“You meet a guy, relinquish a tiny bit of control, and the next thing you know, you’re eating a different part of the pig.” – David Sedaris describing his experience of ending up in Normandy with his husband Hugh pretty much describes my experience of winding up rounding 40 as a CBT therapist specializing in anxiety and related disorders. Only my former graduate advisor is the guy (I didn’t marry him, and this is not that sort of blog post), and I suppose ‘the part’ of the pig I’m referring to is my theoretical orientation.
20 years ago, I was a college senior who had put off securing an honor’s thesis advisor to the last minute. It was pure happenstance that had me waltzing into the office of the Rutgers Anxiety Disorders Clinic to meet with Dr. P, who wanted an undergrad to work with him on validating a scale. He went on to hire me to work as an in home behaviorist following undergrad, and then became my graduate advisor upon my acceptance to the Graduate School of Applied and Professional Psychology at Rutgers. By the time I attended my first class, I was so steeped in CBT that I had no understanding that, as a theoretical orientation, CBT was a relative newcomer to the game, and not necessarily universally beloved by all psychotherapeutic practitioners. Throughout my education and experience in the field, I came to realize that myths and misconceptions about CBT abound. So, welcome to CBT Base Camp 101 – Mythbusting!
Myth #1: CBT is just a set of techniques: There are a lot of treatments and techniques that fall under the umbrella of CBT, however, CBT in and of itself is a rich theoretical orientation. Just as with any theoretical orientation, it provides a framework from which you can conceptualize and plan treatment for any individual client.
Myth #2: CBT Therapists don’t attend to the therapeutic relationship: The work that I do is primarily with clients who have anxiety and related disorders. As such, I’m often asking them to face their worst fears – there is no way that I would be able to do this type of work if I didn’t constantly attend to the therapeutic relationship. CBT therapists absolutely believe in the necessity of the therapeutic relationship; we also acknowledge that it’s not wholly sufficient when it comes to creating change.
Myth #3: CBT takes about 12-15 sessions: Whenever someone asks me off the bat how long treatment will take, I provide the answer universally loathed among clients and insurance companies – “it depends.” If a client is coming to treatment for a specific phobia, has never been in treatment before, only wants to focus on their phobia, has zero comorbidity, and is highly motivated, then we might be able to complete treatment in a handful of sessions! That being said, human beings are complex, and treatment is not 100% predictable, therefore, every client’s treatment timeline is going to be based on her unique strengths, difficulties, goals, and diagnosis/es.
Myth #4: CBT is only effective for surface level problems: Please refer back to myth #1. Sure, under the umbrella of CBT, there are a variety of techniques that are effective with regards to behavior change. I guess we need to bust two myths here – one that behavior change is somehow surface level, and two, that behavior change is all that CBT treatments provide. Research demonstrates that when people change their behavior, their thoughts and feelings actually follow. For example, if you’re a lifelong smoker who stops smoking, your attitudes and feelings around smoking will actually change once you stop the behavior. Further on, CBT derived treatment has been demonstrated to be effective in treating borderline personality disorder (DBT), schizophrenia, and other psychotic disorders. It’s hardly limited to getting folks to stop biting their nails – although if any of you out there could help me with that, much appreciated.
Myth #5: Thou shalt be a theoretical pureist: Ok, this isn’t strictly a CBT myth, but hang in there, the post is almost over. I can still picture my grad school class – there were about 4 or 5 of us who chose the CBT tract, and about 10 others who chose the psychodynamic route. There was one magical unicorn (I hope you’re reading this) who actually did both, but in general, we were told to choose, and choose wisely, because this choice was set in stone. Something I often find myself saying to clients who are in a rush to figure it all out and foreclose on their identities is that the day we stop growing and learning would be an incredibly sad day. I hope that this is what brings you here, to CBT Base Camp – a desire to continue growing and learning, regardless of theoretical orientation or training up until this point.