Calling my mom would be cheaper.

October 17, 2008 2:30 PM

I'm not getting a much out of my cognitive-behavioral therapy. Do my therapists suck, or are my expectations just too high?

So I recently decided to seek some mental-health help for chronic issues I've been having with procrastination, anxiety, depression and unproductivity. Based on the research I did, it seemed as though cognitive-behavioral therapy would be a good approach; I think I'm a fundamentally sane person, but I have lots of bad mental habits and issues with self-control that weren't being fixed by my own best efforts. I thought CBT would offer a stepwise, research-based way of thinking myself out of those un-useful patterns and starting to develop better habits-- kind of like personal training for the brain.

Since then, I've been to two therapists who claimed to be CBT-oriented, and I'm wondering whether I just picked poor specimens, or whether my expectations for this form of therapy were too high. The first one basically sat and chatted with me, occasionally detouring into bigger philosophical discussions/debates or little autobiographical vignettes. He occasionally gave me direct advice about my life ("Well, it seems like you should stay in your grad program...") and dispensed little nuggets of chicken-soupy wisdom ("You know, love always means taking a risk"), but never gave me any homework or did any exercises or, you know, worked on anything.

After two sessions, I left Therapist #1's practice and signed on with Therapist #2; we've had four meetings to date. She's less pompous than T1, but still not especially helpful: essentially, we talk about my life, and she offers the kind of sensible suggestions I've been getting all my life from people more organized than I: Try getting on a schedule! Break your tasks down into little pieces, then do them! Don't wallow in regret over past failures; move forward! It's all great advice, but honestly, if I could have achieved any of those things just by willing myself to do so, I wouldn't be seeking therapy in the first place. I know nobody can do my work for me, but I was hoping CBT would offer some sort of ladder of steps I could climb to help me become able to keep to a schedule, or to move on from guilt and regret-- in other words, a sort of manageable couch-to-5k program, not just a big sign saying GO RUN THAT MARATHON.

I know folk here speak highly of CBT, so I was hoping someone who's had success with it could comment on my experience. Is what I'm getting a good representation of the cognitive-behavioral approach, or should I seek out yet another therapist? And if the latter, any hints on picking someone better this time?

posted by anonymous to health & fitness (16 answers total)

Onbe reason CBT is so popular is that insurance companies like it. Maybe another therapy style will help you more.
posted by RussHy at 2:54 PM on October 17, 2008

These first guy was definitely a bad example. With the second one--have you shared your opinion with her? A lot of clients are uncomfortable with a very direct style, so she may be playing it safer than you would like.
posted by Benjy at 3:01 PM on October 17, 2008

One-on-one has never worked well for me - I find that it lapses into a lot of talking and then talking myself out of what I just talked about (dig?). Quite masturbatory.

What did work for me however was Group Therapy. You end up feeling responsible to the members of the group so you call each other on BS and things... I mean, it definitely depends on the makeup of the group but more people helping you with your problems means a higher percentage of you getting some good insight on why you do things and also how you can change.

Or maybe groups just make it easier to remove the ego so you can see yourself through the eyes of another and choose a plan of action accordingly.
posted by HolyWood at 3:12 PM on October 17, 2008 [1 favorite]

Argh, sorry - higher probability of getting good insight.
posted by HolyWood at 3:15 PM on October 17, 2008

4 sessions is hardly any time at all. I suggest you supplement with Feeling Good and do the exercises for at least 3 months. It is highly likely to work if you do it that way.
posted by Ironmouth at 3:16 PM on October 17, 2008 [1 favorite]

You know, you're paying them, you're allowed to make requests.

i like my therapist, but I sometimes feel we're verging on just me doing a monologue about what I did that this week. That's when i ask her if I can have an assignment, or a concrete suggestion of an exercise I can do when I feel anxious.
posted by drjimmy11 at 3:28 PM on October 17, 2008

This doesn't sound like CBT as I experienced. My therapist had a workbook I was required to go through. I had written homework between sessions (exercises in the workbook) and we discussed my assignment in depth at each session. Our goal was to uncover the illogical thoughts that were influencing my behavior and starve them until they withered and died. There was very little aimless chatting.

