Therapist is Using CBT for Obsessive Thoughts & it’s not Helpful

EveHarrington

MyPTSD Pro
My therapist is trained in CBT and she’s pushing CBT on me and it’s just not helpful.

She keeps telling me to change my behavior to change my thoughts but THIS IS NOT HELPFUL! The obsessive thoughts come and go, sometimes they are really bad. I have told her I don’t want to go back on medication but she’s really doing nothing to help me.

As if that’s not what I’ve already been doing?! I’m so tired of trying to run from my thoughts. Yes, she is telling me I need to get more involved with activities so I don’t think about it. I think she assumes I don’t do anything with my life because I work for myself and don’t have a 9 to 5 job working for someone else? It’s just annoying as so much of my life is spent doing stuff, I’m not just home all the time doing nothing.

Plus, her advice SCREAMS “avoidance” to me and I much prefer ACT which says to avoid avoidance as it just prolongs suffering.

As soon as I stop doing “something else” the thoughts come back.

I just want relief and her advice just doesn’t work. It’s so overly simplistic that I want to scream. Yes, my obsessive thoughts that sometimes get so bad that I want to kill myself will be magically cured if I just DO SOMETHING ELSE! 😡🙄😡🙄

I guess CBT works for some who have obsessive thinking, but it’s not helping me, at least not what she’s advising. I dread having to look for a new therapist.
 
CBT didn’t work for me with obsessive thoughts either. My T, who helped me graduate from therapy, used a psychodynamic approach, which had it’s own set of challenges—transference being the main one. But even working with her she basically told me two things for dealing with my obsessive thoughts:
1) radical self-acceptance (stop judging myself)
2) talk back to them as if they were children, tell them kindly but firmly NO

Both of those suggestions made me want to scream. I felt like she didn’t know what she was talking about, had no empathy, wasn’t professional, etc.

It was the transference that kept me coming back when I wanted to run away.

After years of working with her those suggestions eventually sank in and I was able to do them. CBT (which I tried before I knew I had PTSD, when I thought I just had OCD) didn’t work for me because I needed the therapist’s relational pull to keep me going and because I couldn’t work on a timeline.
 
CBT did not work for me either. My previous T tried to fit me into her CBT box and it was awful for me.

My T does ACT and it makes so much more sense to me.

I know finding a new T can suck. I’ve read a lot of your posts. Is this the same T who dominates the conversation and told you that you couldn’t talk about your boyfriend? If so…maybe change is a good thing? You deserve someone who is on the same page as you.
 
I second what @OliveJewel said. That thought is a voice of someone. And my T would try and work out whose voice it is. (long time I kept saying "mine", which wasn't the correct answer ..!).
But having a conversation with the voice. Repurposing it really. Helps.

But also, saying that, it has helped at times for me to say "no, not now" to the thoughts/voice. But that only has worked after working out all the other stuff (who the voice is, what it tried to do, why it isn't needed now etc).
 
Yeah!

For me, the value in CBT was learning how to distinguish between thoughts and feelings. Before I started CBT, it was basically just one big monster of thoughts/feelings. After CBT, I was pro at being able to tell the difference, and identify them as they were occurring.

Which is far short of what CBT hopes to do, and does do, in less complex and treat-resistant cases. Once I had the ability to Dustin between thoughts and feelings, it was other therapies that had more useful things to do with them.

Unfortunately, many practitioners predominantly use one tool, so the Ts who taught me CBT weren’t the ones who taught me things like ACT, which was far more useful for me too.

Behavioural activation has been critical for me getting well. But it’s one spoke in the wheel, not the fundamental solution.
 
Have you asked her if she’s open to something else? I mean if she is only willing to do CBT and you don’t feel that’s helpful, as much as it’s sucks your wasting your time and money to keep going.

I’m lucky my T doesn’t seem committed to any one modality just to helping me. Maybe tell yours it feels like they’re more committed to CBT than you and see what they say.
 
Lazy therapists are those that use only one model of treatment for all patients. That “one size fits all” rigid thinking is not effective for the treatment of PTSD. CBT is the primary model of treatment taught in both bachelors and graduate schools, and is a bit outdated. It is an evidence based practice, However, as in most behavioral health model research, patients are carefully screened to insure best outcomes, treatment carefully monitored, and outcomes based on patients completing the program.
 
Lazy therapists are those that use only one model of treatment for all patients.
It’s very often not laziness so much as specialisation. CBT is really helpful for a range of very common mental health issues, particularly GAD and MDD, and for a lot of people, it is the only type of therapy required.

In some parts of the developed world, as many as 20% of the population will have one of those illnesses, so it makes sense that there are a lot of therapists that specialise in that type of therapy.

PTSD often has a messier recovery path. EMDR and CBT work well for a lot of sufferers. But there’s a portion of us who will ultimately need multiple therapy modalities for our recovery. And unless there’s access to a trauma specialist, that will potentially mean needing multiple therapists, who specialise in a range of different modalities.

There’s a trade-off there for folks without access to a trauma specialist to consider individually, depending on their own circumstances (particularly accessibility in your own situation), which is: therapist with moderate experience in a range of modalities, or multiple therapists who each specialise in their own modality.
 
I’m similar, especially with dissociation which often means I’m not aware of my conscious thoughts and had to learn to recognise my feelings, how can one label thoughts when they’re blocked? I wasn’t diagnosed with ptsd at the time though had disclosed trauma history. DBT helped to an extent (I did it at a women’s service and all were survivors so it was supportive, validating and reduced the isolation as well), but when I started to feel safer in my home (strict about who had address/keys/etc) that in combination with DBT strategies and animal therapy (I adopted a new fur family member and helped with dog walking) helped me feel safe enough that the urges for my ocd tendencies subsided, and as I learned to ground through flashbacks they subsided further. A couple of decades ago I spent 80% of my waking hours engaged in ocd behaviours/compulsions, and isolated so basically no one knew. Now I still have ‘quirks’ and when triggered or in high stress they get stronger and more time consuming, but they don’t control my life anymore. In two states I’ve found support groups and therapy at women’s centres, perhaps one close to you might have some options?
 
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