Offered CBT therapy again when promised something different

[Piuy]

I've done 2 online CBT courses and one 14 week zoom CBT therapy with a therapist.

I am awaiting autism/ADHD assessments and am socially fearful, isolated, have intrusive thoughts etc.

I was told I could access talking therapy because a violent childhood and maybe a therapy that is aimed towards people with autism.

I had my assessment this morning and the nurse was unpleasant and basically said I need to do more CBT as 'it's not always helpful to find out why we feel a certain way but it's more important to just deal with it. It doesn't matter why'

She also said I should do a face to face therapy, I said I don't drive so how would I get there?

I am agoraphobic and she said 'well this is the problem isn't it. If you do t go any where how can you get better. You should just go to the face to face'

I'm on PIP and ESA because I can't go anywhere alone

How am I supposed to just 'get better' to go to therapy and 'not care about WHY I'm ill or if I have any mental disorders' because that doesn't matter?

I just feel so deflated.

CBT obviously doesn't help me. This would be my 4th round.

I wanted talking therapy to talk about what happened to me as a kid.

Sorry, mental health provision on the NHS is really shit.

A couple of avenues you could try:

Mind have local branches in some areas that offer therapy.

Autism charities maybe also?

Cbt can cover this op, in a cbt therapist and spend most of my time talking about childhood experiences 😁

CBT is a talking therapy.
its also a change based therapy and should be formulation driven.

A formulation is a way of making sense of the problem looking at how past experiences link to a blueprint for how we experience ourself, the world and others - and how this influences the way we interpret things day to day, assumptions we make and the things we avoid and why.

it also looks at areas for trying out new more adaptive ways of coping, eg gently approaching rather than continuing to avoid or asserting our needs and boundaries where we would usually subjugate them.

it can work really well for NT and ND clients but you do have to willing to get out of your comfort zone and try new things. The therapist will of course skill you up and go at your pace though.

You are teying to access therapy and that is great! I resoect your intuition that you need something more than CBT—it sounds like you would benefit from trauma informed psychodynamic therapy (that is what it is called here). You may also have other issues that a good therapist should be able to diagnose such as OCD, depression, anxiety, complex PTSD. While CBT can be good for one of these at a time if you have multiple co-morbid issues you may need a lot of “work before the work” to tease out the best way to tackle things.

Have you watched youtubes or read books about childhood trauma (adverse childhood events), narcissistic abuse, neglect, or child sex anuse? I always reccomend Pete Walker’s Complex PTSD: from surviving to thriving as a great resource. He has a great chart that shows how our characteristic trauma responses push us into behaviors that are often understood as diagnosed mental health conditions.

I tried whilst I had the therapy but as soon as it ended and there was no one to check in on me and encourage me I just stopped.

I can't even brush my teeth some days

Mental health help on the NHS is useless.

CBT is really great - but like any treatment, it isn't universal. It very clearly didn't apply to me and the specific issues I had because the therapist I saw kept saying "oh yes I can see this question/this technique/this exercise won't be applicable but let's just try it anyway." And they just kept trying to shoehorn it in because they had their set templates for each session and wouldn't deviate. And then they say it's because you aren't trying hard enough to make it work. I've never felt worse than after the NHS CBT because I went in to it so optimistic and tried so hard. I can appreciate that maybe non-NHS CBT would probably be better because it might be less rigid.

it can work really well for NT and ND clients but you do have to willing to get out of your comfort zone and try new things

Yeah this kind of attitude. If it doesn't work, it's your fault.

Well, CBT is a talking therapy, and is very good for agoraphobia.

But you could explore whether they could offer trauma focussed CBT or EMDR if it's more of a trauma therapy you need.

I wouldn't assume that, because computer based CBT wasn't effective that CBT as a whole isn't effective. It's very well evidenced. But it's a therapy that depends on your ability to practice and complete homework, which I know is sometimes hard.

Anyone with an iota of intelligence or the ability to think critically needs something other than the medical gaslighting that is CBT. I’m aorry that your nurse was such a cunt. That’s NHS mental health services, I’m afraid. Is there anyway you can access an alternative form of therapy e.g through work? Could you enrol on a university course and use student mental health services? Take out a loan/credit card and pay for something privately?

There aren't really any open-ended longterm therapies on the NHS available. The funds are to treat the most people possible to get them up and running and back on with things. Nobody is going to check in on you indefinitely to hold your hand and make sure you're taking care of yourself, and that's not really the role of the NHS to be really honest.

I have to admit, reading your post, it sounds like anything the nurse suggested you found a way to push back against and say it just wouldn't work. If what's available on the NHS doesn't suit and you've given it your best shot then I think you're better off looking into self-help, or trying to find the resources to go private to find a bespoke therapy that suits you.

CBT won't help you unless you do it. It isn't a magic bullet.

CBT is very well evidenced but its not appropriate for every diagnosis. And it is a ton of work at the cognitive level. Some people need deeper work at an emotional level.

