So You Were Told You Needed CBT

But do you really?

Cognitive Behavioral Therapy (CBT) has long been the go-to recommendation for treating all areas of mental health by many doctors, therapists, and educators. In fact, it's one of the few things graduate students in social work and counseling programs learn or are exposed to. So believe me when I say that my opinions here go against the popular belief that's been going strong since the 1960's. But since the 1960's so many more modalities have developed and have been refined, that it's worth noting, some of the alternatives might actually work better.

While CBT, may have some moments of helpfulness like discovering perspectives other than the one in your head and looking at the "cognitive distortions" you may keep, it focuses solely on your thoughts and how they drive behavior (hence cognitive-behavioral). It theorizes that if you change your thoughts, you change your behaviors, and in turn, you change your emotional state. Simple, right? Just change how you think! But what if the thoughts keep coming back? What if the thoughts are there because of deeper emotions connected to trauma? As the North Carolina Institute of Advanced Neurohealth puts it:

"While it's true that the impact of our thoughts is significant, those facing unresolved trauma also experience the impacts of thoughts they cannot readily reframe when stressors are at play. Because trauma leads to changes in a person's nervous system, present-day triggers from past events can leave them in an activated state of distress. And when someone is distressed, their ability to objectively assess their thoughts suffers, as intense emotions and triggers cloud thinking."

CBT is a problem-solving therapy but it doesn't directly work with emotions. In fact, it likely tries to minimizes and dismisses the emotions that are there.

We predominately live in a culture that is avoidant of emotions so I can see why CBT has gained such popularity over the decades, however, whatever little band-aid it offers, it does not actually solve that we are emotional beings whether we like it or not (and we shouldn't want it to).

CBT isn't interested in what happened before, it's interested in looking forward and many of its derivatives focus on the present moment. It all sounds like a good idea; it sounds pleasant. Trauma, especially going back to childhood, is like having a splinter deeply embedded in your finger that is causing you pain and makes functioning very difficult. Teaching you how to accept it, reframe it, and work around it, trying to find the positive in the splinter being there or challenge the negative thoughts you have about splinters, practicing being mindful of the splinter, or learning to relax the rest of your body is not going to help you. You need to get the splinter out of your finger! Why is the splinter there to begin with, how did that happen and what has it been like for you to carry that burden around with you? How does having that splinter affect your life and relationships, and what do you need to remove it and heal? What does healing actually look like? Other therapies may be able to answer these questions.

In my opinion, we live in a defeatist culture that perpetuates the idea that our sicknesses and afflictions, our troubles, and our sufferings are just our lot in life and the best you can do is to breathe through it, try to distract yourself from it, or tell yourself "it is what it is." With that perspective, it's no wonder the United States has a higher rate of depression than many other countries. In fact, we "rank 29th in the world for the prevalence of depressive disorders, with an estimated 5% of the population affected" But we can't just will our natural human emotions out of existence and we can't convince our nervous systems that it's safe when it doesn't feel that way. We would rather strain our brains trying to change our thoughts and behaviors through sheer will (to no avail) than try anything new. But what if I told you, it's harder to avoid the splinter than to remove it?

There are therapists out there helping people remove their splinters every day. Even more than that, they are helping clients to stop working with wood altogether and have boundaries around other people who have unacknowledged splinters and are projecting their pain onto others. These therapists are working with the mind-body connection and building bridges between the psyche and the conscious. These therapists understand how trauma works (on multiple levels - capital T, small t), they understand attachment, they understand the nervous system, they understand development, and they aren't here to convince your brain that it's not as bad as you think it is. They are here to say, I see what you've got there and we're going to work hard together to unburden and care for what has happened. You don't just get anxiety, depression, etc. like a chronic cold. It's a response to something deeper. What. Happened?

If you are curious about the other modalities that could bring you peace and freedom from the emotional pain you've been dealing with, I would suggest going back to our previous blog post:

The Acronyms of Therapy to see a list of types of therapy that are out there and compare. What works for one person may not work for another so I highly recommend trying a few different ones. Internal Family Systems (IFS), Somatic Experiencing, Polyvagal Theory, and others directly look at emotions, the connection they have with our brain and bodies, how they got there from early experiences and relationships, and how to heal in order to reinstate healthy connection and a sense of safety.

When looking for a therapist these are important factors to weigh when you're reading their profiles and sending inquiries. While doing deeper work like healing past wounds is painful in the process, it's much better than pretending it's not there and continuing to live with something that could be removed. Why continue to suffer?

If you have splinters, you may want to rethink who you contact.