I was surprised. My first blog received so many responses, that I thought I would address a few concerns that were expressed. (They mirror the misconceptions I uncover when I give workshops on CBT to therapists who have not read the major CBT books or received formal training and supervision in CBT or watched DVDs of CBT therapy sessions).
Q: Doesn't Cognitive Behavior Therapy downplay the importance of the therapeutic relationship?
A: No! CBT requires a good therapeutic relationship. Therapists do many things to build a strong alliance. For example, they work collaboratively with clients (making joint decisions such as how to spend the therapy hour), ask for feedback ("What did you think of the session? Anything you want to do differently next time?"), and conduct themselves as genuine, warm, empathic, interested, caring human beings. They also work hard to reduce patients' suffering as quickly as possible. Interestingly, research shows that the alliance becomes significantly strengthened when clients see that their therapist is helpful, that is, when clients see themselves solving their problems and feeling better.
Q: Doesn't Cognitive Behavior Therapy require clients to be motivated?
A: No. Many clients are unmotivated when they first come to treatment. One essential part of therapy is helping clients set goals they want to reach, which often boosts motivation. If it doesn't, it is the responsibility of therapists to help patients build motivation. They need to gently question clients to discover whether the problem is due to a practical concern (e.g., that therapy is too expensive), to the clients' thoughts (e.g., that others are to blame and they shouldn't be in treatment themselves), and/or to mistakes they (the therapists) have made (e.g., interrupting clients too much). It is also helpful to record in writing what clients see as the advantages and disadvantages of coming for treatment and the advantages and disadvantages of not coming for treatment.
Q: How do I know if my therapist is really practicing CBT?
A: You can download a document from www.beckinstitue.org entitled "Q and A about Cognitive Therapy" for a description of CBT. You can also visit the Academy of Cognitive Therapy website to find a certified cognitive therapist. Unfortunately, many people call themselves CBT therapists when they are not employing even the most fundamental elements of this kind of treatment. I frequently discover this when I give workshops. Often 80 percent of attendees self-identify as CBT therapists, yet only about 20 percent raise their hands when I ask who sets an agenda, discusses homework, sends clients home with notes (with what clients need to remember during the week) and asks for feedback, at virtually every session.
Q: Is it true that CBT isn't deep, doesn't help clients gain insight, and helps people only superficially?
A: No! For clients to improve, they need to understand themselves well. They need to know why it is that they are feeling upset and/or behaving in an unhelpful way (i.e., contrary to their goals). The answers are related to what they are thinking at the moment. Gaining this insight is essential but insufficient. Clients need to know what to do with this insight this week to make their lives better.
The next step is to help clients evaluate their thinking, which allows them to appraise situations and problems more realistically. When they do this, they are able to behave in a more functional way and move toward their goals in life.
Clients also need insight into why they think the way they do, which is related to their underlying beliefs, that is, the basic way they see themselves, others and their worlds. These beliefs begin developing in childhood but usually it is not necessary to spend much time uncovering the roots of these beliefs unless clients have personality disorders. Again, insight alone is necessary but insufficient, and clients need to evaluate and modify their unhelpful, unrealistic beliefs.
Therapists often work at deeper levels, too, when, for example, clients' goals are related to finding more meaning in life, living according to their most deeply held values, or coming to an acceptance of problems that can't be changed. However, this work is done (if it is still needed, and often it is not) after clients have recovered from their psychiatric disorder (if they had one).
As for superficiality, if it were valid, then one would expect that people who have recovered from a disorder would soon relapse. The opposite is true. In depression, for example, clients successfully treated with CBT have half the relapse rate as people treated with medication alone.
Q: How do I know if therapy is working?
A: You should be feeling better, behaving in a more functional way, solving your problems and making progress towards your goals.
Judith S. Beck, Ph.D.
President, Beck Institute for Cognitive Therapy and Research
Clinical Associate Professor of Psychology in Psychiatry,
University of Pennsylvania
www.beckinstitute.org and www.beckinstituteblog.org
Follow Dr. Beck on Twitter: www.twitter.com/beckinstitute
Follow Judith S. Beck, Ph.D. on Twitter: www.twitter.com/beckinstitute
Judith S. Beck, Ph.D.: How Much Guilt Is Too Much?
