Topic 10: CBT Myths & CBT Competence {by 4/21}

[CBT Myths] – (1) Identify at least one common CBT myth you have heard from other people/professionals.  What are your thoughts when you hear such comments?  (2) Why do you think some of these myths continue to exist?  (3) What can you do to help dispel some of these myths?

 

[CBT Competence] – (1) How can it be a problem if CBT therapists has a strong aversion to practicing CBT techniques on themselves?  (2) What are some possible indicators to determine if you are receiving quality CBT supervision?  What type of feedback from your supervisor do you think would be most beneficial to your professional development as a CBT therapist?  (3) What are some possible negative outcomes if you do not stay up to date with CBT knowledge and skills?

 

Your original post should be posted by 4/21.  Have your two replies posted no later than 4/23.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

36 Comments (+add yours?)

  1. Victoria Cestodio
    Apr 16, 2022 @ 13:50:24

    One CBT myth I have heard from people or other professionals consistently is that with CBT you won’t have as good of a rapport compared to other types of therapy because it is very science based and that takes away from a closer bond or rapport. My thoughts when I hear these comments is that people that say these things are either not practicing CBT, or are taking the wrong approach to CBT and I feel as though they are somewhat ignorant to CBT. Like Dr. V mentioned in his lecture some people think CBT is too scientific, however even though it is scientific it doesn’t mean we can’t build close relationships with our clients. I think these myths continue to exist because therapy did not really start out having a lot of science based approaches. It was more of talk therapy, where the therapist sits down with the client and it was a back and forth conversation and discussion about the clients problems. Therefore, I think it is hard to understand CBT when therapy started as more of a psychodynamic approach and when they see us using a more science based approach they feel like it’s not as good or personal. What I can do to try and dispel these myths is educate people more on CBT and make them understand as we are based in science based practices we still display rogerian conditions such as empathy, unconditional positive regard, however we just add more to the relationship by adding science based techniques, which shows that you don’t need to just have one type of technique. I think educating our colleagues and even our clients can help dispel these types of myths.

    How it can be a problem if CBT therapists have a strong aversion to practicing these techniques on themself is that if you can’t practice these on yourself, it will be extremely hard to use these with clients, and it will also be noticed by your clients which is extremely harmful to their treatment. Some indicators to know if you are getting quality CBT supervision is having your sessions recorded or watched live because this can provide more information and allows for continuous assessment of our skills. Also, having group supervision is a great indicator you are getting quality cbt supervision. Also, making sure you are getting feedback from your supervisors is crucial. The type of feedback I think would be the most beneficial to my professional development as a CBT therapist would be that my supervisor monitors my conceptualization of clients problems and also formulations of treatment plans, etc. Having feedback on both of these things will continue to make me the best CBT therapist I can be. Lastly, some possible negative outcomes if you do not stay up to date with CBT knowledge and skills is that you possibly won’t be using correct techniques or using techniques incorrectly. Overtime, things will change and shift. Thereofrem, if we do not stay up to date and we are using outdated techniques with our clients, these will not be beneficial to them and they could be getting much more out of their treatment if the therapist was up to date on new shifts within these techniques. You may see that your clients are not progressing as much, which is harmful. Not staying up to date and educated on these shifts will lead us to be incompetent, which is the one thing we never want to be as therapists.

    Reply

    • Vanessa Nichols
      Apr 19, 2022 @ 13:00:40

      Hi Victoria,
      Great post again this week!
      I have also heard the CBT myth that you won’t have a good rapport with the client compared to other therapies as a CBT therapist. I think a lot of these myths, specifically this one, are caused by ignorance and no experience with CBT. Even if more people had viewed a video of CBT being performed, they would feel differently. As I mentioned in Emily’s post, an introductory education in CBT would inform people that CBT is a collaborative therapy, and it’s essential to have a good therapeutic relationship with your client.
      I agree with you that your client will pick up on the fact that you do not use these techniques in your personal life. I think the client would get the impression that you are hypocritical or a phony, and they would no longer comply with your treatment discussion.
      I would also benefit from feedback on my conceptualization and formulation of treatment plans. At the moment, I am doing my first treatment plan and case formulation for Dr. V and Dr. Deolfer’s finals, so I am very new to that. I would appreciate any feedback I could receive about those processes.

      Reply

    • Will Roche
      Apr 19, 2022 @ 13:15:35

      Victoria,

      I like the points you make on why it’s necessary to perform CBT techniques on yourself and the benefits that these can have on future clients. I like the point you make how being unable or unwilling to use these techniques on oneself can have a trickle-down effect on the client. If the therapist is unwilling or unfamiliar with the CBT techniques and homework, how can they expect the client to act differently? I also think you make a great point about having sessions recorded so you can look back and make improvements on areas that you might be lacking in, or confirming that you were doing in a great job in other areas. Lastly, you mentioned how important feedback is from supervisors and other colleagues. It’s definitely important to get outside perspective on how you treat others because it can only make you a better therapist in the long run. Great points all around.