I found this therapist through local government--she was part of the county mental health services.
posted by PatoPata at 3:41 PM on October 17, 2008 [1 favorite]

Seconding Feeling Good as a supplement (or not!)
posted by griphus at 3:42 PM on October 17, 2008

I've also been to therapists in the past that seemed to have a very vague notion of what actually constituted cognitive therapy. I found working with the books (Feeling Good, etc.) on my own to be more helpful. I figure therapists must exist that take a more 'strict' approach to CBT, closer to the process Burns describes going through with his own patients in the books, but I never really figured out how to find one.

My best suggestion would be just to go in and say, look, I want to try following pretty much exactly the steps in these books; is that something you do, or can you support me in that, or what? Maybe even if that's not their usual routine, you can still use them as some kind of support structure for your own practice. And if it doesn't seem to be something they're capable of doing at all, you'll know to move on to someone else.
posted by dixie flatline at 4:11 PM on October 17, 2008

Did you tell the second therapist that you wanted classic CBT therapy? Most therapists will tailor their style to the client's needs (and many clients hate the whole homework/worksheet part of CBT). Tell her that her advice is too general -if you knew how to do that, you would have and that you were hoping for something very structured that breaks down into simple steps so you know exactly what you are supposed to be doing that is different. You can bring in a book, if you want but if she advertises as CBT she should know how to do that. If she doesn't listen to your request or doesn't change her style to meet your needs then you will have to look for therapist #3.
posted by metahawk at 4:25 PM on October 17, 2008

Ditto that the first therapist doesn't sound like CBT or even very good, in my opinion. Four visits with the 2nd may be a bit too early to judge. There is definitely a period of getting all the issues out on the table which allows the therapist to see patterns emerging; you might still be in this stage. I suggest you tell her how feel, let her know that you want more from her; she may be holding back or just waiting to get a feel for things.

Most CBT therapists will give you homework, things to read, etc. My therapist is always giving me things to read and often giving me assignments. We have wide ranging discussions, sometimes philosphical but when he is actually therapizing me he tends to keep me from rambling too much and from dwelling on the past. He gets right to how I am holding myself back, usually with things I am thinking. And that discussion moves very quickly to ways in which I can change my thinking and my behavior. Sometimes it's practical like how to ask for a raise at work, and other times it's a little more esoteric like discussing different meditation techniques to deal with anxiety.

I think that CBT could be great for what ails you, but yes, you need to find the right therapist. I am sure you can get good recommendations here. If you are in the NYC area I can give you the name of my person (mail me at metafilter for that info).
posted by kenzi23 at 4:40 PM on October 17, 2008

Nthing to just talk to your therapist about her approach. When I've seen therapists (not for CBT) I specify that I want them to be very direct and challenging with me. I do not want them to hold my hand and tell me what a horrible childhood I had and oh you poor thing. If you decide therapist #2 is not for you, then I'd call up other ones and interview them on the phone. Tell them exactly what you are looking for and ask about their experience. Tell them you WANT specific things to do. Be specific with them, too. Don't say "I have anxiety and depression and...," instead say "I dropped out of grad school because I was too anxious to go to class and I want to go back next semester."
posted by desjardins at 5:06 PM on October 17, 2008

Nthing Feeling Good, especially the Handbook. I took that away with me on holidays and spent hours working my way through the exercises. Best holiday ever. I returned with a whole new understanding of my behaviours and means of training myself into new ones. Actually doing the written exercises is a must. Writing imprints on the mind in ways just talking and thinking don't. (note to self: spend some time today looking back over the handbook exercises on procrastination and the ten mistaken ways of thinking after I've cleaned my room, done the chores etc.).

I would recommend buying the Handbook, and committing your self to doing the exercises. Then after completion, if required, find a therapist who can coach you on what you have already learned (doing the Handbook exercises teaches you a lot about yourself) and give you directed and focussed one on one guidance in your key trouble areas. Good luck!
posted by Kerasia at 7:19 PM on October 17, 2008

I think a lot of therapists take like one course in CBT and then feel like they know enough to say that they offer it. The first therapist sounds like a classic example of that kind of guy. The second one - it's hard to say. CBT is very practical and often incorporates advice-giving, but the therapist should help break it down further if the steps are not working for you.

