CBT experiences?

[yellowgirl]

Hi, I've had years of therapy at different points in my life (childhood, teenage, young adult, current), but never true CBT.  I've had a lot of hybrid/mindfulness therapy as it seems so popular now.  My psychiatrist suggested CBT for dummies workbook and I went ahead and bought it to work on myself/with my therapist.  How has CBT gone for you if you'd had it?  Did it help significantly?  It sounds pretty practical to me, which I am attracted to.  Mindfulness can be so fluffy that I have trouble with it.  Are there other types of therapy that have really helped you for trauma?

Thanks!

[Blackbird]

Hey there yellowgirl!

My therapist and I do CBT and a bunch of other stuff, he's very versatile luckily. CBT is great for learned behaviors and immediate thoughts, it's a good way out of the funk and it can really help develop more healthy coping mechanisms. I've been doing it for a year and it has really helped me overcome certain blockages I put in order not to feel too much, for example. Or be mindful of the thoughts that come and go being just thoughts.

I have to say I haven't read CBT for Dummies, but wish you luck  May it help you.

[Candid]

How has CBT gone for you if you'd had it?  Did it help significantly?  It sounds pretty practical to me...

My CBT therapist told me to list qualities I wanted in myself and thought I didn't have, then look for evidence of them. He got me to write the 'evidence' down each day, eg. Peter invited me for coffee = I am likeable. Sarah needed my help with course work = I am intelligent. I felt better just looking for happy evidence, forcing me to focus on what's right about me rather than what's wrong.

The therapist made it clear at the start that we weren't going to discuss anything in my past, we were just going to focus on my day-to-day life. I think it would have been helpful if I'd stuck to it but that's not my strong suit.

I'm now on a very long waiting list for trauma therapy. All my therapeutic work so far suggests I'm treatment resistant.  I know I need to process a lot of stuck emotion from childhood abuse and trauma, because I alternate between numbing out (dissociating) and being as hard on others as I am on myself. It's not a happy space and it isn't like I can ignore it and it'll go away: it's got much worse over the years.

As to mindfulness, I simply can't do it. My mind wanders even when people are speaking to me. I'm barely safe to cross the road!

[Blueberry]

Just a note to Candid, I've been told I'm 'therapy resistent' before but that was by Ts who were out of their depth with me. I do not believe that you or I are treatment/therapy resistent, just that for a long time I couldn't find anybody who could work with me adequately. Not enough trauma therapists around, and even any old trauma T wasn't enough. Then I finally found somebody i could work with. There were other people I had worked with who'd understood but they only did work in groups and took private payers. I did go there, and made progress, but still I knew I needed someone to work with me one-on-one, where I could go regularly, not just 2-3 times a year. That's what I now have and I am definitely making progress. You will too when you find somebody who has what it takes to work with you. Who can meet you where you are and not where he/she thinks you ought to be right now.

I don't find you being hard to others here on the forum    I used to be really hard towards myself and pretty hard to others, so maybe wouldn't recognise it in somebody else. But on the whole your posts come across pretty empathetic to me.

I think that I've had training in mindfulness in inpatient therapy, though they wouldn't tell us why we were doing xy ( I always like to know and not all Ts will say) and if we were given a name, it wasn't CBT. I don't live in an English-speaking country. Anyway, I never did too well in a clinical setting with  'mindfulness' but at home I'm better. Same as with meditation. I used to be able to do it, then I started having panic attacks, flashbacks etc during meditation. BUT I love colouring in, I also sometimes sing to myself for hours on end. A counsellor (not a T) once told me that these are both active forms of meditation, just not the passive, sit in one place, focus mind on inner light or whatever. I bet it's the same with mindfulness. If you find something you can feel mindful about, just being there in that moment, then I bet you can be mindful. Totally focussed on what you are doing - like writing out poetry for somebody, even if it's just for two minutes.

to you Candid.

[Candid]

I am definitely making progress. You will too when you find somebody who has what it takes to work with you. Who can meet you where you are and not where he/she thinks you ought to be right now.

It would help if they knew more about the effects of trauma than I do, but I haven't come across that. Oh, and if I didn't usually feel smarter than the therapist, that would be a plus.

I don't find you being hard to others here on the forum   

I'm more considered here, just get seriously irritable with people IRL.

I love colouring in, I also sometimes sing to myself for hours on end. A counsellor (not a T) once told me that these are both active forms of meditation, just not the passive, sit in one place, focus mind on inner light or whatever.

Yeah, singing always feels good. I do it so rarely! Don't want to inflict my voice on innocent bystanders.

to you, Blueberry.

[Three Roses]

yellowgirl, I am new at therapy, although I've seen counselors off and on for most of my adult life. My current therapist uses gestalt. I'm just a few visits in.

[woodsgnome]

Only thing I know for sure is my current T's approach is highly flexible. From my perspective the trust level seems more important in what we've done than any specific technique. While we've touched down on several levels with those, it seems like CBT has held it together. But CBT is a broad category to start with. While we've wandered into identifiable approaches, my T has skillfully woven all connections back to focus on my needs within an overall umbrella combining 'where-I'm-at-and-where-am-I going' looks with relieving heavy traumas still flooding my system. Especially at the start it was necessary to risk visiting that murky past in order to emerge (an ongoing process) beyond the pain/grief/anger cycle. But the trust level already mentioned made it worthwhile to take the risk (which all therapy is).

