the sessions.

CBT is always going to be a challenge, as it's about changing how you think, which will likely put you out of your comfort zone.

I've done the NHS online course (for low mood) with weekly check-ins from a psychotherapist - and initially felt the same way with some of the goal setting. However, in the long run, I do feel it really helped.

Improving your self esteem is hard. I've had incredibly low periods over the past decade. It made me constantly question myself and I never felt like I had the 'right' answer. Even when that answer was something like an opinion (and therefore no wrong answer) I would find myself saying 'I don't know' again and again.

Maybe this exercise is trying to help with that? If you don't know what to do, try picking something new at random. Draw or colour something. Dance along to your favourite song. Try a yoga video. Make a meal you've always wanted to try. Read a new book. Pick anything and understand that there is no wrong answer. Even if you don't enjoy the activity, you have learnt more about what you do and don't like doing than if you hadn't done anything at all - which helps with confidence down the line.

I would definitely say keep at it.

I think therapy doesn't work because of what happens in the one hour a week you are with the therapist.

It works because of the journalling, discipline, reflection, experimenting etc you do week round.

It is hard work. And time consuming. And it doesn't feel great.

It took me a while to understand my therapist couldn't fix me or change me. But that they could support me as I did.

So in one sense your therapist is right.

And her challenging you is trying to help you.

The onus is on you to try the techniques. Or it won't work.

But maybe switching will help. It does sound like the trust isn't there and you aren't working well together. You might do much better with someone else.

@Yummypumpkin

I think therapy doesn't work because of what happens in the one hour a week you are with the therapist.

It works because of the journalling, discipline, reflection, experimenting etc you do week round.

It is hard work. And time consuming. And it doesn't feel great.

It took me a while to understand my therapist couldn't fix me or change me. But that they could support me as I did.

So in one sense your therapist is right.

And her challenging you is trying to help you.

The onus is on you to try the techniques. Or it won't work.

But maybe switching will help. It does sound like the trust isn't there and you aren't working well together. You might do much better with someone else.

This explains it very well, this was my experience of it.

CBT can work very well indeed for self-esteem issues. I think that your case perhaps needs more careful handling, hence my thinking that the therapist is inexperienced.

@Yummypumpkin that's really well put. I often say to people that therapy is like learning a musical instrument - your hour a week will have little impact on your development - you need to practice practice practice.

However, bring up how you're feeling with the therapist; it may be your negative self-imagine talking, or they might need to work differently

Well there are several different kinds of CBT. It sounds like the CBT they are giving you is designed more for depression than for self-esteem. So Perhaps these initial sessions are designed to see whether your low self esteem is being caused by depression (depression does cause low self esteem).

Secondly, there are no right or wrong answers in therapy. Whatever pops into your head, say it even if it seems silly. I think your self esteem is influencing you here and your trying hard to give “right answers” there are no wrong answers.

Third, “I don’t know” is a perfectly good answer. Don’t feel bad about it.

If the coffee with a friend was suggested as an activity that would bring your mood up, it isn’t meant to be a therapy session in itself where you are “honest” with your friend. It’s meant to be a time where you can connect with another human, talk about anything at all, distract you from your hard work in therapy, and just to make you feel better. The therapist is trying to find things you enjoy that reward you in a way because the therapy sessions are hard work and always stir up bad feelings.

It's difficult to comment on the quality or experience of your therapist but I think CBT is intended to change the way you think about things rather than get to the bottom of why you think a certain way.

I went through a very dark and difficult period in my life some years ago and I read somewhere that you cannot think yourself into a new way of acting you have to act yourself into a new way of thinking. I wonder if she was getting you to think of doing things you wouldn't usually dream of doing and encouraging you to do them anyway as a way of challenging your core beliefs about yourself and the way you think others see you. You may get some ideas about things to do which take you outside your comfort zone (just a little way) by finishing the sentence, "I wish I could...".

Would you feel able to have a conversation with her about how this process is supposed to work? I hope you manage to work it out and get some benefit from the process.

I

From all the therapy i have been through... one thing i have taken away is that (almost invariably) when you say "i don't know", you actually do have an answer, but you feel embarrassed or worried or ashamed of how you are feeling and articulating that answer... (obviously all tied up with self-esteem issues as well)
but as pp's have said, CBT is hard because it's about retraining the way you think and approach difficult situations and some of that may involve putting yourself in an uncomfortable position to try and kickstart a new approach...

good luck!!!!

the NHS loves CBT as it gets results (albeit sometimes short lived) for relatively low cost.

I'm surprised the therapist hasn't 'CBT'd' you on identifying other possible reactions around the coffee with a friend.

How do you feel when therapist asks you to think of suggestions (the bit where you say 'I don't know'?) if you feel unable to identify any of the things required of you then it's not going to work.
when is had NHS therapy (second time around as the first time was acknowledged by them to be inadequate, therpists are only human) I felt able to be honest and challenged her on what she was expecting.

try it mate? it could be the first step on being genuine and making progress.

sorry..meant when I had therapy

This therapist sounds shit. Some NHS therapists are.

A basic skill for any kind of counselling is proper listening.
CBT does involve questioning (and "reprogramming") beliefs and habits, but it also involves validating feelings. Sounds like your therapist is pretty shit at the second part. Normally just talking to her about your feelings should make you feel better about yourself, as she validates them. Sounds like she's doing the opposite.

The basic principle is that your feelings are real, and yours, and not wrong. What needs to change is how you look at them, and act about them. The things that need unpicking in CBT is your unconscious beliefs. For instance:
something makes you feel unhappy => this must be because you're such a rubbish person?
The first part is a feeling and needs validating. Your unhappiness (or fear, or anger) is real. Be mindful of it.
The second part is the toxic belief you need to get rid of.
CBT can totally work for self esteem, but you need skilled support.

