Busting Some Myths About Cognitive Behavioural Therapy - Part 2

“CBT is only a sticking plaster, it doesn’t go deep and doesn’t create long-lasting change. CBT is delivered by emotionless barely adult robots. CBT blames me as the client when I don’t feel any better. CBT feels mechanical and superficial, it doesn’t see me in all my complexity. CBT doesn’t do emotions or warmth. CBT isn’t interested in relationships it’s all tools and technique….”

In the second part of this two-part blog post (part one is here), I’ll bust some of the common myths about CBT and explore where they might have come from and why.

Myth 4: Cognitive Behavioural Therapy feels mechanical and superficial; it doesn’t see me in all my complexity.

It's true that some forms of CBT practice seem to come from a very mechanistic understanding of human behaviour: that a + b = c. This is also emphasised in a type of psychological research called component analysis where the researchers will deliberately focus on one specific variable to see if it is effective or not. Reading these studies feels cold and clinical, and then there’s the whole scientific-practitioner stance that psychology takes in general, which definitely doesn’t add “warm and welcoming” to the mix either.

CBT sees the person in the context of interacting systems – the environment, the body, the brain and its many subsystems, thoughts, feelings, behaviours and physical responses. Each of these systems contains infinite systems within systems.

In many respects good CBT work is fractal in nature: we can zoom in on one part of the system and see how it reproduces itself and also how it repeats itself too. A good example of this is with OCD – the urge to repeat or compulsively carry out a behaviour is both a perpetuation of, and a solution to, the experience of distress. When we pay attention to what’s going on we can be both led towards and away from the root cause. We rely on the shared understanding of what the problem means to the client in order to then change it.

There’s a big difference between the knowledge base that CBT draws from and the actual clinical practice. A confident CBT therapist is just as happy working with the whole person and seeing the problems/strengths that person has as part of the fractal picture.

The person sitting with the therapist is seen as a dynamic, interacting system operating at many levels – socially, spiritually, biographically, philosophically, cosmically and so on.

Mindfulness Based Cognitive Therapy (MBCT) for example is very interested in how we generate meaning in the context of “being” or what existential therapists and philosophers would call Ontology. MBCT engages with how we make sense of ourselves, our place in our own life and what it means to be a human being in crisis; it goes very deep, very quickly and also happily tolerates paradox and contradiction.

MBCT works with the poetics of depression and its discontents, and helps people to turn towards what other traditions would call “the dark night of the soul” It’s about as far away from  a + b = c that you can get, yet it’s rooted in cutting edge brain research.

Myth 5 – CBT doesn’t do emotions or warmth.

Sometimes therapy can be hilarious. Sometimes it can be painful, angry, sad or melancholy. Sitting in a room with someone while they struggle with a problem or situation in their lives which then unfolds and resolves, is incredibly moving.

It can feel like both of us are balancing on a highwire waiting to see if it’s possible to take more steps without tumbling over the edge. Sometimes we fall, but more often than not we make it across to the other side, even if we discover that the destination was not where we thought it was going to be.

Any good therapist will be engaging with their client human-to-human in a shared experience of being alive. As I mentioned in part one of this article, CBT founders were very clear and very insistent about the importance of the therapeutic alliance including empathy, genuineness and unconditional positive regard. Emotions and warmth have a very clear and very important place in the work; sometimes emotions are the focus of the work too.

Needless to say, this myth is not true.

 Myth 6 – CBT isn’t interested in relationships, it’s all tools and technique to facilitate symptom reduction.

As with Myth 4 above, some of the origin story of this myth lies in the way research evidence is gathered to “prove” that CBT works. Psychological research “operationalises” the experience of being in therapy into lots of “bits”. One of these is symptom reduction which is measured using clinical questionnaires. The results of the research are then analysed to show that doing some specific thing in therapy was better than doing nothing (or providing treatment as usual).  

This approach assumes a couple of things 1) that psychological distress has symptoms in the same way that a physical illness does and 2) that a reduction in symptoms is equivalent to recovery.

However, in my view, recovery (dropping below a certain score on a clinical questionnaire) is not the same as healing (experiencing a significant and long-lasting change). I’ll say that again: recovery does not equal healing.

CBT can work horizontally to aid recovery using useful tools and techniques but also vertically using the therapeutic relationship to address those bigger issues of meaning, values and fulfilment that plague us all. This is a decision that you as a client can make in partnership with your therapist.

In my experience the split is 50/50: some people want a fast and effective way to address a specific problem, feel better and get on with life again, so our focus is on recovery. The experience of therapy will be like taking a short self-development course.

Others are ready to take a deep dive into the murky waters of schemas, language games, interpersonal habits, rules or patterns and the ways we process information about self, others and the world to cause ourselves (and others) suffering. There will be curiosity about what happens when we deliberately disrupt, adapt or replace these deeper structures to live a different life.

The experience of therapy will be like an extended period of self-exploration, with no guarantee of improvement but certainty of change. It should be noted too that many clients I work with move between these positions during their time in therapy, and that’s great.

So, in summary, come for the tools and techniques, but stay for the transformation! (Um….If you want.)

And that concludes my two part blog post busting some of the common myths of CBT. I hope it was useful to you, especially if you have been considering CBT but have been put off by some of the internet naysayers out there.

Of course, there are many factors that feed into a useful therapy experience, including how you feel about the therapist, the environment you meet in, where you’re at in your life, and how much time and energy you have to commit to therapy.

Sometimes though, life puts us in a place where it’s now or never, or we find ourselves feeling stuck and that internal screaming/stress/tension needs to be heard, acknowledged and changed.

If this sounds like you, why not commit to taking care of yourself by contacting us at Rhizome Practice to book an initial session? I promise it’s a robot-free zone!