Is CBT just not for me? Or am I not giving it a fair shake?
October 16, 2012 6:21 AM   Subscribe

Is CBT just not for me? Or am I not giving it a fair shake?

For about 16 weeks now I've been seeing a therapist who specializes in cognitive-behavorial therapy and mindfulness. The issues I'm seeing him for are dysthymia, social anxiety, fear of intimacy, and general uncertainty about myself and life in general.

I have been giving therapy my 100% and doing all of the homework and trying things even though I may have felt skeptical about them. I've tried to be as honest and open in therapy, which has been really hard for me. For different situations and feelings I've brought up, he has assigned daily mood logs as well as cost/benefit analyses and other things pulled from the Burns "Feeling Good" books.

I found the mood logs to be a little helpful in identifying twisted up thinking and replacing the negative thoughts with positive thoughts, but they just haven't been working. I feel like it's one thing to know something intellectually but I still feel like I'm where I started 16 weeks ago. Still completely afraid of relationships and intimacy, no social circle or close friends, unsure of my future and just not feeling great in general.

As we progress it seems my therapist just wants me to do more and more of these fucking mood logs. I'm getting resistant to them because they feel pointless; circling what emotion I feel then identifying the twisted thinking and putting a number on it just doesn't do anything for me.

Please help me to be more open to this process or maybe point out what I'm doing wrong; I really want to get better and live a somewhat normal life. It took me years just to get the courage to go into therapy and I'm left with a feeling of, "this is it? filling out forms?"
posted by anonymous to Human Relations (15 answers total) 11 users marked this as a favorite
Keep with it. It should take longer than that.
posted by Ironmouth at 6:24 AM on October 16, 2012

You are allowed to shop around! What is the likelihood that the first therapist you see is the best fit, after all? Talk to your therapist about your concerns, and meanwhile look for others who could help you.
Don't discard the whole of CBT because of one bad fit!
posted by Tarumba at 6:24 AM on October 16, 2012

Still completely afraid of relationships and intimacy, no social circle or close friends, unsure of my future and just not feeling great in general.

Three and a half months of work, even hard and diligent work, isn't going to give you immediate results in any of those categories. Hell, I can't think of any new and worthwhile activity wherein that span of time yields much of anything, honestly. You're not going to paint even a passably good painting after sixteen weeks of practice. This isn't terribly different, in that respect.

No one here is privy to your sessions and can tell you whether your therapist is good or bad, or what your inner life is like and what needs to be fixed. You're free to find another therapist, of course -- again, the length of time you've spent working on this is absolutely miniscule as far as sunk-cost goes -- but this isn't like taking medication. You're on a road to get to a place where you can put yourself on the road to get what you want (relationships, friends, whatever.)
posted by griphus at 6:36 AM on October 16, 2012

Kinda beaten on preview but: Have you talked to your therapist about this issue specifically? Let them know how you're feeling about the process and why you don't want to do mood logs any longer; he or she should be able to adjust the approach to make it more salient to you.
posted by lilnublet at 6:37 AM on October 16, 2012

Shop around, look for skills groups or group therapy as an adjunct, consider meds.
posted by the young rope-rider at 6:44 AM on October 16, 2012

There's no one treatment for depression that works for everyone all the time. And an incompatible (or just bad) version of any given treatment does not mean the treatment is categorically ineffective. Could be your therapist isn't a good match; could be CBT isn't for you; could be CBT isn't for you right now.

For me, therapy works much better in conjunction with medication. Otherwise, I can spend long stretches of a therapy session curled up silently in a chair, feeling miserable but unable to vocalize or explain it. I remember reading Feeling Good during one of my low points and realizing that, although it made sense and seemed right in theory, I just couldn't apply it to myself - it just felt so false. Medication got me to a place where I could actually work with my feelings and thoughts and fears, instead of being steamrollered by them.

