Thoughts on CBT

Anonymous said to realsocialskills:
TBH, I’ve found that for me, cognitive behavioral therapy has been the most helpful. the whole concept of radical acceptance–the “yes this is really hard, I acknowledge this, and I can still do it” mantra–has really, really helped me.

realsocialskills said:

Was that in response to this post about therapy? If so, I didn’t intend that to be an anti-CBT post.

I definitely know people who CBT has helped a lot, and I can see a lot of merit in that approach.

What I meant was that it’s important to be aware that there are different methods. If people think that all therapy is the same, it’s much harder to find a therapist to support them in the kind of work they want to do.

For people who primarily want to do emotional processing work, CBT is not usually a good fit. Something like psychodynamic therapy or art therapy is usually better.

If someone is expecting a feelings—and-history-oriented psychodynamic approach and their therapist is focused on CBT methods, it’s not likely to be a particularly successful therapy relationship (unless they change their mind about what they want.)

Similarly, if what you want to focus on is problem-solving and you *don’t* want to do a lot of problem-solving or delving into your past, CBT may be a much better approach than psychodynamic.

One caveat about CBT: it can sometimes create problems for people with disabilities. For people with disabilities, one of the most important life skills is self-assessment and learning to say “I can’t” sometimes.

If a CBT therapist doesn’t understand disability well, the commitment to teaching “it’s ok that it’s hard, but you can do it,” can be a problem. Because sometimes we can’t — even if every other client the therapist worked with overcame doubts and found a way to do it. Because that’s what disability *is*; sometimes we can’t do things that other people can do.

This can particularly be a problem for people who don’t have good self-assessment skills and have a history of being pushed into thinking it’s wrong to say “can’t”. Or a history of being taught that they can do anything if they try hard enough. CBT can sometimes play into that dynamic and make matters worse.

That doesn’t mean that disabled people can’t ever do CBT safely. (I know people with disabilities who have benefitted from it). It just means that there’s an additional risk involved, and that it’s important to monitor that and pay attention to whether it’s becoming a problem.

tl;dr CBT is sometimes useful, including in situations in which other therapy approaches do not work. It’s not always the best therapy approach for everyone in every situation. There are ways in which CBT poses particular dangers to people with disabilities who have trouble accepting that they can’t do some things. It is also an approach that helps a lot of people in a lot of situations, including some disabled people.