BEST and WORST cognitive behavioral therapy (CBT)

How do you know if you're getting bad CBT? Therapy is mysterious, there are no goals, you aren't learning skills, there's no homework, and you never leave your chair.

0:00 - What is (good) CBT?
1:21 - Therapy is mysterious
1:57 - Treatment has no goals
2:57 - Not developing new skills
3:27 - No homework
4:46 - Never get out of your chair

Topics Discussed:
- cognitive behavioral therapy (CBT)
- exposure therapy
- Acceptance and Commitment Therapy
- Dialectical Behavioral Therapy
- #CBTworks

Connect with Ali:

THE PSYCH SHOW! Creating mental health videos that educate, entertain, and empower! Produced, written, and edited by clinical psychologist Ali Mattu, Ph.D. All videos are provided for informational purposes only and do not constitute clinical advice.

If you or someone you know needs help immediately, you should take one of the following actions:
- go to your nearest hospital emergency room

[drali]

Have you tried CBT? What was your experience like?

[vl]

I don’t know if I got bad CBT or CBT in general just doesn’t work for me, but I’ve always found that it makes me feel so invalidated. And exposing myself to my fears has only made my anxiety worse.

[j.h.miretskay]

Another sign of bad CBT: The therapist focuses exclusively on behavioral management and skills training while minimizing or outright ignoring the structural issues that give rise to the supposedly maladaptive behaviors, and working to reinforce docility and obedience in the face of oppression. CBT makes sense when applied to limited or specific circumstances, but becomes behaviorism when taken to a general scale.

[susanne]

0:22 - What is (good) CBT?

5 signs of doubtful CBT:
1:21 - Therapy is mysterious
1:57 - Treatment has no goals
2:57 - Not developing new skills
3:27 - No homework
4:46 - Never get out of your chair (with exceptions)

5:57 - Questions for us (the viewers)

Thank you very much! Kind regards!

[TheCaptainAlexander]

3 years until I got diagnosed with Persistent Depressive disorder, generalized anxiety, and ADHD about a year and a half was spent in CBT talking about how i do not have goals and questioning what my diagnosis actually should be. Best case scenario CBT turned into doing things so the therapist felt better. At worst it felt like an interrogation. I'll say whatever you want but it doesn't change anything on any sort of fundamental level.
It felt like being trapped in a box with someone until i said i was better so they could say they did a good job and get paid.
This Cognitive behavioral therapy is a horrid therapeutic approach that should only be used for targeted cases.
Instead CBT seems to be used as a cheap means to churn out therapy and therapists.

[michaelmorse]

"At least you have a family that loves you" "I deal with abusive workplaces all the time and im ok" "no excuses"

[Trip_mania]

Ha! I am having very bad CBT right now. Let me just rant for some minutes. For the last two sessions the guy was just questioning everything I was saying, regardless of if it was important for me or not. He asked me how I was doing and why, and I could not even finish my sentence he was just interrupting me all the time at each answer and branching to other questions so I could not even get to my point, which was that I was ignored by a girl and it gave me strong suicidal thoughts again. AAAAHHH! I don't even know what we are doing. Each time he gave me assignments and we never looked at them. He was just asking me about my procrastination and ended up giving me homework about my addiction problems that I did not want him to deal with. I could not even say what I wanted. And I have years of experience about my depersonalization, for example, he didn't know what it was, had to ask a colleague (which is ok to me) and at the next session he tells me I don't have it because I did not describe the symptoms with the exact correct words (I said I felt like my body was a robot I was controlling from a distance, instead of saying that I don't feel like I am myself). F*ck that... I spent hours and hours learning about it and he doesn't even have a clue what I am talking about. I felt I had to justify absolutely everything I was saying, I was constantly invalidated, he wanted me to just drop everything I know about myself and just listen to him because after 5 minutes of conversation he knows exactly what I have and the 10 years of therapy I already had with other therapists don't matter, I can throw them to the garbage because now I met him and he knows everything. Absolutely everything I say just comes from my deluded thoughts and I have to surrender to the new truth he has about me after talking with me for 5 minutes. Thanks you if you were bored enough to read this until this point.

[asherhebert]

Ali, these imperfect videos are amazing. I think this is what the internet needs. You're addressing issues, you're teaching us, you're sharing psychology. These are important things. But also, you are giving us an authenticity that we crave and makes your videos easier to receive because they come across as more familiar. This is how we experience university lectures, conversations, and therapy sessions. Thank you. I hope these videos show you that they are less imperfect than you expected them to be. Perfection only ever exists in light of criteria that depend upon the situation and the person(s) prescribing the criteria.

[luisaortega]

I've done CBT in the past and they never worked me for me. I've done the homework but rarely will be discussed on the next session, sometimes I had to repeat myself and talk again about how I feel (it can be a bit frustrating sometimes) and besides I struggle identifying my own emotions. Most of my mental health problems have been treated with meds and through psychodynamic therapy and it did help a lot. I don't think CBT is overall a bad type of therapy but I think is only useful to certain people, so it's not for everyone.

[arielnecessary]

I had CBT but it did more harm than good. I was often criticized so that I ended up feeling like I couldn't do anything right. The therapist even told me that her other clients were all doing better than me.
It seemed to me that there was no allowance for the bad behaviors of others. I was always at fault for responding wrong. So I came to believe that CBT is just gaslighting the client. When I complained to the therapist, there were repercussions, so I felt like I was being punished for standing up for myself.
These things, and many others, led to me quitting CBT. Maybe I just had a bad therapist, but CBT has been poisoned for me.

