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Seeing behind the curtain

Started by Rev+, July 01, 2022, 12:45:19 AM

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Zero Gravitas

You seem quite passionate Trenter, are you a hack fraud yourself?

bgmnts

Quote from: TrenterPercenter on July 03, 2022, 11:26:13 AMThat isn't CBT.  It is a caricature of a therapist used by anti-therapists to mock them, or possibly a Facebook meme.

Remember when you got all pissy because people reduced Corbnyism down to some happy clappy bullshit? When Centrists go how does saying having kinda nicer politics change anything?  Ever heard anyone on this dear forum talk about then need for peace and love?

<strokes beard, adjusts monocle> How does that make you feel?



Well i've engaged in CBT therapy and yeah it's basically that in my experience.

TrenterPercenter

#32
Quote from: Zero Gravitas on July 03, 2022, 11:37:48 AMYou seem quite passionate Trenter, are you a hack fraud yourself?

No and I despise the positive pop psychology movement (the actual roots of Seligman and Csikszentmihalyi were good).  Go back through my history and you will find me quite vocal on this.

In the same way I get annoyed with happy clappy spiritual frauds I get annoyed when people dress up their own issues and ignorance as facts (as I do with racists, homophobes, sexists etc..).

Zero Gravitas

I meant just generally.

Good on you for wanting racists, homophobes and sexists to have a factual grounding though.

TrenterPercenter

Quote from: bgmnts on July 03, 2022, 11:39:50 AMWell i've engaged in CBT therapy and yeah it's basically that in my experience.

Your experience is not a reliable foundation for your summation.

We can prove this quite easily, it's not like CBT hasn't been evidenced or written down as to what it is.  Do you want me to post all of the stuff about that proves your idea of what it is wrong?

Is there any point of me doing this because you'll obviously just ignore it like you usually ignore any inconvenient parts of my posts?

You don't like CBT then don't do it, no one is forcing you to do it as you have seen from this thread it has helped other people so perhaps you need to consider that you jaded depressed to the point of toxicity might have something to do with it and shouldn't be really seen as guide for others.

Instead why not send Zetetic a PM and ask him to get you a house #notpositivethinking

bgmnts

Quote from: TrenterPercenter on July 03, 2022, 12:05:24 PMYour experience is not a reliable foundation for your summation.

We can prove this quite easily, it's not like CBT hasn't been evidenced or written down as to what it is.  Do you want me to post all of the stuff about that proves your idea of what it is wrong?

Is there any point of me doing this because you'll obviously just ignore it like you usually ignore any inconvenient parts of my posts?

You don't like CBT then don't do it, no one is forcing you to do it as you have seen from this thread it has helped other people so perhaps you need to consider that you jaded depressed to the point of toxicity might have something to do with it and shouldn't be really seen as guide for others.

Instead why not send Zetetic a PM and ask him to get you a house #notpositivethinking

Well no I agree I suffer from severe long term depression and CBT didn't help, so I suppose my experience would only be applicable to those who suffer from severe long term depression. If my experience isn't enough to make a summation then god knows what is. But I get it you have a vested interest in this and that's fine.

TrenterPercenter

Quote from: bgmnts on July 03, 2022, 12:10:37 PMWell no I agree I suffer from severe long term depression and CBT didn't help, so I suppose my experience would only be applicable to those who suffer from severe long term depression. If my experience isn't enough to make a summation then god knows what is. But I get it you have a vested interest in this and that's fine.

You are saying your summation "If the world is not worth living in due to all the suffering in it, just think positively."

Is the correct one that defines CBT? The one we all have to agree with? No it's an opinion and a very jilted one, how have others found it useful?   

What vested interests do you think I have btw? Shares in CBT.  Not the first time this bollocks has been pulled, I work for NHS in mental health, I try and help (you know like the people you worry about killing themselves).  I know you find it hard to believe but some of us actually do care about other people and play an active role in our socialist beliefs around it, but yeah keep talking about us and treating us like shit, we are only in it for ourselves.

