5 signs you’re getting bad cognitive behavioral therapy (CBT)

Nothing pisses me off more in my job than
finding out someone wasted years of their life in bad cognitive behavioral therapy. Hey welcome back to the psych show. I’m Dr. Ali Mattu clinical psychologist and
cognitive behavioral therapist. I want to talk to you about that today. CBT what it is and how to know if you’re getting
bad CBT CBT is one of the most effective treatments for things like anxiety depression bipolar
depression A.D.H.D and a whole number of other problems. It’s about understanding yourself your strengths
and weaknesses learning how to get unstuck with your thoughts developing skills to help
yourself manage difficult emotions and also learn how to be in the kind of situations
that you want to be in. While there are a lot of great CBT treatments
out there and available with decades of research behind them and there’s a lot of people who
know how to do these treatments as a patient as a client who’s trying to navigate the mess
of the mental health system it’s really hard to know if you’re getting real good CBT. So in this video I’m going to outline the
top Signs That You’re Getting Bad CBT number one therapy is mysterious in CBT the process
is all supposed to be very transparent what you’re doing why you’re doing it how the treatment
works. It’s kind of like a car you can open up the
hood and see all the parts and you know how this thing is working. If your therapy is mysterious if you don’t
know why you’re doing something if the rationale hasn’t been provided. If it doesn’t make sense how the techniques
being used are going to lead to the goals that you want it might not be CBT speaking
of goals that gets to my number two which is your treatment has no goals. CBT is a very goal oriented treatment. You have specific observable measurable goals
and you’re able to know how your symptoms are doing where you are in relation to the
goal you’re working on and when you get to that goal you kind of know that OK maybe it’s
time for us to start ramping down to treatment it’s well no not ramping down tapering off
tapering off when it’s time to start tapering off treatment. If your therapy doesn’t really have any specific
goals if you don’t know if you’re making progress towards the thing that you came into treatment
for you might now be getting CBT and it’s OK to go into treatment and not necessarily
have a goal sometimes that’s what we do in CBT is we try to help develop goals. That’s totally cool. But you kind of need to know what you’re working
on and getting back to my first point. You kind of need to know how you’re going
to get there. The third way to know you’re getting bad CBT
is you’re not developing new skills. This is one of the central things in all cognitive
behavioral therapies is whether it’s cognitive therapy or exposure therapy Acceptance and
Commitment Therapy Dialectical Behavior Therapy. There’s so many different types of cognitive
behavioral therapies out there. But one thing they all have in common is developing
new skills new ways of dealing with your thoughts new ways of dealing with your emotions new
ways to be in a situation. Number four is no homework. One of the things CBT might be infamous for
is having homework things that you have to do outside of your session with your therapist. The thing about therapy is it’s great but
it’s only for a small chunk of your week maybe it’s 45 minute therapy maybe 50 minute therapy
sometimes less than that and it’s not enough to help you take the gains you’re making in
your therapist’s office and extend them to your life. There’s nothing we do in life that we can
just like practice for a little bit once a week and then we’re done like whether it’s
learning a new instrument playing a sport or any other skill you develop in life you
have to practice it. You have to do it over and over again you
have to do it outside in your real life and that’s where Homework comes in and CBT a CBT
therapist will often help you to learn something in session and then give you a specific homework
assignment to practice that outside of the office. It’s not to say you are going to have homework
every single week but CBT extends its reach outside of the office and it usually does
that through homework. The number five way to know you’re not getting
good CBT is you never get out of your chair or sofa or chaise lounge. Many CBT treatments will at some point get
you moving in some way. They’ll get you to practice something they’ll
get you to act in some way with a lot of my patients when we work on anxiety. We leave my office and we go into the kind
of situations that are difficult for them or maybe if I’m working with someone who has
depression we might practice a skill in my office we might not leave the office but we
might kind of get up and do something. I should say with some people I work with
we might do the whole treatment in the chair like for example if I’m working with someone
who has generalized anxiety disorder and they struggle with worries and uncertainty we might
do all of that stuff in the chair like help them develop skills right there in my office. So there are some exceptions here but CBT
is an active treatment. It gets you to do stuff and if you’re not
doing stuff you’re not doing CBT. Have you been in CBT. Have you been a good CBT or bad CBT what’s
your experience been. Let me know in the comments below if you like
this video give it a thumbs up if you want more videos that celebrates psychology and
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40 comments

  1. I've had CBT, and I am currently in what I think of as maintenance. I have PTSD (with some other stuff) and I find my monthly appts really helpful in staying on track. Luckily I live in Australia and have access to ongoing treatment with little hassle. I have mostly had a good experience with CBT and I know that I am more of an issue than my therapist…im resistant, stubborn, fight myself and go back to unhealthy thoughts very easily. I think my therapist is the bomb, he pushes me, and challenges me and I wouldn't be heading off to Uni this year if it wasn't for his continued input.

