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A thread of the posts by @cait.bsky.social. They read as follows:
I had my first talk therapy session with my new therapist and she hit me with the "you're very self-aware" ☹️
not the "pleasure to have in class" of therapy
that's right, I know all the tools and have developed countertools so they no longer work. welcome to thunderdome Link to post
I'm so done with therapy. I've been going since 1989 and whilst there have certainly been some worthwhile insights, I believe the whole thing is as much about propping up the economic stakeholders (the 'industry') as it is about effective help. It's a lazy no-effort button GPs, employers, friends, anyone, can press to rid themselves of listening to your 'problems'. So you pin all your hopes on it to find relief. It's such a let down.
There are so many issues. Firstly, it is situated with a culture. A western capitalist culture. I reckon it's all about making you feel less like the obvious wage/mortgage slave you are and more like an 'empowered' 'aspirational' boss. CBT is definitely gaslighting. But the biggest elephant in the room is how the 80% of your problem -- the societal and market forces pushing down on you -- are never referenced as the cause. They are scarcely offered an a discussion point. Like, the very thing which fucks you up is indiscussible. It's always what 'you' can do. Basicallly it's: 'you've got an attitude problem'.
CBT is definitely gaslighting.
More of us need to start saying this. All therapists are powerless to help you with the existential angst inherent to living within a Western capitalist system, but many of them will flat out deny that current material and economic conditions are a root cause of many societal problems that lead to chronic stress and mental illness.
CBT is jank as fuck. You can't reframe your way out of poverty, especially not once you start developing physiological issues related to chronic stress and depression. The notion of it is offensive to me, and the CBT worksheets I was given are the epitome of paternalism. What a waste of time. I have had some luck with using DBT strategies on my own though, and I'm hoping to get referred to a DBT therapy group. Group/peer support has been more helpful than I had thought it would be.
Ok but it's great for what it's great for. CBT can't fix poverty, but it can fix a tendency to let minor setbacks spiral into full blown panic attacks or an inability to ask loved ones for help.
Plenty of problems aren't the sort therapy can help with despite them having huge mental effects. But plenty of people have problems therapy is actively good for. In the same way therapy won't fix your (rational) economic anxiety, if you torpedo every relationship you're in communism won't fix you, but DBT might.
We don't negotiate with therapists.
We don't negotiate with the rapists
A series of circumstances have made me effectively resistant to CBT, and sadly not the kick-based one. "Talk to yourself as you would to a friend", they say to the dude who has never had any and therefore has no idea of whay does that even mean
“Talk to yourself as you would to a friend”
I've never heard of this technique. The one CBT technique that I know is labeling your thoughts (according to the type of cognitive distortion) and countering them. If you do it long enough, your thinking is supposed to change. Changing any habit is difficult, though.
I think the idea is that, when you're judging yourself really hard for something you've done, you're asked to consider what you would think of a friend who had done the same thing. A lot of the time people would view the friend as having a made a forgivable mistake, even though they're treating the behavior in themselves as evidence of an irredeemable and permanent character flaw. So it's like, use supportive language when you talk to yourself. Remind yourself of all you've done right and all you've overcome, that sort of thing. Forgive yourself and build yourself up. It's a specific instance of the kind of labeling-and-countering you're talking about.
It's also that what you want out of the friend is not for them to run away or apologize profusely, it's to own up, apologize, and try to be better next time
You could try needles or sounding or a cage. Kicks aren't the only option!
Ask you doctor if stoicism is right for you.
Stoicism is just sparkling loneliness.
And life is just wasted time before death.
I wanted to smack this one coworker so damn hard. He shouldn't shut up about it like it was the answer to all my problems, and I'm just standing there like, "You mean the thing I've been doing literally most of my life?!"
Talk to yourself as you would to a friend
I prefer to be honest with myself. While I don't saddle my friends with my problems.
The point is to be kind to yourself. You should be honest with your friends, but you should make efforts to frame that honesty in a caring and positive light, ensuring them that they're safe with you and that you're raising your concerns out of love for them.
The therapist's point is that most people know to treat they're friends that way, but tend to be much harsher and less generous with themselves. So: cut yourself some slack, is the message.
When I had friends we’d constantly insult each other.
wait what? isnt... being self-aware a good thing?... pleasure to have in class? i have got to beissing something here.
"You're very self-aware" is basically a meme in the corners of the internet that discuss trauma. It's a genuine compliment on the part of the therapist, but also an implied admission that they won't be able to help you.
You're already aware of the observations they would make and the tools they would propose, so you might as well skip to the end and look for another therapist.
