CBT: how much the therapist matters

[Gadfly]

Hopefully someone with a bit of experience using CBT can give me some advice with this. I had my first CBT session this week, and found the experience a slightly frustrating one. The 'practitioner' was terribly sweet and keen, but I lack confidence in her. She's a trainee in the local mental health service, and obviously very young, so can't have had a great deal of experience, and her manner revealed quite how inexperienced she is (incoherent and nervous on the phone, very reliant on reading off the notes and worksheets in person, didn't seem to understand the experiences I was trying to talk to her about). I know that trainees need to be trained - it's not that I feel I deserve someone who's already qualified - but I do wonder how much benefit I'm really going to get if I don't have faith in the ability of the practitioner.

So; how much does the actual therapist matter? If I do the 'homework' tasks will I get the benefits, or might it be best to look at dealing with my anxiety privately?

I would say that trust in the practioner is pretty important - I had CBT some time ago and mine was I'd say very experienced -she had a student with her too who did some of the treatment,but I felt it was backed up by the psychologist in charge. A lot of the exercises I had to do (for OCD) were frankly very scary and I would have felt a whole lot less able to do them unless I felt she knew what she was talking about,iyswim. It was also backed up by a consultant psychiatrist who oversaw my treatment.
Subsequently I had a bit of a wobble and was assigned a very young and inexperienced community psychiatric nurse who was absolutely hopeless.(I know people have to learn but she had no clue)

I rather thought that might be the case. Not sure what my strategy should be now; I imagine that if I don't feel I've made progress by the end of the sessions I'm scheduled to have with this trainee, the powers that be might allow me to see someone else.

Dealing with local mental health services in this area has proved so very frustrating. I guess they just approach panic and anxiety disorders in a very routine manner. I might explore self-help a bit.

mm,it's tricky- perhaps see how you get on for a few more sessions, but think it's reasonable to say if you don't feel confident in her. Self help wise,I've tried hypnotherapy for anxiety and it is good for calming and relaxing. My BIL is one and found mine for me - they must have all the proper accreditations etc...

The trouble is, I'm not sure who I can express my concerns to! The referral to the mental health service was through a nurse at my GPs' surgery, and this practitioner is the only person there I have had any dealings with. I could talk to a GP at my practice, but realistically, time is going to be tricky soon (first baby due in 6 weeks) and I really want to get some proper help, as I'm scared I'll be an awful mother if I can't get a grip on myself and start feeling/behaving a bit more normally.

I've just been having a look at CBT self-help books on Amazon, and my partner says he'll ask a friend of his who found books very helpful what he used. Thanks for the hypnotherapy idea; it's not something I'd considered might help. I've always thought I'm not the suggestible type, but you never know, and I just want to get mended.

am sorry that you are going through this - I think pregnancy can bring on huge anxieties - I know that my own was riddled with awful anxiety (which is why I was sent the CPN who was so useless !!)I think perhaps go back to speak to a GP at your practice and explain - you never know,things might get speeded along for you as birth is imminent - they will want a mum who is able to look after her new baby after all (that's what my doc said to me - in the end it was him who helped me more than anything)
I am a very twitchy person but did find hypnotherapy helpful - it can take very few sessions to be able to learn to self hypnotise and relax. Lots of luck and am sure you'll get through this xxx

You'd think they'd want to help out speedily, but my experiences so far have been a bit off-putting: originally my midwife referred me to the perinatal mental health team; they wrote to her a month later basically saying "we're really busy because staff are on summer holidays - send her to her GP"). Then my referral from the GP practice nurse got lost in the post. As I'd heard nothing, I asked her to re-refer me, and now I've ended up with someone who, as I've said above, really doesn't seem in command of what she's doing.

May I just ask if the method she used yesterday was standard? She had a bundle of worksheets spread out on the table, and pretty much just read parts of them out, and got me to write bits in the gaps. I'd thought that the actual face to face sessions wouldn't be reliant on worksheets, and that those kinds of tasks would be my 'homework' instead.

I think you're right - I'm going to make an appointment with a GP next week and explain things.

It doesn't sound like my treatment -the worksheets bit - I can't remember needing to fill in anything - occassionally she'd do diagrams on a whiteboard to illustrate levels of anxiety. Homework I can't remember either. If you aren't happy with the treatment and it sounds as though you aren't,then it won't really be helpful. My thinking is that this kind of treatment requires trust and confidence in the practitioner as you will be facing things that are frightening for you and need to feel there;s some solid backing.

Gadfly, could you bring up your concerns about how your therapist has approached this, etc, at your next session with her - it might help establish what you need (from your perspective) and what she is missing (from her perspective).

It could be a useful session for you both and a good therapist needs to get feedback from a client in order to grow/make changes, etc.

CBT is not for everyone, the homework tasks are useful and the emphasis on this type of therapy is not on the strength of the therapeutic relationship but on challenging the irrational, etc. The CBT therapist and client relationship is more psycho-educational.

A user friendly book that is easy to follow is Mind Over Mood by Dennis Greenberger and Christine A Padesky.

Good luck x

I did a group course in CBT, and really it was a waste of time. It's good for surface emotions, but crap at dealing why anyone gets themselves into such a mess in the first place. It seems to be all about practical solutions, which can help if you're in that kind of situation.

I had a course of CBT last year. I didn't click with the therapist, and that certainly held me back, but I did feel like it helped a bit. To be honest, I got a copy of CBT for Dummies and that was very helpful.

Thanks for posting your experiences on here. Before I actually got around to doing anything, my therapist/self-help guide or whatever she is called to say it has been decided I don't have to do guided self-help with her in person anymore, and I can do a computer delivered course of CBT at home instead. This is what I had been asking for since it was first suggested to me by the nurse at my GPs' surgery, so I'm pleased, if a little surprised at the turn around (the therapist had told me it was being discontinued by my PCT). Whether it'll prove useful is another matter, but I'm relieved to have the opportunity to try it, and to not to have to drag myself to meetings (I will be 35 weeks gone tomorrow).

We'll see how it goes...
Otherwise, I'll have a look at CBT for Dummies and Mind Over Mood as suggested above, both of which have good reviews on Amazon.