Masters of your own demise.




Zetetic

#37
Quote from: Dr Rock on July 03, 2022, 10:38:56 AMI've not had great experiences with CBT, how do other countries deal with people who are down in the dumps? (@Zetetic)
When England setup IAPT (with funding predicated on the basis of returning people to work), there were "consequentials" (i.e. cash) for all the other countries of the UK and political pressure for them also provide talking therapies for "common mental disorders" (i.e. anxiety and depression).

My understand is that a lot of this went on services that might describe themselves as "counselling" - "person-centered", "interpersonal" - and quite a wide range of "psychotherapy" (of various degrees of theoretical wackiness).

In recent years, at least Wales and Scotland have tried to produce lists of what they consider evidence-based therapies for various conditions, covering some of the above. See this, for example. Note that there is a lot of CBT on there, particularly for the "lowest" intensities of intervention, including "computerised" "self-help". (I think the fact that "CBT" can be re-packaged relatively easily like this - and that this has been incentivised by, amongst others', England's push for mass delivery of it - is really relevant to people's experiences of it in practice.)

Often the people in these services will actually have some training in CBT, unsurprisingly. But, for better or worse, it won't be the thing that they trained in and it won't be as heavily prescribed in format as what England's IAPT services deliver as the frontline options. (I note that glossing over the last decade of development in England's IAPT services is a big gap here on my part - apologies).

These other services in the UK will be very similar to England's IAPT services in some respects - they'll still often have very limited courses of treatment (6-12 sessions?) for example. The resource constraints are worse, if anything, not better in these places.

They'll also be very different in some respects, including the way that England's IAPT services are subject to substantial nationally-determined performance management metrics and other countries' mostly aren't.

As someone who loves metrics for the sake of metrics, I think this is double-edged. I think IAPT's metrics are mostly pretty rubbish... but they're better than having no idea if your services are doing anyone any good. (And some of IAPT's worst metrics were rapidly jettisoned or deprioritised in the fallout of the global financial crisis, IIRC, because no service could deliver anywhere near them.)

All of this points to the context in which "CBT" is delivered probably being as important as deciding what "CBT" actually means, if we're interested in people's experiences of it and whether it "works".

On that note, it's worth discussing what IAPT's main outcome metric is. The main outcome metric that IAPT services in England are measured on is whether, according to those bits of paper that ask you to rate how well you've slept and how often you've thought about killing yourself in the last two weeks, you have significantly less symptoms of anxiety and depression at the end of your course of therapy than at the start. (In case it seems like I'm being snotty about those bits of paper - and lot of people despise them for good reasons - I love those bits of paper.)

It is more complicated than this, for lots and lots of reasons, but not much more complicated. There are things that you can start poking at around whether this is a good outcome measure for therapy - what about a month after the end of your course of therapy? what about people who abandon therapy half-way through? - but let's leave them aside (edit: and it's not like all these issues are ignored now, to be clear).

How good is IAPT at meeting that metric? About 50% of people finishing a course of therapy at IAPT services end up reducing their anxiety and depression symptoms - according to the bits of paper - to the level found in the wider population. At the same time, about 10% have significantly worse symptoms. (Edit: Some of that 10% is presumably people getting worse for reasons unrelated to engaging in talking therapy... but some of it is probably harm from talking therapies. Another massive thing to open.)

Is that good or bad? Well, it's not massively different one way or the other - where we can get the data, and it is often harder because of the lack of national-level performance management - to the sorts of services run elsewhere in the UK.

(Edit: A much more interesting question, certainly for individual services, is maybe "What's the difference between the 50% and the 10%, and the 40% left over?")

One response to this might be (as perhaps manifested a little by Trenter?), to say: well, they're all actually using CBT. I think that's definitely true to an extent. Even if you call yourself a "psychodynamic therapist" and, in theory, believe that depression and anxiety is about sublimated desires to fuck family members on the basis of race memory or the like, these days you probably still use bits of CBT in your practice.

