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What is CBT?

suessmayr

suessmayr

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Joined
Jun 30, 2008
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Sydney, Australia
I'm just curious because although I see a psychotherapist who I believe practises CBT I just can't identify it in our sessions. We essentially just talk. I need to know if he's actually doing CBT or not - if he's not, I need to see a psychologist who does.
 
In my experience CBT, despite being a well-defined method of therapy, can actually be less structured than you might think. Essentially it is "just talking" but involving CBT will define the way the discussion is guided. CBT generally involves changing the way we process our emotions by consciously challenging the way we think about things. We often can't change the emotions that we have, they just happen and a lot of the time they are subconscious so we can't consciously do anything with them. But we CAN control our thoughts, which in turn can affect the emotions that arise from the way we process things that happen to us.

Does this sound like the underlying concept of what your psych discusses with you?
 
Well he does sometimes talk about how to deal with panic by thinking in particular ways. And he was saying how insomnia is uncomfortable at worst so that I should not stress about it. But I don't know - is this CBT? He's never given me any material or anything like that. He's never had me work on anything between sessions. He's tried to get me to do exposure with him but I think this is just because he's gay and wants to hang out.
 
If he's a professional, then he's actually wanting to do exposure. If you think he's coming on to you, just mention your suspicions to him. Fraternizing is the fastest way for a psych to lose their license, so I'd really be surprised if that was the case.

Seems to me like you should be getting 'homework' between sessions, but I'm not a clinical psychologist so I don't really know for sure.
 
suessmayr said:
He's tried to get me to do exposure with him but I think this is just because he's gay and wants to hang out.
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Did he mention what the exposure sessions would entail? I can't see why they couldn't be incorporated in to your regular sessions, so maybe you can agree to do the exposures (which can be very beneficial for practising the techniques you actually learn in your therapy sessions) but not outside of your usual session time.
 
suessmayr said:
He's never given me any material or anything like that. He's never had me work on anything between sessions. He's tried to get me to do exposure with him but I think this is just because he's gay and wants to hang out.
Click to expand...

My therapist would say that this sounds like a tactic to avoid accountability. I can identify 2 tactics: attacking his competence, attacking him personally.

All best
 
CBT is pretty simple to identify imo. You identify the faulty "cognitions" or thoughts/behavoir, then you restructure new thoughts/behavoirs to replace those thoughts.

Reframing would be a form of CBT.
You tell me you think most woman hate bald men. I ask you why. I take those reasons from you, then simply replace them with more logical or more useful reasons. However with CBT there is a much heavier behavoiral component obviously. Its more than just thought reframing. A lot of what you read in NLP (neurolinguistic programing) is actually CBT. They are in a way synonymous to each other just that NLP focuses a bit on other things too.

Anyway if you want to identify it is usually carried out in a systematic way, unlike psychotherapy which is very random and imo useless. You will be given exercises, projects, plans & sometimes drs will take you into simulated environments to practice "systematic desensitization" which is a form of CBT. What you mentioned in this thread however does not sound like CBT. It sounds like simple cognitive reframing or thought reframing. It IS definitely related to CBT but CBT is very specific, very organized, and very strategic. You could technically call it CBT. But since he's a psychotherapist he likely has no idea what he's doing.

I've seen some of the best psychotherapists in my state, one in particular who was a fucking genius the guy was great. But even his sessions for the most part were useless. I love psychotherapy and have even taken clinical psychotherapy classes to learn how to do it. But CBT is way better, way more useful, and wayy more effective imo. I just know way too many people that go to psychotherapists and do nothing but sit on a sofa for x years crying about their life. But unless you are actively persuing specific goals and new coping mechanisms to replace old ones, like is done in CBT, you likely aren't accomplishing a whole lot.

I know others will yell at me for that comment too but its just my personal opinion. Psychotherapy is just a crock of shit for the most part (another reason I love it its like sales/advertising for the mind). Its nothing more than a person venting why their life blows and then a "certified" dr telling them "oh no you're wrong your life doesn't blow as much as you think". Fuck that shit wasted 8 years between like 6 different drs and the shit never helped me. But things like NLP/CBT are far more effective and again thats just my opinion. NLP is also something you don't need a doctor to do either, another benefit.
 
CBT usually involves homework - either identifying the negative thought processes you have, then later on trying to change them, or focussing on the behaviour side and trying to maximise behaviour that improves your mood and positive thoughts, and minimise behaviour that has the opposite effect. The sessions involve a lot of talking, but my therapist was very interactive and got me to do a lot of the talking and various exercists during the sessions. I imagine this can vary, however.

There are a couple of great online CBT resources out there, you could take a look and see if the ideas seem to fit with what you are doing?
Living Life to the Full and MoodGym are the ones, they are both written by psychiatrists and are very good.

There is also a really good overview of CBT here, written by the UK Royal College of Psychiatrists.

If you are unsure about what CBT is and what your therapist is doing with you, I think you should talk to them about it. It is really important that you are both on the same page and working in the same direction. If you feel uncomfortable with them at all, then maybe you should change therapists? It's really important to have a good, trusting relationship with them - after all, you are trusting them with your mind!

Good luck <3
 
I'm learning a lot from this thread, so thank you to the OP for the question and to all the responders. I think this would really help my husband and I deal with guilt. Is CBT only done by psychologists and psychiatrists (as opposed to therapists)?
 
Psychologists, generally. There are self-study techniques that use CBT principles, but it works best with a good psychologist guiding things.
 
