This is the second of two posts taking a closer look at Cognitive Behavioural Therapy. Cognitive Behavioural Therapy or CBT is an evidence-based talking therapy used to treat mental health problems such as anxiety and depression. This post will look at some of the common myths and assumptions about CBT.
A little secret: I never used to like CBT. I have always been and still am a big advocate of therapy, but my view then was that therapy should be open-ended and unstructured. I thought that the structured and present-day approach of CBT meant that it would disregard issues from the past and not leave space for the client to feel listened to. Then I had the opportunity to train in CBT and therefore understand it more fully. What I realised was that my assumptions were completely wrong! And if I had some assumptions about CBT then maybe you do too.
10 common myths and assumptions; a bit of information about why these might not be true.
Myth no.1: CBT involves a lot of work
CBT really involves as much or as little work as you want! Yes, it’s different to other therapies because it does mean doing some therapy work between sessions. But this might just be a few minutes each day, or a couple of extra 10 minutes a week. On the other hand, if you want to do more, you can.
Calling it work can be misleading. What you’ll actually be doing is collecting information about what you are currently doing, building on things you normally do, weaving in activities that you want to do, trying out strategies to help in your daily life. Often people enjoy this and might choose to do more that we’d planned. But this is always completely up to you.
Myth no. 2: CBT means ignoring past issues
This was a big assumption that I had. And it’s true that the focus of CBT is on the present, rather than the past. But this doesn’t mean that we ignore past issues. It’s important to understand problems in the context of the past as well as the present, which is why as assessment will always include understanding your personal history. And sometimes, we need to revisit issues from the past within therapy too. One of the concepts of CBT is that we form beliefs about the world. ourselves and others early in life. Sometimes we might look at these core beliefs in therapy.
Myth no. 3: CBT is like a band aid. The changes I make in therapy won’t last.
This was another of my assumptions before I trained. I felt that because CBT focusses so much on the present it is unlikely to make any real lasting impact. Well, this is wrong, and there’s a large amount of research to back this up. Having now trained I can understand why CBT can create genuine lasting change. Within therapy we are not focussing on where a problem has come from, but instead the focus is on what is maintaining them. Change is also not something that happens once a week in the therapy room. Its a process you take up at home, in your daily life. Towards the end of therapy we focus our work on maintaining progress and managing when things might get difficult again. This means that once therapy ends, its not such a change. You just continue the work you haven been doing. I have seen people recover from mental health problems, and, continue in this recovery for many years after therapy has ended.
Myth no. 4: CBT is structured so I cannot talk about what I want to talk about in sessions
This one is completely wrong. There is always space within sessions to talk about what you want to talk about, and as a therapist I would always encourage and welcome clients to bring their own material into sessions. Sometimes we will use this content as our therapy work in the session. We might weave some structured content in, or look at difficulties that have come up for you in your week with a CBT lens or problem-solve different ways to approach the situation.
Myth no. 5: CBT is just for adults
Nope. CBT is for children and teens too. The content will be different for kids so that it is accessible. So we might do more play-based and active and less sitting down and talking. And parents might be in sessions. In fact for younger children there is some evidence that parent-only sessions can help. Teens often get on well with CBT. Again, sessions can be adapted as teen issues are not the same as kid or adult issues.
Myth no. 6: In CBT I’m just going to be told I should be thinking or acting differently
I think if it were this easy then I would be out of a job! It’s really hard isn’t it, when you’re feeling sad or scared, to make changes, however small? And yes CBT does involve making these changes, but its a gradual process, and it might not be the change that you’re expecting it to be. We both look at your situation in a new way – it’s a bit like a exploring to start with. We see what we find together and then work out the best way change can happen. Sometimes it’s small daily changes that lead to a big change. Sometimes something happens one day and things suddenly shift. We work together, at your own pace.
Myth no. 7: In CBT I’m going to be made to do things I can’t handle
There are two issues with this statement. First, you should never be forced to do anything you don’t want to do in therapy. Therapy is meant to be supportive. So you will always have a choice about what we tackle and how. Having said that, some mental health issues take bravery to tackle. For example, we can use CBT to tackle a phobia, but it will only work if we ultimately face that fear. In therapy sessions with teens I have been absolutely inspired by brave individuals who have courageously challenged their fears. So yes, CBT sometimes requires bravery. But the second part of this statement is also untrue. We work together so that you can handle what we tackle in the session. We do it gradually. You won’t be expected to take on what you can’t handle. What I do often see though, is clients who are blown away by how much more they can handle than they realised before.
Myth no. 8: I don’t need to go to CBT because I can get it from a worksheet or online program
There are so many CBT-based programs out there. And I do believe that they have value and can be hugely helpful for some. But they are not CBT. The difference is that they take the concepts of CBT and apply these so that they are relevant for most people. The content might well be similar to what you might do in a CBT session. But in a session, content will be based on not what is relevant to most, but what is relevant to you. We will use the information we have on what works for most alongside the information we have about your situation. Not only that but we can pace the content as you need, and adapt it to what is going on for you week to week. It’s a dynamic therapy relationship. Not a program!
Myth no. 9: CBT is not for me because my mental health issues are too stuck for me to change
When we’ve been living with mental health issues for a long time it can feel like anxiety or depression is just part of who we are. I do not claim to have a magic method here that will solve all your problems. Like any therapy, CBT takes work and time and will not be effective for everyone. However, what I would say is that anxiety and depression are not personality traits. Change is possible at any stage of life, at any depth of despair and however long you have been struggling. What might not be possible is for you to hold that hope. This is really understandable. We can start with one session, and work from the stuckness.
Myth no. 10: CBT is cold and clinical
I’m ending with another of the assumptions I had before I trained. I was lucky enough to experience some fantastic empathic warm counselling as a client when I was a teenager. Somehow I didn’t equate CBT to these experiences and felt that the structure and scientific approach would get in the way of feeling listened to and supported. But CBT is a therapy. And relationship is hugely important in therapy. As a therapist I aim to be someone you feel safe with, and someone who listens well. I want you to feel supported and understood. Yes there is structure. And yes we often will approach problems and situations in a scientific way, to try to understand them more. But we are also two humans, working together. To me, having a good warm empathic connection is super important.
I hope to have given you a little more insight into CBT. If you missed the first post then you can read it here or if you want even more information on CBT then you can find it here. If you are wondering if CBT is for you, then do get in touch or visit our website to book a free consult and learn more about how we can help you at Imagine Therapy.