The other side of it is the uncomfortable (if not downright horrifying to some of us) possibility that, even if all therapies aren't equal (and I'm not arguing for the dodo bird verdict) in theory, then the more that you actually get into delivering talking therapy for thousands and millions of people then so many other things matter much more than what therapy you claim to be delivering. Most obviously: how good the therapist is at developing therapeutic relationships (a whole other box to unpack) and whether the person wants a talking therapy anyway.

(One significant problem with all this is that you can absolutely juke your stats by how you manage your waiting list in all sorts of ways. See people sooner - better outcomes. Put the right barriers between referral and therapy - better outcomes.)

(Edit: All this completely skips over signposting and collaboration with services charged with changing people's situations, again for better or worse. Apologies.)



TrenterPercenter

@Dr Rock basically that is a very VERY longwinded way of saying what I said - they use CBT, like us alongside a whole range of psychological therapies.

Why we are limiting this to countries within the UK I've no idea because CBT is used internationally in every major developed mental health system in the world (Canada, Netherlands and Japan) and has a heavy focus in what is the largely thought to be the best and most progressive MH system on the planet, Australia.

Zetetic

I thought I'd start by writing about the UK, because it forms a sort of natural experiment, with divergence at a very particular point in time (tied up with different political ideologies).

The courses taken by the different countries of the UK in the early 2010s clearly are different (and if they weren't, what was the point of setting IAPT up in the way it was), with a much stronger emphasis on counselling and people with broader training that what IAPT aimed at.

The lack of interest in the differences between the NHSs of the UK is a massive shame, I think. It's obvious why the four governments tend not to want to think about it too much though.

Zetetic

It'd be interesting to know if attitudes towards "CBT" differ across the countries you've mentioned.

TrenterPercenter

#41
I'll try and explain to people what Zetetic is saying here in a way that is understandable and I'll point out where he is going wrong/introducing bias/not being clear with the facts.

First off what he is failing to make clear and should be doing is that IAPT was a government initiation whose goal unsurprisingly was to as the name suggests "improve access to psychological therapies", the idea was to get put therapists into GP services and scale up delivery via other training routes to become mental health practitioners.  He is being misleading here for a few reasons, firstly by ignoring what came before the idea to scale up treatment.  Prior to this you could not easily get access to MH services, you largely had to be in a psychotic crisis and you could scarcely get talking therapies for depression.  Prior to IAPT talking therapies accounted for just 3% of the mental health budget.  This meant people just didn't receive ANY support or had to wait to be very ill to access treatment, there wasn't great care before there was less, and outcomes were worse.  Without this very important context is misleading and promotes conspiratorial thinking.

It is true that IAPT at it's conception was tagged to cost savings but again this is misleading virtually ALL healthcare is tagged to cost savings, we say getting a hip replacement has a cost saving because that person can be active, less likely to require state benefits and is more likely to return to work.  The idea that there is something exceptional about IAPT here is misleading, we don't think hip replacements are bad for people just because it has an economic benefit to society.  Throwing in the phrase "predicated on returning to work" is again (unsurprisingly) misleading, just think, are all IAPT appointments about getting you off benefits and into work? Could you only get an appointment if you were on benefits? No, there are economic benefits for mentally well populations so economic cases can be made for it, this is incredibly simple.

What is being pulled in here rather convolutedly is that IAPT involvement with payment by results as part of "welfare to work" so for example you can't work because you have anxiety and depression so rather than just pay you to sit at home (which does actually have loads of consequences of comorbidity) they say a condition of your benefit is you need to go on course to improve your mental health to aid your return to work.  Some people hate this some people love it.  Return to work is tangible measure that lots of organisations, from drug rehab to youth services use as proof of success and payment there are of course really important conversations here about what work and what about those that work doesn't occur for - this is a different issue though and I'm happy to discuss this on it's own merit, it's not really much to do with CBT though.