CBT, or another style of therapy, can give people the tools they need to dig out of depression. But maybe you need tools and a light. Maybe you need just the light, or an arrow pointing the right way, or enough air. Maybe antidepressants will help get you there, or exercise, or a supportive friend.

And if you ever have trouble bringing something up in therapy, or think of it after the session's over, it can help to write it down and bring it with you to the next appointment. A good therapist will listen to "this isn't working" and help you find something that does work. It can be really hard to draw the line, because things do take time and effort to kick in, but if you're seeing no progress and feeling no confidence in your current treatment plan after a couple months, it's time to change things up.
posted by Metroid Baby at 7:21 AM on October 16, 2012 [2 favorites]

I found the mood logs to be a little helpful in identifying twisted up thinking and replacing the negative thoughts with positive thoughts, but they just haven't been working. I feel like it's one thing to know something intellectually but I still feel like I'm where I started 16 weeks ago. Still completely afraid of relationships and intimacy, no social circle or close friends, unsure of my future and just not feeling great in general.

The things you detail are effects of your preconceptions and beliefs about the world and other people. Learning the CBT process is only the first step. As you rewire your expectations and reactions to stimuli, your anxieties will start to lift.

So you are still in phase one, but you are sort of expecting phase three results. For example: changing your mindset won't get you friends. It will only allow you to be more open to going out and doing new things, which will allow you to meet new people, and then allow you to be receptive to friendly people. If no compatible people happen to cross your path RIGHT NOW, you have to keep looking.

CBT depends on the idea that unhappiness stems to a large degree from what our expectations are about the world. If you expect unpleasant outcomes, you will find them. But if you expect positive outcomes, you will find those too. If you have a bad experience along the way, a positive outlook allows you to cast that experience off as a "shit happens" moment, instead of more proof that the world is a miserable place.

The way to create more positive outcomes is to frame your expectations carefully. You can't just say "I'm going to have a good day at work today" because you can't control the actions of others. Instead, you frame your expectations more like "I'm going to have a good day at work because I am going to try my best." That small shift in mindset allows for a positive experience even in the face of stressful occurrences. The only way to fail that is to not try your best, and that's something you do have control over. At the end of day one, you sit down and analyze any moments during the day where you slipped up, and figure out a better reaction for next time. And in doing that, even if you slipped up in the moment, you do end up trying your best because you identified a problem situation and figured out a potential solution.

It is sort of like applying the scientific process to our thought processes. You hypothesize, test and analyze. It it an iterative process, and the success is in making the effort.

As for the problem of knowing something intellectually, but believing another subconsciously, that means you are half way there. You've identified one of your problem thought processes! You have to just keep on reminding yourself of the objective truth until you believe it subjectively. It is almost literally faking it until you make it.
posted by gjc at 7:28 AM on October 16, 2012 [2 favorites]

I suffered from those exact symptoms and found some CBT workbooks helpful in getting me better at acknowledging thought patterns and changing them. But for me CBT didn't get to the deeper issues of why I felt that way and how I could deeply feel better. I moved on to a more eclectic/psychodynamic talk therapy and found it very helpful. It still took a Long time (years). But my experience with CBT was that I felt talked down to, whereas with the next therapist we explored in a way that while still uncomfortable, but never made me instantly resentful.

If you find yourself thinking "oh, a log, how Novel." or "deep breathing? really? like I don't DO that?" (my experience), feel free to look for a different kind of therapy.
posted by ldthomps at 7:29 AM on October 16, 2012 [2 favorites]

I also had a really good experience with ACT, not so much as a replacement for CBT as a supplement to it. It's relatively new in comparison to CBT, so it can be hard to find actual in-person practitioners, but the book sio42 recommended is a really good place to start.

