What is CBT Therapy Like?

I have always been a little confused by the idea that it's one thoughts alone that upset one, rather than what actually happened. Like my mother died when I was a child. This seems to me to have been an intrinsically upsetting experience, and I can't get my head around the idea that it would have been possible to think about it in a way that would erase the pain of it.

I remember being totally confused by the Stoics when I read them in college, long before I had ever heard of CBT. Like their ideas about grief just didn't reflect my lived experience at all, and it seemed to me they were trying to deny the normal, human response to death.

But I realize plenty of other people find this kind of thinking useful! I get it for some things, and even for some types of grief, but I have a hard time agreeing that it is always one's thoughts that are the real problem.

Thanks - I appreciate your reply! I still remember the exact wording of the Epictetus quote about not being upset when your wife dies. It just seemed so ridiculous to me, and so in denial of the power of love and loss. I was actually quite shocked when I found out there was a school of therapy based on Stoic thinking! Did not compute...

I have found CBT helpful-but no one ever tried to help me see death as being ok. The kind of thoughts that I learned to challenge would be thoughts that I was responsible for a death (thus leading to guilt). Or thoughts that someone was treating me badly because I deserved to be treated badly.

A current example. My pdoc's daughter has died from cancer. She was just out of college. I need my pdoc, he is not available. Those are facts. I need to figure out a way to get what I need that doesn't involve pdoc. That is a fact. What is not a fact is the idea that he has bailed out on me like other important people have done. Or that he is the only way that I can get help. Or that if he really cared about me he would be available. Or that he will never return to his office.

So CBT doesn't solve the problem, nor help with my feelings of desperation. But thinking about the situation and keeping my brain to the facts means that I am not freaking out over being abandoned and that helps me stay more mentally clear and do the problem solving I need to do. CBT also doesn't ease my feelings of sadness for him and his family, nor my feelings of uncertainty about if/when he will return.

This is going to be long:

My T used CBT and REBT quite a bit, but he NEVER did the whole worksheet thing, and he didn't get all hung up on labeling thinking errors, etc. I think one of the problems and reasons why CBT often doesn't work well for people is that it is used by therapists who can't seem to get beyond the "textbook" and actually apply it individually to the actual client sitting in front of them. I also dislike that it is often termed a "short-term" therapy and that many label it as only for very surface-level work. NONE of those descriptions applied to how my therapist applied behavioral work in my therapy at all, yet he most definitely was using CBT and probably more specifically REBT in our sessions probably at least half of the time.

What my therapist did was to work with me consistently and diligently in the skill of recognizing when I have been triggered and exactly how to work my way out of that triggered reaction through some very step-by-step methods that on the surface were very easy but in practice took years to be able to internalize (which is why I think behavioral work generally does need to be long-term work, particularly when you are working to counteract decades of skewed thinking about the self that resulted from very young exposure to abuse).

So what did it look like in practice? Okay, I might go into session all worked up about something -- maybe something happened at school that has me all upset and anxious and angry. My therapist would work with me to work backwards from my upsettedness which was generally way out of proportion to the actual event. Rather than waste time blaming the incident or person that I say upset me, my T helped me recognize that when my emotional reaction is out of proportion to the current event, there is something going on in my thinking that is probably much older and much more self-engrained into my psyche that I need to figure out.

So, what was I thinking just before I got upset? "Well, I was angry because X was accusing me of Y." Again, the initial impulse is to focus on the current event, but the reality is the thought is older than that.

What was I thinking before that? This is harder because it happens in such a split second and almost on a subconscious level that I don't recognize it, but it IS there. Well, "I was thinking 'How dare X blame me for Y when I did nothing wrong!'" Closer.

What was the thought underlying that? Well, "I hate it when I am blamed wrongly." Better.

Where does that come from? Well, repeatedly my abuser said X to put the blame for my own abuse on me. Good.

How did that leave you feeling? I felt great shame and I'm tired of feeling shame over other people's grievous errors. Good. So, when X did this today, that triggered that old thinking which is where my reaction came from.

(Editing to add: This is where I don't agree when people say behavioral methods ignore history. It is at this spot that sessions could take some time and get rather intense as we explored that history specifically as it pertained to my emotional response at that moment. There is NOTHING surface-level about that kind of work.)

Can I set the old stuff aside and look at what happened today as the adult I am today? How can I look at the current event differently? And we'd process the current event, this time without the old baggage attached. My anxiety and anger would subside and I could think clearly enough to actively problem-solve the current event.

We did this over and over and over again until I could finally do this without him walking me through it. I finally internalized the process so that I could actively set my past where it belonged -- in the past -- and deal with my present in much more effective ways. Learning how to do this has effectively brought my once very severe PTSD reactions pretty much to a halt, has effectively given me strategies so that I am no longer debilitated by anxiety and depression, and has effectively calmed my whole being. I finally have some inner peace and have the ability to find that peace within myself, even at times when my world around me is highly stressful.

That's the power of behavioral techniques IF they are truly internalized with the help of a therapist who really knows what they are doing.

Epictetus himself did not have an easy life. He was born a slave, was physically abused, his intelligence did not win him a great life, but he survived.