@Yummypumpkin

I think therapy doesn't work because of what happens in the one hour a week you are with the therapist.

It works because of the journalling, discipline, reflection, experimenting etc you do week round.

It is hard work. And time consuming. And it doesn't feel great.

It took me a while to understand my therapist couldn't fix me or change me. But that they could support me as I did.

So in one sense your therapist is right.

And her challenging you is trying to help you.

The onus is on you to try the techniques. Or it won't work.

But maybe switching will help. It does sound like the trust isn't there and you aren't working well together. You might do much better with someone else.

Absolutely this, wot @Yummypumpkin said

CBT in a group setting can be very helpful.

Then you are coached over your own stuff and watch other people wrestling with theirs. It's so.much.easier seeing what other people are missing about themselves.

For example, did I read correctly that you can't think of anything new to do because you have got into the habit of always putting yourself last? That you think the therapist is getting frustrated that you cannot think of something to do for yourself. ?

I doubt the therapist is frustrated by this, it seems as if you are absolutely at the point of what you need to change in order to get out of this way of thinking that isn't serving you well. Of course it's easier for you to jump to your habitual thoughts of 'why you can't' make this change than to make that change, to think of something.

That might be where you are stuck now.

Please consider that you putting yourself last, not being able to think of something you would like to do for yourself and thinking that your therapist is getting frustrated by you - these are all your thoughts.

Thoughts that are your habitual way of thinking. Thoughts that do not serve you well.

CBT is one way to help you push past these kind of negative thoughts so you can think differently about yourself.

Go on, challenge yourself to think of something you would like to do? It could be very small scale (at first, then work upward). It could be to have a five minute break in the day when you savour the hot drink of your choice and dream. Five minutes when you do immediately default to that it's not for you, that you don't have time, that you are too busy, that others need and even deserve your time more than you do. Five minutes that you do each and every day because it's for you, it's your work to do.

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Try that and see what comes up. Maybe have a notepad and pen to hand to log just the activity. If any thoughts about 'why not' come up for you, don't focus on them, just let them drift away.

You might just enjoy the peace. That would be a lovely thing for you to have in your life.

You might find some other 'things' come up that you could start arranging to do for yourself.

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You might notice over time how putting yourself first, even just for five minutes each day, "because you are worth it" does to how you feel about yourself, your self esteem

This is just an example, the one that worked for me, the one I noticed when I was watching someone else be coached in a group setting. I'm sure you will find something for yourself. However you start, as Yummypumpkin explained, when you do the work the magic starts to happen. All the best

Five minutes when you do NOT immediately default to that it's not for you

Sorry, a very necessary not missing there.

And I don't mean any of the crossing out, either. Sigh. Hope you find something helpful to get you started. xx

All helpful. Ta for the replies. Maybe it is the process...

Its nhs therapy so whilst it's great I'm getting it I know it's not the most cosseted option. Which is fine and prob a positive. I'll keep plugging away, I'm happy to put the work in and I know that change is hard.

I did type some specific replies about why
I kind of want to explore why I have no hobbies rather then just do stuff but it did sound negative and I'm trying to be accountable so I deleted all that.

I do like the "I wish I could" idea. I'm going to start there and I'm going to log what I do with my time (and if I enjoy it) to show the therapist that I'm out there interacting with people and she can have concrete examples to use from my life.

Plod. Plod. Plod to better mental health!

Sounds very promising @nodogz

Agree with the practice outside. I was always told its like weight watchers etc where the one hour session doesn't make you lose weight or change eating habits, it's the practicing in between

CBT is a model of how the brain works. Not everyone thinks that way and even people who do don’t think that way all the time.

Try counselling instead.

Your therapist can give you the tools for resolving your issues, but they can't do the work forward. If you are just shutting down all their suggestions and giving non-answers to all their questions then there is very little progress you can make.

It sounds like you're trying to give the right answers, you can't do a thing because you don't know the correct thing to do, in a situation where there isn't a correct thing, just as long as you do something. Just print out a list (www.dofe.org/wp-content/uploads/2021/05/programme_ideas_-_complete.pdf is aimed at kids doing their hobby requirement for DofE but it's a good list) and throw a dart at it, and try anything that isn't really not managable (health concerns making couch25k not viable is fair enough, but you can't rule out everything), once you're engaging with the therapy rather than refusing it maybe things will go better.

Nosy, that is such a useful list!

CBT is hard work and you do have to be willing to do that work.

I have no idea what I could do? I have no hobbies or real interests and haven't ever (always putting myself last).

Part of the exercise she suggested is to challenge those kind of thoughts - that's how CBT works. So you say you have no interests and you always put yourself last - she's asking you to try and cultivate an interest and put yourself first. Just saying "no" isn't going to help change anything,

@nosyupnorth That list! My brain tried, it tried REALLY hard to poo poo everything on that list. (And I have tried quite a few) But frankly there was no way I could justify saying there were no ideas of something new or enjoyable to try!

I think I have a few things to try:

• I'm going to cook through some of my fancier cookbooks - and rope in the rest of the fam as co-chefs
• I'm going to take my dog out everyday and see her gallop about in the leaves
• I'm going to freshly brew my morning coffee and imagine that my significant other is Keanu reeves whilst I drink it
• I'm going to prioritise working out twice a week over general child wrangling, cooking, cleaning and work
• Investigate keeping a herd of alpacas
• paddle boarding (assuming non-sewagey water)
• plan over the top Christmas decorations

Ahhh, @nodogz that sounds lovely.

I can really relate to that thing where your brain tries really hard to get you to think something. I'm sure recognising that really is the first step towards getting it to work for you and with you. Enjoy.