      Reply

    • Madelyn Haas
      Apr 20, 2022 @ 19:36:32

      Hi Victoria,

      I enjoyed reading your post for this week. I think you had a good retort about CBT being too “science based.” Yes, compared to other talk therapies, it is very science forward, but that is NOT a bad thing. Just because a less effective therapy style came first does not mean that is the correct and only way to do therapy. Countless studies have shown the efficacy of CBT, so people are obviously doing something right by using it/practicing it.

      I also think you had good points on adequate CBT supervision. Listening/watching live/recorded sessions is a good benchmark because it gives the supervisor a non-biased view of how you did in session. I also think, like you said, it is important to look for a supervisor who will supervise you on all aspects of therapy, including CBT interventions, treatment plans, therapeutic alliance, and more. Good job this week!

      -Madelyn Haas

      Reply

    • Moises J Chauca
      Apr 24, 2022 @ 14:48:05

      Hello Victoria,

      Great post! I have also heard some of the myths you shared in my PSY 101 college course. However, as you say just because it is scientific-based does not mean we can’t build relationships, we also know that without a therapeutic relationship treatment will not work. I agree with your point about practicing your own techniques and getting CBT supervision. Without these, we will not be able to provide great therapy, and it can be harmful to our clients.

      Reply

  2. Emily Barefield
    Apr 18, 2022 @ 10:55:14

    I have heard the myth that CBT is too rigid/mechanical/technique focused and does not focus enough on the person themselves. I can how someone who has just heard of CBT and evidence-based practices may have this thought. CBT is more scientific in nature, which may contribute to people jumping to the idea that it is too rigid. When I hear this, I wish that people would do more to educate themselves about CBT before jumping to this conclusion. One of my favorite things about CBT is the balance between the Rogerian, humanistic aspects of therapy and an evidenced-based approach to helping people. It is also important to recognize that the priority of therapy is to provide the best possible care. Helping people get better is more important than making sure that they feel warm and fuzzy during the 50 minutes the therapists has with them each week but helping them feel valued and helping them get better can and should be done simultaneously. Several times throughout the book, Dr V. talks about how Rogerian qualities are necessary but not sufficient for change in therapy. Helping people understand who believe this myth understand that the therapist does not have to choose between humanistic qualities and evidence-based practices (as this would be black and white thinking) could help dispel this myth.

    Having a strong aversion to practicing CBT on oneself can be highly problematic. If you do not think they are worthwhile, this attitude will likely be picked up on by the client, which will likely result in low motivation by the client. Additionally, I think it is unethical to expect clients to participate in a technique you do not think is worthwhile and helpful for the client’s improvement. Also, practicing CBT techniques on yourself will help you be more familiar with the techniques themselves and better be able to troubleshoot potential difficulties the client may have with them. To ensure I am receiving quality CBT supervision, I need to make sure that my supervisor specializes in CBT (she does!). I also need to, whenever possible, ensure she is observing me directly and monitoring my skill development generally and my skill development specific to CBT. CBT evolves over time and improves as more scientific research becomes available. As research progresses, CBT will incorporate this into its interventions. In order to provide the best possible care to clients, it is important to stay up to date with training and research in CBT. If the therapist does not stay up to date with this research, they will be providing limited care to the client. It can be considered unethical to provide dated care to the client when there are new treatments better supported by research available.

    Reply

    • Victoria Cestodio
      Apr 19, 2022 @ 11:22:21

      Hi Emily,
      I also have heard your myth so many times! I agree with you that one of my favorite things about CBT is that it has a mix of rogerian skills and also that evidence based which I only think makes CBT stronger than maybe other types. I think when Dr. V said in his book that rogerian qualities are necessary but not sufficient for change, I think that is put perfectly. Yes they are needed, but not much will happen if you only use those skills. I also like how you said you think it is unethical to expect clients to participate in techniques you do not think are good yourself. I think that was a great way to put it and I couldn’t agree more!

      Great post!
      Victoria

      Reply

    • Vanessa Nichols
      Apr 19, 2022 @ 12:51:25

      Hi Emily,
      Great post this week!
      I have also heard the myth that CBT is too rigid/mechanical/techniques-focused. I had similar thoughts enter my head when I heard that as well. I just wish people would educate themselves on CBT before jumping to a conclusion. Once they did, they would see that these techniques are used alongside humanistic and Rogerian techniques. If people even took introduction classes to CBT, they would quickly learn that the therapeutic relationship is an essential aspect of CBT. Without the relationship, CBT is significantly less effective.
      I like that you pointed out that it would be unethical to expect clients to participate in activities that the therapist does not consider worthwhile or helpful. That didn’t even cross my mind, but you are correct. Our job is to help the client alleviate distress and not harm the client any further. IF we are pushing techniques we don’t believe in, we are not helping the client and could potentially harm the client.
      I also agreed that not staying up to date on CBT knowledge and techniques is a disservice to your clients and could potentially cause harm. I agree with you that it is unethical as it is our job to know the most effective treatments and techniques for the disorder we specialize in.