[Jossegossegrisfis]

I went through CBT about two years ago and watching this video it seems like they did everything right! And I mean, I felt myself that the treatment helped me, but it's still a relief hearing from a professional that I seemed to have gotten what I was supposed to get.

[BlackHayateTheThird]

When I was in South Korea I discovered/ realized that I had PTSD. I had a painful flashback which made me realize I had survived sexual assault and an abusive relationship. I didn't fully understand it was PTSD but through the symptoms (being angry and belligerent, which is very uncharacteristic of me, when hearing we would watch a film about comfort women- aka women who were systematically raped and abused, being cold and shivering on a day that was hot summer weather, remembering experiences and being frozen in place for extended periods of time) I realized that something was wrong, and I had to figure out myself. Since mental health is severely stigmatized in South Korea, I was learning Korean, and there weren't many options out there for foreigners I looked after my mental health on my own. I did research and did my own CBT homework. I researched my symptoms, I understood what I was dealing with, how it's affecting me, and I journaled about it a lot which helped me deal with what I was going through. When I got back to Canada, and realized I was dealing with depression and anxiety, I went to a professional therapist in my hometown and did CBT art therapy. Sometimes I didn't feel like doing the art part- I'm artsy but didn't really always connect to the exercises the therapist suggested- and I was free to refuse the exercise if it didn't serve me. My therapist helped me realize I felt guilt and release that, and understood myself and my experiences better, and she utilized my experience in doing my own homework. So basically I want to say it's ok to not always connect to the exercises a therapist suggests, and not every relationship with a therapist will be amazing- sometimes you gotta shop around. And if you don't have the financial means, and even if you've done therapy before, there's online resources to help you do your own CBT exercises and find a way to better understand yourself and what you've been experiencing.

[voncreek]

After 4 sessions of CBT this is what it looks like to me (Example)

Patient: I'm scared of water.
Therapist: Ok for your homework go jump into a pool.
Next session:
Therapist: So how did it go?
Patient: I didn't do it, how am i even supposed to do that?!
Therapist: So why are you here if you're not doing what i ask?

[katieg]

cbt is so expensive and i feel like people aren’t open to the idea of it not working sometimes. thank you for making this<3

[dynamitecity]

My experience of CBT is making me feel like I’m almost at fault for my own behaviours as if what I’m doing is out of complete intent. The same things are said to me about: if I had suicidal thoughts, have I planned to commit suicide, some of the things I tell myself aren’t true, what is it that I want from them? I’ve tried medications such as Sertraline and Fluxoteine and neither of them worked, in fact they given me mood swings for months.

I grew up with a mother who passed away when I was 11 years old but up till then I didn’t get the proper development as a child. I was exposed to a lot of malevolence and deceit. Watching my mother go from one addiction to another(drugs to alcohol). Entangled with drinking buddies and people who didn’t have her own well-being at heart. If it wasn’t that it was with partners that would beat her up, all of this made me miss a lot of school, and personally I think it hit me hard as I grew up. I have mood swings either way where I go from 0-100 in such quick succession then back to 0 in quick succession, to periods of very low moods where I don’t want to leave my bed, wash or even go outside at all.

[marcusdl]

As a counsellor who also has needed to find therapy for myself, I’ve found a lot of practitioners who advertise as a CBT therapist are what I call a worksheet therapist. I’ve attended a first session where the psychologist, without knowing who I was or what I needed, started the session with a cbt worksheet in front of him because he had already decided that that was what he was going to do with me.

The reality is, cbt can be powerfully helpful as a psych tool, but in part the array of prewritten worksheets and templates can make practitioners forget to first treat a client as an individual and, frankly, be lazy.

Good CBT by comparison feels personally meaningful and directed to the client.

[anas]

You're foreigner and your therapist doesn't ask how to pronounce your name. He can't remember where you're from so he always referrers to your home country as "your country" even you moved for good. He seems bored. He gives you CBT sheet and says to challenge your thoughts.

[lindalouise]

I did couples CBT therapy. The therapist ignored why I presented - a partner who did daily verbal abuse & was shoving me around. No surprises here - therapy made him worse since therapist did not directly address these issues. After he assaulted me, made me unconscious, breaking bones, I left him & Seattle. When I told the therapist about what he did she wrote back to me feel free to contact her when I get back to my creativity.

[suzannekruyswijk]

I've had CBT for my chronic fatigue. It was horrible, I only got worse and worse. The team kept saying I had to get worse to get better. However towards the end of the therapy (the point where they said beforehand that I would be 'cured') I was the sickest I had ever been. It then took me and ny parents about a full month to convince them to let me stop, which then resulted in mental problems from the experience. I can't believe there were two psychiatrists and a doctor who all decided to let me do this. Now, a year later, I'm almost mentally recovered but am still angry at the fact that they let me (and others like me) do a therapy that has been proven to do harm for some cases of chronic fatigue. I hope that there aren't many people around who have gotten bad CBT, it sucks!

[threeofreeds]

Love this, navigating different types of therapy and trying to figure out if the treatment I'm getting is right is a big challenge. This was very informative!