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CBT make you worse?


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So I've been in CBT therapy with a really great therapist since February. I say great because I had a therapist before that who was definitely not. But still, I feel like it just makes me feel worse about myself because I can't do the simple things she wants me to do. And everyone is telling me I have to try harder and I know that ultimately I'M the one that had to fix myself and that's the killer right there. If I'm the thing that's holding me back well fuck. I don't even know.

Opinions/experiences with CBT and BPD?

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I think that's one of the primary reasons Marsha Linehan created DBT... She found that for people with BPD, CBT just wasn't validating enough of the emotional experience. So DBT is like CBT plus validation. Trying harder isn't always the answer. Sometimes it's about working smarter.

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It's been similar for me - I know people who have benefited greatly from CBT, but I don't personally think that BPD is a disorder which lends itself well to CBT.  I have found CBT to be of limited utility for me in addressing some of my problems with social anxiety and self-esteem, but not so much in terms of the biggest problems in my life.  Admittedly though - the therapist that I was working with was not very experienced and I was very young and perhaps not able to articulate my experiences as well.

 

For me personally, the root of my problems isn't really dysfunctional thoughts.  I know that feelings theoretically lead to thoughts.  But I didn't even GET to the thoughts - I was just having these huge eruptions of feeling, and no amount of identifying distortions was going to do anything other than piss me off more and more because I felt invalidated.

 

DBT has helped me the most because of the piece about identifying and accepting your feelings without acting on them.  DBT is all about balancing acceptance of where you are with the need for change, and that was much more acceptable to me, because I spent my whole life (like many people with BPD) being taught that my feelings were invalid and needed to be suppressed or changed.  What I really needed to learn was how to accept my feelings and experience them safely - that was the part that has really been the most healing for me, although I still struggle with it.

 

Secondarily, I firmly believe that BPD is in part a problem of damaged attachment.  And I really have needed and benefited from a strong (if rather...tumultuous) attachment relationship with my therapists.  Pure CBT doesn't really emphasize that piece, and for me, and I know for many others with BPD, it's a really essential piece - having that corrective attachment experience of being safe in a relationship, and being able to express anger and frustration with another person without being abused or rejected.

 

I don't want to be the person who says that DBT is the only solution for every person with BPD - because that's not true and the scientific literature supports that DBT is not the only effective approach.  I have also benefited greatly from less focused therapy - I don't know what to call it - my current therapist says it's called supportive psychotherapy.  We focus mostly on building a safe relationship, and on working through feelings and challenges that I have in the present.  DBT has really added a huge extra piece though, because I really did need some practical training on literally what things I needed to do outside of therapy to keep myself safe and help myself function.

 

Have you tried discussing with your current therapist how difficult this is for you and asking for alternate suggestions?  Many times even the therapists who are the most wedded to a given approach can admit when it isn't the right fit and either try another approach themselves, or recommend someone who can.

Edited by tryp
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With my therapist (back in the day) CBT was a stepping stone into DBT, once I "mastered" my CBT skills, I was then placed in DBT therapy. CBT is limited, it has its positives and negatives. I know a little about BPD, not enough to say what skills can be used for that type of MI. I can say, based on my experiences with my mother who is BPD, that CBT for HER would not be enough, DBT would be most beneficial.

 

I have a daughter, and she has/had some emotional issues and her doctor uses CBT with her, she is too young to sit there and write it down but her therapist has helped her to understand her feelings and thoughts and sort things out. My point is, CBT has its place, it is useful, there is a reason it was created and people do benefit, but it is a case by case basis, for you it may not be beneficial but it does help atleast with better understanding a situation, but it isnt as beneficial when it comes to a coping stand point.

 

I agree that discussion with your therapist would be beneficial in figuring out what is best for your case, I hope that you can find what will best help you. Good Luck!

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In general, my experiences with CBT haven't been that helpful -- there is some limited benefit, but I frequently end up more frustrated and upset than before I started. I think my experiences are a mix between what you and tryp report. In some cases, the emotions come so quickly and powerfully, there's never an opportunity to identify or respond to some cognitive distortion. And in more rational moments, I find most CBT approaches almost offensively simplistic. It feels like the conclusion is "if you didn't feel that way you wouldn't feel that way." Which I already know -- and if I could change how I felt, I would.

 

I've read about DBT and tried some elements on my own. It doesn't seem, at least for me, to be a self-study kind of thing. I've done some searching for a therapist who practices DBT (as has my current therapist) without any success. I think it might be beneficial for me with a trained therapist and a group. 

