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Seeing behind the curtain

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

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Rev+

This is mainly a run-up to a very minor anecdote, but bear with.

My other half spent years training as a counsellor, and as a result CBT will never be of any use to me should I need it.  We talked about it so much during her studies I'm too familiar with both the back and the front of it.  It's also an extremely unhealthy approach but that's another thread.

Anyway.

One day a week, I work in an office that shares a space with Citizens Advice.  An organisation mainly staffed by volunteers but fuck me, you can tell which ones are paid - the volunteers tread on eggshells around these people who wander about like royalty.

Anyway.

So, Citizens Advice.  They exist to help people through legal issues that they may not have any reason to know about until it crops up.  Complex issues that need a neutral third party.

Anyway.

This morning they ran out of milk for their tea and coffee, and all just fucking moaned.  It took a discussion between six people, over the course of an hour, to determine how to fix this problem.  There's an Asda two minute's walk from the office, and you have to walk past a Londis and an Iceland to get there.

You get the point.

Ray Travez

I read about this recently in a book by Oliver Burkeman. It's called the bike shed effect, or Parkinson's Law of Triviality. Here's Oliver Burkeman's piece on it-

https://www.theguardian.com/lifeandstyle/2010/may/15/change-your-life-trivia

Why do you think CBT is unhealthy? I'm not a fan, but I don't have an issue with it either

Poirots BigGarlickyCorpse


touchingcloth

They should have tried CBT. Cold black tea.

Sebastian Cobb

Shit errands like that are usually better than work. You can usually long them out as well.

bgmnts

Quote from: Rev+ on July 01, 2022, 12:45:19 AMThis is mainly a run-up to a very minor anecdote, but bear with.

My other half spent years training as a counsellor, and as a result CBT will never be of any use to me should I need it.  We talked about it so much during her studies I'm too familiar with both the back and the front of it.  It's also an extremely unhealthy approach but that's another thread.

Do you feel it's an unhealthy approach to mental health issues or does your partner share this?

And re: Citizens Advice, sounds standard for an office. Mostly just useless wankers trying their best to do as little as feasibly possible.

TrenterPercenter

I'd also be interested on this take regarding CBT?

Rev+

CBT does have its uses but it's used far too broadly, at least in the UK, as both a default and final option for mental health treatment.  It's appropriate for loads of people, it'll just never work for me as I'm aware of the reason certain questions are asked, the flow of conversation, and the conclusions that are reached.  That's what I meant by 'seeing behind the curtain' - being aware of the process can destroy it.

I do have a general problem with CBT, though, in that it minimises actual problems and pushes them back on the patient.  Nothing is a real problem, it's all about how you interpret it.  So your electricity isn't getting get cut off because you cant afford the bill.  Your legs still work after the accident, so you can make it upstairs to the bathroom.  Everything's okay, as long as you change your attitude.


Zero Gravitas

But it's soo damn cheap!

It's popularity is in no small part due to that, and it being ideologically compatible with corporate and institutional mental health schemes, which for some weird reason aren't great fans of looking at conditions and environment.

bgmnts

I tried CBT on an online course and yeah I got that impression. The idea you're meant to just will yourself out of severe depression isn't too far from hippy dippy shit or pull yourself up by your own bootstrap shit.

Fuck knows.

H-O-W-L

CBT worked (and continues to work) for me personally but a lot of my anxiety issues are based around perception and interaction and counteracting evidence and stuff, so it is basically laser guided for someone like me. Would be shite were I not able to manage my depression in other ways.

TrenterPercenter

Quote from: Rev+ on July 02, 2022, 12:03:40 AMCBT does have its uses but it's used far too broadly, at least in the UK, as both a default and final option for mental health treatment.

Hmmm it's still not that available, waiting lists are generally long.  It is used too broadly because it has been seen as a panacea when it is quite specific is what it should be used for.  I'm not sure quite what you mean as default and final option, this is 9/10 medication.

Quote from: Rev+ on July 02, 2022, 12:03:40 AMdo have a general problem with CBT, though, in that it minimises actual problems and pushes them back on the patient.  Nothing is a real problem, it's all about how you interpret it.  So your electricity isn't getting get cut off because you cant afford the bill.  Your legs still work after the accident, so you can make it upstairs to the bathroom.  Everything's okay, as long as you change your attitude.