      Reply

    • Will Roche
      Apr 19, 2022 @ 13:06:29

      Emily,

      I really like the points you made about the blend between science and Rogerian qualities of CBT, I mentioned a little about that in my response. I made the point that it appears like CBT spends too much of its “advertisement” focusing on the scientific side of therapy rather than making the Rogerian side just as important, because it is. People won’t necessarily find a therapy that’s strictly scientific and empirical because it’s missing the empathetic quality in it’s advertisement. Similarly, a person should not go to a therapist that only focuses on the warm and fuzzy feelings as you mentioned because that strays away from using empirical techniques to help change one’s cognitions and feelings about themselves and others. I think you make great points about how both qualities are needed in order for a therapist to make headway with their clients, great job!

      Reply

    • Tressa Novack
      Apr 19, 2022 @ 19:25:43

      Hi Emily,
      I used a similar myth that CBT is too rigid and cold. I think it is a very common misconception that people think that CBT does not focus at all on people’s emotions. I like how you point out that people may not feel warm and fuzzy during sessions, and that is okay because sometimes you can’t feel that way when you are working hard to get better. However, even though CBT can be difficult at times that does not mean that we as therapists are not warm and empathetic towards our clients. I agree with your comments on why not practicing CBT on ourselves as therapists is problematic. I agree that it is unethical. I do not think it is right to try to make clients do things that we are not willing to do. If we feel this way how can we get clients to believe that these techniques will help them? Great post.
      Tressa

      Reply

  3. Sergio Rodriguez
    Apr 19, 2022 @ 12:10:31

    [CBT Myths]
    (1)
    One of the most common myths that I’ve heard about CBT is that CBT focuses on the individual’s behavior and overlooks the context. Understanding the context as the family, culture, and what are more known in the systemic theory as mesosystem, macrosystem, and so on.
    I consider that CBT specializes in how the individual behaves and responds to multiple stimuli from the ambient. In fact, the context is going to give CBT a clear sense of why the person is acting that way. CBT approach does not just even recognize the context, it also works on helping the client to respond to such context and, if it is needed, will impact other areas in the client’s life.

    (2)
    These myths continue to exist because multiple people don’t even have a deep and genuine sense of what a fundamental CBT approach looks like. Likewise, another reason is that people who practice CBT don’t do it properly. For example, many therapists forget how important it is to use the based-evidence model, which implies reviewing the literature, assigning homework to clients, and supporting their interventions with some scales, among other techniques needed to complete an actual CBT intervention.

    (3)
    I can think of a couple of times I’ve worked in different agencies and worked with other mental health professionals and therapists who had different approaches to therapy. Again, the impact I had on the organization was related to the importance that I stressed of the evidence-based practice. But, at the same time, integrating those professionals to the advantages of CBT techniques like negative automatic thoughts or core beliefs was essential and made a difference for them to clear those myths and comprehend the therapy for the benefit of the client.

    [CBT Competence] –
    (1)
    The main problem I can mention is that it will be harder for you as a therapist to teach and help the client make some progress on their treatment if you don’t know or have ever practiced any of the CBT techniques daily. Of course, most clients will also have difficulties practicing or simply believing in CBT techniques, and the therapist can “pretend” to know and explain, but it has to be more than that, it is something that has to be internalized to guide others.

    (2)
    The main factor is the experience of the supervisor and how into CBT that professional is. It won’t be the proper supervision if the supervisor has a mix of theoretical orientations or doesn’t practice CBT whatsoever. The ideal scenario would be live session supervision (mirror, in person, earbuds), it would facilitate and improve the way you perform in therapy. Good feedback from my supervisor will be if I get specific directions and instructions about the way I implement the CBT techniques. It has to be done by checking the theory and coming back to my performance when I have a situation where I have a challenging case. Finally, I should get detailed feedback about my case formulation and treatment plan.

    (3)
    Psychology per se evolves and is in constant evolution. This means if I just stick to what I learned 5 or 10 years ago, there is a huge possibility that most of those theories could have been modified or improved based on the scientific model. Therefore, I won’t provide my clients with the best and most updated service. This is why it is definitely relevant to keep up to date, read new articles, review colleagues’ work, attend webinars, courses, and numerous other options offered to stay up with the most recent research for CBT.

    Reply

    • Emily Barefield
      Apr 20, 2022 @ 22:45:59

      Sergio,

      I haven’t encountered the idea that CBT overlooks context as much, but I think it is important to discuss. I liked how you brought up that CBT both recognizes contexts and helps clients learn how to respond to their context and even modify if it if appropriate. I agree that the myths primarily come from a lack of understanding of CBT. I also like how you emphasized the importance of adhering to evidenced-based practices as a CBT therapist.

      Having done CBT techniques on ourselves will certainly improve our ability to teach the techniques to the clients. I also agree that internalizing these methods will have a positive impact on the client’s experience. It is important for the feedback being given to be based directly on the CBT skills, which can only happen if the supervisor is a CBT therapist. I agree that feedback from live sessions is necessary. I also liked how you talked about feedback coming back to theory, I had not thought of that. I also appreciated that you highlighted that due to its scientific nature, CBT is constantly evolving and improving, and it is important for us to keep up to date in order to provide the best treatment. Great post!

