5 Reasons Cognitive Behavioral Therapy May Not Work for You

By Merely Me Monday, February 06, 2012

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Maybe you are thinking about going to therapy. So you do a search on the Internet for information and you come across one of the more popular types of therapy, Cognitive Behavioral Therapy (CBT). During your search you find that much of the information is vague and non-descript. In frustration you find the same generic information either cut and pasted or rewritten for the masses on various mental health sites. You find the basics, however cognitive behavioral therapy (CBT) is a combination of two therapies including: cognitive therapy (focusing on helping the patient change their irrational or dysfunctional thought patterns) and behavioral therapy (focusing on changing maladaptive actions and behaviors). "Great," you may wonder. "So how does this help me?" You also find that the literature proclaims this type of therapy as effective for treating a multitude of mental health conditions. Yet in many cases you aren’t shown the studies or research to back up these claims.

Will CBT be an effective treatment for you? The answer is: It all depends. There are many factors which impact on the usefulness or functionality of any mental health treatment. In this post I am going to discuss why there is no clear consensus on what cognitive behavioral therapy entails. In addition, I will list some of the potential reasons why CBT or some variations of CBT may not be an effective treatment for some people.

When someone uses the term “CBT” can we be certain of what they mean?

One of the problems in assessing whether or not CBT is an effective treatment for you is the fact that when people write about this type of therapy they usually speak in very general terms. Thomas A. Richards, Ph.D.Director of the Social Anxiety Institute has this to say about CBT:

The specifics or details of CBT are not universally applicable. This has been a thorny issue for professionals who do not really understand what cognitive-behavioral therapy involves. With the advent of managed care, the insurance companies now want therapists who say they can do "cognitive-behavioral" or "solution-focused" therapy. So, in order to be included in these groups and panels, professionals now will usually say they do "cognitive-behavioral therapy".

The insurance companies like CBT so much so that quite often they will not pay for any other type of therapy. The reason they like it so much? CBT is usually short-term and costs less than psychodynamic or interpersonal type therapies. But what does it mean when a therapist says he or she does CBT? You may have to ask the individual therapist as there are a wide variety of ways this therapy may be interpreted and used.

For example, here are just some of the off-shoot varieties of cognitive behavioral therapies offered. If you read any of the descriptions you will see that these methodologies can be extremely different from one another but still under the umbrella of CBT.

• Rational Emotive Therapy

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Comments (15) | Add comment

John McManamy, Health Guide

2/ 6/12 8:43pm

Great article, MM. I don't recall actually writing an article on CBT in the 6 years I've been writing on bipolar here at HealthCentral. I have an ancient article on my mcmanweb site, along with some other ancient articles on talking therapy. It's obvious, after reading your piece, that I'm going to have to update them.

Merely Me

2/ 7/12 7:22pm

Hey!

Well it is a popular topic and most times we hear these vague recommendations but I don't think people really get that this type of therapy covers a lot of different variations. You can't really assume that much about it until you speak with the therapist you will be seeing. My first therapist used a psychodynamic interpersonal approach and this worked wonders for me. But nowadays...I don't that I could get my insurance to pay for such therapy.

I would love to hear from our members about their individual experiences with talk therapy and what worked and what didn't.

Looking forward to reading what you all write on the Bipolar site on this topic!

Thanks so much for stopping by.

Rena

2/ 8/12 12:17pm

Psychodynamic interpersonal approach? Could you explain what that is, please?

Merely Me

2/ 9/12 5:40pm

Hiyah Rena

As with all the various therapies...each therapist is going to interpret these approaches in their own way. But generally the psychodynamic approach doesn't dissect a person into behaviors and/or cognitions but looks at the person as a whole. It is more traditional therapy, if you will, where talking about your childhood, dreams, and exploring unconscious motivations can play a more key role in the therapy that some other approaches.

PsychCentral does a good job of explaining this type of methodology. It can focus a lot upon how unresolved conflicts from your past can be revisited in your current relationships. One of the goals of the therapist may be to increase your insight and awareness of these themes and connections in your life. But again there are many variations and the approach has greatly evolved from Freud and lying on a couch while the doctor takes notes.

Interpersonal therapy simply means that the focus is upon your relationships with others. This can be brief therapy or long in duration depending upon your needs. Some therapists who do interpersonal therapy will combine techniques of the psychodynamic approach and some will focus on only the here and now.

