CBT - is it supposed to be somebody telling you to do things you already know you should be doing?

[ghaghagha]

This is what I've found, or am I missing something?

She told me I need to sleep (I already know this) she explained how sleeping better will have an effect on my behaviours and emotions (I already know this too)

I know it but still don't do it, How would somebody else telling me I need to do it suddenly make it possible?

In fact a lot of my depression is springing from guilt over not being able to do the things that I know I should be doing.

Am I being deafetist or is there some proof that someone else telling me to do these things has an effect? Is there some kind of praise/reward psychology thing going on?

I have to pick one thing ands do it before I see her next

It takes time. And the suggestion to do just one thing is so that you make small changes which are do-able and you can succeed and keep on succeeding doing. The guilt is something you have to address slowly.

They should be providing you with lots of strategies to help with anxious feeling, repetitive thought loops etc that stop you sleeping. When I did CBT they gave us 'homework' to do every week to help implement the strategies.

That doesn't sound like its helpful. To be fair, to back and say exactly what you have said here. CBT should be aimed more at your guilt response from what you've said. Picking a random health issue like lack of sleep doesn't sound useful.

I tried CBT twice for a complex phobia, once as a child of 12 or so and again at 30 whilst pregnant with my first child.

As an adult I had an experience very similar to yours. The whole process was frustrating and confusing and ultimately failed. As a child I had the same experience, except during that all my thoughts were reinterpreted so that I was told what I was thinking too. This was also frustrating and confusing and doomed to failure.

I think there are some great CBT practitioners and some less great ones. I also think it works far better for some people and some problems than others. For me, as an adult at least, I was already very proactive about getting help, I was hoping to get specific 'tools' that I could use in that fight. I think the CBT I received would have been better suited to someone who had just pulled their head from the sand and needed a well meaning kick up the arse! That was my take on it anyway!

Sympathies. I was missing something too . I couldn't get on with CBT. The only "help" was having access to a therapist and also the "homework". I had a strong feeling of not wanting to let the therapist down so actually completed thehomework around 80% of the time. A couple of sessions actually ended up as me having a bit of a meltdown and the therapist just letting me (I mean in a nice way - he didn't try to get me to do cbt stuff as he knew it would be pointless iyswim). I think cbt works better if you have specific "issues". Give it a few sessions - it might improve.

That was my experience of it when I was forced to attend group CBT while I was suffering from appalling depression. They gave us a photocopied list of suggestions for things to do to make us feel better when we were down. It included "kick the autumn leaves." I had a breakdown not long after.

Sorry you are not having a good time, but I'm afraid this is exactly my experience of CBT. (Actually I did not have CBT but an even cheaper variant which is basically being given a badly photocopied synthesis of every self-help book you have already read in attempts to fix things for yourself)

I think it is particularly bad if you have a religious background which has caused a lot of guilt and anxiety about thinking the wrong things. Having someone tell you what to think, like it is some brilliant new idea, is so depressing and stressful. Being told to sleep and that it is good for you is just insulting. But I was also pretty insulted when my "practitioner" (who was about 23 and I am guessing had no children) suggested that I might be tired because I was sleeping too much when I had a breastfed 3 month old and a toddler.

Sorry to rant on. I was just trying to be comforting, saying "it's not you", but it went out of control. My health visitor said I should try to get some "proper therapy" so basically admitted that CBT is not proper and is rubbish.

Good luck, I hope you find something else that works for you.

No, it's NOT supposed to be telling you what to do at all! The principle behind CBT is that feelings follow thoughts. So it's about observing which thoughts prompt what feelings, how that sequence hampers you, and how to change the thoughts so you get more helpful feelings. I think an awful lot of counsellors have latched on to the "Behavioural" part thinking it just means telling clients to change their behaviour. Like you couldn't get some bloke down the pub to do that.

Maybe have a bit of a read around it and, better imo, work through the mood gym site so you get an idea of what CBT's supposed to do. Then start training your therapist

Ghag there is a very important line in your OP "A lot of my depression springs from not being able to do the things that I know I should" - think it's the other way round:
You can't do a lot of the things that you used to do because you are depressed.

Depression is a deceitful illness and makes our thinking become distorted.

I think you need to see a GP for help, maybe meds for your depression.