This is a completely superficial representation and understanding of CBT, and you say your partner delivers this? I've never EVER heard any CBT practitioner, CBT trainer or anything in the vast amount of CBT research I've had to look through say problems aren't real.  If anyone has ever said "your electricity bill isn't getting cut off because you can't afford it" then you need to complain to the BACP.

People that commonly say what you've just said here generally don't like being challenged, physios get this a lot as well "why can't they just fix me/give me painkillers rather than telling me I've got to do it".  It's a very passive outlook, passive doesn't mean not angry it means you want other people to solve your problems, CBT therapists are trying to get you thinking in ways that support healthy behaviour for you manage your life, absolutely nothing to do with putting "the problem back on you" or saying it isn't real.  It works, and this what people fail to grasp, because that is how your brain works, not "we think your brain works like this", no that is how it works by building neuronal connections and we can literally observe this happening in real time. 

It isn't suitable for everyone because people might not be at a stage at which they are ready for it and it works on a logical rational part of the brain, more deeply embedded emotional problems it is less effective for it.  Also how effective it is, like all therapy it is down to skilfulness of the therapist.  You can see therapists and especially CBT practitioners in the same light as gym instructors, they are not there to agree that yes you have put on some weight and give you a hug, you go to a counsellor for that.  If you are in a situation where you just need to talk about your issues then this is the place to start.

Stigdu

I found CBT worked really well for me too. I like cold, hard facts, so reading about why the brain works the way it does, pumps out adrenaline, quickens the heart rate, deprives the brain of oxygen, fight or flight, all that stuff, was really helpful to me.

Knowing that I can re-wire the way my brain thinks through perseverance, small steps at a time, really helped me when I was one of the lowest points in my life and didn't leave the house for about 6 weeks.

There's still *plenty* more work to do, but the meds I'm on help.

Zetetic

Quote from: Rev+ on July 02, 2022, 12:03:40 AMCBT does have its uses but it's used far too broadly, at least in the UK,
Worth being clear that England's emphasis on CBT, its mass-implementation as something heavily manualised and given by people with very limited training, and the idea that these things would "pay for themselves" by getting malingerers back into work are unique in the UK.

This is not to say that other nations haven't also looked to CBT as the thing that should be made available (alongside medication) at scale, but England's IAPT is a very peculiar setup with a very particular history and set of ideological committments.

TrenterPercenter

Quote from: Zetetic on July 02, 2022, 10:04:58 AMWorth being clear that England's emphasis on CBT, its mass-implementation as something heavily manualised and given by people with very limited training, and the idea that these things would "pay for themselves" by getting malingerers back into work are unique in the UK.

Jesus Zetetic do you ever consider how you present these things might be harmful to other people. 

CBT is different from IAPT and it really isn't as simple as Zetetic is making out that is some conspiratorial ruse to get malingerers back to work (he'll say he isn't saying that but he is because he knows better than to just say these things in the way that he does).

CBT is an international, well evidenced model of therapy and anyone considering it should look into it - not all CBT is delivered through IAPT or "welfare to work" programs.  Zetetics whole IAPT angle is to do with how the health service is manipulated by governments and the problems that exist in under-funding of services which are seen as cinderella services so "thinking your way back to work" is just another form of not taking MH seriously....but then on the other hand campaigners for better MH services, parity of esteem and raising awareness around MH equally seem to be a focus of this myopic unhelpful approach to these problems.

EDIT.

Forget it not wasting a day arguing about this again.  I hope every find something that works for them and things get better for them. 

Kankurette

It has worked for me, but that's because it was focused on changing destructive behavioural and thought patterns, not 'just think yourself out of your depression and everything will be fine'. And that was what I was aiming for, I wanted to change because I've lost friends and wanted to break the cycle of destruction, and I've done things like quitting Facebook and cutting down on the number of Space gigs I go to and trying not to place so much worth on the opinion of a man who only acknowledges my existence when it's convenient for him. That doesn't mean it's going to work for everyone and tbh I do find it a bit weird about CBT being recommended for things like ME or fibromyalgia. Unless it involves adapting your lifestyle. My pain is not all in my head.

Zetetic

#16
That "CBT isn't IAPT" is part of my point.

Nevertheless, I think we shouldn't pretend that many people's experience of actually-existing-CBT is via England's IAPT services, with their particular approach to implementation and with their particular genesis in returning people to work (which is not a terrible thing to measure but is perhaps prone to being a terrible target).