Obviously these approaches are not going to work for everyone or for every mental health issue. But for me...with a long past of unresolved loss and trauma...it was the appropriate type of therapy for me to receive a combination of these methods. I am a traditional gal at heart.

I could write a whole post on this topic...it is fascinating how many types of therapies there are out there.

Thanks for your question...I hope I answered it a little.

Rena

2/10/12 2:01pm

Thanks MM for replying. This does give me more understanding. I would love to read more in this, if you do decide to write more on all the different typed of therapies. I think understanding how they work helps in them working on each of us. Thanks again. You are my fountian of knowledge!!!

Rena

2/16/12 4:00pm

MM,

Could you please view post from ccoa. I think it is not associated with this sites content and is questionable. I have seen these postes on some of the other sites too. Just trying to keep us all safe. Thanks.

Rena

Merely Me

2/16/12 9:22pm

Thanks Rena!

Just a little reminder...no spam is allowed on our sites.

Any spam will be deleted.

Rena

2/ 7/12 2:47pm

I have been going to a LCPC for 1.5 years. For the approval of my insurance co., she labels herself as a CBT provider. She is wonderful. She has not only addressed my past history/childhood, she has addressed my inherited traits, family history, medical issues, home life, work life, sleep patterns, relationships, hobbies, friends (or lack there of) disfunctoinal habits, thoughts and items carried from childhood (healthy and harmful) and etc., etc., etc. She has even addressed the clothes I wear, which are to big and worn to promote my hiding from the world tendencies. My therapist has even addressed my diet and made me aware of my compusive/emotional eating.

She is very warm, comforting and her primary focus seems to be on my comfort and ability to feel safe in her office and be able to share whatever I want to share. She addressed my issues in a very loving way and makes me feel like I am not crazy or unfixable. I adore her.

Her office is minimally decorated, to promote focus on the issues at hand and not be distracted. It is very warm and relaxing. This is the one place I truly feel safe and protected.

She addressed my anxiety issues and I was invited to one of her therapy groups and have been attending the group for 1 year. I love the group. I would have never thought that I could actually talk about what I really feel in front of other people. We do different exercised at each group meeting. We do meditation, art, visualization techniques, answer specific questions she has posed for us to ponder and think about, chosen toys as if we were children and then talked about why we chose them and why she thinks we may have chosen them, do laugh therapy in addition to us laughing often in the group, talked about where we see oursleves in 5, 10, 20 years, chosen rocks that we were most drawn to and discussed why, etc., etc., etc.

She suggests books for me to read that I have learned an enormous amount from. I can then discuss the books or my thoughts/ reactions to them with her.

She also does a daily inspirational blog that we can all post our meditation word or phrase for the day on. This helps me feel connnected to her and to the group every day. It helps me to stay on track and focus on me, which I have issues with not doing.

There are some issues she suggests that I don't share with the group (like my issues with pealing my skin off/ inflicting pain, that some of the members of the group may not understand. She is very protective of me. No one has ever been very protective of me!

I hope this helps others here. My issues that my LCPC (Licenced Clinical Professional Counselor) helps me with are: Depression, Anxiety, ACoA (Adult Child of Alcoholic), Eating disorder, Having RA (Rheumatoid Arthritis)/A Chronic Disease, Disfunctional Relationship, two parents that are Hoarders, Sleep Disorder (insomnia and being a rotating shift worker), just completing 4 surgeries on my hands and arms in the last 10 months and struggles through and etc.

I feel extremely lucky to have found my therapist. She along with you MM and the sites here are saving my life!!!

Merely Me

2/ 7/12 7:29pm

Wow Rena!

Your therapist sounds phenomenal! Where do I sign up?

See this is where saying a therapist does CBT can mean absolutely different things depending upon the therapist. Your therapist sounds like she looks at you as a total person and is covering all your issues from various angles. Then you add the creative exercises and the group therapy...I am really impressed.

My CBT therapist...unfortunately...was a dud. :>) He had the warmth of a cold fish and did not help me with the goals I wanted to work on. If he had given me any useful techniques...to help me on specific issues I may have even accepted his lukewarm personality but...it just wasn't meant to be.

Your therapist sounds like she goes above and beyond what most therapist may do and I am so glad you found her.