Re CBT - I think you have had some good responses. I had a severe episode of depression 2 years ago and the meds helped a lot. I had a CPN for several months and she was into CBT though admitted that she had only done a short course. I think it is a relatively simple theory but it didn't really help me - in fact it annoyed me. At its most simple it's trying to changing the NATS (negative automatic thoughts into more balanced ones) I think it's "horses for courses" and I know many MNs have found it helpful.

CBT has become the panacea for all sorts of emotional distress and I'm not sure that is very helpful.

I think your first port of call is the GP. Maybe write down the symptoms that you are experiencing, including everything and in a list as it's easier to read and either talk to the GP or give him/her the list. I don't think we can access any therapy while we are depressed.

Hopkinette OMG at "kicking the autumn leaves" - how insulting is that!

garlicnuts, "then start training your therapist" - I know that is a joke, but actually that is part of what I found so annoying about my CBT-lite: I honestly felt that I had a million times better insight and understanding about, you know what, everything, than this very young man working through a very limited programme.

I felt exhausted by having to explain very basic things to him like: you don't leave tiny breastfed babies with other people for a few hours without a very good reason; you don't sleep much with tiny breastfed babies; you don't have a choice about your routine with a toddler, it might look good that you are eating breakfast at 8 and in the park at 9 but this is not evidence of anything other than the physical impossibility of lying in bed when you have a 2 year old to look after; this is before you even get anywhere near any of the metaphysical stuff.

I am of course spoilt by mn which is full of women who just know all this stuff and have a very good context in which to place it if you want to unload on here. But I was annoyed that I had to educate my practitioner for most of what was supposedly my therapy. It's hard work explaining things all the time. Ask a teacher, they are always tired. I didn't want more work.

Vezzie, I have to admit it was an in-joke. I've "trained" nearly all the therapists I've seen - fortunately, a few insightful and recommended some very good books - I know this is not uncommon. In the first few sessions, a new therapist makes a bundle of assumptions about me; I try to suss out where she's at with her training and thinking. Then, keeping an open mind, I aim to work with her to get what I want from our relationship. The last counsellor I saw was a CBT practitioner with the NHS. She was good, but did start off telling me to do the things I know I should be doing - I believe I pointed out she was pretty much telling me to pull my socks up! She listened to what I had to say; we came up with an amended treatment plan and it was helpful.

I wish all counsellors were wise, intuitive, balanced, strong, intelligent and unselfish. But they're not, they're people doing their job as well as they know how. Most, ime, do have fresh insights to offer and are able to direct the process in ways I might not have considered (as they're supposed to: some, sadly, don't or can't.) In general you get the best out of counselling by viewing it as a two-way process from the off. Ideally, it's a learning process for both participants.

Your example of the counsellor telling a new mother she's sleeping too much is a fantastic example of the practitioner's assumptions damaging the therapy! I was interested in what you said about religious training & bad thoughts; I went to bed thinking about that. I identified with it because, although not religious, I was heavily controlled by my parents to the same effect. My first CBT therapist was very skilled and, after the 'assumption breaking' sessions, focused entirely on my thought-feeling cycles, with mountains of homework every week. Although we didn't achieve a single one of the standard CBT objectives, I consider my time with her one of the most enlightening periods of my life.

I like the mood gym because it is very simple and sticks entirely to basic CBT principles. I still use it when I need a psychological kick up the arse

Are you OK ghag as I notice you have not come back to the thread, not that you are under any compulsion to do so of course!

Garlic, sounds like you work very hard to get the best out of the therapist. Well done for explaining the "pull your socks up" to the therapist - that is the sort of thing that would make me feel inarticulate and glum and defeatist.

The religion thing only dawned on me very recently, it was not clear to me at the time of the CBT-lite. I was having horrible and familiar feelings but only later realised that the familiarity came from the years I guiltily worked at doublethink as a good Catholic girl.

I believe that CBT was conceived as a way to free the mind so as to allow a knock-on freedom to the emotions; but is usually practised as a simplistic and prescriptive straight-jacket for the mind instead ("Think this and all will be well! All is not well? Well you're not thinking what you were told, are you")

YY, Vezzie, and that puts you straight back into cowed schoolgirl mode! Very therapeutic

I have had CBT for my post natal anxiety and as a whole had a good experience with it, half the battle is having a therapist that you have a good relationship with and feel u can share. I found distraction techniques very helpful and questioning yourself often just sends you round and round in circles. One method is to train your mind to think about other things when you start to have a thought or feel an emotion. I used to do the times tables and come up with alphabet games like naming animals or countries with each letter, the idea is that the distraction will allow the anxious thought to pass. I have learned that by decreasing my anxiety I can decrease the guilty feelings etc I know it's not easy and I still struggle very day but it's worth a shot. I also found mindfulness good as it allows your mind to calm down. My one piece of advice would be give it time as you do learn the skills and gradually without u knowing they start to work. I feel for you and hope u feel better.

