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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
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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.
That’s great for the people for whom talk therapy and CBT is effective, but the point of my comment and presumably the point of the comment I replied to is that talk therapy using CBT is the de facto standard in the West even when it harms people.
Again, happy that the CBT-lovers have found their thing, but those of us that find it patronizing and minimizing to be told we’re what’s wrong (for CBT not working like it does for others) instead of the clinical framework not being right for us should have the right to push back against clinicians and pro-therapy laypeople placing specific models of care on a pedestal.
If you can’t see that CBT is being applied as a one-size-fits-all solution, especially for young adults and at free/subsidized municipal clinics (who have clients highly affected by poverty and minority stressors), I really don’t know what to tell you. It’s harmful to people but you feel like you can’t talk about it because then people think you’re either entirely anti-therapy, antisocial/defiant, or drug-seeking.
Ok cool, you’re absolutely not taking my argument as I made it. I was acknowledging that it’s bad for several things it’s bad for (implying it’s commonly prescribed for those things) but also acknowledging that it’s worth accepting that it’s good for what it’s good for. Maybe it’s bad for some people who have problems it’s good for. But I’ve seen people who desperately need the skills it teaches parrot the rhetoric of it being useless and harmful before so I do feel a desire to speak up in its defense as well.
Hopefully you’ll get what you need, regardless of what it is. And yeah, poor people disproportionately need financial assistance more than training to see cognitive distortions.
Therapy will not fix anything if you’re unwilling to make the effort to change.
At this point, if you still lack motivation, maybe it’s time to go the medication route. It helped me overcome the inertia.
We don’t negotiate with therapists.
We don’t negotiate with the rapists
I’ll take “The rapists” for 400
They never negotiate with you
What about philanthropist, Africans, dyslexics, children, that sorta thing?
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
Yeah, good call. I meant to have a line about that. You would help a friend get over the blame and self-criticism and get to the actual business of changing for the better.
Ask you doctor if stoicism is right for you.
Stoicism is just sparkling loneliness.
And life is just wasted time before death.
I saw it as the philosophy of the (wage) slave.
There’s a few different ‘end states’ to stoicism.
Realizing that you have control over your own emotions opens you up to the ability to counter emotional reactions, e.g. despair at being a wage slave. Despair will keep in wage slavery, because there’s no way to make it better. Stoicism is ignoring despair. Intellect loads the gun, instinct knows what happens when you pull the trigger, and, by not letting your emotions choose the target, you go for the one that causes the greatest good and next thing you know you’re getting picked up at a McDonald’s across state lines.
I wish the dead could write - I’m sure they’d make a better argument for checking out than trying stoicism.
Stoicism is just dissociating philosophically
“I am not my feelings and have control of my actions beyond them” is nothing like disassociating
Sorry i was just trying to be funny. Most of these “stoic lone warrior” types do just use it to act tough by repressing emotions though
And happiness is just your brain misrepresenting misery.
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?!”
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You could try needles or sounding or a cage. Kicks aren’t the only option!
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.
I’ve always heard talk to your inner child/talk to yourself with the compassion you’d show a child
As someone who grew up constantly criticized, still no idea
I had the same issue, and eventually realized we have resources specifically for learning this: I started reading parenting books.
I would recommend “Unconditional Parenting” by Alfie Kohn as a starting point.
On one hand, good to know there is an answer; on the other, I’m generally priced out of purchasing books, so it’s as good as being forbidden from learning the answer (unless I find a summary online).
How you would treat a child, how your childhood self should have been treated not how you were treated as a kid. If a kid came up to you with your problems what would you say?
Take the criticism for example. Would you not tell the kid some along the lines of “that sucks, bud. Its not really your fault. I’ve been there and made it through, you can too.”
I don’t know, wasn’t “tough love” supposed to be necessary to prevent kids from growing up too pampered and entitled? At least that’s how I used to be treated back in the day, as if any assistance would make me incapable or unwilling to sustain myself (not like that made any difference, I was still unable to pull my own bootstraps and am therefore well behind my peers)
That is the alleged sentiment I suppose, there’s a difference between tough and abusive that many parents never really figure out. There’s no one type of parenting that is best for all kids. Pulling up by your own bootstraps is a paradoxical statement for a reason.
