I did not have a good session with my therapist this week, I don’t think she likes me very much. It may be that there is a personality clash or it might be her method of delivery or perhaps a mixture of both that is making the experience less than helpful. My first response was to rattle off a cutting indictment of my experience but having given myself time for reflection, I have begun instead to think a little about the process itself. I do not claim to be a psychologist and my views arise simply from my limited personal experience so I can only apologise in advance to anyone who is likely to have a more academic and balanced viewpoint.
Firstly, by way of explanation, the therapy I am receiving is CBT or cognitive behavioural therapy which aims to challenge inaccurate and irrational views about oneself which can lead to disordered thoughts or behaviour. These are commonly those such as ‘I haven’t done it perfectly, so I must be useless’. Or ‘she didn’t find time to speak to me, so she must hate me’.
I have never experienced CBT or indeed any kind of therapy before and I appreciate that my therapist has seen many clients and so for her, repeating the same arguments and processes with each one must become a bit tedious. This approach however, has risks. Surely the process becomes formulaic? I am able to lend a little credence to this suggestion because I have talked at length with another patient at the clinic who has used the same therapist and who can amusingly repeat word for word the same responses I have received. In theory, CBT has been shown to have huge benefits (even if this is a placebo effect) but surely a ‘one size fits all’ approach isn’t entirely appropriate?
I am twelve weekly sessions into a course that is meant to last a year. The first three or four weeks I found extremely difficult not the least because for some reason it took that long for my actual name to register and I found the constant need to correct quite stressful. Probably more than it should have been in hindsight but it sort of matters. That apart, I found it hard not to resent the constant digging through my past and the unwelcome thoughts that accompanied this. These difficulties haven’t changed but I have become accustomed to something which was initially uncomfortably unfamiliar. That said, I still feel that though I have now been ‘trained’ to give the responses, these are very much open to being judged, as if my reactions to a difficult episode in my life is somehow not good enough, and so by unravelling these thoughts and feelings paradoxically I actually feel worse about myself.
Generally, I have found the absence of social niceties very strange as my particular therapist doesn’t indulge in any small talk to ease the way into the session. I have no idea if therapists are taught not to talk about the weather or their holidays but it makes it difficult to engage when instead I am met with a silent but questioning stare. How do you even start a conversation about yourself when your levels of discomfort are already sky high because the encounter does not reflect in any way any social or business meeting you have ever been to? Even a job interview is easier because at least then you have someone asking you questions to allow you to sell yourself in a positive way. Here, it is all about searching for the negatives that I do not ordinarily choose to engage with, and I have to come up with these myself and without prompting.
Anyway, I have stuck with it, not being one to give up on anything lightly, although of the 12 sessions I have endured so far I have only felt better about myself after one. The others have left me feeling somewhere on the scale from suicidal to slightly despondent. I am not proud of my response to the latest session, in that, unable to process the intensity of my feelings afterwards, I turned to physical harm instead. Enough said. The fact is, I trusted to the therapist my feelings of somehow letting myself down by being my usual over active and over dynamic self in Cornwall and was not expecting her to suggest that I was creating a poor role model for my children in that I am not giving them any idea of how they can deal with their own stresses and difficulties in a healthy way. I did try to defend this assertion by saying that my children are all independent thinkers and are all very aware and not easily influenced, but by putting the idea into my head that I was causing them so much damage by my behaviour and openness she did not then allow me to accentuate the positive. If there is any positive.
She also asked me what I wanted from my upcoming review session in mid June which is a 4-6 weekly gathering of the people involved in my care. This will be my first such meeting so I found it difficult to answer but I suggested that I should stick with being in the clinic as I feel that I am making progress both with the weight gain and mentally. Now I thought this was me trotting out a positive and rational response which should surely invite some sort of agreement by the way of reinforcement. Instead all I got was a raised eyebrow. In my vulnerable state I could only take this to mean that no, I shouldn’t be allowed to be receiving help, I don’t deserve it, and all I am doing is wasting people’s time. Desperately seeking reassurance I asked if she thought I had made any progress. On the basis that this is very very important to me right now, and I really can’t stress this enough, I was hoping for a small crumb of comfort, but all I received was a curt, ‘well I can see there’s movement’. When I replied, ever desperate, that I hoped this ‘movement’ was in the right direction, she simply honked. I was left feeling bereft and confused.
Surely CBT should include some element of empathy and compassion? Some shared human understanding rather than a robotic response? I can clearly see the traps that I fall into of faulty thinking or inaccurate views leading to disordered emotion or behaviour patterns (though this is an over simplification as there are so many other things at play), but the gap caused by exploring these negative feelings needs to be filled by something that facilitates helpful and supportive thoughts. It appears to me, from my limited experience, that CBT is a somewhat inflexible approach, in that it aims to prevent the mental filtering that goes on by noticing failures more than success, but takes little account of the fact that the actual negativity is rather more a symptom than a cause. There is also a paradox in applying a rigid formula of therapy to an eating disorder, which is, after all, all about inflexibility of thought and behaviour.
I have a feeling that CBT as a method perhaps over simplifies the problems it is attempting to solve. By its very nature, it sets out to dispel negative thoughts that arise from cognition. However, there are other things at play, such as genetics (for example, my sister shares my perfectionist tendencies), and social context. Also, surely some negative feelings are actually rational and realistic? By reframing reality I am simply being told to exclude some legitimate feelings. This does not help someone like me who deals with the process of reward and punishment as a prop for everyday life (which to some extent I suspect is part of the human condition). As humans we are motivated to achieve goals, and by training the brain to thwart the process the mind is using to deal with basic emotional and motivational needs CBT is going to have limitations, and leave a gap that needs to be filled.
I mentioned earlier the social context, which is not to be taken at all lightly. CBT seems not to take account of the here and now responses which do not rely on cognition but on inherent response. Being part of a community, you can’t help but to have reciprocal reactions to those about you by mirroring their behaviours and thoughts. The community of a hospital ward where the patient’s interaction with the outside world is severely limited is a unique social situation where these responses can be seen only too clearly. Incredibly distressing and disturbing events are witnessed by this community and this causes a direct activation of emotion which bypasses any cognition. This can be seen in society generally by public overreactions to events such as Princess Diana’s death and the Manchester bombing which have no real personal effect but serve to show how another’s pain can be directly felt. The point is that CBT focusses primarily on the self and does not fully account for basic social needs and relationships which impact on mental health; being the sense of mutual support, kindness, care and sense of family that we all crave.
I fear that I am going to be unable to engage with the therapy either because of a tendency to over intellectualise and see the broad view rather than how it affects me personally or possibly it’s down to my stupidity in that I have an inability to process simple cause and effect. Either way, we are all different and have a multitude of experiences, needs and unique biological set up, and there can be no totally successful uniform approach.