I'll remind people at this point I used to work for one the governments flagship providers here and I left because yes the processing of individuals and target driven goals were counter to improving peoples health.  This wasn't confined to "CBT" or "IAPT" referrals but I've no doubt use of techniques in this format can be used for both good and bad, saw it, lived it, rejected it, literally took them to court over it - taking this a step further and insinuating all CBT or IAPT referrals are conducted in purely cynical ways and dancing on a pin head that it is made it up is utterly gross and becoming of actual bigpharma lobbyists.

TrenterPercenter

#42
The context that CBT is delivered is of course important, it will predict outcomes but this is being dressed up again and made needlessly confusing. Further more I don't recognise Zetetics take on talking therapies as if they are all CBT, he talks about them as if they are all just the same wavy gravy thing that can be used interchangeably all are CBT.  This is nonsense CBT comes from the cognitive movement in psychology and is based around how the Prefrontal Cortex works it is about managing feelings through thoughts, not cancelling them or saying think yourself happy, but modifying emotions and resultant behaviours via thoughts it's evidence base is strong because it is a good external representation of how internal neuroanatomical neuronal connections are made, this isn't some mumbo jumbo this is the observable way that brains work here is a video of it..


Now you can take this knowledge and go into the "release your potential" world make mega bucks or like me you can graft it out in the shitty NHS trying make sure poor people still get access to thing like this and try and build services that can deliver this work.  This absolute love-in for pharmaceuticals, in a country were most mental health conditions occur by age 14 means you are just medicating kids, just stop and think about it for a minute and what that means ffs.

CBT is not the same as psychodynamic therapies, which obviously aren't about fucking your parents, and are hardly delivered anywhere, but of course counselling is a talking therapy and not CBT or anything like CBT, neither is cognitive analytical therapy or eye movement desentivisation therapy or interpersonal therapy, family focused therapy....there are a shed load of techniques and psychotherapies that practitioners use that are not based on CBT mechanisms.  It is very hard to explain this all without going through reams and reams of information but I will say this I'm not some "fraud hacking" positive mind guru, I'm a MH specialist that has worked for nearly 17 years now in NHS MH services, being a mental health guru would be a piece of piss and much MUCH better remunerated but I actually remember where I come from so I've always stuck true to actually trying to help people where they need to be helped, and not just those that can most afford it.  This does not come without sacrifice.

I dare say Zetetic does have some skin in the game here also and cares about people but it troubles me that he can't see how he isn't helping by taking the approaches he does - this isn't simple a case of not criticising IAPT or CBT but how and on what basis.

Dex Sawash

Is there not something you can just spray on it?

Zetetic

IAPT's conception wasn't just tied to "cost savings". The economic case for funding it was very openly and clearly tied to the idea of returning people to work and increasing tax revenues, and this is relevant to the way it was setup and managed.

It was very open, because the people involved were very proud - understandably - of having found a way to sell talking therapies to third-way-ish new-public-sector-management New Labour (and later the Coalition government).

The services set up by the devolved governments with the consequentials of IAPT funding weren't setup in the same ideological context and, for better or worse, weren't setup with the same aims or management structures angled towards those aims.

A clear example of this is that a key - nationally dictated - performance indicator for IAPT services, at the time they were setup, was "fewer people on sick pay and benefits". This is something that they were measured on and managed towards. While the global financial crisis rapidly obliterated this as an actual viable target, it remains a major part of the point of English IAPT services. (It's kind of bizarre to try to disappear this under "well they don't actually limit access to people on benefits".)

This wasn't the case for services elsewhere in the UK, setup at the same time with vaguely comparable amounts of cash. From a purely economic case POV, it would have made very little sense in these places because of course the devolved nations' governments don't profit directly from reduced benefit payments or increased tax revenues. (The drivers in these places were different and the services setup differently with different aims. Often, arguably, undermeasured at the same time.)