As a psychotherapist, working with people who are self-aware is a pleasure. I wouldn't ever say that to someone if not meant as a genuine compliment.
Although I believe not many of our patients actually are as self aware as they think. I think we as humans often are good in introspection where it's easy and comfortable to do so, while glaring over pretty blatant cognitive errors in some other parts, and this is usually where problems arise and disorders develop. And interestingly some people seem to think of themselves as someone who's perfectly introspective but just for some external, unchangeable factor immune to any kind of positive change. Maybe they could feel irritated about the compliment, because in their minds it reinfoces their idea of being helpless against their problems (in the sense of: I already know everything, it's just not possible to change anything or I would've already done that)? I could imagine that's how I would feel, but of course it's just a guess.
Self-awareness is a good thing, but it’s also the bottom of the barrel when fishing for compliments. In therapy, specifically, the implied sentiment is, “Well, at least you know how fucked up you are.”
She’s making the comparison to the “pleasure to have in class” line, because it’s similar. If a teacher genuinely has good things to say about a student, it’s probably going to be more specific (i.e. – they were inquisitive, a quick study, made their peers laugh, etc). “Pleasure to have in class,” by contrast, is a generic compliment that doesn’t really say anything.
EDIT: Okay, so based on a few of the latest responses, I felt that I should clarify something. I don’t think people who use these phrases intend for them to be insults or demeaning in any way—this includes Cait’s therapist in the original post. It’s just that it can be perceived that way, which is what I think the post was making fun of.
If you’re also an introspective, self-critical person, please don’t take someone saying this to you as an affirmation of your faults. It’s almost certainly an innocuous and genuine observation.
but it’s also the bottom of the barrel when fishing for compliments.
I can see that you have good intentions...
Really, though, there is no bottom of the barrel. Self-awareness is something that some people in therapy genuinely lack. Good intentions are something that some people genuinely lack. Kindness is something that someone people genuinely lack. Being capable of being unobtrusive for others is something some people genuinely lack.
These are not the bottom of the barrel, but solid foundations you can build from. Someone with good self-awareness can give constructive feedback both in session and irl. Someone with good intentions will actually try to improve rather than use therapy as a place to vent. Someone who is kind will use the skills and motivation they gain in therapy to build a nice community for themselves because it is reciprocal.
Imagine OOP except without self-awareness. Their subconscious has developed countertools that make therapy ineffective but they are not able to describe those countertools or even know their functioning. All they can say is that the therapy doesn't work. That sucks so much worse than the situation OOP is actually in.
Imagine OOP
Ever since I played Control I only read that as Object Of Power
it stands for Object Oriented Programming, actually
/s
Oh my god I literally just now got why my therapist kept saying that. I hate people do this and then expect me to get it. Especially therapists they should know better. If you try to sugarcoat it I won't get it almost guaranteed. Fucks sake what a waste of a time she was. Should have known something was up with how defensive about Israel she was...
Should have known something was up with how defensive about Israel she was…
Holy shit, your therapist should not be debating politics with you! That's right up there with your therapist trying to convert you to their religion or praying with you. That's a line that shouldn't be crossed.
Is there actual evidence that CBT actually works? It's always thrown out there as something that helps, but it doesn't. It doesn't work.
It depends if you're really into it. Personally I don't like my testicles being hurt.
Is there actual evidence that CBT actually works?
Yes! In fact, that's its biggest selling point. It's an evidence-based therapy.
Just go on google scholar, type in "CBT meta analysis" and read the results
Not with my search settings, I'm not.
Sorry, I'm convinced meta analyses are garbage written by the least capable academics. They create yet another "study" that supports X or Y position without testing anything at all--that outsiders use to further an X or Y agenda. More meta-studies based off other meta-studies! It's mountains of useless bullshit.
For example, a more recent meta-analysis by Wykes and colleagues (2008) examined controlled trials of CBT for schizophrenia and confirmed findings from previous meta-analyses (e.g., Gould et al., 2001; Rector & Beck, 2001), suggesting that CBT had a small to medium effect size as compared to control conditions on both positive and negative symptoms.
How brain-rotted do you have to be to think this says anything? "We reread the articles and they still say the same thing... because... they're written." Maybe we should perform another meta-analysis on the same articles! Third time's the charm!
The underlying papers are of no use at all:
CBT for depression was more effective than control conditions such as waiting list or no treatment
Like holy shit, really? This is your foundation of evidence that CBT works? Just look at the proponents of CBT--it's a magical, effective treatment for everything under the sun! I can't take it seriously, especially when it's pushed as being as effective as medications.