 

What has been helpful is psychodynamic therapy, and EMDR. The psychodynamic work has only taken me so far -- I've been able to develop a great deal of insight and understanding into "what went wrong." But translating insight into change has proven elusive. The results from the EMDR have been, to be candid, pretty surprising -- I'd say that's helped the most, in the shortest amount of time. When my therapist suggested it I agreed, mostly because I didn't think it would hurt. I didn't think it would actually do anything. However, it's actually helped a lot with older traumas. Hasn't worked as well with more recent events -- I'm not sure why.

 

I'd also agree with tryp's observations about BPD and damaged attachment. You have no idea.

 

Good luck. 

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I have worked with both CBT and DBT and agree with the majority of the replies about CBT. I struggle with it a lot because sometimes I have no cognitive thoughts and I just " feel" depressed, lethargic, down, whatever. I do, however, gain some great strides with a book on CBT by Dr. David Burns called ' The New Mood Therapy."

I have found it to be a " pick me upper" at times when I am depressed. 

I do find that using a triple column technique to sort out my distorted thoughts help. 

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I have to say, I really hated Dr. Burns' book.  The whole thing felt insanely invalidating.  I'm glad it helped you though, and I know many people get a lot out of it.

 

My pdoc told me she doesn't like Feeling Good either - apparently she uses Mind Over Mood.  I've never read that one because I have no desire to do CBT.

Edited by tryp
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yes. i found that cbt did make me worse. it's that whole "you just need to turn your frown upside down!" type thinking that just got me incredibly cranky. it's also the admin involved with cbt - just write this down here, write that down there, observe, change, and everything's peachy type work. everything is not peachy. this is not working. i'm not going to write down every experience that i'm having and pull it apart.

in short - i just railed against it.

i haven't tried dbt yet - but am scared that it's going down the same rabbit hole.

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I'm glad some people are helped by Dr Burns... but I absolutely can't stand his books!  My pdoc recommended two of his books, and I wanted to argue with him (Dr Burns, not my pdoc) on practically every page. There were all these stories of people who have little hang-ups, but basically live in nice friendly worlds and are well-adjusted and have all the skills they need to succeed in the nice friendly worlds, so as soon as they drop the hang-ups, life is good for them.  Come on!  What about people who have real problems?

 

DBT is different in some crucial ways, and was good for me.  I don't think I would do well with CBT but maybe with a very, very good therapist I could find some of it useful.

Edited by tamagotchi
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Thank you so much to everyone who took the time to reply. I was in a low, low, low state when I wrote this, so I didn't include much information but I'm glad that you all were able to get what I meant.  Just your replies have made me feel more validated than therapy ever has. 

 

@Wooster - "It's not always about working harder." Thank you, yes. 

 

Thank you EVERYONE. Seriously, you don't know how much it means to me to hear that there might be a reason that I'm not getting any better. It's not just my fault because I'm not trying hard enough.  The only problem is I don't have any insurance except for Medicaid and the nearest DBT is an hour and a half drive.  So I don't see myself getting a DBT therapist anytime soon. That's discouraging.

 

I have the workbook. I have all the sites bookmarked. I'm not saying I'm not trying, because I try. But geeze, there's a reason I need therapy. I can't do it by myself. I need a teacher, a mentor, someone to hold me accountable and teach me how to do all these things. I'm not the type of person that can just read it in a book and get a great reward from it. But I'm sure you guys understand that. I'm just venting.  

 

I could run this by my therapist, but we've already had the "maybe we should try a different approach" talk three times now, I think?  She's a great therapist, really.  Maybe that's why I feel so gross about not getting any better.  I feel like I just go in there every week and complain about how much I suck and she tells me I'm doing great and then the hour's over and I've really accomplished nothing. I feel like its a waste of gas tbqh. I've toyed with the notion of quitting but...then I wouldn't have her at all.  And at least she listens to me. 

 

Gah idk. I'm pretty manic right now. I wish I could sleep, instead I'm just fixating on everything that's wrong with me and how I can't do anything about it and sure one day I'll be able to get DBT but I'm not getting any freaking younger you know.  I want to be better TEN YEARS AGO, not ten years from now. Sorry I'll shut up now.

 

Thank you, thank you, thank you for all of your support. 

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  • 3 months later...

Oh, it is such a relief to find people who feel about CBT the same way I do. 

My therapist has me doing CBT before I start DBT or Schema therapy (it's a study of some sort, I won't know which one I'm doing 'til it's done) and I feel like clawing my eyes out, it's so tedious. She's a great therapist and I adore her, but the books she's having me read- currently it's Feeling Good- are just making me want to set things on fire. All those little case examples which are either completely fake or completely useless are just... insulting. I find them insulting. 

 

*Flails*

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