      Reply

    • Lexi
      Apr 21, 2022 @ 09:35:23

      Hello Sergio

      You bring up such an important point about remembering to look at behavior in context and to consider individual traits and factors when examining behavior. Behavior – adaptive or maladaptive, does not occur in a vacuum and it is to in the spirit of CBT to examine and treat the individual in a collaborative and tailored way. I enjoyed you discussion too about the ways that we can help dispel myths or misconceptions about CBT in our future practice by really simply “doing it the right way” – if we practice faithfully and with integrity the clients and others who we encounter will learn by our example. I think it is important to remember that CBT is a newer approach to therapy and a bit of a delay in knowledge more generally is probably normal. With time, we hope that the knowledge in the general population will increase and that the average person will have a stronger and more accurate understanding of CBT. Love your point too that the field of psychology is ever evolving – we can’t rely on what we learned years ago – we will need to be prepared to adapt throughout our careers, remain teachable, and be proactive. I appreciate hearing this from you given how much experience you already have in the mental health field and working with clients directly.

      Reply

  4. Vanessa Nichols
    Apr 19, 2022 @ 12:41:37

    A common myth I have heard about CBT is that CBT is just “positive thinking.” I think it’s frustrating to minimize so much work to just positive thinking. I think statements like that also minimize all the research supporting CBT as an effective form of therapy. My initial thoughts are if CBT is just positive thinking, why would people seek expertise, and why would they pay so much money for positive thinking.
    I think a lot of these myths exist because CBT is not the norm for therapy, so it is easier to discredit it than to learn about an entirely new form of treatment. I also think that other therapists and psychologists may view successful CBT as an insult to their theoretical framework.
    I think education is the best way to dispel these myths. The more research that supports CBT and shows its effectiveness, the less these myths will hold up. I think articles and conferences are a great way to disperse information to a wide group of people who practice all different theories.
    I think it’s a problem because it can make you look hypocritical or like you don’t believe in the techniques you are pushing on to other people. A CBT therapist who is firmly against CBT techniques on themselves reminds me of a restaurant cook who refuses to eat in their own restaurant. It might be nothing, but it does look good for the restaurant. I think a client would have difficulty completing their work, and you may face more noncompliance.
    A possible indicator of whether I am receiving quality CBT supervision is if my therapist also practices CBT. While this may not necessarily be a requirement, it does seem helpful. I also think it is beneficial if I have a trusting relationship with my supervisor. Sometimes it can be uncomfortable to seek supervision; however, if my supervisor is nonjudgmental, supportive, and trusting, I will have an easier time. I think any feedback would be constructive. I think an area I struggle with is warmth and feeling comfortable, so helping me like that would be beneficial for me personally. I also think direct and immediate feedback would be super beneficial. I know this can’t always be the way, but it’s helpful if I receive feedback directly after the session. That way, I know what they are talking about specifically.
    Possible negatives would be competence, compliance, treatment effectiveness, and treatment efficiency. Not being up to date on CBT research and skills means that I could be using ineffective tools or tools that are not as efficient as the new stuff. I could potentially be causing the client harm due to my incompetence.

    Reply

    • Victoria Cestodio
      Apr 19, 2022 @ 15:25:20

      Vanessa,
      I think the myth you provided is so relevant. I think it is extremely frustrating also that CBT is just seen as “positive thinking”, and it is almost insulting to CBT therapists. I think you made a great point on why these myths exist about CBT, and I think you’re right. CBT is not the norm therefore people in turn think it is ‘wrong’ or not correct. I also talked about in my post that education is a huge part of starting to dispel these myths, and I think educating people like this will hopefully in turn lead to a better result.

      Great post, very insightful!
      Victoria

      Reply

    • Lauren Pereira
      Apr 19, 2022 @ 16:54:41

      Vanessa,
      You included a very interesting myth that I had not heard before but it is definitely important to bring to peoples attention. It can be very frustrating to identify CBT as just “positive thinking” because there is so much more that comes along with it. Education would be a great way to dispel these myths. The more research people can find on this therapeutic method, the more they realize the complexity to it. It will be much easier to identify the positive outcomes to CBT once you have more knowledge on the subject.
      I agree with you that a positive indicator would be if you have a therapist that has also used CBT. Having that experience can be so much more valuable to consider when allowing your clients to also go through the same form of therapy.
      Lastly, I like how you incorporated competence and compliance within the negative reasons for not being up to date on CBT research and skills. These tasks are important to stay on top of in order to give your client the best therapy that can benefit them.
      Great post!

