Cognitive Processing Therapy

[whiteraven]

I think my therapist is going to recommend CPT at my next session. I'd like to hear from anyone who has gone through this process, positive or negative experiences. I also am curious as to what happens once the sessions are completed - is that the end of therapy?

 

[grit]

Hi Whiteraven,

I read few of your comments and (in my limited exposure) you are acutely cognitive person so I wonder why a therapist would recommend that.

In the therapy books, it says when a therapist recommends other type of therapists or formats or medication, the therapist has failed to connect with the client or feels threatened by the client in some ways. or that the therapist's pride or accomplishments are threatened and they feel they cannot do the job.

IMHO, it feels to me that most of us with trauma survive this much because we use cognition/intelligence much higher than average and what we need most help with is body pain to translate to words of emotions and affect states.

 

[whiteraven]

I read few of your comments and (in my limited exposure) you are acutely cognitive person so I wonder why a therapist would recommend that.

I don't know very much about CPT, but from what I've read, it an exploration of the relationship between thoughts and emotions that are a result of the trauma. It actually seems to fit pretty well with what I'm going through.

In the therapy books, it says when a therapist recommends other type of therapists or formats or medication, the therapist has failed to connect with the client or feels threatened by the client in some ways. or that the therapist's pride or accomplishments are threatened and they feel they cannot do the job.

Are you saying that therapists don't utilize different techniques within their practice? My experience has shown that when something doesn't work, they try something new. I think that's what my therapist is doing. We've tried different approaches and they really haven't helped (or I've not been able to commit to them) and he wants to find something that will.

From what I've read, this is a recommended treatment for PTSD that is *very* structured. I have some concern about that - I can do it, but just the thought freaks me out, because I am worried about the lack of control I'll have. I totally get that that's a problem for me, but still...

 

[Friday]

@grit ... CPT is a refined version of CBT / under the CBT umbrella of therapies, and is actually what’s being employed a lot of the time when people think they’re doing CBT. (The are, just a focused piece of it, particularly suited for trauma). TF-CBT (trauma focused- cognitive behavior therapy) is largely CPT. When people talk about processing trauma? A lot of the time they’re referencing exactly this modality.

Whilst a lot of specialities in psych use a multi-modal technique, trauma therapists nearly always do... by nature of the specialty. The use different therapies, and different techniques, with the same client, because trauma has such a wide range series of effects on a person’s life. By coming at the trauma from different angles, they’re far better able to help their clients stabilize, process, & rebuild. Switching modalities and therapies in trauma therapy is less about not connecting, and more about connecting best.

@whiteraven Structure is relative. Talk therapy, for example? Is almost completely unstructured. And virtually useless with PTSD. Super useful with a huge number of disorders, conditions, and problems; PTSD simply isn’t one of them. EMDR, meanwhile? (A form of exposure therapy, under the CBT umbrella) Is extremely structured, and also extremely effective in dealing with trauma. But how 2 individual practitioners each perform talk therapy and EMDR, may actually be the opposite.

So how structured the CPT will be will depend a lot on the therapist running it AND the client they’re treating. Some are going to be very rigid, others very flexible. Some are going to strictly adhere to a session number (12 is common, but that’s more about insurance/politics and averages. Consider if it takes the average person 12 sessions to process a single trauma, there will clearly be clients who move along quite a bit faster, those a bit slower, and those with thousands of traumas spanning decades ...they who won’t need 12 sessions per trauma, but there’s also no way in hell they’re going to be 1000x faster than a person with a single trauma, processing a thousand traumas in the time the average person takes to process one trauma). Somwhile 12 is common, many therapist are going to easily adjust to 9 or 56 or 132, depending on that particular client’s needs.

Generally speaking there will be a lot more structure in the beginning, when one is learning how to use the tools they’re being taught, and get looser the more practiced and at ease they are at employing them.

You’re always in control, though, at the end of the day. Slowing down, speeding up, focusing more on this or that? That’s always something we have final say, over. It’s not like they plug us into a machine and hit “start” ;)

***

When I’m on a clock? Whether that’s 12 sessions, or 6 months, or whatever? I’ve come to think of that time period as the space I have to LEARN a technique, rather than master it, or complete it. If I do master or complete? Awesome. But I don’t go in thinking I will.

 

[grit]

I don't know very much about CPT, but from what I've read, it an exploration of the relationship between thoughts and emotions that are a result of the trauma. It actually seems to fit pretty well with what I'm going through.



Are you saying that therapists don't utilize different techniques within their practice? My experience has shown that when something doesn't work, they try something new. I think that's what my therapist is doing. We've tried different approaches and they really haven't helped (or I've not been able to commit to them) and he wants to find something that will.

From what I've read, this is a recommended treatment for PTSD that is *very* structured. I have some concern about that - I can do it, but just the thought freaks me out, because I am worried about the lack of control I'll have. I totally get that that's a problem for me, but still...

Sorry I may misunderstood your original post. If you meant the same therapist will do different modality, oooh that is great and even preferable for trauma based therapy - change according to each client.

I thought you meant the therapist was recommending you out to a person who does that. That is what I meant by if a therapist starts to recommend meds or different therapists, it is usually a sign of the therapist's feeling not up to the job....key word is usually. and usually this is not a good sign.

So glad to hear it is the same therapist trying different methods with you. Good.

