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Why CBT Alone Does Not Help in a Crisis

10/06/2016 11:09 | Updated 10 June 2016

CBT did not help me in a crisis. It did not help me feel my fear and my pain, which has to happen first, before change is possible.

From experience, I find that for this well proven technique to work best certain other boxes need to be ticked first. We need to be emotionally and mentally ready for CBT. Confused? Let me explain.

Imagine the last time you were in a real crisis (eg relationship, physical health, work, finances, bereavement etc). What did that feel like?

Like most people, I have had several crisis points in my life, and many more are bound to happen. The biggest one was my cancer diagnosis, because everything in my life was thrown into turmoil and crisis. Like an atom bomb, destruction, no certainty, no safety net, no direction. You don't need to be affected by cancer to understand what I mean. It's just an example.

At a crisis point, feelings and often thoughts are confusing
, too many to mention. Our body and minds go either into fight or flight; some people even switch between them. Do you recognise those feelings? Often there is an emotional numbness and / or dogged focus on one thing, or we just crumble and give up. Now imagine doing CBT, when you are in that place.

To put it into a very very simple nutshell, CBT helps us to look at things in a different way. The idea is that with a different attitude and understanding, we will behave differently, and therefore also feel differently.

When I was at my cancer crisis point, I was mentally and emotionally too overwhelmed, confused and closed to be able to try out new ways of looking at it. And what's more, I did not want to look at it, never mind differently! I was distraught, I was angry, I was still stuck in disbelief.

For CBT to work,
I would have needed an acceptance of my new reality and willingness to face it and work it through. All of that did happen for me, a lot later, and not with CBT.

What I needed first and foremost was

  • Someone to just listen and witness my turmoil.
  • Someone to just give me space to let out my confused thoughts and feelings.
  • Someone that does not want to reshape my angry and fear.
  • Someone not to give advice or rush ahead of me with solutions.
  • Someone not afraid of my feelings.
  • Someone that I do not need to take care of and protect from my feelings.
  • Someone that does not flinch, when I say cancer.
  • Someone that does not minimize my cancer and my feelings about it.
  • Someone that respects my distress and confusion.
Someone that would give me just a bit of hope, by just sitting there and not doing anything at all, just sitting there and sitting through it all and somehow holding it together and in doing so holding me together, until I am strong enough to hold myself together. When that is in place (and often that someone is a counsellor or therapist, some of these approaches might be called relational, person centred, integrative, humanistic, transpersonal), then we can eventually move the lid off the emotional pressure cooker, without fear of a destructive explosion or self combustion.

Because the calm and steady listening and being with us of the other showed that they can. They they did not break and did not explode and did not run away.

So perhaps I can do that too and can contain and deal with my fear, and rage, and grief, and hopelessness.

It did take me while to get to that place, where I could feel all that without fear.

My argument and opinion is that for CBT to work, we need to have done the feeling part first.

Karin Sieger is a BACP registered and accredited psychotherapist based in London. She specialises in supporting people affected by cancer. In her blog, Between Self and Doubt, she reflects and life and death and how to thrive despite cancer.

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