Thursday, April 23, 2009


Something I've been thinking about a lot lately is Cognitive Behavioural Therapy.  When I first read about it, it confused me more then anything else.  I remember looking at my professor and saying "I just don't get it", I also remember her smiling, and giving me a look that said she completely understood why I was having trouble with it, but was going to let me figure it out and not tell me.  I then chose to write a paper about it, applying it to a situation, so that I could gain a better understanding of it.

For a while, I thought I really had it.  I'm quite good at using it in my own life in fact.  Stuff going wrong in my life.  Okay, what was that activating event, what was that thing that started it off.  Okay, got that down.  Okay, what was my belief, what do I believe about this situation, perhaps I have a black and white principle that I'm using to cover this and forgetting about shades of grey, or maybe my belief is just plain negative, or wrong.  And of course what was the consequence, what happened when I followed my usual belief pattern.  Sometimes realizing this is enough to say "oh, okay, I don't need to freak out".  Other times it's really important to put the next step into place, to dispute that belief and put a new one in it's place.  Sometimes it's one we already know and can slide into comfortably, other times it's one that takes a little more work. 

Take this example with bestest bud, in this example, she does nothing wrong, and I let my beliefs and emotional consequences get me irritable.  Bestest bud and I are carpooling to choir practice.  The last time we carpooled to choir practice, we were late because of traffic.  This practice is around the same time of day, and bestest bud is meeting me at my house.  Bestest bud calls to check what time practice is and states that she's going to be later then planned as she is dropping off a friend on her way.  Getting grumpy, I immediately assume we're going to be late and tell her we mind as well just phone in late now because we'll never make it.  I decide to go sit in my car and sulk so that we can be on our way as soon as she gets to my place.  I am grumpy, bestest bud is tired and hungry.  Not a good combination.  This makes me not as pleasant a driver as I try to "zoom" around traffic to get on my way.  Turns out, we're not late.  In fact, though we're just on time, we're almost the first people there.  Oops. 

So, looking at this situation later, it was easy for me to see what beliefs I had and how they led to my irritability.  First of all, I believed that since we got stuck in traffic once we were always going to get stuck in traffic, even though it was a different season, as in, not winter!  Then I believed that if we were late it was the "end of the world".  Finally, I believed that bestest bud was going to make us late, even though she assured me it would work out, which it did. So, if I'd inserted some new thoughts the situation might have been different.  "Well, this gives me some extra time to play with the Sophie Cat" or "Bestest bud will probably be tired after school all day, I could make her a snack", or "well, if we're late, we're late, it'll only be a couple minutes, at least we're going to be there!"  So like I said, I can do it for myself.

Then though, there are clients.  I am constantly catching clients in these black and white thinking traps which are probably even more obvious to me since I just reread the chapter in my favourite text book a couple weeks ago.  The hard thing I find, is challenging them.  I'm also learning that sometimes we just have to let them go.  It's important to focus on the therapeutic goals and not insert our own goals.  Just because a client says five different things I think this ABC method could apply to, doesn't mean any of them need to be the focus of or session. 

I think one of the reasons I've struggled with understanding CBT is because I tend to think of it as something I could just "throw in" in an eclectic method, and maybe when I have more experience and practice I could, but right now, it's hard for me to do that.  If I was going to use CBT with a client, I think I would spend a session on it, and begin by explaining the ABC concept and then brainstorming places they could use it and finally getting them to practice at home, perhaps with some worksheets.  I think it's a great therapy, especially for people who struggle with very negative black and white thinking, but I don't think it always works, and there's definitely a time and a place for it.


prin said...

great post! on so many levels :) i remember my first encounter with the word "cogitive" it was in a psychology text which should be enough of an explanation as to my confusion. i poured over those pages until i was almost blind, thinking w t f? i think it was after the first philosophy course that i finally got it cognitive = thought process. geez why didn't they just say that? but don't get me started on psychology textbooks...
then there was your description of how you feel being late. as one who all her life *had* to be at least 15 minutes early everywhere she went or she didn't go i'm here to tell you that it gets easier with age and especially seemed to get easier for me after chilbirth when, from that point on, you are never ever early for anything :)
i also loved your description of the thought process behind this and alternative answers to alleviate the stress, it was beautiful!

antiSWer said...

I've used some CBT with people I've worked with and what you described at the end is how I've done it. Explain the model, then discuss how it could be used. Have some worksheets, do them in session and then ask them to do them for homework. Or even just to bring some more situations to look at for next time. It can really help.

prin said...

shoot i just realized i misspelled cognitive in my earlier comment...anyway i came over here to see if you know about "therapy worksheets"? He's got a great site going on over there. not in anyway implying that you need to go over there, believe me you could give him a run for his money. it's just a great site. to check it out...

Still Dreaming said...

lol, way to catch your spelling Prin. I totally did not notice that. And I'm going to check out that website too.

I'm so glad you guys understand my confusion and understanding.