  2. Thanks so much! I’m about to start with a new therapist on Friday because of these reasons. Let’s hope this one’s a bit better! 🙂

  3. I've had CBT for my chronic fatigue. It was horrible, I only got worse and worse. The team kept saying I had to get worse to get better. However towards the end of the therapy (the point where they said beforehand that I would be 'cured') I was the sickest I had ever been. It then took me and ny parents about a full month to convince them to let me stop, which then resulted in mental problems from the experience. I can't believe there were two psychiatrists and a doctor who all decided to let me do this. Now, a year later, I'm almost mentally recovered but am still angry at the fact that they let me (and others like me) do a therapy that has been proven to do harm for some cases of chronic fatigue. I hope that there aren't many people around who have gotten bad CBT, it sucks!

  4. This is a great explanation and set of recommendations for something that’s sometimes vague (even for me, who’s halfway through med school haha).

  5. Hey, thank you for your insight. 🙂 I also wanted to share that I am very thankful for your last video, where you talk about anxiety and perfectionism. Your courageousness facing your anxiety inspires me to be more brave myself, to let mistakes happen and be more imperfect. I feel that you were quite open and honest in the last video. I appreciate that very much! Thanks!

  6. Hi Ali
    Again, wonderful video! I didn't notice any downside of this spontaneous way to tell the content. I got more time to think about the information, especially because I'm not a native speaker.
    While watching a video of Veritasium about immediacy, I got the idea for a challenge you could do: have you ever considered making a live stream? (By the way, this video is worth to watch: https://youtu.be/ozHMkDZqWI0)
    Best wishes, Janosch 🇨🇭

  7. Love this, navigating different types of therapy and trying to figure out if the treatment I'm getting is right is a big challenge. This was very informative!

  8. Please share the evidence to support the connection between CBT and ADHD. I am not aware of such. This is in reference to your opening statement.

  9. Ali, these imperfect videos are amazing. I think this is what the internet needs. You're addressing issues, you're teaching us, you're sharing psychology. These are important things. But also, you are giving us an authenticity that we crave and makes your videos easier to receive because they come across as more familiar. This is how we experience university lectures, conversations, and therapy sessions. Thank you. I hope these videos show you that they are less imperfect than you expected them to be. Perfection only ever exists in light of criteria that depend upon the situation and the person(s) prescribing the criteria.

  10. I tried a therapist via the site Betterhelp, and watching this video made me realize how bad this resource was for me (having depression + social anxiety). It was the most cost effective option for me at the time, but there wasn’t homework or goals during my time with the therapist! He did offer some ideas + books to check out (The Velveteen Principles, Daring Greatly by Brene Brown) but there was no expectation that I’d be working on anything. I don’t know. Maybe it isn’t considered “real therapy,” because it was online therapy?

  11. I appreciate your discussion to help me evaluate the treatment I am receiving. After several years with a prior therapist, I still had no idea where I was headed or how/when I might reasonably get there.

  12. Great video! I'm a social worker looking for further my cbt proficiency. Do you have any recommendations on schools or seminars I could attend?

  13. I've recently started training as a CBT therapist in a program called CETA. It's a short-term American (John Hopkins university) program to help mostly those who suffered due to military conflicts and don't have access to a lot of trained therapists. We were instructed about getting active, setting goals and being transparent about the techniques, so I guess it's a 'good CBT' after all.

    I can't find it's page on Wikipedia but there are some articles in NCBI.

    Have you heard about it in your professional surrounding? I

  14. I went through CBT about two years ago and watching this video it seems like they did everything right! And I mean, I felt myself that the treatment helped me, but it's still a relief hearing from a professional that I seemed to have gotten what I was supposed to get.