The idea that "CBT-informed" counseling isn't widespread is also bizarre - but in any case, it's Trenter who tried to claim that everywhere else uses "CBT" and have now tried to dismiss the idea that the other parts of the UK deliver things other than CBT in services comparable to IAPT (or they simply don't count or something?). I was trying to offer an understanding that - because of its efficacy - many talking therapists will have ended up drawing CBT into their own practice.






Zetetic

I think it's also worth noting that the "no one is forcing you" and "it's not like IAPT appointments were only available to  people on benefits" points are actually a bit more complicated than that.

There have been various relationships between Jobcentre Plus/DWP and English IAPT services - proposed, announced and actually realised. These range from allowing DWP/JCP referrals to IAPT, to co-location, to co-assessment. Again, for better or worse, there is a thread of drawing together benefits and treatment for common mental health disorders in England in a fashion that I don't think is the case for, for example, hip replacements. (If, at any point, one of the four KPIs relating to hip surgery in the UK had been getting people of the sick, then that would be interesting. Noting that at least of one IAPT's 4 KPIs at launch was entirely capacity focused IIRC).

And that's ignoring the wider of context of Tory manifesto promises (2015?) of making benefits conditional on engaging with medical treatment, or the awareness that people have that obtaining different forms of treatment is often conditional on having made it through a particular pathway to begin with.



Zetetic

Regarding my "skin the game":

I, am told, have depression and have had it - one way or another - for half my life at least now.

I went through IAPT services in England and comparable services in another part of the UK. I have found talking therapies useful, including where these have drawn on CBT.

I've worked with a wide range of mental health services in that other part of the UK, including talking therapies under various badges, including trying to help those services with capacity and demand work and with measuring what they was important. I've often looked to IAPT services' work on both of those when doing so.

I've worked with other mental health services for whom return to work was an important measurable outcome, for the service and its users, alongside many others. (I didn't personally disagree.)

I am on an extremely unfashionable antidepressant, have been for a decade and intend to remain so for the rest of my life. (Well, actually, I've accidentally discontinued it over the last week. I'll be on it again in a matter of hours.) It's probably fairly profitable, but for a couple of generic manufacturers and not one of the more exciting Big Pharma players.

I've worked with taking therapies services to try to show that, under the right circumstances, they could act as an alternative to medication for at least some people, and I've tried to flag the risk that price fluctuations in the more popular antidepressants pose.

TrenterPercenter

Quote from: Zetetic on July 04, 2022, 01:50:38 PMIAPT's conception wasn't just tied to "cost savings". The economic case for funding it was very openly and clearly tied to the idea of returning people to work and increasing tax revenues, and this is relevant to the way it was setup and managed.

You are not saying anything just misleading people further either intentionally or ignorantly. The case for funding was transparent because health funding is nearly always argued along economic means.  Cost savings from mental health are always present unless you are  just looking to open asylums again, but for everyone this time, not just people with severe psychotic disorder.

It's nonsense and borderline conspiracy theory to say this was all cooked up by New Labour to sell talking therapies (you are going go on about Layard now but if so you are missing the bigger point about there was evidence and support for these approaches before IAPT was being cooked up).  There was always a case for improving access to psychological services, there was always a need for more psychological support accessible prior to crisis point.  You keep ignoring this very obvious fact because it doesn't suit your borderline conspiratorial narrative.

Someone has a health problem mental or otherwise, they receive treatment, they get better - that is health economics. (EDITED jus repeating myself now).

Of course it is relevant (and not bizarre) that you can get talking therapies outside of employment programs because it obviously proves that it isn't in all cases a system based on payments for returning to work.  You can't separate the "health benefit" from the "economic rationale" for services and you are missing the importance of non-clinical infrastructure for MH interventions. 

Why don't we have a conversation about what IAPT should be delivering? what things IAPT needs to make it better? how a modern MH system should look?

Quote from: Zetetic on July 04, 2022, 01:50:38 PMThe idea that "CBT-informed" counseling isn't widespread is also bizarre - but in any case, it's Trenter who tried to claim that everywhere else uses "CBT" and have now tried to dismiss the idea that the other parts of the UK deliver things other than CBT in services comparable to IAPT (or they simply don't count or something?). I was trying to offer an understanding that - because of its efficacy - many talking therapists will have ended up drawing CBT into their own practice.

