What I’ve realised over the last couple of weeks

I don’t know about you, but Cognitive Behavioral Therapy (CBT) was the bedrock and focus of what I was taught at university in my training to become a Psychologist. I was taught that CBT was the king of kings; ruling over all other therapies and that’s what an overwhelming body of research told us.

I was never taught deeply about the cost of CBT – what is it missing? when does it not work? We would just skim the surface of this topic at university. I think the more established I have felt post full registration, the more I have looked beyond CBT to what other therapies can offer.

When I first began to review my use of CBT, I had focused on the effects that using CBT has on clients and their outcomes. Lately though my focus has shifted – to what impact has learning CBT had on me?

A part of CBT innately concentrates on the cognitive, how to help a client to think differently. In my experience, all this focus on the client’s cognitive experience can miss another part of the equation that can have a massive impact on how we think – emotions.

I know CBT considers emotions, but it doesn’t seem that emotions were considered a core component when CBT was created. Otherwise if emotions were so important in CBT why wouldn’t they put it in the name? How we name something can have a dramatic effect on how we engage and interact with that thing. It seems that when they had the CBT launch party, emotions either blew the party off or wasn’t invited. The cognitive element became a star of the show, with emotions being kept backstage.

What I’ve managed to do since my last post

I had another excellent Deliberate Practice (DP) coaching session with Nathan Castle. He reminded me that I have now been doing DP for 6 months – which is pretty cool. The focus on the coaching session was on my over-explaining, we discussed a conceptualisation of my over-explaining that I made. We then listened to an audio recording from a client session, the recording served as an example of my over-explaining to help Nathan observe and experience it. Nathan introduced me to principles from short term psychodynamic therapy, such as reflecting to the client their underlying/primary emotion as concisely as possible, e.g. “you feel (insert emotion)”. We then did a behavioural rehearsal, where Nathan acted as the client in the audio, but now my job was to respond to Nathan using the new principle – “you feel x”. My response to the client was broken down into a series of steps; before I respond to the client I was to take a few moments with my anxiety, lean into my anxiety, take a deep breathe and then say “you feel” while inserting the primary emotion. We practiced the rehearsal a few times. I was relieved at how much easier this started to feel compared to my over-explaining, I felt no where near as cognitively and physically taxed. My homework now is at one point in client session use the “you feel x” steps to increase my comfort, counterbalancing my over-explaining tendencies.

Reaching for Deeper Emotional Depth

These reflections and my coaching session with Nathan have helped me consider where I have come from, which is CBT, to where I want to go – achieving deeper emotional resonance and depth with clients. Having deep emotional moments with clients feels all too rare in my sessions. I wonder if my journey with CBT fostered some sort of intellectualisation in me, which turned into my over-explaining tendencies; acting as a barrier to emotional resonance and depth in my therapy.

I was always taught through university that ‘aha moments‘ for clients in sessions are rare and to not expect them. Was this because those that taught me also had a focus on the cognitive? Is emotional resonance and depth a key component to an aha moment? I feel an invigorated sense of hope that I am about to find out.

P.S. I am signing off for the year – this will be my last post for 2021. I will start back up on the 21/01/2021. I hope you have a wonderful holiday, some well deserved time off and a happy new year. I’ll see you in 2022 🙂

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