  15. I had CBT when I joined a psychosis program, I had no idea how it was supposed to help me and I still don’t really. While I loved talking to the pdoc who was treating me, I did not get anything out of it and I’m very closed off about trying it again.

  16. 0:22 – What is (good) CBT?

    5 signs of doubtful CBT:
    1:21 – Therapy is mysterious
    1:57 – Treatment has no goals
    2:57 – Not developing new skills
    3:27 – No homework
    4:46 – Never get out of your chair (with exceptions)

    5:57 – Questions for us (the viewers)

    Thank you very much! Kind regards!

  17. At Kaiser, I can only see my therapist once every six weeks. Sessions are so spread out that I wonder if there's any point to this at all. I hear people talk about weekly therapy and it sounds like a pipe dream.

  18. When I was in South Korea I discovered/ realized that I had PTSD. I had a painful flashback which made me realize I had survived sexual assault and an abusive relationship. I didn't fully understand it was PTSD but through the symptoms (being angry and belligerent, which is very uncharacteristic of me, when hearing we would watch a film about comfort women- aka women who were systematically raped and abused, being cold and shivering on a day that was hot summer weather, remembering experiences and being frozen in place for extended periods of time) I realized that something was wrong, and I had to figure out myself. Since mental health is severely stigmatized in South Korea, I was learning Korean, and there weren't many options out there for foreigners I looked after my mental health on my own. I did research and did my own CBT homework. I researched my symptoms, I understood what I was dealing with, how it's affecting me, and I journaled about it a lot which helped me deal with what I was going through. When I got back to Canada, and realized I was dealing with depression and anxiety, I went to a professional therapist in my hometown and did CBT art therapy. Sometimes I didn't feel like doing the art part- I'm artsy but didn't really always connect to the exercises the therapist suggested- and I was free to refuse the exercise if it didn't serve me. My therapist helped me realize I felt guilt and release that, and understood myself and my experiences better, and she utilized my experience in doing my own homework. So basically I want to say it's ok to not always connect to the exercises a therapist suggests, and not every relationship with a therapist will be amazing- sometimes you gotta shop around. And if you don't have the financial means, and even if you've done therapy before, there's online resources to help you do your own CBT exercises and find a way to better understand yourself and what you've been experiencing.

  19. The fifth one!! ITS SO REFRESHING TO HEAR ABOUT EXPERIENTIAL PRACTICE IN THERAPY!!! Roleplaying and practicing is so important and I thought that was soley something used in adventure therapy settings.

  20. How does one know what kind of depression/anxiety the actually have before doing research on finding a therapist????

  21. I hate CBT. I had a male therapist who would treat me like my brain just didn’t work right. He never validated me or let me feel the way I felt. He just said “but you’re not fat. You’re not ugly, you know that so why do you feel that waY” UGH !

  22. Just started working with a CBT therapist but she is not strictly CBT. She has given me homework but it is hard to do as my PTSD symptoms are out of control right now

  23. Ha! I am having very bad CBT right now. Let me just rant for some minutes. For the last two sessions the guy was just questioning everything I was saying, regardless of if it was important for me or not. He asked me how I was doing and why, and I could not even finish my sentence he was just interrupting me all the time at each answer and branching to other questions so I could not even get to my point, which was that I was ignored by a girl and it gave me strong suicidal thoughts again. AAAAHHH! I don't even know what we are doing. Each time he gave me assignments and we never looked at them. He was just asking me about my procrastination and ended up giving me homework about my addiction problems that I did not want him to deal with. I could not even say what I wanted. And I have years of experience about my depersonalization, for example, he didn't know what it was, had to ask a colleague (which is ok to me) and at the next session he tells me I don't have it because I did not describe the symptoms with the exact correct words (I said I felt like my body was a robot I was controlling from a distance, instead of saying that I don't feel like I am myself). F*ck that… I spent hours and hours learning about it and he doesn't even have a clue what I am talking about. I felt I had to justify absolutely everything I was saying, I was constantly invalidated, he wanted me to just drop everything I know about myself and just listen to him because after 5 minutes of conversation he knows exactly what I have and the 10 years of therapy I already had with other therapists don't matter, I can throw them to the garbage because now I met him and he knows everything. Absolutely everything I say just comes from my deluded thoughts and I have to surrender to the new truth he has about me after talking with me for 5 minutes. Thanks you if you were bored enough to read this until this point.

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