Don’t Think About The Elephant—Why CBT Fails So Many Of Us

[EveHarrington]

Sorry if this is a bit incoherent, I’m not feeling well right now.

I had a therapist who actually understood CBT. She told me I wouldn’t ever be able to just change my thoughts, (as she knew how my brain operates) so I’d have to change my actions. She was right in on the money, as when I change my behavior, my feelings and thoughts can indeed shift.

I guess my struggle is in that I have seen a number of therapists since her, and all have wanted me to focus on changing my thoughts. It doesn’t matter that I tell them this doesn’t work for me, and that a previous therapist determined that it wouldn’t work for me—they all decide that I must change my “bad” thoughts. This is problematic for not only the reason stated in the title (for those not familiar, the “don’t think about the elephant” exercise actually makes you think about just the elephant), but also because it reinforces those thoughts in your head via the negative neural pathways theory.

I’m not sure why so many of these therapists have determined that the wheel must be reinvented. Is it an ego thing? “I know best, and even though my NEW client has told me exactly how the CBT triangle works for them, I know they are wrong, I know their past therapist is wrong, and we must do things my way!”

Why is there an inability to pivot and treat clients as individuals? I mean CBT is pretty straightforward in this regard. If a client has an inability to change their thoughts directly, then you attack it from another angle. And the thing is, it really can work, but too many therapists are focused on that list of cognitive distortions as if that is the end all and be all of CBT.

And you know what? I don’t just have these thoughts for no reason…..ALL of my thoughts that are detrimental to me have a laundry list of why I believe them to be true, and so now we get into gaslighting territory. My last therapist had me make lists of why my thoughts were false. And now we are getting into the area of not being able to trust yourself, because you are trying to make yourself believe that all of those past experiences and your interpretation of them is just flat out wrong. (You really are just gaslighting yourself at this point, as you doubt your own reality.)

I really did think that these therapists had a rhyme and a reason for approaching things this way, but after it happens to you multiple times, you start to realize there’s a big breakdown in the system—I can’t help but think that the way they are being educated in social work school is such that the focus of CBT is in changing your thoughts, especially since my last therapist was still being supervised.

I find it much easier to simply be able to recognize these detrimental thoughts as problematic and to move forward from there, but the problem is in trying to change your thoughts. I mean when I can recognize them as problematic and not focus on them, I am better able to move forward. I still have my last therapy homework book—dozens and dozens and dozens of pages of hyper focusing on my thoughts—it made me so much worse. (And no, don’t get me started on the “it gets worse before it gets better” stuff, because I was forced to the point of becoming suicidal again, and relying on crisis lines. My therapist knew this and refused to change her approach, saying if I didn’t want to do things her way, she would let me go. Great philosophy, right? Drive your clients to the brink and don’t actually help them, cuz if they die, it’s not your fault, they should have just called 911 or whatever. ) I’m not ever going to look at that book again, I just want to burn it.

If this isn’t your experience, that’s great, but no need to reply saying so, because “not all therapists” or whatever. I know that not all operate this way, as I had one myself.

 

[Rose White]

CBT failed me too, also made my symptoms much worse. I needed something more relational.

 

[Roland]

I feel you. I've had a good amount of success with identifying core beliefs and working on reminding myself the inverse. Like say I believe that other people's feelings are my responsibility/fault and I get anxiety attacks whenever I think that and maybe the other person does/says something. Recognizing when I'm starting to get triggered and why (the core belief) and then reminding myself "I'm not responsible for how they feel, they are responsible, I don't need to fix them". Long process but it works.

(That was made to be an example, I don't think I gave enough context for the specific belief and inverse to make sense but I think you get the picture).

It's so not "just stop thinking that and think this instead". It's about awareness. Glad you found a therapist that helped you. I've had some bullshit ones myself and it's not a good time.

 

[Abstract]

CBT didn't work for me either. And made things worse for me in certain ways. It was also for years before I acknowledged or discussed trauma. That's ironic in and of itself and is a little bit related to some of my difficulties with CBT.

But I know it helps so many people.

Have you tried the more modern tweaks like DBT and ACT? Massively more helpful to me. Some aspects of DBT may speak to some of the concerns you mention about CBT.

There are also just masses of pure CBT therapists out there so that may be part of mother reason for your difficulties.

 

[Friday]

I had a therapist who actually understood CBT. She told me I wouldn’t ever be able to just change my thoughts, (as she knew how my brain operates) so I’d have to change my actions. She was right in on the money, as when I change my behavior, my feelings and thoughts can indeed shift.

Agreed. Completely.

I guess my struggle is in that I have seen a number of therapists since her, and all have wanted me to focus on changing my thoughts.

Idiots abound.

Why is there an inability to pivot and treat clients as individuals?

Because brilliance is rare?

And now we are getting into the area of not being able to trust yourself, because you are trying to make yourself believe that all of those past experiences and your interpretation of them is just flat out wrong. (You really are just gaslighting yourself at this point, as you doubt your own reality.)

It’s what I despise most, about PTSD; not being able to trust my own judgement.

I really did think that these therapists had a rhyme and a reason for approaching things this way, but after it happens to you multiple times, you start to realize there’s a big breakdown in the system—I can’t help but think that the way they are being educated in social work school is such that the focus of CBT is in changing your thoughts, especially since my last therapist was still being supervised.

There is rhyme & reason… it helps most people. Not all, not by a long shot, but most is a good starting place, so that’s where most people start.