I'm not sure Epictetus ever wanted anything other than to be a schoolteacher (after his master freed him), and the way I read him (I've read through The Handbook and the Discourses several times), he sounds like an upbeat guy.

For Epictetus, and the Stoics in general, the key to the best life possible, a flourishing life, (Eudaimonia) is one of progress towards moral perfection.

But when I am in a very bad space in my life...physically, fiscally, and emotionally...as right now...then old Epictetus kind of grates on my nerves.

Since reading this thread I have been contemplating all of this. I wrote an email to my counselor (we only do phone chats - she's with my insurance company) that CBT wasn't working very well. Her response was that maybe I needed to seek support "out in the community." Well, she knows I already tried that and couldn't find adequate support I could afford.

So then I started to think that maybe Epictetus is a comfort for those, like me, who find themselves in extreme conditions. What I mean by this is that my life is quite hard. The last thing I need is for my counselor to abandon me because I have been unable to adequately do CBT on my own.

My difficulties are straight forward. I need a good job, I need a better place to live, I need more money, and I need more social connection. These would improve my mental state. But these things are not easy to come by. I live in a very competitive part of the country.

Epictetus himself did not have an easy life. He was born a slave, was physically abused, his intelligence did not win him a great life, but he survived.

Epictetus speaks to me because I have sustained a lot of loss. Some of it may have been due to my incompetence. But not all.

Just like you losing your mother at so young an age. It brings to mind the great writer Leo Tolstoy. He lost his mother at a young age. It affected his entire life and he returned to it again and again. He tried following the Stoics...but in the end it was love that saved his sanity.

He did not remember his mother but she represented unconditional love. So when he was older and in a suicidal and spiritual crisis he returned to her memory again and again...and from there applied what now might be called radical self acceptance.

Maybe if we combined CBT with love it might work better. I think that's what Linehan tried to do with DBT.

Really interesting conversation - thanks! I didn't remember anything about Epictetus's life, just his odd admonition not to get too attached to kissing one's wife!

Thanks for this reply- your last line really spoke to me. My therapist uses compassion really actively. He has a background in CBT but the compassion is much more in the forefront of what he does.

I have never really done CBT but to me the most useful aspect of having a therapist trained in it is that there is a sense that there are many techniques that the therapist can use to help you feel better. I had a person-centered therapist who retraumatized me, I think largely because I dredged up all this trauma and then he had no idea what to do with any of it- his orientation didn't seem to allow him to to make any recommendations. I was just supposed to sit there in this little stew of trauma-induced fear and sadness and somehow work my way out of it through talking to him? It didn't work for me. My current therapist clearly thinks much more about helping me figure out how I can help myself, and also how I can be kinder to myself. It feels like there is a lot of love/compassion/kindness in the room, with most of it aimed at figuring out how I can channel it to myself to better take care of myself.

Don't mean to ramble, and not sure I'm making sense, but this is a very interesting discussion.

I have always been a little confused by the idea that it's one thoughts alone that upset one, rather than what actually happened. Like my mother died when I was a child. This seems to me to have been an intrinsically upsetting experience, and I can't get my head around the idea that it would have been possible to think about it in a way that would erase the pain of it.

I remember being totally confused by the Stoics when I read them in college, long before I had ever heard of CBT. Like their ideas about grief just didn't reflect my lived experience at all, and it seemed to me they were trying to deny the normal, human response to death.

But I realize plenty of other people find this kind of thinking useful! I get it for some things, and even for some types of grief, but I have a hard time agreeing that it is always one's thoughts that are the real problem.

Behavioral work has never been presented to me as "it is my thoughts that are the problem." And, it has never been presented as all thoughts are a problem or all reactions/emotions are a problem. Actually quite the contrary.

What I learned was to distinguish when my emotions/reactions are completely normal, rational, proportionate, etc., from those times when my emotions/reactions are disproportionate to the event. There is a big difference. I had a hard time really knowing the difference, validating my own feelings when they were perfectly "normal," and knowing which reactions were a problem. I thought most of my life that pretty much all of my reactions and emotions were wrong. So, behavioral work was really helpful and validating because I learned to honor my emotions and respect them, and I learned how to treat my emotional self kindly and in healthy ways in those moments when the emotional reactions were actually over the top and out of proportion (and how the heck to tell the difference.) It has led me to a place of much more internal peace.

I have always been a little confused by the idea that it's one thoughts alone that upset one, rather than what actually happened. Like my mother died when I was a child. This seems to me to have been an intrinsically upsetting experience, and I can't get my head around the idea that it would have been possible to think about it in a way that would erase the pain of it.

Leo Tolstoy.... tried following the Stoics...but in the end it was love that saved his sanity.

Do you have any evidence that Leo Tolstoy tried following the Stoics? In A Confession, he mentions Epicureanism (and Buddhism, and Schopenhauer).

The point is that the Stoics promote a kind of cool detachment (same as Buddhism) and this is often not in alignment with the human experience.

The Stoics <promote cool detachment>... Love in the Christian sense is more warm and humanized.