Again, more misleading stuff.  I said CBT is used widely internationally, because out of all talking therapies it has the most impressive evidence-base.  You keep going on about things like you are interested in merits but you can't admit the very obvious fact that CBT has been found to work, in independent trials, in this country, internationally, in the best journals and reviewing bodies, it is often found comparable or better than other psychosocial treatments.  It's a harder treatment to perform but there are lots potential benefits if successful over long-term medicalised options.

I've no idea why you again take the most convoluted approach to these problems.  Is CBT effective? YES the evidence suggests it is.  Job done.  Is CBT over prescribed? YES it isn't suitable for everyone and has become a silver bullet (And corporatised because that is how models of care self sustain themselves and propagate in a capitalist system). Is this IAPTs fault? YES in part IAPT has created an over reliance and focus on CBT, but creating a mass scale talking therapies service is a worthy mission and just because that infrastructure isn't doing things exactly how many people who work in this area think it should doesn't mean it isn't a starting point for much better future services.

I'm way beyond CBT and IAPT in my work, I absolutely understand the limitations of CBT, but it's hard to have conversation with someone so committed to not wanting a reasonable discussion about it all.  Reasonable means being "transparent" about all aspect of MH cares not just focusing on the failures of one admittably large service IAPT and contextualising it in the reality that all MH services operate in.

You are making me stan for IAPT and CBT much more than I am really comfortable with if I'm honest but that is because of the way you are approaching this rather than any great love for it.

Zetetic

I'm not arguing against there being a need for widely available psychological support because it's not something I disagree with or relevant to a discussion of what actually-existing-CBT has been in many people's experience.

I've clearly set out specific features of IAPT's history that take it beyond "oh well everything has to have an economic case". (Setting aside that particular ideological commitment and framing it in terms of "cost savings!)

Zetetic

QuoteYou are making me stan for IAPT and CBT much more than I am really comfortable with if I'm honest but that is because of the way you are approaching this rather than any great love for it.
My suggestion is that you stop, because I think you now read things into my "approach" that I can only swear aren't there.

I think we might at one of our impasses.

checkoutgirl

Quote from: Rev+ on July 01, 2022, 12:45:19 AMthe volunteers tread on eggshells

Why would the non paid people be like that? Surely the ones getting paid would be more on their guard? What's the incentive to not telling people to do one if there's no financial consequences?

checkoutgirl

Quote from: Sebastian Cobb on July 01, 2022, 08:46:11 PMShit errands like that are usually better than work. You can usually long them out as well.

Yeah I'd offer to go to the shop immediately. Breaks up the day and you get a bit of exercise, plus you can buy something in the shop on a whim e.g. a donut or sausage roll or banana etc.

TrenterPercenter

#52
Quote from: Zetetic on July 04, 2022, 02:53:02 PMI'm not arguing against there being a need for widely available psychological support because it's not something I disagree with or relevant to a discussion of what actually-existing-CBT has been in many people's experience.

Yes but you are not making it clear that peoples experiences vary, that CBT as a failed model isn't easily derived from people bad experiences of crap services.  I agree with Mr Veg in as much that IAPT might be a bad advert for CBT, that doesn't get us close to what CBT actually is and whether the science behind it works.

Quote from: Zetetic on July 04, 2022, 02:53:02 PMI've clearly set out specific features of IAPT's history that take it beyond "oh well everything has to have an economic case". (Setting aside that particular ideological commitment and framing it in terms of "cost savings!)