I find it much easier to simply be able to recognize these detrimental thoughts as problematic and to move forward from there, but the problem is in trying to change your thoughts.

Change your actions. Thoughts follow. Not always in a beneficial way, word to the wise. So keep in mind who you WANT to be. And act that way. And when you don’t? Take note, and correct. And correct, again. And keep doing so. Until you are; thoughts/feelings/actions, who you want to be. That’s a lifelong course. An art form. Easily f*cked up, and can f*ck off. But? Worth returning to. We are the only ones who live our lives. Live the one you want. Or try to. And keep trying. Until you do.

 

[Calmdown]

I hate CBT. I was in therapy several times and CBT was the least helpful. When I was younger I did therapy mostly for social anxiety (the cause for it were bad experiences because of selective mutism in childhood) and it always came down to the therapists pushing me to do things I didn't want or wasn't able to do. So these attempts failed and then there was nothing else they could do, only arguing and more arguing.

Now a good example of different therapy approaches:
The first time I was in that clinic therapists tried to push me to give a presentation in group therapy because it is a "safe space". Well first of all it wasn't a safe space for me, it is a group of people and I hate being in the spotlight and secondly it is "out of the norm" to hold presentations in group therapy which would have made it more awkward and not less awkward than in school. This just lead to endless discussions with the therapists.
I didn't feel well in groups so I pushed my chair a little bit backwards, immediately the therapist told me to come back, like I was insulting the group with this behavior.
I had inner blockades, I wasn't able to take part in some therapies like art therapy.
In the end they sent me home way earlier to educate me that my actions have consequences. I can't tell you how much I suffered the consequences of selective mutism and inner blockades my whole life, that is the whole point I went to this clinic.

8 years later I went a second time to the clinic. I told them that I need an expierenced therapist and that I want to be on the trauma station. Luckily they accepted both.
The therapist told me that she expects traumatic causes for my problems with groups (school was hell with selective mutism) and that it is important to be able to get out of the situation when I want to and that enduring situations like CBT demands is not working for traumatised people because enduring is something you can be very good at with trauma but there is no learning effect, next time it is just enduring again. So I was allowed to get out of all group sessions when I wanted.
On this station it was made clear from the beginning that everyone can sit as far away as they want in group therapy. It was the opposite of my first stay and
it still is my best therapy experience to this day. I had more control over situations and more importantly it was accepted that I have these blockades and problems, no criticism, no one told me that I have to suffer consequences, I never experienced that in my life before.


Now regarding the work on thoughts. In one CBT therapy I was told to replace bad thoughts with good thoughts and with training it would change how I think. This wasn't plausible to me and I think it mostly works for less severe issues. If I don't feel like it it is meaningless, these thoughts are there because of deep issues. I need to work on a personal level with a therapist, but in CBT everything is so superficial and CBT therapists miss so much on the relational level.

Social workers love CBT and they will force it on everyone because it is "common knowledge" to just put yourself in situations you fear and then everything is well again because people are nice and the world is nice etc. This is why I hate CBT too, it is now common knowledge to do it this way. "Social anxiety" is a keyword now, what you say before and after that doesn't matter: Social anxiety = CBT exposure therapy. But I need to work on my self worth, it is deep down completly broken, when I feel better I have less issues with social anxiety.

It also doesn't help that there is a wave of CBT therapists and other therapy forms are declining.

Different therapy approaches attract different personalities and CBT therapists choose it because it is their way of thinking, so they are pretty inflexible because they just can't understand how much more there is in the inner world and on the interpersonal level.
In general I am annoyed about of how inflexible most therapists are, I have the problems and I am inflexible because of it, I don't need therapists that are not able to move even a little bit.

I only consider CBT therapists if they also do trauma therapy but if there were enough therapists where I live I wouldn't even think about that.

I could go on and on, I hope I didn't hijack your thread. Just want to tell you that I understand your issues with CBT and aside from mental issues the personality is also a deciding factor of which therapy form to choose.

 

[hypervigilant]

Love this thread, the reality is CBT works while you are up and there and riding the wave, but nobody gets the default button. Our default is the abusers voice and however much therapy I have over the years I cannot drown it out. I grew up under that voice, it runs through my views like my own, it's my whole way of thinking, living, functioning.

 

[Veronica]

CBT just seems like a pointless modality. I went to a trauma therapist and all she ever did was CBT. I was drugged and raped at 13, by my brother’s drug dealer. My parents forced me to have an abortion then sent me away to reform school. My brother and his dealer spread the story all around and I became the joke of the town. Even years later when I visited my parents to help with my mother’s terminal illness, I would encounter people I knew who would snicker when they saw me, passing a rumor that I just got out of a mental asylum. I had to live nearby for a while to take care of my mother and couldn’t believe how people never got past what happened at age 13. I went to a trauma therapist for this, just to help deal with having to be there. All she did was tell me to change my negative thoughts and stop assuming people are thinking bad things about me. Um…they’re telling me what they think, I’m not assuming. It was a really weird shot at therapy, and that woman had 30 years as a trauma therapist!

 

[hypervigilant]

It also doesn't help that there is a wave of CBT therapists and other therapy forms are declining.

Yes, I have had therapists that have had many tools in their box such as emdr, parks inner child, hypnosis, eft, ect which means they are more rounded and open to different things working for different people rather than just the one size fits all.
I'm now awaiting DBT in a group setting for BPD because all survivors of child abuse have BPD!
I hate this blanket thinking that we are not individuals who need tailored help.