I don't think it sounds like your getting very good cbt, if you're getting it at all. Cbt is quite concrete and involves identifying maladaptive thoughts/behaviours, and then replacing them with more realistic thoughts. In cbt, you should learn how to indentify all the categories of disordered thinking styles (such a catastrophying, black and white thinking, over generalising, etc). You should learn to indentify what events activate these thoughts, what feelings or behaviours these induced in you, and what the consequences of these behaviours/thoughts are. Once you're good at identifying this process for all your thoughts, you can start indroducing new ways to think about the same activating event. CBT is something that needs to be done regularly in your daily life to have effect, it doesn't work if you just sit in an office talking about it for an hour a week. I've always had papers and exercises to follow because that's how you get practise and help it become 2nd nature.
 
This is the basis of my group therapy. Individual sessions reinforce and help me integrate this into daily life. My therapist is NOT a psychologist. I have an appointment with one this Thursday (finally - made the appointment 3 months ago!)

HERE THEY ARE

Maladaptive Thinking Patterns

1. Victimscript: Blames others or circumstances (stress, tiredness, alcohol etc.) for choices that they are making.

2. Unrealistic Self-Image: Sees self as responsible despite actions.

3. Closed Thinking: Unwilling to listen, to share information, or to be self critical; goes on assumptions; lies, more by omission than by commission.

4. Sense of Entitlement: Believes that s(he) has specialo rights and privileges without reciprocal responsibilities. Expects to be center of attention; expects to have needs anticipated even without being expressed.

5. Compartmentalized Thinking: Tends not to see patterns, that actions from the past effect the present and future and impact others.

6. Inappropriate Expectations: Doesn't appreciate consistent effort required to accomplish tasks; easily bored.

7. Control through power: Expects to be able to control situations and other people; uses manipulation, intimidation, punishment and retaliation to achieve this goal.

8. Specialness: A sense of being superior or unique; they hold themselves above certain rules and expectations while fully expecting others to live by them.


___________
I find it helpful to identify my top 3; they may change depending on the situation/audience.
 
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Tactics to Avoid Being Held Accountable
(tactics protect our Maladaptive Thinking Patterns)

1. Putting others on the defensive:
- attacking their competency
- attacking them personally
- claiming others don't appreciate any changes or efforts toward change that may have been made
- bringing up irrelevant issues
- letting others do all the work (use of silence)
- minimizing the situation
- demonstrating anger
- picking at details
- paying little or no attention

2. Controlling information
- agreeing with no intention of following through
- saying whatever will please or satisfy at the moment (includes saying "yes")
- leaving information out, distorting information, mentioning self-serving information only
- being intentionally vague
- confusing others by including too much detail or not enough
- refusing to give any information (silence)

3. Controlling interactions:
- listening selectively and hearing only what is self-serving
- diverting attention to minor points
- insisting s(he) "forgot" (in order to avoid being held accountable)
- focusing on being "misunderstood" as opposed to addressing the issue
- shifting to blaming others and/or circumstances
 
@mami: Wow, that sounds exactly like my former boss. You're not a mid-50s Serbian-Canadian electrochemist, are you?

;)
 
I like the links posted by effie. The way it's broken down on the MoodGym site is we react to events based on patterns of thinking. Those thoughts effect specific emotions. Those emotions bear on our future behavior.

I guess the idea is your thoughts frame your emotions and subsequent behaviors. The objection I have is what about when your thoughts and emotions are so intertwined that your emotions predict the nature of your thoughts. Like if you're having a shitty day, how are you supposed to view a flat tire with positive thinking?

In most of the scenarios, it assumes that you measure your thoughts prior to feeling the related emotions, so it might not be as effective with a person who has primal emotional responses to different situations. Although once the initial reaction fades away it should still be an effective tool.
 
^ It takes awhile for the change in thoughts to correspond to a change in emotions, but if you keep up with it, it will happen. CBT is an ongoing process, try not to get discouraged if there aren't instant results. You are essentially teaching your brain a new way to think, so it's going to take some time and a bit of work before those new pathways are strengthened and become natural.
 
Thanks for all the great posts.

I should clarify the comment about my psychiatrist being gay: I walked into his room once when he wasn't there (he forgot I had an appointment) and there was gay porn open on his laptop. Also, he seems particularly interested in sexual details - like he always presses to know things about my libido. And he has asked several times, incidentally, if I could do anything sexual with a male. When we spoke about opiates he kept returning to the fact that some doctors will write scripts for sexual favours.

So it's just a sort of pattern I guess that makes me feel uncomfortable about the idea of hanging out with him. I'm not concerned about his homosexuality as such though.

Also - he is a psychiatrist with a masters in psychotherapy. So he has the M.B, B.S and M (Psychotherapy). He's not just some new age crack-pot practising psychotherapy.
 
Sussmayr, whatever the sexuality of your psychiatrist, if they are making sexual comments to you (taking a sexual history is fine and is normal, telling you that doctors will write scripts for sexual favours is not okay at all!) then I strongly think you need to find a new psychiatrist, and possibly report this behaviour. It is unacceptable, especially from someone who you need to place a great deal of trust in.

The homosexuality isn't an issue obviously, it's the fact that he seems to be making inappropriate sexual comments to you and is making you feel uncomfortable that is not okay at all..
 
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Yeah I suppose. But he hasn't done anything directly; he's too smart for that. I would only stop seeing him if I became convinced that he was not giving me optimal treatment because of some sexual preoccupation. And seeing a new doctor is such a drag, especially if you have a history with drugs because it takes probably at least a year for them to begin to trust you.

I think I'll ask him tomorrow about CBT and about whether there's anything I should be doing on my own to help myself.
 
Yeah, definitely ask him about that. CBT is pretty much all stuff you should be doing on your own in between sessions, so I think you need to ask him what's going on..

I feel you with the difficulties getting a new doctor. I just worry that seeing a therapist who you don't have complete trust in, because they have made you feel awkward with some of their comments, isn't going to help you to work through things with them..

Good luck <3
 
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