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When cognitive behavioral therapy (CBT) not working

Perhaps you’ve tried CBT before or know a lot about it. Maybe it was effective or useless.

Perhaps it’s completely new to you and you find it fascinating 🤨 or confusing to learn. Or you have no interest to learn at all.

These are all the normal reactions to CBT.

CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.

CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts, such as a thought, a feeling or a small action plan.

It’s definitely a powerful tool when there’s no or little resistance to seemingly “correct” or “rational” suggestions—to think more positive or to make small action plans to improve your situation 💪

But let’s be honest, we’re usually not this lucky 😖

At least not the cases I see from my practice.

We all use some sort of "commander approach" to suggest our body respond in a certain way, when it works, it works really quickly. When it’s not working, we get stuck.

My students used to ask me does it mean we have to leave CBT and use mindfulness instead?

I’ll talk about mindfulness in my future posts, it’s powerful with the right clients but can be ineffective as well.

But perhaps if we stick with CBT a little bit longer, and weave in some other tools, we can make CBT effective again. Sometimes it’s not the CBT framework not working, there’re so many ways to play around thoughts, feelings and actions.

Don’t give up yet

If we still work on behavior modification within CBT framework. How about we modify the commander approach? If we can be more flexible and adopt an indirect and permissive approach, it might work better for the resisting part. This commander part may be an internalized controlling adult part and our build-in “bodyguard” got alerted.

Think about this command “stop lying to people”? How are you feeling about it as a clinician/coach/friend/family member to a person needs support.

It’s likely your audience may adopt a defensive or avoidant approach. Lying is not easy but not lying might be more challenging

How about telling a story of another person, overcoming the urge to protect themselves by lying and built a more authentic relationship with others. The resisting part of the 🤥 might tune in more with an indirect metaphor.

There’re so many other creative ways of using CBT helping avoidant or resistant clients. Therapy can be very fun and creative 🙌

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