Just what I always needed! Condescention and dismissal!
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.
oooooh wow… gosh yea… thanks for sharing.
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.
I don’t think your therapists necessarily meant it in an insulting way.
… with how defensive about Israel she was…
Oh. Yeah, time for a new therapist, then. Can’t expect healthcare professionals to share all of your political beliefs, but not simping for genocidal ethnostates is a pretty low bar.
not simping for genocidal ethnostates is a pretty low bar.
A therapist should keep that shit to themselves, regardless of what their political beliefs are. My psychiatrist is a Catholic, but if he started telling me that I should go to church I’d be looking for a new psychiatrist.
Oh this was years ago I wasn’t good at saying no to people and standing up for myself. Also kept believing what others said over what I thought since my memory is bad and I zone out a lot.
I don’t the only that’s necessarily what your therapist was getting at.
I’m not defending her stance on Israel btw. Also her stance on Israel might imply religious beliefs and that’s a whole other conversation.
However, I disagree with the commenter that said self-awareness is a good thing.
If you want to go through life empowering others, avoiding doing any harm of any kind, and leaving the world somehow better for your existence, then yes self awareness is a good thing.
However, if you want to be happy, satisfied, and go through life being comfortable and not require therapy, then self awareness is most definitely not a good thing.
That is to say, self awareness is highly correlated with anxiety and depression.
However, if you want to be happy, satisfied, and go through life being comfortable and not require therapy, then self awareness is most definitely not a good thing.
I have to disagree. Self-awareness made me feel better about myself, not worse.
You know what requires therapy? Having a gnawing sense that you’re a failure or a coward or something like that. That’s what a lack of self-awareness will get you. That is to say, you’re going to have some opinion about yourself no matter what, and without self-awareness it’s going to be a distorted one.
That is to say, self awareness is highly correlated with anxiety and depression.
Curse you, autistic introspection!
I can’t handle the idea of paying someone like that even a single time, I’d feel so ripped off and violated.
It can be, though quite often anxiety can manifest as being too self-aware all the time, to the point that it’s getting in the way of actually enjoying life.
aaaaah yes fair i can see that, sounds a smol bit like me but bit more negative… good to know.
It’s also worth pointing out, I think, that if you’re only aware of your weaknesses and such, but don’t/can’t recognize your strengths, then you’re not really that self-aware
I feel that’s kind of getting into gate-keeping territory. Self-awareness imo just requires a person to be aware of themself, and whether that person is self-critical or self-appreciating is a different analysis of that awareness.
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I’d argue self-appreciation and self-deprication can both get in the way of self-awareness. Someone experiencing clinically significant grandiosity is likely lacking in self awareness just as someone experiencing clinically significant negative self talk (i.e., cognitive distortion) is likely lacking in self awareness
This seems to come down to a difference in definition. You are viewing self-awareness as only able to be positive, and having an implied lack of bias.
I don’t expect either of those, I just view it as someone thinking about how they think or act, regardless of whether bias exists in that process. It’s all self-awareness.
You are viewing self-awareness as only able to be positive and having an implied lack of bias.
I am not at all viewing it as only able to be positive; it should be accurate. Why call it awareness if it’s not reflecting reality?
I just view it as someone thinking about how they think or act, regardless of whether bias exists in that process. It’s all self-awareness.
That’s not self awareness, that’s meta cognition
Metacognition is a sub-portion of self-awareness that does not look at behavior. They’re intrinsically tied to one another, but self-awareness is broader than metacognition.
I’m not saying either of our definitions are incorrect - ‘self-awareness’ changes meaning somewhat depending on whether it’s being used philosophically, psychoanalitically, etc. And the fact it’s now used by the general public its meaning naturally shifts. I am saying your definition is more exclusionary, though, treating it more as a virtue to strive for rather than just an action one takes.
Functionally, if the only self-awareness is accurate self-awareness, then it can only be an advantage, and thus positive.
I would also argue that awareness does not need to be reflective of reality - you can be aware of hallucinations you are experiencing, or you can be aware that you are experiencing hallucinations. Both are awareness, but only one is more accurate to reality.
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.
Aatub
I’ll get back to you, probably over the weekend.
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?
That’s why writing meta-analyses is considered quite the task and why scientists only get to write them by invitation.
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 🤷♀️