Edit: This might be important to understanding why some people have come to despise "CBT" so much - rather than (in what might be taken as a joke in other circumstances) suggesting it's because those people simply weren't good enough to engage with CBT properly.

For what it's worth, I found aspects of CBT much more useful following both changes in me and the context in which they were presented to me.

Zetetic

Edit: I'm not sure I can deal with the response to this.

TrenterPercenter

Quote from: Zetetic on July 02, 2022, 11:12:01 AMEdit: This might be important to understanding why some people have come to despise "CBT" so much - rather than (in what might be taken as a joke in other circumstances) suggesting it's because those people simply weren't good enough to engage with CBT properly.


Yes but that means doing both doesn't it and being clear on that point (which you were not).  Someones experience of CBT via an underfunded IAPT practitioner might be very different from them receiving it somewhere else and this conversation evolved into a criticism of CBT.

It's not rocket science to see how implying "yes and it's all big conspiracy of English MH system to get malingerers back to work" (something that isn't even that simple on it's own merit) might feed into a very negative view of the therapy itself.

TrenterPercenter

Quote from: Kankurette on July 02, 2022, 11:10:05 AMIt has worked for me, but that's because it was focused on changing destructive behavioural and thought patterns, not 'just think yourself out of your depression and everything will be fine'. And that was what I was aiming for, I wanted to change because I've lost friends and wanted to break the cycle of destruction, and I've done things like quitting Facebook and cutting down on the number of Space gigs I go to and trying not to place so much worth on the opinion of a man who only acknowledges my existence when it's convenient for him. That doesn't mean it's going to work for everyone and tbh I do find it a bit weird about CBT being recommended for things like ME or fibromyalgia. Unless it involves adapting your lifestyle. My pain is not all in my head.

In the main it is good for negative thought cycles and that can lead to anxiety and depression.  The anti-depressants are just doing similar things on very crude and base chemical level, exercises your own control over your brain chemistry is infinitely better than being dependent on SSRIs to manage your mood.

It takes time and energy though and people just can't generally be arsed with it - those that do often find it life changing.

Mr Vegetables

The thing is that the colloquial use of the phrase "CBT" and the actual psychological technique "CBT" probably aren't the same thing, because what's called "CBT" and provided to actual people is, from my experience, exactly what Zetetic describes.

Given that I think "CBT doesn't work" is a useful thing to say for people with no money or power navigating a health service, because from their perspective it is entirely true. Like, I dunno, how "chocolate is poisonous" would be a useful thing to say if all the stuff you could buy in shops was actually made out of arsenic, even if it did not meet any kind of rigorous definition of what chocolate actually was. These are two different things with the same name; the only way to get people to trust the evidenced one is probably to make that really clear.

My own experience of something called CBT on the NHS was exactly what Zetetic describes to the point of horrible parody, which is why I am saying this. It involved someone saying they should think about how things weren't so bad after his mother had died, and that sort of thing. I got an angry letter for non-attendance the day I had to miss it to go to my stepfather's funeral after he hanged himself, saying I might be discharged from all the mental health support waiting lists for failing to take personal responsibility.

When things like this are labelled as something they're not, I don't think it's society's fault for coming to use that label negatively. It is the correct and sensible thing to do in any context they might really encounter it. "Ah, but kittens are fluffy and harmless!" you say to someone who's been thrown into a pool of alligators with "KITTENS" written on the side. It's not really a debate about people just not understanding zoology, and I don't think this has much to do with any working therapies that actually help.

TrenterPercenter

#21
I think that is basically an argument most racists make about immigrants not being the nice immigrants and the ones that commit loads of crime and don't want to work.

I understand your point though some CBT is going to be shite because it is delivered by a crap therapist.  Some CBT is going to be crap because it performed for the purpose of getting you back to work and rehabilitation.

CBT is a model it is incredibly well evidenced hence why it is so successful. It's like saying I had a McDonalds burger and it was shit so all burgers must be shit.  Once it is translated into therapy it becomes a product so this is about the product that CBT is being used in.

You are accessing CBT in a completely underfunded system of which there is about 5000 qualified practitioners for literally millions of people, you get paid shit, work ridiculous hours listening to peoples issues all day and getting shouted at for not sorting them out.  That is why the better CBT therapists leave and set up themselves privately (same as many other areas of health). 

