Arguing about CBT w/ T

So today I saw my T for the first time in a month; we had a double session. I told her I had been feeling depressed, hopeless, couldn't get out of bed for a couple days this week b/c of my job situation. I also eventually told her I had been having suicidial thoughts and she kept asking me to elaborate but I didn't want to.
She specializes in CBT, and we started talking about my thoughts regarding how I feel about myself, ie worthless, stupid, hopeless, etc. She said they were cognitive distortions and pulled out her list of cognitive distortions and started saying what type of cognitive distortion I had. Then (and she ALWAYS does this) she asked, "Well, if one of your friends was unemployed, would you tell them they were stupid and useless?" and of course I said no. She is always asking me this question: "Well, if someone else were jobless/didn't have a PhD/received a bad grade would you think they were stupid, etc?" And the answer is always no, I wouldn't,and then she always asks why I think this way about myself if I don't hold other people to the same standard. I understand where she is coming from, but it doesn't change my belief about myself. I feel like she is trying to logically talk me out of how I feel about myself, but it's not working, and I told her that her "technique" wasn't helping. Then she started asking me what qualifications I had regarding employment, and I grudgingly named my academic MA degree and the two years of experience I have working with kids. Even though she knows this about me, I know she was trying to get me to see that I'm not useless. So finally I said "OK, so I'm not completely useless, I'm just 90% useless." And she said "OK, so you're 90% useless, that's better than completely useless." So basically we spent more than an hour with her trying to use logic or CBT or whatever to reverse my thoughts, but it wasn't working.
Maybe I'm just stubborn, but I felt like she wasn't getting that I feel this way. Even if maybe logically I'm not as useless/stupid/a failure as I think I am, I feel like I am, and I felt like she was trying to use to tough love/logic to reverse my thoughts, but it wasn't working. I guess I just wanted her to listen to me instead of pulling out her CBT stuff.
Finally she asked why my previous boss had written me a recomendation for a job, and I said because he's a nice guy and he's from the same hometown as me (I also think by this point I was just being stubborn) and she said, "So there's no reason other than that as to why he would write you a recomendation?" and I said no. So then she said "OK, so why don't you just call him up and tell him you're completely useless and a failure and he shouldn't write you a recomendation?" I told her that obviously I wasn't going to sabotage myself.
I was getting SO frustrated by this point, and it was not how I had imagined my first session back going at all. Then I was saying that I didn't want to get out of bed for a couple of days and I didn't want to go grocery shopping, etc. because I didn't deserve to eat, I didn't deserve to do anything, etc. And she asked me what good this kind of thinking was doing, and I said that I just didn't feel like I deserved anything. And she said "Well, OK, why don't you just lie in bed and feel ****** about yourself for the rest of the day if you feel like that?" and by this time I just said "OK, fine then, I will lie in bed for the rest of the day." I just felt so frustrated and pissed that I was spending my first double session back arguing with her. I just genuinely wanted to talk to her. So finally she was like "Well, OK, I see that cognitive behavioral therapy isn't working." and asked me what I would want to talk about, but by that point I didn't want to talk about anything.
Anyways, for the last 20 mins. I did eventually end up talking to her about my trip, and I gave her the magnet I had bought from the Freud museum that said "Analyse me," and she loved it. But when I gave it to her she was also like "I don't know if I deserve this since I haven't been doing a very good job of analysing you," or something like that.
I know that she wants to help me, but I was just really frustrated today because I understand that yes, maybe I am not thinking logically. But arguing with me about it and telling me to go to tell the guy who is writing me a recommendation that I am stupid and worhtless (even tho I know she was being sarcastic) isn't helping. And the thing is, is that my situation really is not good. Like being unemployed, in debt, and finishing a useless MA program is enough to put anyone into a negative mind frame.
I did tell her I was frustated, and I even told her I wanted to throw something b/c I felt so frustrated. I do think she got it, that her technique wasn't working, but I was curious to see what others thought on here about CBT as a remedy for depression, or about my T's comments, or about what your T has said if you were in a similar situation.