Thank you so much for sharing this and adding balance to our discussion. I love when people talk about their individual experiences because we learn so much this way.

Thanks again for your comment!

Rena

2/ 8/12 12:21pm

I do love my therapist and she helps me so much. It is difficult to compare since she is the first and only therapist I have ever had.

Judy

2/ 8/12 8:24pm

I share your opinion about CBT, Merely Me. My therapist uses it to some degree, but it's just a tool along with many others. I really liked this paragraph you wrote:

2. In some cases cognitive behavior therapy stresses the therapy technique over the relationship between therapist and patient.

If you are an individual who is sensitive, emotional, and desires rapport with your therapist, CBT may not deliver in some cases. Again, the therapist is the critical element here. One of the stated roadblocks to effective CBT is that some therapists will hammer away at the patient’s dysfunctional thoughts but pay little attention to the fact that this is a multi-dimensional person affected by emotions, social interactions, and biology. It has been said that therapeutic technique is often less important to the overall outcome of therapy than the relationship one has with the therapist. If you do wish to try cognitive behavior therapy find a therapist who meshes with your personality.

From my perspective, I believe it is SO about the relationship, about feeling that you are being heard and understood.

I don't have any problems with insurance paying for my therapy - they understand EMDR is a preferred treatment for PTSD. Besides, I thought that the mental health parity law that was enacted more than a year ago was in effect, which means you get covered for mental health the same as anything else. Although I do know that they want it to be "medically necessary." And I know that there are exemptions from that law, especially among self-insured employers. I think that's one advantage to being on medication - further proof that it's medically necessary! And, some providers are much more adept at knowing how to deal with insurance companies than are others. Mine has gone to great lengths over the years to get me the number of sessions needed and now it's not even an issue, but I've got really good insurance.

Anyway, thanks for the comprehensive look at CBT - you sure did a lot of research!

Merely Me

2/10/12 6:02pm

Thanks Judy!

I totally agree with you. It is all about the relationship. If that is not there...I really don't think therapy is going to be all that effective. Otherwise you might as well get the information from a book.

I remember the days when my insurance was so good...I could have bi-weekly sessions with my therapist. This was decades ago and I worked for a huge hospital. But then these benefits dwindled to...next to nothing....with huge co-pays. Despite the laws I think insurance companies do differ on what they deem to be necessary treatment. I dare say that you are lucky to get the therapy you do and the frequency. It is still very difficult for some to get the help they need. And for those without insurance...it is simply a nightmare.

Thanks so much for sharing your experience here. I think you found yourself a great therapist and methodology that helps you. I love when you talk about your experiences because they are so positive...gives me hope that someone is getting good therapy!

Have a great weekend Judy

Judy

2/ 8/12 8:26pm

WELL, I HOPE THIS WORKS - GOT AN ERROR MESSAGE TRYING TO SUBMIT THIS.

I share your opinion about CBT, Merely Me. My therapist uses it to some degree, but it's just a tool along with many others. I really liked this paragraph you wrote:

2. In some cases cognitive behavior therapy stresses the therapy technique over the relationship between therapist and patient.

From my perspective, I believe it is SO about the relationship, about feeling that you are being heard and understood.

Anyway, thanks for the comprehensive look at CBT - you sure did a lot of research!

italiangm

2/ 9/12 8:01pm

"3. CBT promotes assumptions which may be faulty.

One of the basic tenets of CBT is that your faulty or irrational thought patterns and cognitions are responsible for maladaptive behavior and mental health problems. If one accepts this premise then some practitioners may dismiss the other factors which play a part in mental illness such as genetics and biology. It assumes that the thoughts precede emotions, which isn’t always true. It also usually labels any “negative” thoughts as pathological or dysfunctional and again, this is not true.

Another faulty assumption is that changing one’s thinking patterns can improve one’s mood or decrease the symptoms of a mental disorder. Unfortunately this does not always happen. One cannot always “think” themselves better."

Non-Fearful Panic Disorder is one of those situations where CBT falls short. I wrote about NFPD at http://www.healthcentral.com/anxiety/c/683441/130721/fearful-disorder

Merely Me

2/10/12 6:05pm

Hey there

I definitely want to read this post. You have such in depth knowledge and experience.

Thanks so much for sharing!

5 Reasons Cognitive Behavioral Therapy May Not Work for You

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