      Reply

    • Tressa Novack
      Apr 19, 2022 @ 19:17:53

      Hi Vanessa,
      Great post! I also find that myth to be frustrating. I like how you said that conferences and articles are a good way to get correct information out to large groups of people. Talks and publications supporting CBT and explaining what it is are important for people to learn about what it is. I also agree about what you have to say regarding why these myths exist. I think that CBT is a newer form of therapy that people who have been practicing under a different theoretical may not want to take the time to learn or accept. I also like what you have to say how therapists using CBT skills on themselves. It is important to for therapists to use these skills on themselves so that we can effectively explain skills to our clients and show that we believe in what we are preaching.
      Tressa

      Reply

  5. Will Roche
    Apr 19, 2022 @ 12:55:09

    One myth I had heard about CBT is that it’s not as personable or it’s colder than other forms of therapy. I think because people think that it uses empiricism, homework and other strategies that there isn’t a personability or rapport-building aspect to it. Knowing what I know about CBT, it’s definitely on the other side of the spectrum of that opinion. Anyone with even a short background in CBT would know that rapport is arguably the most important aspect of therapy and every therapist should strive to build a strong therapeutic relationship with their clients. Like I previously said, I think the myths continue to exist because of CBT’s emphasis on science without necessarily mentioning the empathy and personability of this form of therapy. I think because it has such an empirically-based reputation, those with little knowledge about therapy do not realize that science and empiricism are not the only parts of CBT, and that it’s actually quite the opposite; the rapport and relationship comes first, and the science, methods, and empiricism comes secondary to building that relationship with the clients. I think CBT as a whole needs to emphasize the importance of rapport and empathy just as much as it emphasizes the scientific and empirical side of the treatment. Whenever you hear about CBT I think the scientific aspect of it comes first, and I think the rapport should come first or they should be presented equally. I think this would help dispel some stigma/rumors about CBT and how it works.

    I think not being receptive to practicing CBT on oneself could have several detrimental impacts on the therapist and their clients. First, if the therapist does not believe in practicing these methods on themselves, it appears they might not believe these methods are effective. Consequently, this will probably feed into how the treatment of a client works too. If the therapist does not show motivation in teaches that these techniques work, it will reflect poorly on the outcome of a client. Practicing CBT techniques on oneself will also help familiarize the therapist with the process, which will likely help the therapist guide the client if they are stuck on an assignment or need general guidance on working on the techniques together. I think some indicators that would present quality CBT supervision would be if my supervisor would suggest CBT techniques throughout my every day work with clients. I also think a supervisor that puts an emphasis on homework for clients would also be telling of how my supervisor appreciates and facilitates CBT in her curriculum. I think it would be important for me to receive and appreciate constructive criticism on how I could improve my CBT skills for my own personal professional development. I think not staying current with my CBT skills would be detrimental as I could lose the foundation that I know have. Without a foundation, all other skills and techniques will start to fall apart and become loose. Marinating the original skills and education of CBT is very important in not falling to the lazier sides of therapy.

    Reply

    • Madelyn Haas
      Apr 20, 2022 @ 19:48:34

      Hi Will,

      Great post this week! I have also heard from others that CBT is “colder” than other types of therapy. This just isn’t true, but I believe you are onto something when you discuss why the myth may have started. CBT is a science based therapy, so people must just assume that because its science based, it cannot value rapport and the therapist-client alliance. In her post, Victoria mentioned that she thinks that it could come off colder because it is compared to the original type of therapy: exclusive talk-therapy like psychoanalysis. CBT is more structured and introduces homework and other elements, so the uninformed may assume that is colder and less personal. I also think your discussion about a potential supervisor focusing on helping you with your CBT is good. I think it would also be important for the supervisor to teach us about more general therapeutic skills as well.

      -Madelyn Haas

      Reply

  6. Will Roche
    Apr 19, 2022 @ 13:07:28

    Emily,

    I really like the points you made about the blend between science and Rogerian qualities of CBT, I mentioned a little about that in my response. I made the point that it appears like CBT spends too much of its “advertisement” focusing on the scientific side of therapy rather than making the Rogerian side just as important, because it is. People won’t necessarily find a therapy that’s strictly scientific and empirical because it’s missing the empathetic quality in it’s advertisement. Similarly, a person should not go to a therapist that only focuses on the warm and fuzzy feelings as you mentioned because that strays away from using empirical techniques to help change one’s cognitions and feelings about themselves and others. I think you make great points about how both qualities are needed in order for a therapist to make headway with their clients, great job!

    Reply

  7. Tressa Novack
    Apr 19, 2022 @ 14:46:32

    One myth that I hear about CBT is that it is a cold and rigid form of therapy. When I hear this it makes me think that people who say that do not really know what CBT is. I understand people may think this way because it is so skill based and we assign homework, but one of the most important things for a CBT therapist is to be understanding and empathetic towards our clients. If we are not we could not properly implement CBT interventions and our clients would not be motivated to see treatment through. I think these myths continue to exist because the CBT field is still growing. I think there are still a lot of therapists who would rather have clients vent once a week for an hour than actually work with clients to implement change. I think the field of evidence based practice is still fairly new in the world of therapy. I think I can help dispel these myths by educating people when I hear them say these things by saying, “no that’s actually not how it works, here’s what I do…” It is important to correct people when we hear them spreading misinformation.
    It can be a problem if a CBT therapist has a strong aversion to practicing the skills on themselves because they will not get a full understanding of the skill, which can be problematic when explaining it to clients, and they cannot vouch for a skill when a client is hesitant to try it. It makes our clients feel better to know we are experts on the skill and that we found it helpful ourselves. Possible indicators to determine if we are receiving quality CBT supervision is if our supervisors sit in or the sessions with us or if they watch/listen to recordings of our sessions and give us feedback on our session structure, our tone of voice, and many other things that take place in the session. Supervisors should also be looking over our case formulations and treatment plans and providing feedback to let us know if we are adequate in those areas. The type of feedback that I would find most beneficial would be on my session structure and my treatment plan and case conceptualization. I want these things to be as “right” as possible so I know I’m leading my client in the right direction and that I am not wasting their time. Possible negative outcomes if I do not stay up to date with CBT knowledge and skills is that I am not using the most effective interventions with clients, and that my competency is waning because I am not as knowledgeable as I should be. This would lead to poorer treatment outcomes for clients, which is unethical when they are putting the time, money, and effort into their therapy.

