Feminist opinions on CBT and mindfulness

[PenguinB]

Does anyone have any links to feminist opinion or analysis, or opinions of their own on CBT or mindfulness?

I left a DV situation and am now on the waiting list for counselling (non CBT). Every time I speak to my GP other professional they immediately offer CBT group or individual therapy or mindfulness with a CBT component. I know these are preferred by the NHS.

I am getting quite skilled at firmly but politely explaining I don’t want CBT. The reason for this is because having spent years disassociating, I struggle to remember events or form new memories.

The forms of therapy offered seem to be about not looking at things with a negative perspective (CBT) or not looking at things outside of the present moment (mindfulness), neither of which either allow me to acknowledge what has actually happened.

This all sounds very personal, but I would really be interested in hearing anyone’s perspective on going through therapy, attending self help groups etc.

Sorry to hear of your DV situation - very well done for getting out. It sounds like you have a pretty good grasp of what you need and what doesn't work for you - my advice would be to hold onto that, your common sense, and take your time, keep looking, asking questions and trying things until you find something suitable.

Mindfulness is popular at the moment - it can be helpful for stress, but it's not suitable for everyone at all times. Whatever route you take you probably need to find therapists/teachers with expertise & experience of working with trauma (guessing you know that but it bears repeating).

Happy to discuss on dm with more details/thoughts, if it's helpful.

No substitute for societal changes aimed at reducing the trauma experienced by women and children in a patriarchal system.

Cookie-cutter CBT - ten session to challenge your thinking and behaviours - is not trauma-informed.

Good psychotherapy with someone who understands trauma will support you to look at your thinking and behaviours, but in a context of holding space for your very complex emotions.

Mindfulness can be a way of disassociating from your trauma. Again, it's a single tool, and it has some effectiveness, but it needs to be applied in the context of a warm and skilled practitioner who understands trauma, and who can safely support you to process that trauma.

My personal experience of seeking therapy to deal with childhood abuse and neglect, mirrored in my marriage, is that many of the standard therapies simply did not help. For a long time I thought that was my fault - I was not committed to being helped, I was not good enough at CBT. Engaging with these therapies increased my self-blame and self-hatred, and bedded down even more firmly my low self-esteem.

It was worse when I saw that CBT is, actually, a gold standard treatment. I felt the fault was in me, not in CBT.

What I think now, is that in someone who does not have unresolved trauma, CBT can be helpful for anxiety. In people with unresolved trauma, it can be helpful for anxiety in conjunction with other, more person-centred therapies. Probably after person -centred therapy has started, and a warm, safe therapeutic relationship established.

From a feminist perspective, it's all a bit closing the stable door after the horse has bolted. It's an individualist approach to trauma. The feminist response is preventative, I think. How to stop women like you and me being subject to DV in the first place.

I have no idea whether my feelings on CBT and mindfulness and therapy are actually feminist beyond that. I know psychotherapy does not have feminist roots, but there is a history of feminist psychotherapy. Hopefull someone more schooled in theory can answer you on this.

Otherwise - I think social support can be useful, I think practices which calm the body and bypass the thinking part of the brain can be useful (so things like tai chi, yoga, mindful walking), I think creative activities can be useful (writing/journalling, art etc) and I think establishing an ongoing relationship with a skilled therapist who is warm and available is helpful.

I would support you in turning down CBT and mindfulness programs while you wait for longer-term therapy. Yes, CBT at a population level is probably a cost-effective and evidence based intervention for anxiety, but in the situation you describe, I think your instincts are good. It took me around ten sessions to establish trust with my therapist (an ongoing process) - ten sessions of CBT and I'd be out the door, with any remaining dysfunction up to me to solve with 'practice'.

Sorry this is long and rambling. I hope it was helpful. I bet women with more expertise come along to answer you soon.

The forms of therapy offered seem to be about not looking at things with a negative perspective (CBT) or not looking at things outside of the present moment (mindfulness), neither of which either allow me to acknowledge what has actually happened.

I don't have a lot of experience with CBT and it seems from what I've seen that it can be done badly. However I'm not sure that it's meant to work the way you are suggesting, that it would preclude acknowledging what has actually happened. I think, if it's done well, ultimately it's meant to have as one effect making it more possible to look at what's happened more clearly. My dad did this kind of therapy for a while in relation to childhood trauma, and that seemed to be part of the goal, to remove it as a source of uncontrolled emotional reaction in his everyday life, but it also meant that later, he was able to see more clearly what role it had played in his life

Anyway, that might not be relevant to you but maybe it would be worth looking more at what the outcomes might be with that kind of therapy.

The problem with some NHS areas is there is a set process, ie you have to complete CBT and need more therapy before they will refer you.