 

[whiteraven]

So how structured the CPT will be will depend a lot on the therapist running it AND the client they’re treating. Some are going to be very rigid, others very flexible. Some are going to strictly adhere to a session number (12 is common, but that’s more about insurance/politics and averages. Consider if it takes the average person 12 sessions to process a single trauma, there will clearly be clients who move along quite a bit faster, those a bit slower, and those with thousands of traumas spanning decades ...they who won’t need 12 sessions per trauma, but there’s also no way in hell they’re going to be 1000x faster than a person with a single trauma, processing a thousand traumas in the time the average person takes to process one trauma). Somwhile 12 is common, many therapist are going to easily adjust to 9 or 56 or 132, depending on that particular client’s needs.

Thank you for this, @Friday. It really helps understand it better. I was freaking out. LOL

You’re always in control, though, at the end of the day. Slowing down, speeding up, focusing more on this or that? That’s always something we have final say, over. It’s not like they plug us into a machine and hit “start” ;)

I think I saw 12 sessions and the rigid structure and thought that was it. Thank you!

 

[hithere]

I did it. Cognitive Processing Therapy is a 12 session protocol. The protocol is available to view on the US Veteran's Affairs site under PTSD. This is the protocol used by the VA which they call the "gold standard" of trauma treatment. They also use Prolonged Exposure. It has research evidence as being very effective, however, there is a high drop out rate as well. If it is done the way the creators designed it. it is effective. There are 12 defined sessions and these are best done twice a week. However, you can do them once a week. From my experience I would not advise having them further apart because if you do it--you will be in for a ride-- so buckle up. Thus the high drop out rate. But if you stick it out and actually do the homework, you will be glad. If both therapist and client are committed to do the protocol as designed it's very effective. The most anxiety and "symptoms" increase right before session 4 which is a detailed written account of the event. After session 4 my symptoms went way down. Concerning that trauma, the symptoms surrounding it really dropped off. If you have mutliple traumas you pick the most distressing and only use that one. Each session there should be a questionnare rating your symptoms so the therapist can put them in a graph and see the improvement. For me I was so dissociated and had lived much of my life dissociated that it did not do the entire job for me and actually doing the protocol brought up a lot of other distressing traumas that I never dealt with AT ALL. In theory the distress with the "other" traumas is supposed to be taken care of with just focusing on the one. I think that If we had stopped and started again with one of the other traumas I think I would made even better progress. but... oh well. I don't know what happened. I was very symptomatic. However, I do recommend the protocol. Regarding that one trauma I processed in the 12 sessions, I can now talk about it freely, think about it freely, it does not cause me problems it did. I had never told anyone about those events and I now have been able to others about them. . I can say it worked for that trauma very well. When the 12 sessions was up I continued therapy and eventually got to IFS which is kind of what I'm doing now. Good Luck.

 

[whiteraven]

Thank you, @hithere! This was so helpful. Yes, I found the protocol and everything else online, which was also helpful but scared me a little. Still, I do better when I have the information beforehand.

For me I was so dissociated and had lived much of my life dissociated that it did not do the entire job for me and actually doing the protocol brought up a lot of other distressing traumas that I never dealt with AT ALL. In theory the distress with the "other" traumas is supposed to be taken care of with just focusing on the one.

I think this is one of the things I'm worried about. I have multiple traumas and only know bits and pieces of each. I had a period where I didn't dissociate much, but that is back, full force. And it seems like my insiders hold most of the information about the traumas.

 

[whiteraven]

Saw my therapist today and he did introduce CPT. I was comforted by the fact that he is not pushing it and he is willing to be very flexible. I don't know why I was worried about that; that's just how he is.

Don't yet know if I'm going to proceed with this, but I did take the depression screening - 26/27. I already knew my depression was severe, but maybe this will drive that home for him.

 

[New]

@whiteraven just wanted to let you know I’m doing this CPT now.

I’ve been in therapy a while with another therapist and we did EMDR way too soon and it backfired due to multiple traumas.

I just started seeing this new Therapist about 2 months ago so we are still in the early stage of therapy and she recommended CPT and I was glad to hear it wasn’t EMDR.

She said for me it will be slow which of course I didn’t want to hear. I just want a quick fix. We both know that won’t work. I am hopeful and am going to try and not set a time line this time.

I don’t have any tips or advice except to say I’m going through this with you and I’m here. Sending you positive vibes. You are doing great!

 

[whiteraven]

@hithere I wanted to thank you for sharing this information. It helped me be prepared to discuss this with my therapist when he brought it up Monday.

just wanted to let you know I’m doing this CPT now.

Thanks so much, @Faith Andrews! I am so glad there are other folks here who have done or are doing this.

My therapist and I discussed this in detail on Monday (probably more discussion about it to come, though). He is friends and wrote a book with one of the founders of CPT and will be able to consult her whenever he needs to re: any issues that arise. Since he's relatively new at this, we are walking through it together, but I'm really grateful for that.

I did the first set of worksheets this week and I think I'm probably going to like it, since I have a really hard time even bringing up trauma (because I mostly don't believe it qualifies - he tells me differently). Anyway, I'm looking forward to seeing how this progresses.

 

[New]

@whiteraven I had an appointment yesterday. There is an app you can use on your mobile phone to help you and your therapist with this. It also will remind you of appointments.

I’m sure your therapist told you but I thought I would mention it if not. We haven’t started using it yet.