The question is what do you do about it.  The solution so far seems to the kicking the people that have remained behind in service, reducing more funds to it and upping access to medication.  Great job.  This idea that if you collapse the budget of IAPT then it will go to sorting everything else out is so utterly incoherent it's quite infuriating.  If you cancel IAPT without a replacement which would have to operate under the same constraints then lots of people will get much iller and die.  That is what will happen and there is no guarantee that anything would be put in its place.

Kankurette

I can't believe you got penalised for going to a loved one's funeral. That's awful.

TrenterPercenter

Quote from: Kankurette on July 02, 2022, 06:17:48 PMI can't believe you got penalised for going to a loved one's funeral. That's awful.

I think if you don't cancel your appointment they will just see it as a DNA and they'll send you a letter.  They are not penalising him for going to a funeral.  If you were booked in for an ultrasound and didn't show up for it you would receive a letter from your surgery warning you about future DNAs, because it costs money to have staff booked in to carry out these sessions and someone else could have used it.

Nothing to do with CBT and I can't say I've ever heard of any practice forcing people to go to sessions in place of going to a funeral - I think it is in everyones interest for that session to not go ahead.

Mr Vegetables

Quote from: Kankurette on July 02, 2022, 06:17:48 PMI can't believe you got penalised for going to a loved one's funeral. That's awful.

Oh, I didn't love him, he was the worst. It's more that it underscored the bleakness of the sessions themselves, having to go along and think about how everything was alright in a situation like that. And you are of course in a vulnerable and precarious situation where you know even this terrible service can be taken away, which is pretty bleak as well.

I'm not really wild about being compared to a racist for saying all this; that seems a bit off really. I think this particular service done in this particular way probably did more harm than good, and that it's important to say so. Literally having nothing at all probably is better than having people who aren't qualified in CBT saying "your awful situation is okay if you think about it," in the same way that having no surgeons is probably sometimes better than having randoms slice off your legs. It is possible for inadequate intervention to be destructive and that doesn't seem controversial to say.

TrenterPercenter

#25
Quote from: Mr Vegetables on July 03, 2022, 12:01:13 AMI'm not really wild about being compared to a racist for saying all this; that seems a bit off really.

I wasn't comparing you to a racist, I compared your argument to one commonly used by racists to highlight how just because the logic in the argument fits it doesn't mean it is correct.

Nothing you are saying is controversial it just sounds very biased so I'm not convinced that you are being fair in your assessment. 

For example you present your missed appoint as if this is something unique about CBT and as if they have done something consciously nasty.  If you are telling me you cancelled your appointment because you had to go for to a funeral and they said "NO YOU HAVE TO COME TO YOUR CBT SESSION IT'S A MORE PRESSING ISSUE THAN LIFE OR DEATH!" then I could see why you would be upset, it's still nothing to do with CBT, missing health appointments and getting bollocked for it are not a valid criticism here.

Which then leads me to this potential caricaturing of your intervention citing "your awful situation is ok if you think about it", I don't believe that is the entirety of your sessions.  Again if you really sat in room for an 40 minutes with someone that just repeated that to you or said it once and then you sat in silence then I'm not sure how representative your experience really is.  I'm not even sure what your alleged statement is meant to prove saying to someone "you are having a bad time right now but people do get better through things like CBT" of which there is a lot of evidence that they do isn't a terrible thing to say, you've just phrased it in the worst possible way.   People use the term "okay" to reassure others, when people say  "you mother died but it's okay" they don't mean it's good that they died they mean you are going to be okay.  Obviously "thinking" about things is important too, there is not much point going to a psychotherapist if you are not interested in thinking about things.  Lots of people don't like therapy that isn't anything new or surprising, neither are the base caricatures of therapists.

I'd say what really has happened here is whoever assessed you referred you to CBT when you should have been referred to counselling as they would have been helping you come to terms with the loss of your mother.

Dr Rock

I've not had great experiences with CBT, how do other countries deal with people who are down in the dumps? (@Zetetic)

bgmnts

If the world is not worth living in due to all the suffering in it, just think positively.

Just doesn't jive with me, but then that probably is the best one can do so fuck knows.

TrenterPercenter

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)

They use CBT.

TrenterPercenter

Quote from: bgmnts on July 03, 2022, 11:01:15 AMIf the world is not worth living in due to all the suffering in it, just think positively.

That 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?