I am sorry you had such a difficult time. That is exactly the type of stuff that my T did that helped me, so I have no advice. Sounds like you need her to come at it from a different angle though.

Thanks pbutton! And that is good that it worked for you. I guess for me is when someone is trying to argue with me that I am not stupid/useless and trying to tell me that I am wrong in thinking that way, it is automatically my response to go against them. And I think that maybe T is stubborn also, so that is why she was arguing with me about it for so long. For me, it would be incredibly hard to give in to what T is saying and admit that I am not a horrible useless person. I don't feel like I deserve to say that about myself though. ANd I really did just want to talk to her about other things, or maybe just have her listen to me talk about being depressed, instead of automatically going into CBT/logical/argumentative mode.

(((franki))) Sounds like you really needed to connect with T on some level but CBT wasn't what you needed or wanted at that time. It sounds like you just needed to be heard?

What could you say to your T about what you needed in that moment from her? What were you hoping for in terms of treatment?

I see where you're coming from. My Ts have told me positive things about myself over the years that I have a really hard time believing. My last T, however, acknowledges that when I feel so down and horrible about myself, that it FEELS very real to me. More importantly, she says that just because I feel something, it doesn't mean it's true. I found that concept very comforting.

You don't have to suddenly think you're the best thing since sliced bread, but I think your T just wants you to consider other possibilities. She asked me a similar question about others- if I thought some people were worth less or less valuable/deserving than others, and I thought about it and said "no." I didn't and still don't think any person is worth more (or less) than another, and hey, I'm people too!

Sometimes it's still tough to love myself 100%, but it's been easier by opening my mind to these ideas. Hopefully you can give it a try too.

Only you can change your belief about yourself; the CBT is just a tool to help you do that. You can literally decide to think, "Well, I look at so-and-so who does not have a job, we are friends and I do not think they are stupid so, in order for them to like me, I probably am not stupid either." Do not confuse what you believe with what you feel! You cannot control what you feel, that follows belief.

My T was a calm, quiet woman and I was an anxious one. It occurred to me that either the sky was not falling as it felt like it was to me or my T was "crazy" (for not seeing and acting like the sky was falling). I decided the sky must not be falling. Still felt like it was but I acted as if it were not since, logically, it probably was not.

You can feel lousy, be depressed and in a bad mood, etc. but still decide to get up and shower, dress, greet people pleasantly, and go to the library for an hour or two and research job opportunities. No one says it is easy or feels good but, logically, you cannot find a new job while you are in bed sleeping? Doing what needs to be done will change your belief about yourself, positively, and your positive beliefs about yourself will make you feel better. You cannot suddenly wake up at 4:00 in the afternoon and feel positively about yourself when you have not done any positive action to point to.

Start with where you are. You went to therapy and had a good discussion with T, good in that you had an opinion and expressed it "passionately" (you cared). Keep up the good work. You are thoughtful (capable of thought/argued your point), intelligent (believed you saw a flaw in your T's arguments and argued your point forcefully to her and here), hard working (showed up to work with T instead of just rolling over and giving up), etc.

CBT is great for some people, but certainly not everyone. For me personally it is a really bad fit. The CBT stuff makes me feel really disconnected from the T. Occasionally my T resorts to some of the CBT talk and I call her out on it, and tell her not to pull that CBT crap on me.

Don't feel bad if this approach doesn't suit you. There is no "one size fits all" therapy.

Best,
EJ

"It sounds like you just needed to be heard?

What could you say to your T about what you needed in that moment from her? What were you hoping for in terms of treatment?"

Yes, exactly! I think I just wanted someone to talk to instead of her whipping out her bag of CBT tricks and trying to reason with me. I also wanted to tell her about my trip and seeing my extended family, which had been an emotional experience. I even got some pictures developed to show her, but we never got around to it because we spent so much time talking about CBT. I just don't think I'm at a place where I can see myself in a more positive light; I think once I get some financial/job security I could maybe, perhaps, start working on that, but right now it is harder than ever to try and rationalize away my negative feelings about myself. I really just wanted to talk to her instead of having her try and do CBT on me.