No you haven't, I'm not sure if you are fooling yourself or what but the fact some New Labour people commissioned a service because it would save money from people being on benefits isn't a) a bad thing it itself but more importantly b) is something that is just intertwined with that outcome.  Everything does have an economic base, it's a cost benefit analysis and it in some cases it is brutal (see NICE refusing late stage bowel cancer medication because it only temporarily prolonged life).  What you've got is a load of people that see IAPT as vehicle to provide treatment to people that wouldn't be able to get access before and a few powerful people that see it as way of cost saving and providing value for money.  The problem with these systems is how they are managed, there is often a problem with scalability and self-sufficiency because of the economic model we pursue but I am trying get you to think about the distinction between health economic claims that a service will provide x cost savings and how a system might be managed in what we would deem immoral ways.  An example being "creaming" in which in a payment by result system the least severe/embedded symptoms become the most desirable group for providers to work with.  A solution to this has been to use payment by distance travelled (i.e. billing of actual work achieve not simply set targets/result), but to do this you need actual "person centred care" (alongside skilled assessors) which you threw in the bag with a load of other things words seemingly too wishy washy (or whatever the point of that paragraph was).

TrenterPercenter

#53
Quote from: Zetetic on July 04, 2022, 02:55:44 PMMy suggestion is that you stop, because I think you now read things into my "approach" that I can only swear aren't there.

I think we might at one of our impasses.

I don't actually think you work for Bigpharma and wouldn't necessarily have a problem with that medication is an important treatment (because it is cheap and accessible), I think you are failing to appreciate the bigger picture here and appear to be disinterested in how that might come across to other people who might be deterred from accessing support because it's all a big New Labour con and doesn't work, CBT practitioner are all frauds.  Just to be clear you are not saying this, I think you think the opposite in fact, you are just careless to the already quite poor understanding of MH that is out there in the public and don't seem even slightly bothered to address it.

Rev+

Quote from: Zero Gravitas on July 03, 2022, 11:37:48 AMYou seem quite passionate Trenter, are you a hack fraud yourself?

I didn't say it!  Everyone saw me not say it.

-------------------------------------------------------------------------------------------- End Thread

TrenterPercenter

Pretty nasty stuff @Rev+ and @Zero Gravitas.


Also well done to Zetetic I'm guessing this is a result of some sort.

Dr Rock

If CBT didn't work for you when you was depressed, are there any other treatments the UK NHSs could make easier to get?

Stigdu

One of the best treatments I had in the 25 years I've had this phobic anxiety disorder is down to two words.... my wife. Without her support and, quite frankly, kicking me up the arse to take bigger steps, and more often, I'd never be in the place I'm in today,  mentally speaking.

Zetetic

Quote from: Dr Rock on July 05, 2022, 09:40:41 AMIf CBT didn't work for you when you was depressed, are there any other treatments the UK NHSs could make easier to get?
Ah, bugger my short link seems to have broken.

Personally I think the big one is "counselling" - being able to talk to someone in a more open-ended way about how you feel and what you want to be different, who might then offer bits of CBT (or stuff drawn from it like "behavioural activation"). 

My experiences, and the impression I get from others, is that many people despise being introduced to CBT in the format of "here's the six sessions, here's the format they're going to take, here's the homework you're going to be asked to fill out" - particularly if they're expecting something else from a 1:1 talking session.

People want a chance to form a relationship, of some kind, I think, and that's harder to do when your time with someone is focused on filling out worksheets and hitting semi-hidden learning objectives.

Something here also about it being seriously recognised by someone else that your problems are real and your reactions ... understandable or even reasonable, before you work on changing them because they're not useful.

The problem is that - as well as requiring someone with a whole set of difficult to recruit for or train for qualities, these things fundamentally take time and that's a hideously scarce resource.

(There's something here about other ways of trying to "deliver CBT", like group lecture formats described as training or skills-focused. Plenty of people would hate those as well, but it'd be a lot clearer what you're signing up for. These do exist now, to be clear.)

Zetetic

Quote from: TrenterPercenter on July 05, 2022, 09:36:46 AMAlso well done to Zetetic I'm guessing this is a result of some sort.
I have been trying to work out what each of us want to get out of our interactions, and in my defence I don't think it's that.