I had some blood work done and it indicated that I would likely have a negative or poor response to an antidepressant I'd been taking for nearly a year. I'd tell the doctors that it does absolutely nothing, but they kept increasing the dose and insisted it would do something positive. It never did. These are the same disinterested, bullshit doctors that would tell you to engage in CBT.
All the therapists would gaslight you into believing it's all your fault: just think your way out of it. Fucking bullshit. Absolute puerile bullshit.
The reality is I suffer from something that has a genetic component to it: crippling depression that runs in the maternal family. No. Talk therapy doesn't do shit. No. CBT doesn't do shit. Appropriate drugs actually work and I'm now in a so much better place after living my whole life with crippling depression, anxiety and panic attacks. I finally feel able to live a normal life. Do you know how much money and time I've wasted on talk-therapists? They're not doctors. They're complete time-wasters. They should be banned as I'm convinced they perpetuate harm.
Even proponents of talk-therapy have that fundamental caveat that absolves them of everything: it could take years before you see any results. It's all con-artists selling snake-oil. Psychology is such a bull shit field.
Meta analysis is actually the best class of scientific evidence. A meta analysis looks at the totality of research on the subject. Because any single study can yield different results, scientists need to do many studies. Certainty in science comes from replication. If repeated studies show the same results, those results become more certain. If a new meta analysis confirms the result of an old meta analysis, it shows the results are likely to be accurate.
The new meta analysis included newer research. That conclusion is saying that the newer studies match the results of the old ones. That's how science works. Nothing can be certain unless its replicable. Most science is like this. Papers are written by scientists for other scientists. Meta analysis from every field are exactly like this.
But any study like these looking for the general case. This analysis is making limited claims with strong certainty. This study is saying that, with a great deal of certainty, CBT has a small to medium effect on most people, but not all of those who get it.
There are many problems in medicine. You have encountered many of them.
Its clear CBT didn't work for you, but that in no way means that the science is wrong, or that meta analysis, as a concept, are bad science.
The drugs that you are taking were studied in exactly the same way. There are analycies and meta analycies on their effects that will sound just as pointlessly reduntant as the one you looked at. That is the process.
How about this?
Method: Thirty-four CBTp trials with data in the public domain were used as source data for a meta-analysis and investigation of the effects of trial methodology using the Clinical Trial Assessment Measure (CTAM).
Results: There were overall beneficial effects for the target symptom (33 studies; effect size = 0.400 [95% confidence interval [CI] = 0.252, 0.548]) as well as significant effects for positive symptoms (32 studies), negative symptoms (23 studies), functioning (15 studies), mood (13 studies), and social anxiety (2 studies) with effects ranging from 0.35 to 0.44. However, there was no effect on hopelessness. Improvements in one domain were correlated with improvements in others. Trials in which raters were aware of group allocation had an inflated effect size of approximately 50%-100%. But rigorous CBTp studies showed benefit (estimated effect size = 0.223; 95% CI = 0.017, 0.428) although the lower end of the CI should be noted. Secondary outcomes (eg, negative symptoms) were also affected such that in the group of methodologically adequate studies the effect sizes were not significant.
This is the “Wykes and colleagues (2008)” cited in the first sentence. The only reason your example paragraph sounds like that is because everything it wants to say has indeed already been written.
I agree with a lot of what you say, especially being forced into an "evidence" based system, I was like, who's evidence? Because I can surface studies that show things you don't support work, but anyway.
Ive gotten help from a talk therapist, she saved my life, but according to the healthcare system where I live now, there's no evidence it helps and I can go fuck myself.
That’s why meta-analyses are so important. They look at every attempt at studying said thing and see whether it worked significantly more times than it didn’t, and why people don’t just cite a single study as conclusive evidence.
And what nuance do we lose in between?
Sadly this is all medicine, I lost so much faith in it as soon as it wasn't "extremely obvious problem with extremely obvious solution." For the brain, it's a much worse situation because we understand it so little. It turns into "throw random ideas at it and hope one works" and a lot of people are just lonely or needed lifestyle changes so it "works" for them :/
omg thanks for pointing that out
My understanding is that it’s the best method we have at the moment, but might still be ineffective for as much as half of all patients who undergo it.
So, yeah, it kind of sucks, but no other intervention has a better body of evidence behind it. Our understanding of mental illness is unfortunately just very limited.
I seem to recall that, consistently, the quality of the therapeutic relationship is the most important factor for improvement. In other words, get a therapist you like rather than one specialized in a certain branch of therapy 🤷♀️