If you're convinced that this approach has something to offer you, why not make sure you find someone who really knows how to do it? You don't say where you are but here there's a center for cognitive behavioral therapy here in San Francisco. That site has a link page titled "Finding a Cognitive Behavioral Therapist Outside the Bay Area" with some links to CBT professional associations. Maybe check out some of those links.

But definitely, you're on the right track - don't stay with a therapist if you don't have some degree of conviction that they know what they are doing with you, or if you feel there's not a good fit. Therapy can be hard work and expensive, so it's important that you feel confidence that the therapist will ultimately be able to help you get where you want to go.
posted by jasper411 at 7:47 PM on October 17, 2008

Huh.
Hi Me?

I've got similar deal, but my counsellor at least has been more CBT-y.
I've already read some on CBT, but couldn't seem to do any by myself.

I went in, sat down, told him about my procrastination, told him about how I'd just realised I had an unconscious belief that hadn't been helping (specifically, that getting help for mental health issues, inforced the notion for me that that meant I was broken or something) and as soon as I'd realised, I was able to let go of it, but til that unusual point* I'd been entirely unaware that I had that notion, so how could I find other irrational beliefs to counter them?
That I am often unaware of what emotion my body was feeling - I often don't realise that something is making me anxious. That I'm trying to figure out what I can do to be more aware of that. And with the procrastination, the really frustrating thing is that I'm not aware of any negative or irrational or even just consistent thoughts that lead me to procrastinate - it just feels that when I get a bit tired or bored, I get more easily distracted, and then it just feels like my brain shuts down for a bit, and I find myself wasting time without even remembering I'm supposed to be doing something else.

Anyway, he nodded and went - "Hmmmm...
I think you need to be more aware of what emotions your body is feeling, and be aware of what thoughts you are having that lead you to procrastinate" etc.
I nodded and said - "Yeah, exactly" and then waited for him to elaborate.
After an awkward silence, I realise he wasn't going to do anything other that restate what I've said I've already been trying to do.
This happened several more times over the session.
The homework was to 'be aware of what thoughts I am having that lead me to procrastinate'.
Surprisingly or not, no progress was made before or over the next two sessions.
I have one more paid for, but I'm not using it yet, as it seems like a waste of time unless I can go back to him with something 'to work with', but he's just telling me all the same things I've been trying to do on my own, that haven't been working.

So far, I've gotten better inside with "The Now Habit" by Neil Fiore, and "Do it Now" by William Knaus. Yes, I'm procrastinating on reading them, but there is a summarized version of The Now Habit available at http://groups.yahoo.com/group/TheNowHabit/

I'm also looking into mindfulness, or body awareness type meditation classes, to improve my awareness of what I'm feeling etc. I don't know if that would help you.

If a lot of your depression and anxiety is stemming from concerns about your productivity and procrastination, you might be able to hire someone like a life coach-type person to address those issues, while still working with a therapist about the anxiety & depression (also given the coaching stuff seems to be cheaper).


*
Unusual aka *cough*acid*cough* aka psychological laxative.
It also caused me to realise I was depressed, and make the decision to see a Dr, get medication, get counselling, tell my friends how I had been feeling (and do so); and I also tallied up several months of shared-house expenses and accounts for a shared house, go grocery shopping, make up a plan of what 'depressed-Elysum' should do for the rest of the week, and see rainbow fractals everywhere.
o_O
I'm not sure that's a standard response. And sorry for the sidetrack.
posted by Elysum at 3:44 AM on October 18, 2008 [3 favorites]

Oh, and apparently,
short term outcomes predict long term outcomes - can't find the study, but if you haven't gotten any positive results within the first 6 sessions, you probably won't get much over a longer term.

And given the cost, I can understand bailing out earlier. If you've actually had someone recommended though, maybe try 3 sessions at least?
posted by Elysum at 3:48 AM on October 18, 2008