For me, this is pretty unique; most of my past T's were rigidly attached to certain approaches more than others, seemed anchored to a 'soft' CBT rather than a more inclusive or intense one. What I mean is they seemed unable to get out of their own box, let alone regard mine--the actual client--in that picture. Some were stuck on their academic years, involving approaches from which they didn't dare stray (I suspect part of this might be due to the wizard behind the curtain--the insurance game!). Suffice to say I often felt like I was a round peg being squeezed into their square slotted game board.

Perhaps my T's wide-ranging approach doesn't work with everybody. She readily admits the approach might not work with everybody, e.g. someone who regards the T as more 'parental' and authoritative. I've fallen into wanting that sometimes--given how tiring all this work is. Her own description emphasizes that she works with clients, and isn't doing therapy to them. Some of that depends, of course, on how much previous work the client has undertaken, and personality styles rank high in how the relationship might unfold. For me, the working together approach matched my needs; again, it's pretty individualistic, it seems to me.

I'm a 'freeze' type per Walker's typology--the sort he identifies as being very hard to treat and who can quickly leap out of therapy, given the freeze's intense people phobias. Mentioning Walker reminds me of something else unique about this T from the others I've had--she knew in an instant what I meant by cptsd. All the others regarded that as out of their bailiwick and were unwilling to get beyond their limited landscape.

The only thing I know for sure, based on my experience, is that effective therapy isn't a given, the trust level needs to be there, and/or developed. And both parties can, and should, contribute to this. It's complex, and fragile, and (sigh!) can be critical in how we claw our way out of this.

[Kizzie]

Hi Yellowbird - I find CBT really helpful for challenging those negative/fearful voices we all seem plagued by.    I like Pete Walker's thinking though, that this is only part of what we need, the other is a good enough relationship (with a T is fine), in which our ability to trust and feel like we belong in this world is reignited. As for mindfulness, my attention wanders too lol, so now I just call it "noticing" and it seems to take the pressure off being perfectly mindful.  E.g., When I hear a cranky voice I notice it more if I can, wonder "Hmmmmm, where's that coming from?" and then challenge it with some CBT type thinking 

Just wondered as I read about being treatment resistant if that's something T's say because they are not trauma trained and experienced?

[Candid]

The last T who implied I was treatment-resistant was sole worker at a trauma therapy centre, practising EMDR (badly, I think). She was the one who first said CPTSD to me, because I was baffled by the fact that I had every single PTSD symptom except visual and auditory flashbacks. In a letter to my GP she wrote "as you know, this is a complicated case". What's complicated? So I had nearly six decades of experience in my psyche, much of it deeply unpleasant or even life-threatening. So have most people here, far as I can see.

There was nothing complicated about my case, but this T never used the word scapegoat. It's tough to come from a bright family all relating well to each other, to see that they're good people with sound judgment who behave well to everyone else, and to contrast that with how they treated you. I don't think I could have been born into a better family, so there's been this perpetual wistfulness that they rejected me.

Another thing about this T that might have had some bearing on the case: I was aware she had an adult daughter who had chosen to study in another state even though we were in a university town. Can't speculate as to how that might have come about, only that I was aware of it.

CBT was good for focusing on the positive in my life but it did nothing about the nagging voice that said: You weren't good enough for your own lovely family. If mother behaved well and was loved by everyone else in her life, we're not talking PD. Inescapable conclusion: it was me. Expectations that no one else would like me either appeared, for a very long time, to be a self-fulfilling prophecy. When I get into trauma therapy, relationship is the first issue I'll tackle.

[Blueberry]

Just wondered as I read about being treatment resistant if that's something T's say because they are not trauma trained and experienced?

Kizzie, in my experience, Ts say this when they feel out of their depth with us. They've maybe done their trauma T courses, but they lack experience. Which they need for CPTSD, and especially more complex cases of it. When I was hearing that I was "therapy resistant" about 10-12 years ago, that was before there was such differentiation between PTSD and CPTSD and before Ts and docs seemed to realise how devastating emotional abuse can be. In my case they were often digging for the 'real' trauma, which hurt me really badly, that just reminded me of what FOO used to say about children with 'real' problems as opposed to mine.   

As for the ones who haven't any training in trauma T, most of them run a mile internally, but can't admit that, so blame us with labels like "therapy resistant" or in my country a favourite is "You're Borderline! I don't take Borderline patients" without even doing a proper diagnosis. After I'd heard this Borderline 'diagnosis', a Borderline and trauma specialist did a bit of a test and categorically ruled out Borderline in my case.

Of course there are exceptions. I've posted on another thread about how an occupational therapist was willing to work with me on trauma and Inner Children. She was willing to learn from me, among others. The work with her was very helpful.

[Blackbird]

About being 'treatment resistant'...

I had a psychiatrist that told me I wouldn't benefit from therapy because I had "too much insight"... Go figure. Then he figured that I was treamtent resistant with three months between appointments of ten minutes. I changed psychiatrists and I'm in therapy.

I think it's established, it's a red flag for a bad therapist. If we are in fact resisting therapy, either they're going too fast or not doing enough. I know it's us who do most of the work, but the therapist must lay out some ground rules, why would we go to them otherwise?

[Candid]

Ts say this when they feel out of their depth with us.

Yep. They can't handle what's been done to us. We have no choice -- and we get fed up with toning it down so as not to scare the T.

I think it's established, it's a red flag for a bad therapist.

I agree.