"My last T, however, acknowledges that when I feel so down and horrible about myself, that it FEELS very real to me. More importantly, she says that just because I feel something, it doesn't mean it's true. I found that concept very comforting."
Yes, that is what my T kept telling me yesterday, but I insisted on arguing with her about it. I also think that when someone tries to reason with me about how I am not a failure, it is just my gut reaction to argue.

You can feel lousy, be depressed and in a bad mood, etc. but still decide to get up and shower, dress, greet people pleasantly, and go to the library for an hour or two and research job opportunities. No one says it is easy or feels good but, logically, you cannot find a new job while you are in bed sleeping? Doing what needs to be done will change your belief about yourself, positively, and your positive beliefs about yourself will make you feel better. You cannot suddenly wake up at 4:00 in the afternoon and feel positively about yourself when you have not done any positive action to point to.


I have been doing that for the past couple months, (ie going to the library, looking for jobs, getting up in the morning, etc) but in the past week, after coming home from vacation and not getting hired for this one job I was very hopeful about, it really got to me, and that was when I started getting seriously depressed. I do have another interview this week and just found out I was accepted as a non-degree student at Hunter, which helped me to come out of my depression a little. It just really got to me this past week.

"Start with where you are. You went to therapy and had a good discussion with T, good in that you had an opinion and expressed it "passionately" (you cared). Keep up the good work. You are thoughtful (capable of thought/argued your point), intelligent (believed you saw a flaw in your T's arguments and argued your point forcefully to her and here), hard working (showed up to work with T instead of just rolling over and giving up), etc."

And yes, I was not happy with session because I had wanted to talk about more than just CBT with her, but at least I let her know it wasn't working. I am not even upset that we argued/disagreed, I am upset that I feel like I wasted my double session arguing when what I really wanted to do was tell her about my vacation etc. I mean, I also wanted to talk to her about being depressed, but that wasn't all I wanted to talk about.

"CBT is great for some people, but certainly not everyone. For me personally it is a really bad fit. The CBT stuff makes me feel really disconnected from the T. Occasionally my T resorts to some of the CBT talk and I call her out on it, and tell her not to pull that CBT crap on me.

Don't feel bad if this approach doesn't suit you. There is no "one size fits all" therapy."

Yes, I think my T finally acknowledged that it wasn't working at the end of session. Plus I feel like she gets all clinical/professional when she starts talking about CBT, which I don't really like.

"Maybe I'm just stubborn, but I felt like she wasn't getting that I feel this way. Even if maybe logically I'm not as useless/stupid/a failure as I think I am, I feel like I am, and I felt like she was trying to use to tough love/logic to reverse my thoughts, but it wasn't working. I guess I just wanted her to listen to me instead of pulling out her CBT stuff."

My T has used CBT/REBT approaches with me a great deal of the time. I quoted what you said above because you said you "feel" these things about yourself. Your T is trying to get you to see that those really aren't feelings; those are beliefs about yourself. They are your thinking, not your feeling. That was an important distinction for me because he taught me that I acquired those thought/beliefs about myself many, many years ago, and they were mistaken beliefs that I bought hook, line, and sinker about myself based on how the dangerous and abusive people around me treated me, what they told me about myself, and what I believed I had done to justify the treatment I received.

Realizing and acknowledging that my beliefs about myself and other people in those regards were mistaken and being able to pinpoint how those beliefs developed allowed me to rethink them. It took time, LOTS of time, but I have been able to restructure my thinking into more reality-based, present-time ideas that are so much healthier. I had to let go of those old beliefs that I truly, truly thought were accurate and be willing to learn the truth about myself (which was really that I'm a pretty decent person--strangely it was frightening to admit that or see that about myself).