    Reply

    • Lauren Pereira
      Apr 19, 2022 @ 16:44:55

      Tressa,
      I heard the same myth, stating how CBT is a more rigid and harsh form of therapy compared to others. With all of the assessments that can come along with CBT, it can definitely look more complex. But in order to better understanding it, people need to truly experience it and learn more details about what it is really useful for. I like how you mention the importance of being empathetic and understanding towards your clients. In this way, therapists can motivate their clients in completing the necessary tasks that need to get accomplished in CBT and clients will have more trust in their therapists.
      You make a good point that therapists will not fully understand the skills if they do not experience it themselves. This leaves more room for problems down the road in therapy with their clients. It might be difficult to convince your clients to practice certain skills and techniques if you have not done so yourself. A good skill that you listed was to listen and watch recorded sessions in order to get more beneficial feedback. It is helpful to have the opportunity to look back on what was done and consider more possible options. Lastly, I agree that not staying up to date with CBT knowledge and skills can lead to poorer outcomes for the clients.
      Great post!

      Reply

  8. Lauren Pereira
    Apr 19, 2022 @ 16:09:08

    When first learning about CBT, I heard a myth that stated how CBT is more harsh and cold than other forms of therapy. I understand why it might look this way to people who have not experienced it or learned much about it before. It may look this way at first because of all of the assessments and techniques that therapists give to their clients in CBT. Some tasks can be seen as more challenging and other tasks may even make a client directly consider and experience traumatic events that they have encountered in the past. These people may not realize that this form can actually be one of the most effective forms of therapy. CBT techniques give clients a clearer understanding for why things need to be done. It is significant to build that rapport with your clients so they can begin to trust your actions. In doing so, it will be more likely for them to try out new techniques in sessions. In gaining your trust, they may also gain more trust in themselves. And when given challenging tasks and homework assignments, it can help motivate that client to complete what they need to in order to get to a positive outcome by the end of therapy. In order to help dispel these types of myths, it is important to explain the bigger picture of therapy. Sometimes, that type of exposure is needed in order to overcome some of the most challenging obstacles. In doing so, this type of therapy can be one of the most effective and it may be more beneficial when considering how these clients reach their goals at a quicker and more efficient pace than other forms of therapy. Explaining some key elements to CBT may be able to shy people away from believing the myth.

    Having a strong aversion to practicing CBT can be problematic. It might give the client the impression that you do not truly believe in the techniques, which will have your client feeling less motivated in completing them, themselves. This can also come off as being hypocritical. If you are not willing to try these techniques on yourself, why would you recommend having your clients complete them. Sometimes, it is best to have experience with such techniques in order to already have positive feedback on why they are significant to use in therapy.
    I believe that a possible indicator in knowing you are receiving quality CBT supervision is if your therapist already has a good amount of experience with this form of therapy. If they have used these techniques before, it can be beneficial in understanding that they know what they are doing and it is more likely a client will then put their trust in you. It would also be helpful in knowing that the therapist has used this form of CBT on themselves before, indicating that they have self experience in knowing what they are doing and in understanding what to expect throughout the process. Getting direct feedback can be very helpful in getting a better idea from what was just talked about. The more trust you have in sessions, the easier it will be to give and receive feedback. Getting immediate feedback will then help both the therapist and client in considering what was spoken about and what can be adjusted to make the situation better.
    If you do not stay up to date with CBT, your treatment may not always be as effective and efficient. It is important to stay on top of new research and skills that are directed towards CBT in order to best use it within sessions. Not doing this can possibly cause a distance within your therapeutic rapport. You must stay on top of your research and skills in order to do what is best for your client and to keep your confidence high as a therapist. In doing this, you can benefit from getting the best results within CBT.

    Reply

    • Emily Barefield
      Apr 20, 2022 @ 22:58:10

      Hi Lauren,

      I also talked about the myth of CBT being seen as more harsh and rigid than other forms of therapy. I think that is an important myth to address. You brought up some good points about why people might think that such as the use of assessment, homework, and directly addressing trauma. I agree that explaining CBT and helping someone gain a better understanding of the theories behind CBT and the research that supports it would help dispel these types of myths.