I personally had really good person centred therapy through an agency offering unlimited counselling for survivors of abuse, the way they treated me there vs the NHS was amazing. There are also general counselling agencies out there who offer similar, it's worth a google to see what is in your area.

I think from a feminist perspective the medicalisation of normal trauma responses is a huge issue. The person who has suffered trauma is given a diagnosis when they are in fact responding perfectly normally and need some help to get through.

The NHS can be awful for treating trauma responses, I know one woman who waited a year for specialist trauma psychotherapy and when she got to the list they told her she was too traumatised for it to work.

Dissociation is how your brain has protected you, so any attempt to integrate your experiences into your memory should be done with a professional trauma therapist I think. I did CBT and quite honestly, it triggered one of the worst experiences of dissociation I ever had, although I think you can get trauma-based CBT but this was not what I had. Mindfulness I found quite useful but it brought issues to the fore so I would not do this without professional support, to be honest. If you think about it, mindfulness is bringing presence to a situation, so it was a bit like peeling an onion on the layers of awfulness until I was aware of them all (and of course needed to process/come to terms with)

I was lucky enough to have a year’s counselling from a rape crisis counsellor which enabled me to move on. I do not do any meditation now because I am scared of being re-traumatised as I associate it with working things through.

I am not sure if these comments are helpful; I am tired. I think keep looking until you find the right support

I am sorry to hear about what happened to you.

I think CBT is problematic in my case for much milder reasons, but there is a feminist component arguably.

I have a tendency towards perfectionism of various forms and this is related to eating disorders, addictive behaviours etc. Trying harder to get everything right, and thinking thinking thinking thinking about how I am going to improve and be better next time, is directly associated with a lot of negative feelings about myself and harmful effects.

CBT, with some practitioners, taps directly into that rule-based "I will work harder" mentality. It leads to feelings of shame, exhaustion, self loathing. you could always have done better. you could always have tried harder.

A lot of women in particular, I think, need encouragement to try a little less hard and think a bit less about being good and following rules and having self discipline and good behaviours.

Another aspect of CBT which I think is less intrinsic, but it's often practised this way, is that when you detect negatives in life they try to tell you you are imagining it. Women are systemically disadvantaged and they are not imagining it. We have to watch our behaviours be judged more harshly, men be given more credence and more kudos at work, put up with being ignored and disrespected and belittled. I do not appreciate being told to "turn it around" or to be made to imagine how the person who has insulted me is under his own pressures or whatever. I think about the other person's point of view and feelings all day long. I want therapy to restore me to my own fucking point of view and feel comfortable living there at least some of the time, to stop second-guessing about how I am probably wrong or I misunderstood or deserved what happened to me.

Anecdotal. I consider myself a lifelong - if unconventional - feminist.

Eventually, after lots of mindfulness (which helped) and other therapy (which also helped, in the main) I had some fabulous CBT (nothing like the entry-level CBT worksheets I'd had ten years before) and became pretty-much well. So I have to acknowledge, it worked for me.

Before starting the last round of therapy, I made a timeline of my life, showing all the experiences that had led me to that point. It was a massive piece of work, but it gave us somewhere to start. I found that being really 'heard' about my life helped a lot.

All of these comments are very helpful and are giving a better understanding of what goes on in therapy.

Women’s Aid rang me yesterday, after a referral from the GP, and one of the first things they offered was group CBT. If it is being offered by Women’s Aid is offering it for DV there must be some benefit, but My previous experience of CBT makes me feel they have specific responses they are looking for which you are directed towards giving.

And that whole process reminds me of abuse - that someone else is trying to convince me that I think or feel certain things, and I don’t know for sure what I think or feel well enough to state it in a brief statement.

And that whole process reminds me of abuse - that someone else is trying to convince me that I think or feel certain things, and I don’t know for sure what I think or feel well enough to state it in a brief statement.

My experience of abuse is that it undermines your sense of self-trust. But I do think you can trust your instincts. If it feels abusive to you, then that's how it feels to you. It doesn't matter who's offering what, or what the journals say about it.

Is there anyone at WA you can talk to about your feelings re the CBT program before attending ? I have no idea how WA provision of CBT differs from provision elsewhere, and possibly that's good information to have ?

But honestly, you can rely on yourself and your instincts. If something in you is saying 'No' to CBT right now, that's OK. You are allowed to listen to yourself, and your own feelings, and act accordingly.

DBT (Dialectical Behavioural Therapy) is what you might want to look at. It has training modules which allow you to set your own targets. You are able to set our strategies that suit you aligned with your beliefs.
Check out Marsha Linehan's works and also look at the Mind Reframed website.
There is no invalidating of thoughts/emotions in DBT. In fact it's the opposite, but the practice of it to resolve all of emotional health really works.
It's used for patients suffering from complex PTSD (including DV).
NHS waiting is looong. And private help on his is super expensive but it's be worth giving Mind Re-framed a call.