Judith S. Beck, Ph.D.: The How and Why of Cognitive Behavior Therapy
Elaine Aron, Ph.D.: How to Find a Good Therapist
Robert David Jaffee: Psychotherapy over Psychopharmacology
What is Cognitive-Behavioral Therapy?
Cognitive behavioral therapy - Wikipedia, the free encyclopedia
Beck Institute for Cognitive Therapy and Research
a working alliance is necessary (for all treatments) - but CBT therapists do NOT focus on the emotional quality ( hostile, seductive, evasive, wary, etc.) that come to life in the therapeutic relationship - revealing deeper patterns of fears, defensive strategies, maladaptive maneuvers. This occurs only in a truly psychological therapy. It is called Cognitive Behavioral because it is determinedly just that.
The intersubjective experience, skillfully deciphered by an expert psychoanalytic therapist, to help the unconscious become conscious, is intentionally ignored or side stepped in CBT.
This does not mean CBT can't provide symptom relief and a greater capacity to tolerate psychodynamic work. But getting at the 'roots' is not the goal of CBT; some patients prefer it that way.
Researching CBT is much easier than researching what really goes on in most private practice offices. Therapy, and life, and the ongoing work one does on oneself, is much messier than any cut and dry CBT. If most real world practicing therapists adhered to CBT methodology as it is often practiced for research purposes, they'd soon be sitting all alone in their offices stroking away at their 'statistically valid results'.
CBT certainly has its uses but like any other Procrustean orthodoxy . . .
But CBT is very good for business. You never run out of clients, because they keep coming back. One may cure himself of, let's say, fear of spiders, but he'll come back in some time with a brand new fear of flight.
Machines function, people live. And nobody goes to therapy because they can't function proprerly.
What kind of a twisted person could ever say - "it feels good to function/to be functional"?
The fact that CBT has the most research points only to the conservatism of NIMH and insurance companies. Mindfulness-based therapy, and Emotionally Focused Couples Therapy also put up some very impressive results, but are less studied because CBT continues to suck up the research dollars to preserve its hegemony. It does not mean other treatments are less effective. The therapist's approach, in many well-designed studies, constitutes only 12 percent of whether therapy is effective anyway. Much more important to success is the relationship between therapist and client, regardless of the therapist's orientation.
...Also, ironically, studies have shown that when mental health professionals-including CBT therapists-seek out therapy, they are less likely to choose a therapist who practices CBT than any of the other major orientations, including psychoanalysis, family systems, mindfulness-based, humanistic, etc.
I do not suggest that CBT is not valid or helpful in many situations. It's just that I've never met a CBT person who did not feel compelled to tell me their way is the best. They are the evangelical fundamentalists of the field of psychology. It is tiresome beyond belief.
http://moodgym.anu.edu.au/welcome
PLEASE... I am in no way part of this site, I am not advocating this site, and I have never even used this site. The only reason I mention it is because it a free interactive web site and I thought it may be of interest of people who have read this article. In the sites own words:
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What is MoodGYM?
"MoodGYM is an innovative, interactive web program designed to prevent depression. It consists of five modules, an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment."
Who is behind MoodGYM?
MoodGYM was designed and developed by staff at the Centre for Mental Health Research at the Australian National University, in collaboration with other researchers, mental health experts, web and graphic designers, and software engineers.
Do I need to pay to use MoodGYM?
No, MoodGYM is provided free of charge to the public.
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A review of this site is here: http://www.findingoptimism.com/blog/reviews/mood-gym-cbt-online/
Again, I must stress I know nothing about this site, but thought it may be of some interest to readers here.
CBT taught me how to put names on the emotions I was feeling, and how to handle those emotions in a more constructive manner. I realize that not everyone benefits from CBT, but for me, it was a life-changer.
Also note: almost all research into "evidence-based" practices are based on follow up of less than a year and almost always 3-6 month intervals. I think this is not adequate.
The very word "client" emphasizes the pecuniary relationship over the therapeutic connection.
patients need therapy. Clients need new soles on their old pumps.
What has also helped is having a therapist and a GP who are familiar with meds and know which ones work. Both these things have been a big help with OCD.