CBT for me started to feel like a battle with my brain after a while - trying to fight away all the negative thoughts with "rational" responses, and yet afterward I would still feel the bad feelings and start to get even more anxious (and yes, resentful) because I didn't feel any different after almost a year of therapy. ACT became a way to work with my brain instead, to feel my feelings and accept that they were real, and were OK, and wouldn't hurt me even though they felt so painful. Somehow this made me a lot more receptive to CBT because it didn't seem like I was having to constantly tell myself how wrong I was in my head.
posted by DeadliestQuack at 9:41 AM on October 16, 2012 [2 favorites]

I really didn't get along with CBT for anxiety about relationships, fear of intimacy and hypochondria. Like you, I found it repetitive and a bit .. shallow? Like it wasn't really getting to the depths of things. I know it is meant to be about thought processes rather than thought content, but I ended up thinking that I had real issues to deal with, not just how I thought about them. I know CBT works for a lot of people, but it didn't for me. I felt like I was just going round in circles.

I ended up having Cognitive Analytic Therapy, which was so much better for me. It's more like the traditional idea I think people have of therapy, and my therapist really helped me think about why I start thinking in certain ways because of past experiences. I am still on anti-anxiety medication (and think I always will be) but am so much better even though I only had a few months of CAT.
posted by Dorothea_in_Rome at 10:36 AM on October 16, 2012 [1 favorite]

I think two things are happening here. Your expectations for progress may be unrealistic, and you may also not be someone who gets much from CBT (I hate CBT). Even if you find another therapist or therapy framework, though, you probably still want to work with that therapist on setting up more realistic expectations for progress. (Asking, "How long do you think it will take to reach my goals? What changes am I likely to notice first? How will I know if I'm making progress?" is totally valid within a session or two.)
posted by jaguar at 10:56 AM on October 16, 2012

This is just to say that CBT is only one kind of therapy among many. I think some CBT tools are helpful but much more so in conjunction with an empathic and strong therapeutic relationship/attachment. How do you feel with your therapist? Can you fairly comfortably be open and honest and spontaneous without feeling judged--or do you at least sense things moving in that general direction? As people said above, CBT can start to feel like it's only band-aiding deeper issues and also can cause you to fight your own feelings and thoughts. Personally, I think that accepting your thoughts and feelings without judgement and also realizing that your thoughts and feelings are not YOU is helpful. The last thing most people need is more self-imposed criticism, guilt and control. Right? All of our superegos are already way too powerful. Maybe try ACT, which I've only read about. Or find someone with a more psychoalaytic relational approach. There also are meds. There also are therapies that use sensations in the body to work with tolerating and regulating affect (somatic therapy.) I'd say, talk to your therapist honestly about your current doubts and concerns and frustrations. Based on how that conversation goes, make a change or try it a bit longer. After three months (or any amount of time) there is no miracle cure. But, I think you should be feeling some positive affects even just from having that new space and relationship in your life.
posted by tacoma1 at 3:15 PM on October 16, 2012

CBT worked pretty well for me, and then I got switched to another therapist that wasn't doing CBT (I was going to sessions at a phd clinic, and they didn't have the best system), and everything started falling apart for me. I can't remember what the second one was.

This is not to say that you should expect a miracle cure, you should just talk about these specific issues and the therapy not meeting your expectations or goals. Even if they arn't the best therapist, they should be able to talk through the issues with you, and either help you reset your expectations, or possibly recommend someone better for you.
posted by jonbro at 3:42 PM on October 16, 2012

CBT may not be for you - I would look into other types of therapy.

There are many different ways to approach therapy - it is ultimately about finding something that is right for you personally.

You don't mention how the mindfulness is going - maybe you can try mindfulness and ACT?

Or maybe you would benefit more from deeper analysis?
posted by heyjude at 4:29 PM on October 16, 2012

i just want to say i think your expectations aren't too high for right now. i don't think you really expect a close circle of friends, but you'd expect at least some new acquaintances, some prospects, some opportunities, something to look forward too. i think what you really mean is you don't even have that yet.
posted by cupcake1337 at 8:40 PM on October 16, 2012

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