      I agree that communicating to the client, even in a more subtle manner, that you do not think the CBT techniques you are assigning for homework will negatively impact their motivation to work on them. I agree that it is important for a good supervisor to have experience in CBT. I also like that you brought up the idea that the supervisor should have experience using CBT techniques on themselves. Direct feedback is also very important, and I like that you brought up as close to immediate feedback as possible is best as this allows you to make the necessary changes to benefit clients as soon as possible. Staying up to date on the best practices for CBT is important in order to get the best results. I appreciate that you tied therapeutic rapport into this section. Staying up to date on CBT practices is a great way to demonstrate expertise. Great post!

      Reply

  9. Madelyn Haas
    Apr 20, 2022 @ 19:19:09

    In relation to CBT, I have heard people say that it is too “impersonal” and “rigid” when compared to other therapies. I’m always surprised when I hear this because CBT, like most other therapies, focuses on the client-therapist rapport a lot and can be used creatively. Without a strong client-therapist alliance, there is no way any therapy will be as successful as possible. I think these myths tend to continue to exist because a lot of people do not know much about cognitive behavioral therapy. Just saying the words “cognitive behavioral”, it sounds very “science-y” and may intimidate or confused people. Based on the name alone, people could come up with assumptions. If someone described the worksheets and interventions (without mentioning the therapeutic alliance), it could sound rigid and not personalized. When I hear misinformation/myths about CBT, I can do my part to dispel them. I can educate people on what CBT is in a nonjudgmental and non-confrontational way. I can also practice this type of therapy until it is normalized, and the myths start to dispel.

    It could be a big problem if CBT therapists have an aversion to practicing techniques on themselves. For one thing, they will not get the experience or insight from practicing the technique on themselves. For another thing, they will come off as disingenuous and non-empathetic if they push clients to do something that they themselves wouldn’t do. There are a few indicators that you’re receiving good CBT supervision. If the therapist frequently uses CBT for their clients and call themselves a CBT therapist, that is a good sign (but not a perfect sign). Another sign is that they supervise you on CBT techniques as well as other therapeutic techniques. If the therapist seems knowledgeable on CBT, that is also a good sign. I think good supervisor feedback would be about multiple factors: session structure, use of interventions, therapeutic alliance, and treatment plans. It would also be nice for the feedback to be about live or recorded sessions. The thing with CBT is that it is always developing. New techniques are being made and utilized. If you do not continue to stay up to date, you could be using out of date or less effective techniques. You could be missing out on very helpful interventions.

    Reply

    • Lexi
      Apr 21, 2022 @ 09:42:27

      Hello Madelyn

      I like your point about the potential to come off as disingenuous to clients if we aren’t willing to use the same techniques on ourselves – and that links back to rapport – successful therapy relies a lot on trust in the relationship and on the client’s perception of us as “experts”. How can we expert for them to perceive us as experts in something we refuse to do ourselves? Very true point and I don’t believe this is a “fake it til you make it” moment. I think clients will pick up pretty fast if we don’t know what we are talking about or don’t really see the value in whatever we are having them do. People in general hate being “told” what to do and so asking a client to do homework can already be a lot – never mind if we are asking them to complete something without the willingness to complete it ourselves. Being familiar with these techniques from a “user perspective” also helps us to understand hurdles, difficulties, and benefits so that we can empathize with the clients’ experiences completing them and be better able to connect and guide them through the exercise as well by preparing them for those things that we encountered. Having first-hand knowledge in CBT is so important and I think will make a huge difference in how the client experiences therapy and in overall outcomes.

      Reply

    • Sandra Karic
      Apr 23, 2022 @ 22:08:37

      Hi Madelyn,
      I’ve heard that CBT is too impersonal and rigid as well, and have similar thoughts when I hear that. CBT really does emphasize creativity and building rapport so it’s weird how often people say stuff like this. Also, we’ve explicitly learned in basically all our classes that the therapeutic relationship is important. I agree that some people may make these assumptions because CBT sounds science-y. I like your points about why not practicing CBT techniques on yourself is dangerous and completely agree that it would lead to not getting as much insight and coming across as disingenuous. Lastly, I really liked your thoughts on supervision!

      Reply

  10. Lexi
    Apr 21, 2022 @ 09:26:59

    One misconception about CBT is that it is a highly structured and one size fits all approach to treatment – when in fact as we all know CBT when done correctly is very tailored to the individual and does actually involve a lot of collaboration and creative problem solving. Even though CBT does have a healthy amount of structure it is not by any means a cookie cutter approach to therapy- nor does it put clients into a box. (again, when done correctly). I think myths or misconceptions about CBT come from a general lack of knowledge – CBT is a relatively new therapeutic approach and is so different from the more traditional approach of psychodynamic therapy – I am optimistic that as more people experience and practice CBT the understanding will increase. As mental health professionals who practice CBT the best thing, I think that we can do to help this process is to be open about our practice, to educate clients, and to practice CBT as it is intended.