CBT gets touted as a short-term therapy and very surface-level for only dealing with present day issues, but that has by no means been my experience. My T would say that is a textbook definition/description of CBT done very lock-step and structured, but it has not been the reality in complicated cases of abuse and shame and PTSD. It can take a very long time to explore where that old mistaken thinking came from and learn to restructure your own thinking. But once you can get your thinking to line up with reality, the pay-off is that your emotions/feelings are no longer based on mistaken ideas about yourself and the world around you, but about a clearer concept of who you are and what you have experienced in your life.

Be patient with yourself as you work through this. Rome wasn't built in a day as the old saying goes. My T has a book that he kept pushing me to read. In fact, he didn't even ask me to read the whole book, but two or three chapters in the middle of it. The title is The Anxiety & Phobia Workbook. I don't really have anxiety or phobia issues, so I was resistant to picking it up, but I finally did. In the middle of that book are two chapters about mistaken beliefs and cognitive distortions (I don't have the book in front of me right now to tell you exactly the chapters or titles, but they are pretty easy to find). You don't need to read the whole book at all. What this book does so well in those two chapters is has you explore what your mistaken beliefs are AND where do they come from. It is a quick, concise, non-convoluted overview of those CBT/REBT-type concepts that finally validated where my thinking had come from. I finally sat down and really worked at these chapters kind of over and over again and really journalled deeply about those beliefs and my history in regards to them. And over time, it started making some sense to me and my thinking slowly, very slowly, started to restructure about my past and myself.

I found cbt completely useless. If that is the only thing in the therapist's toolbox, I would find a new one.

Certainly agree with that. A therapist with only one technique/modality would seem to have a limited ability to address the unique needs of a his/her clients.

I don't like CBT either. It's just not for me. There were a couple sessions where my T went more in that direction with me, and it was like a red rag to a bull... She told me that our therapy is like making a cake and it was one of the ingredients. I told her I didn't want CBT in my therapy cake..

If she's used it since it has been with enough subtlety that I haven't picked up on it..

Does she understand your need to be listened to? A lot of times therapists can pick up on this and don't have to be told, but sometimes we need to spell out what we need from them. (My T even asks me sometimes, "what are you needing from me today?" It helps him to know that, even if it is a question that makes me take responsibility and dig deep.) I think the first session back after a long break especially calls for listening. However, you did say you told your T you were having suicidal thoughts, so maybe that was behind her strong emphasis on trying to get you to change your thinking. She was worried about you and perhaps CBT is the only method she knows how to use to help.

Why do you have double sessions? When the session is a big argument, it would be very painful, at least for me, to have to tolerate that length of time. Could you have single sessions with her until you get back on track or are doing more productive work?

I really hate arguments so your session sounded so hard to me. When I am tempted to enter into an argument with someone, I try to remember that it takes two to argue. I can decide I will not be part of an argument with the person. If the other person keeps harping on the same subject, I just let them say all they have to say on the topic by pausing after they speak and allowing silence. Then perhaps I ask, "is there more?" When they have said all they have to say, we can move on.

Once I asked an instructor/clinical psychologist about using CBT for depression and she said in her practice, it works with 50-75% of clients, and that this is similar to what research shows. She found that, in her hands, another evidence-based treatment for depression, Interpersonal Therapy, helps a greater proportion of people. So she tends to start out with IPT as her default rather than CBT. So please don't feel bad that CBT isn't helpful to you at this time because it seems that's true for a lot of people. There are other therapies that may help. Maybe once you get to a better place with your depression, you can revisit CBT and some of its elements may help then.

