Therapists Providing Care: Why Cognitive Behavioural Therapy is not enough

There are countless different ways, or “modalities”, to do therapy. When I was doing my masters program in counselling psychology, most of my peers gravitated towards Cognitive Behavioural Therapy or CBT. CBT was designed by Dr. Aaron Beck in the 1960s. At its core, CBT hopes to teach people that their thoughts, feelings, and behaviours have a causal relationship. Then it encourages people to change the way they think. For instance, if you think a thing like “I miss my ex”, you will feel a thing ‘loneliness’, then you will behave a certain way like text your ex. Teaching these principles is something we in the industry call psychoeducation. This is a very simple example, but these principles of CBT extend into someone’s core beliefs about themselves, others, and the world, and someone’s “schemas”. Schemas are patterns of thought people use to interpret their world. 

Beck’s research into the relationship between thoughts, feelings, and emotions is scientifically sound. Obviously there is much more to Beck’s theories than simply explaining how thoughts, feelings, and behaviour work. Many people who do Cognitive Behavioural Therapy find that it has had a positive impact on their life. CBT and its adaptations are perhaps the most widely used therapies right now. Therapists like this therapy because it offers an easy to follow step-by-step process. Insurance companies like it because it can be delivered on a predictable schedule, such as 8-12 weeks. Therapists encourage their clients to complete worksheets and thought records so that they can identify their thoughts, feelings, and actions with the hope of being able to get control over them. Delivering CBT therapy can be learned just like fixing a car can be learned. There are certain steps to follow and when they are done, there is a very predictable outcome. If you’ve been receiving CBT from a therapist and you haven’t shown the predicted outcome, you may notice your therapist getting frustrated with you. This has happened to you, this is your red flag. I suggest you talk to your therapist about this and/or start thinking about finding a new one. 

Because CBT can be learned in this way, it has attracted a demographic of therapists that want to do this work because of the perks having this career offers. Being a therapist is good money. Depending on the specific situation a therapist can make their own hours. Their performance is rarely evaluated by a superior and there is an arrogance that can accompany the belief that you’re helping people. There is also a certain social status that comes along with being a therapist. If your therapist became a therapist for these reasons, there is a strong likelihood they gravitate towards step-by-step therapy techniques like CBT. Here’s a great tip if you’re looking for a therapist. Most offer free consult calls, book a consult and ask them why they became a therapist and really listen to their answer with curiosity. 

From what I’ve seen in my own clients and my own life, psychoeducation is helpful, but it is really just one piece of the giant puzzle of empowering someone take control of their wellbeing and mental health. CBT is a scientifically supported method, but what you may not know about scientific research, particularly in the field of psychology, is that the population of people researched are typically WEIRD. In this case WEIRD stands for white, educated, industrialized, rich, and democratic. Research is starting to be more diverse these days, but Beck’s research would have been primarily focused on university students that fit into the WEIRD category. It’s not a stretch to say that WEIRD people are privileged people. It’s easy to connect the dots that a step-by-step therapy designed by a privileged person is effective for privileged people that have privileged problems. 

For those that have less privilege like BIPOC, women, differently-abled people like those with ADHD and ASD, and traumatized people, the methods that help privileged people may not be so effective. Personally, I believe this to be true. Quite simply, these people need more than what CBT can offer. They need more from their therapists. The need to be cared for. They need safe and secure relationships. Unfortunately for many people, they have yet to find this type of safety and security in their lives. And this type of care is something that CBT cannot offer. Frankly, it was never designed to either.

I became a therapist after I reached my own mental and emotional rock bottom. I found myself sitting in a chair in the emergency room, crying uncontrollably while a police officer stood guard beside me. When I was finally called to the mental health nurse, there was a puddle of snot and tears at my feet. At this point in my life I’d already been in therapy for several years. I’d been receiving CBT and I could tell you exactly what was happening to my thoughts, feelings, and behaviours. But all of that self-awareness did nothing to ease the depression, anxiety, and loneliness I felt. The “care” I received from the doctors and nurses in the ER that day, and from the outpatient psychiatrists I had to see in the following weeks left me feeling more rejected. I was sent home with worksheets and I was told to keep journalling and meditating and that I would be fine. I left that experience feeling like no one cared about me, and in the end, that’s what I really needed. 

I decided to become a therapist because I knew that from the bottom of my heart I care. I care about you, the person reading this right now. I care about each and every one of my clients. And I do this work every day because I know that I can show people that it isn’t just lip service. With healthy professional and personal boundaries, I will do whatever I can to support my clients by meeting them where they are at, showing them unconditional positive affect, and providing genuine care. It’s my hope that more and more therapists realize that this career is much more than a job with some pretty good perks. It’s a calling. It’s a calling to offer respect to everyone around you. It’s a calling to offer care to those who have lived so long without it.

Thanks for taking the time,

River