The guy answering your call won't be a secretary - he's the psych running the business. Good luck

My previous experience of CBT makes me feel they have specific responses they are looking for which you are directed towards giving

You sum up really eloquently how I feel after having had three lots of CBT over the past ten years. As you say, if the group CBT is offered through Women’s Aid then it may be worth a go but I wouldn’t hesitate to call WA, ask if you can speak to a practitioner about what to expect. Because you’re totally right in thinking that CBT and mindfulness may be useless or even dangerous for trauma. I really felt with CBT that nobody wanted to hear about the things that had happened and were happening to me, and that was how I felt at home as well.

I’m very lucky to be having Compassion Focused Therapy with a clinical psychologist on the NHS. We’ve been at it a good while and may yet be some time but it does feel different, more flexible and more understanding of difference than other therapies I’ve had.

I wish you all the best OP

How about you have more of a chat with women's aid and let them know your worries? Ask any questions you might have and then determine if you think it's for you or not?
I've worked with quite a lot of women who have recovered from domestic violence, some have benefited from CBT, some haven't wished to go there
Everyone's different and you know you best x

God - sorry too many typo and grammatical errors, I am tired!

there must be some benefit,

There may very well be, for some, or even most. Doesn't mean it's right for you, or maybe not at this time. I think it's very important to respect your feelings, as JanesKettle says above. Ask questions, maybe try it out if you feel comfortable enough to do so.

Healing is a funny thing. I think it' s often shaped differently than we imagine. Back and forth, up and down.

Wishing you well.

I think there are different strands of CBT. The early ones seemed to be "change how you think about the event(s) and make yourself happy", helped along with prescriptive worksheets. There was an insinuation that if you don't get happy by the end of it, you've failed.

Things appear to be more nuanced and sophisticated now, but I've not delved into it because I was so put off from my early experience.

There's trauma-informed CBT and there is also Schema therapy which is a way of working with deeper parts but developed from CBT.

The thing is you can ask questions. You can ask the therapist if the CBT is contra-indicated with dissociation. And any other questions or concerns you have. You can write them down to bring with you too - easier to read things out than remember them sometimes!

And trust yourself. It's hard but if something doesn't feel right, it's ok not to do it.

The women’s aid worker is going to meet me at my doctor’s surgery after Christmas, so can discuss it more with her then.

My experience so far is that dealing with all the various agencies connected to DV requires some tenacity.

For example I am on my third GP. The first I left because I had to move to a new area due to the DV. The second kept leaping to conclusions so I moved to a third (same practice) who is good.

But the more I am able to explain going into a situation the more likely I am to get something out of the process.

Btw OP I am in no way affiliated with this team but if the description of what DBT resonates then talk to your GP about getting yourself on to the NHS website

www.mind-reframed.com/dbtskills

Doh!

But the more I am able to explain going into a situation the more likely I am to get something out of the process.

This is true. But remember, they (the workers - GP's WA, therapists) also have a responsibility to be clear and communicative with you, and to understand that trauma can impare our ability to explain what has happened, what we are concerned by, what we need.

It's a two way street - the onus is not entirely on you to 'get it right', it's also on the practioners treating you.

Best of luck in your discussion after Christmas.

www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd/treatments-for-ptsd/#.XehBQCWnyEc there is a trauma focused version of CBT

OP I think your instinct re CBT is good. In my experience CBT is often a sticking plaster. It's used a lot by the NHS as it's more easily measurable than other forms of therapy (and usually cheaper) but the evidence of it's effectiveness 2 yrs later is questionable. Trauma-focussed CBT delivered by a therapist with good understanding of DV may be ok.

You have to be careful with mindfulness with trauma too. For some, traumatic memories can actually make this retraumatising. Yoga is better as you have a focus for your mind that removes you from other thoughts.

Huge sympathies OP. In my experience the NHS is useless in helping women with trauma. Many women suffering ptsd/mental distress are labelled Borderline Personality Disorder. However many female psychologists now believe that their symptoms are a normal response to the trauma they've experienced. Anyhow I'm rambling. Take good care of yourself - lots of self care does help - and be with loving people.

What about acceptance commitment therapy??

It is growing in popularity and has a good evidence base

After horrific DV I found psychotherapy so useful ❤️❤️❤️❤️❤️❤️

Dr Jessica Taylor has written well in this field... she was previously Jessica Eaton

www.victimfocus.org.uk/about-us

I was referred to CBT. I don’t think any CBT actually happened. I just talked and vented and cried and possibly ranted on occasion. I enjoyed having someone ‘on my side’ and who would listen for an hour. After 6 or 7 sessions, I felt so much better and able to function again.

So, even if you are referred for CBT, the therapist may take a different approach and work with what is best for you. Please do access whatever you are referred for. If it doesn’t work, you can always cancel future sessions.