My first therapist was a mild CBT practitioner. We didn't need to work much on irrational thinking, but she sometimes tried behavioral suggestions. One thing she suggested a couple of times was that I do something nice for myself, like taking a bubble bath. I hated that LOL! I wanted to work on my problems, not take bubble baths. To me, she just seemed so clueless to think taking a bubble bath would help me with my problems. When she suggested several things that were unhelpful, she then asked me what thing I would like to do that would make me feel better and I said sleeping. So she and I began a systematic effort to help me find ways to sleep. This was soooooo helpful. She helped me with something I needed help with! It was very concrete and within her ability to help. I think a number of my other issues were just too complex for her. Looking back, I think the trick to getting something helpful from her was to choose something to work on that was within her ability. Then we made progress on that. At some point, she wasn't helping any longer, and I quit therapy. Later I found a T who had the skills to tackle the bigger problems in my life, like my floundering marriage, trauma, etc. I tell that story just to encourage you that there may indeed be things your T can help you with, even if she can't help with all your issues right now.

Could you discuss with your T what she might be able to help you with? Also raise the idea of a different approach from CBT? Do you know if she knows more than just CBT?

Even though I've written some things that make it sound like I don't like CBT, I am now reading a CBT workbook and do find some of it helpful, like getting mobilized and planning a schedule for the week to include some activities I like. I see that these are actually along the lines of the bubble bath suggestion my former T made! So now maybe I find this helpful but not so much when I had much bigger problems in my life. Back then it seemed like she was focusing on trivia.

Good luck to you, frankie.

Franki, I totally agree with every word that you said. Would it have been more helpful for you if your T would have tried to explore where those feelings are coming from? I think that it is helpful to jump into those feelings with other person and help them explore them. During this exploring some of those feelings can be expressed so that they can be released and let go of. I personally have little use for this superficial use of CBT.

However, you did say you told your T you were having suicidal thoughts, so maybe that was behind her strong emphasis on trying to get you to change your thinking. She was worried about you and perhaps CBT is the only method she knows how to use to help.

I do think that when I told her I was having suicidal thoughts it worried her, and she probably thought that trying to practice CBT would help with them. However, I've told her before that I don't like CBT. I have been trying to do the worksheets and things like that, but when I felt really bad this past week I couldn't even do them. I think sometimes the worksheets help when I am only feeling midly negative, but not when I am so bad that I can't get out of bed. I also think that you and the other posters have made good points in regards to her ability to do other types of therapies. Her main focus is CBT for eating disorders, actually, and she did help me enormously with my ED. On her faculty page and her Psychology Today and somethingfishy pages, it says she is mainly CBT and sometimes uses psychodynamic therapy (which I am not super sure what psychodynamic means, sounds kind of vague). So I guess because her therapy is so CBT oriented it makes sense that she would immediately go there, even though I've told her before that I am not really that into it, even though I do try and do the worksheets. It's not that I mind doing the homework, it's just that I don't find it particularly helpful, and definetely not at this moment. The thing is, is that I honestly don't think I would ever leave her. I am way too attached to her, and I do feel like we have a great connection, and I know (or at least prety sure) that she does genuinely care about me. But maybe you guys do have a point that she should try brancihng out and trying different methods, instead of constantly whipping out her list of cognitive distortions. Yesterday when she pulled out the cognitive distortions list I actually rolled my eyes and said "This is the third time you've pulled that list out." But I really wouldn't leave her because of her focus on CBT.
Why do you have double sessions? When the session is a big argument, it would be very painful, at least for me, to have to tolerate that length of time. Could you have single sessions with her until you get back on track or are doing more productive work?
This was actually the first double session I've ever had with her. We decided to schedule one since this was the first time I had seen her in about a month. Next week it is back to single sessions.

Yes! I think that I would have appreciated so much more if I could have just talked to her and have had her make some suggestions instead of trying to force CBT down my throat (OK maybe that sounds a bit dramatic). I do think that CBT maybe would help me once my situaiton stabilizes, but yesterday I just wanted someone to talk to instead of pointing out my distorted thoughts.

I think just letting someone air out how they feel is the best route. No need for suggestions at this early stage. The whole area needs to be explored first. How can suggestions be made before all of the info is gathered. "How are you feeling?", "Where is that coming from?" "How does it feel when that happens"?, etc. Explore, explore, explore!