Glad you are feeling better Scotty. Agree about mindfulness.

One of the difficulties I think is finding the right balance between taking responsibility for your own health (and how good that can be for you, when done to the right degree) and not blaming yourself for your ill health (which is in a thousand ways not your fault). I think this is a problem for certain personality types: the notion that "there is something you can do about this" leads in a quick and far too slippery way to "AND WHY HAVE YOU NOT DONE IT ALREADY? Why are you not like x, who is rich, and y, who is happy and popular, AND like z who is beautiful?"

this is interesting:

thedirtistemporary.tumblr.com/post/29415664452/olympian-voluntarism

What a good link, Vezzie. And my poor old mind would like to thank you for summarising it so neatly, above! I was encouraged to hear about ACT (Acceptance and Commitment Therapy) not long ago. About halfway through my therapy, I realised I wasn't going to fix things by overcoming them, so much as by accepting various limitations and seeing what I can do with that. One of my favourite old Chinese sayings is "The way out is further in" - which means: if you can't get around or over the obstacle, go through it. No therapist has been truly on board with this so, if/when I'm able to access more guidance, I shall find one who's heard of ACT in hopes that we'll be on roughly the same page.

Vezzie, v interesting link! In total agreement, lots of MH issues due to societal/systemic failure IMHO but SO much easier to pathologise/blame the individual

That's a fantastic link vezzie, I have honestly lost count of the number of times I have heard the saying 'the only person who can get you out of this is you' even my brother whom I love said as much, I don't know whether he had forgotten about my pregnancy cancer scare which had me at the hospital every single week for 39 weeks, my sons heart problems and lack of movement or my grandfather passing away but apparently it was all mind over matter. I was so angry when people said that because I am strong and have tried everything to get better and I am slowly getting there but it's taken time, hardwork, determination and most importantly medicine and therapy. Society has made up its mind on mental health, it's escapism for those not brave enough to deal wih reality and everyday life, an absurd theory given how much fight you hear of new mother trying desperately to overcome there illness and enjoy the most precious time in her life. I resent everyday that mental illness has snatched from me but I have never given in and refuse to believe the speed of my recovery is down to my own 'try hard and you'll succed' because if that was the case I would be brand new by now revelling in the delights of motherhood instead of dealing everyday with this horrible illness. Thank you for sharing, i was laughing the other day about how many people probably went out and bought new bikes and gym memberships inspired by the Olympics and how many will gather dust and go unused as the fad fades away! Good on anyone for taking on any challenge in life but believe me it takes more than weeks belief to overcome every obstacle!

Couldn't agree more ScottyLF.

Never added to a discussion before so excuse any newbie mistakes! I've read this thread with interest and thought I would add my thoughts (even though it's a bit late in the day). I have an MSc in Rational Emotive Behavioural Therapy and CBT (both are therapies that place emphasis on your thinking being at the route of disturbance, i.e. depression, anxiety, anger, guilt, shame, jealousy, hurt etc). There are lots of ways of approaching these problems, CBT is only one of them and may not suit everyone. One of CBT's current problems is that it now has the backing of the Government and CBT has become the therapy of choice in an NHS setting, but the delivery can be very tick box with little broad assessment of the client's problems. Often this assessment is done by the least experienced person, a sort of 'gatekeeper'. Clearly this isn't going to produce good results and people start to draw conclusions that Cognitive Therapies don't work, when they can be very helpful. The other thing I'd urge anyone to do before seeing a CBT therapist is to check that they are accredited by the BABCP or the AREBT. This is the list of therapists who have focussed on CBT specifically and who, frankly, have been through the wringer to get trained and continue with clinical supervision to stay accredited. All sorts of CBT courses are springing up because of its popularity and many of these courses are meaningless. At the above professional bodies you'll also find some properly qualified CBT therapists who are trained in ACT as well.