Cognitive Behavioral Therapy
CBT has long been praised for its effectiveness in treating a variety of mental diseases, such as depression and anxiety, as well as for preparing patients to deal with problems with self-worth, motivation, procrastination, or even interpersonal relationships. However, with the increased focus on mental health in recent years, CBT has also come under scrutiny and criticism. Many claim that it invalidates our response to systemic problems, oversimplifies complicated human experiences, and encourages a culture of positivity that isn't necessarily useful.
However, it is unclear if the invalidation stems from the modality itself or from a subpar implementation of the strategy. A client's ability to recognize the "cognitive distortions and maladaptive responses that are getting in the way of them achieving the goals they have set for themselves" is the main objective of CBT. CBT is an action-oriented approach that follows a structured framework to help people learn how to manage their mental health concerns in a short amount of time, ranging from eight to twelve weeks, as Samriti Makkar Midha, a psychotherapist from Mumbai, explained to The Swaddle in 2021. The "quick solution" claim, however, may be the source of the issue.
"In the near run, it really benefited me... However, over time, it proved to be less beneficial. "Maybe, I was just doing the technique wrong," wrote Lauren Bunke from Chicago, who underwent CBT to treat her anxiety and depression. "When I get in the habit of challenging every negative thought I feel, I end up skipping straight to the 'feeling better' part and not doing a really important step — fully experiencing the negative feeling and really exploring where it came from. However, the therapist who taught it to me would frequently follow this pattern... She taught me to let go of bad emotions and thoughts. Bunke later realized that her anxiety and despair were caused by trauma. However, it remained buried because she infrequently got the opportunity to delve further into her "negative feelings" during her CBT sessions.
We live in a time where quick and simple are fashionable. And CBT appears to accommodate it to some extent.
Clients frequently come to therapists expecting them to be problem-solvers who can "fix" their problems with a wave and a swirl of their magic wands. In contrast, "CBT is, in a sense, easier to teach than other therapies. In a way, it is less demanding as well because it calls for less openness on the side of the therapist, but just emotionally; intellectually, it can be very draining. However, Zohra Master, a psychotherapist and associate member at the Albert Ellis Institute, observes that "people tend to imagine that taking a basic training in CBT would educate them how to use it extraordinarily well. There is a risk of invalidation at the intersection of this quest of shortcuts by both clients and therapists.
"From the first session, my therapists told me that my mentality was the issue, not the illnesses I couldn't manage or other factors like systematic injustices, hardships with money, trauma, and discrimination... According to writer and activist Alana Saltz, who is disabled, the foundation of CBT is gaslighting. "I think that CBT is designed to be negating and contemptuous. And that's exactly what happened to me for so long that even I questioned occasionally if perhaps I wasn't just as hurt as everyone else, that maybe if I just 'corrected' my thinking and could stop feeling nervous, my anguish would go away. However, two decades of therapy just made me feel more disoriented and uncertain. Therapists invalidated Saltz for years, telling her that even the physical pain she was feeling was all in her brain. It wasn't until later that she was given the diagnoses of hypermobile Ehlers-Danlos Syndrome, a connective tissue disorder, and chronic migraine.
Many people who have experienced trauma and systemic abuse can relate to Saltz's story, raising the risk that some CBT practitioners may unintentionally minimize the lived experiences of survivors while perpetuating societal biases and devaluing the validity of their feelings.
However, CBT itself is not the issue; rather, it is how it is administered that is problematic, particularly given that practitioners aren't frequently educated to apply a systemic lens to view mental health issues, as Jahan Ara, a trauma-informed therapist from Pakistan, argues.
The arguments against CBT have substance, according to Ara, but she thinks that therapists' lack of self-awareness, rather than their incapacity to empathize with victims of structural injustices, is a bigger concern. She notes that "many therapists see the issue as within the individual."
She asserts that CBT may be modified to acknowledge clients' legitimate concerns and the realities of the real world without demeaning them, but "the therapist has to be someone who sees social issues. The topic of the "right way of thinking" and "wrong way of thinking" would then need to be discussed extensively since what constitutes the foundation for such clear distinctions? She thinks that therapists who are aware of structural inequalities such as gender politics, poverty, social and religious difficulties, and others do incorporate that understanding into their CBT practices.
In agreement, Master highlights the significance of integrating CBT with other types of therapy in order to give the treatment a more humanistic bent. "CBT places a much greater emphasis on intellect than on feeling. Therefore, the emotional component that is crucial and necessary in treatment sessions is accidentally neglected, but not entirely. Even yet, it's simple to declare "this therapy is good" or "that therapy is bad" and place all the blame on that therapy; In order to help clients obtain the full picture and make these therapies more holistic and effective for them, therapists must actually have a basic understanding of a few therapies.
She continues, "With CBT, I can look at the thought; [when coupled] with a more humanistic approach, let's say, an emotion-focused approach, I can look at the human aspect of it."
It is an important component of the training process for therapists to know what to incorporate when.