Like you don't already know that your thoughts are distorted! Why else would you be in therapy?!

Are you sure that she was trying to argue with you? Therapists are there to help us, but they can't do all the work for us--we have to meet them halfway.

There are many reasons to be in therapy.

Some weeks are like that. When I get that down, I do retire to my bed early with a good book or something, take a break from my "usual" routines and activities that I think I should be doing or usually do enjoy. If I can identify specific stressors, I let some of them go, at least for the moment; often they are beliefs or set-ups I have put in place ("I should have a job by now", "I have to go to this, that, or the other interview/party/activity"). Often I can identify some little thing I would rather be doing or wish I have and just go do/buy that. Feeling down is as good a time as any to enjoy favorite foods; so I don't have a cold/aren't sick, close enough! :-)

I think we practice CBT on ourselves all the time but also BHCBT (black hole CBT :-) and T's want us to concentrate on the positive kind of thoughts and actions and work with ourselves instead of the negative kind, where we tell ourselves how we're worthless failures, etc. and give up. But I think it is possible to feel bad and yet learn to modify the CBT to feel good rather than feel like we're in a lock-step mental conditioning program all the time (which does not feel good).

We know, if we think about it, what feels good to us. Convincing ourselves to get up and take a hot shower when we're feeling depressed, or, in my case, to change the bed so the sheets are clean, that is not a whole lot different to me from some of the tools used with CBT http://www.psychologytools.org/downl...orksheets.html but more personal and likely to get results right this minute.

When T gets into her CBT instructor/clinical mode, you know you don't want that, that that does not feel good at that moment (and only you can know that). Stay with the CBT "theme" and figure out what you do want, what action would help you feel better (changing the subject and talking about your vacation? Discussing/arguing about CBT with T? Listening to T talk so you can take an emotional break (since it's instructor/clinical/head talk))? Practice CBT within the therapy framework; invent a CBT within CBT moment :-)

I've had CBT which i hated at first, it made me angry and i hated the homework, i rarely did it at first. But actually it proved really useful in pointing out my negative core beliefs and channelling my thoughts and finding what was behind them. In the end it def did help me, HOWEVER.... because it wasn't a "depth" therapy it never really got to the core of my self loathing, there was no room to grieve for my past etc which i really needed hence the reason i have now gone into different therapy that allows for that.

My advice is to take what you can from the CBT cos some of it is very useful but maybe explain to your therapist that your needs right now are to process your feeling rather than being constantly challenged on them.

Which reasons don't relate to distorted thoughts?

Have you actually spent all this time on this forum and not realized that many, many people have no clue that their thoughts are distorted? That seems to be one of the biggest issues I see here: people who believe in their whole hearts that what they are thinking is actual fact and reality when in actuality their thinking is completely messed up by whatever in their life has gotten them into this state. The therapist's real challenge is getting people to recognize their mistakes in thinking so that they aren't slaves to that distorted thinking any longer.

People go into therapy knowing they are miserable or lonely or depressed or manic or anxious or whatever, but generally they are not at all aware that all of these feelings they are having are the direct result of their mistaken thinking about themselves.

So, I'd say people generally go into therapy because they don't like how they are feeling, and it is usually in the process of therapy that they realize how tied they are to their screwed up thinking which is often the result of years and years of going through all sorts of yuck in their lives.

My post was in response to this ^ comment. Logically franki knows one thing and feels another and many, many people here make this same comment. Yes, there are others who aren't as aware yet but I come across a lot of people who get that their mind doesn't match their feelings.

My comment that you quoted was only for franki. I wasn't making any blanket statement about everyone on this board.

If the client disagrees with an approach (cbt, emdr, whatever) I would not think it would work no matter how much the therapist loves it. I would think a good therapist could move on for awhile, and if it was a big deal to the therapist, try to approach it again later perhaps after other work had been done.