CBT is basically all they offer. I wanted talking therapy for my issues (anxiety/depression/OCD/ADHD) too but CBT was all the NHS could offer. I've had it several times now, and know all the techniques, and it just doesn't help any more. The only way of getting talking therapy is by paying for it, unfortunately. I really hope the new Government does something to improve the current woeful lack of mental health provision.

That's the problem with CBT though, if you're already depressed or have anxiety issues, putting the time and focus into CBT that's needed to make it work is obviously going to be a struggle, or just not achievable. It's really putting the onus onto the patient to manage their own mental health, and if they could do that, they probably wouldn't be needing medical help in the first place. I'm not a medical health professional but I bet it's not seriously considered to be a solution for those with more severe mental issues.

I would advise trying to refer through an access to psychological therapy route and asking for a more relational therapy (such as CAT) or trauma focused CBT. Often services will have trainee clinical psychologists who can be more flexible who can offer short term pieces of work. Best of luck with it :)

It isn’t. I had a patient come to me this year who had done CBT for a year and a half and finally got up the nerve to tell that first therapist that it just wasn’t working for her. All private pay, here in the US.

She has massive childhood trauma with severe symptoms of OCD, anxiety, intrusive thoughts, etc…she has made more progress with a trauma focused psychodynamic therapy than she did with CBT (per patient report and periodic evaluation).

CBT is not a magic bullet.Not every patient benefits from it. Its true that it is well researched and well respected as a modality. But any treatment has to be evaluated by looking hard at the group that isn’t helped by it. But since the NHS has adopted it those who go elsewhere for treatment, can’t get enough CBT to fix the problem, or who can’t manage the protocol simply vanish from the data. I don’t think we can know that CBT works as the only form of therapy on offer. Its clear that it doesn’t.

I tried it but I didn't feel it helped.

And it east just online. It was 14 x 1 hour sessions with a therapist via video call.

I feel like I'm autistic or there's some diagnosis I haven't gotten.

I've never spoken to anyone apart from my GP about what is wrong with me.

My NHS under illnesses says 'mild anxiety '

I've not left the house alone in at least 5 years. Have no friends. Unable to work. Unable to function.

Unfortunately I just don't think they'll send a therapist out to your house, so it's either going to be online or F2F with you finding a way to attend (eg a friend/family member taking you?).

I'm sorry- it's very difficult. I don't think much of online therapy though, but that's me personally!

My mum battered me. Strangled me. Suffocated me. Pushed me under the water in the bath. Bit me. Scratched me. Slapped me. Hit me with spoons. Hangers, brushes. Told me I was stupid.

I remember feeling the same feelings I have now in primary school about socialising.

I've never addressed any of it and I was told I would get trauma therapy.

I also has an extremely distressing event happen about 3 years ago that messed me up bit no-one cares.

I can't go private. I live off ESA and PIP. I don't have extra money

What's the difference between f2f and doing on a camera though? You're still sat looking and talking to the person?

STPP (short term psychodynamic psychotherapy) is the next line treatment OP, after CBT. It's evidence based and in NICE guidelines. You have had four lots of CBT, only a total sadist would suggest you go back for more of something that hasn't worked. Push now for the next line treatment.

Not all psychodynamic or psychoanalytic psychotherapy is open ended. Believe it or not, open ended psychoanalytic psychotherapy is in the NICE guidelines for one presentation, which is sexually abused girls (treated in childhood ) It is there because there's an RCT evidencing efficacy.

Otherwise, STPP is a very good option that also takes onto account cost and demand.

Good luck.

Just to say, although it is called short term it would be around 30 sessions.

I am sorry for what you went through.

CBT was all the NHS could offer me. I'm autistic too. CBT doesn't work, in fact it brought me to a state of high anxiety. It's awful.

I am neurodivergent and CBT could only take me so far. EMDR was life changing for me, might be worth seeing if you can get that instead.

Ask for a care assessment from social services and as part of that say you can’t leave the house alone and you need a carer / support worker to help you get to appointments .

make it clear you want help towards independence .

I had support from asd services around confidence building / leaving house.

services are patchy and may be waiting lists but there are ways to help you to go out. I had a lot of help and gradually learnt to ask for things in shops and talk to bus drivers etc. many weeks work and lots of practice inbeteeen needed .

face to face therapy in my opinion is a million times better than online (done both) and though it is hard to get to for me - is so worthwhile and helping me do much.

took years to get long term therapy on nhs and was after everything else tried and failed and a major mental breakdown.

CBT did help to a point with managing some of my anxiety. But addressing the deep cause of my issues (trauma) really has helped me.

I will add i found cbt quite traumatising in itself, constantly reliving scenarios in depth. EMDR involved choosing one or two examples, and working around the feelings around those examples rather than going through lots and lots of different ones. It was much more effective more quickly than CBT. I was lucky enough to have health insurance through my work, not sure if it's available without a fight on the NHS.