    A second myth I think is worth addressing is that CBT is simply a practice about shifting negative thoughts to positive ones – while this isn’t necessarily “untrue” it is not the entire picture either. Yes, we talk a lot about positive thinking and adjusting thoughts into a more positive direction – but CBT is not just about positive thinking it is about realistic thinking. CBT helps clients to build realistic patterns of thinking, and to embrace cognitive flexibility. It is not simply a “think happy thoughts approach”… I think again this misconception stems largely from misinformation, ignorance, and a tendency to “dumb things down” or water things down. As practitioners the best thing we can do is to practice the approach as it is intended, to educate clients, and to participate in the field more broadly to increase awareness and help dispel misinformation or to correct instances of partial understanding.

    It is a problem if CBT therapists have an aversion to practicing CBT techniques on themselves because if we don’t buy into the techniques, interventions and processes used in making these changes then we cannot expect our clients to buy into them. Therapists should know how these strategies work and be able to speak to their usefulness based on first hand experience, they should be able to identify potential difficulties and roadblocks as well based on first hand experience. If a technique is too much effort or not worth the time for us to complete as an example, why would we expect more from our clients? I have never worked in mental health – but I expect that receiving both positive and negative feedback would be indicators of receiving quality CBT supervision – I think another indicator would be if that supervisor provides sufficient support and education when difficulties do occur. I think the most helpful type of feedback would be informing me what has worked for them, and offering opportunities to talk about what I could have done differently in session. Additionally, assistance in learning to form good case formulations and treatment plans because I feel pretty nervous about doing this “out in the field” with real people as well. Negative outcomes as a result of not staying up to date on CBT knowledge and skills exist not only for ourselves, our professional reputation and the success of our practice, but of course also for the clients who will suffer as a result as well. Clients may not progress or even get worse, our words and actions as therapists matter a lot and we have potential to do real harm if we are not correct and purposeful in the way we attempt to “treat” clients. CBT is a young practice, and staying up to date on the latest research outcomes, techniques and interventions will only create better outcomes for us as well as the clients who come to us for help.

    Reply

    • Pilar Betts
      May 03, 2022 @ 12:13:37

      Hey Lexi!
      I thought it was interesting that you brought up the myth about CBT being just about shifting negative thoughts to more positive ones. I think it was important to bring up because that is definitely the easy way to explain what CBT is and while that is a part of it, it is important to express the other features of CBT such as the collaborative nature and the focus on forming a strong therapeutic relationship.

      I agree practicing these techniques allows the therapist to gain an understanding of questions, roadblocks, and frustrations that may come up for the client. And as you said if we wouldn’t do the activity ourselves why should we? The client would appreciate knowing this isn’t just a homework assignment you’re going to “grade” like in a classroom. That is not what the process should be like it is collaborative and just like the client puts in work outside of the sessions so should the therapist.

      Reply

  11. Moises J Chauca
    Apr 21, 2022 @ 12:44:13

    One common CBT myth that I have heard from other people is that CBT only works on high-functioning and intellectual people because CBT techniques require the client to set their goals and practice evidence-based techniques. My thoughts on these comments are that these people do not practice or do not understand all the factors that are taken into consideration when practicing CBT. The one thing to point out is that CBT takes into consideration many factors of the client’s life to work on that reduce the client’s distress. I think that these myths exist as many people are not educated on CBT or have had zero exposure to the technique. In addition, I think some people in the mental health field are ignorant and decide to avoid CBT as they think it uses evidence-practice techniques and disregards the client’s unique experience. The best ways to dispel these myths are to educate people and work hard with new research and more techniques. One of the main problems is that CBT is not the primary choice for therapy and at times, it is even disregarded.
    If CBT therapists do not practice their own techniques on themselves, they will lose much experience with the technique and will have a much harder time working with the client on the technique. When therapists practice these techniques, they are able to identify challenges with the techniques so they can modify them to fit their clients and gather examples that can help facilitate these techniques. Some possible indicators to determine the quality of supervision are when the person is able to provide positive constructive feedback and helpful skills, and they are able to share their experience with others. The type of feedback that can help me is on my case formulation and assessments. Lastly, some possible negative outcomes, if you do not stay up to date with CBT knowledge are not using the recent assessments which can lead to inaccurate scores and a misdiagnosed, In addition, not being up to date is an ethical issue, a therapist can lose their license for malpractice.

    Reply

    • Sandra Karic
      Apr 23, 2022 @ 22:16:37

      Hi Moises,
      I’ve heard the myth you mentioned as well, but weirdly I only started hearing it as I started studying psychology more. I think you’re right and that myths often stem from a lack of education on the subject and that some people seem to think that evidence based practice and taking into account a client’s personal experiences cannot coexist. I agree that educating people is the best way to dispel these myths. I also think that practicing CBT techniques on yourself makes you more effective when working with clients. Lastly, I liked that you pointed out that not staying up to date as a therapist is an ethical issue!

      Reply

  12. Jeremy
    Apr 21, 2022 @ 15:17:10

    The most common CBT myth i see in the world is that CBT is exclusively homework and worksheets. While these practices are crucial to CBT, I constantly find there is much more in terms of psychoeducation, theories, and rapport I think especially in the really early years of the practice there is a tendency for therapists to focus on making the client fit the worksheet, which has a tendency to come off as cold and distant. This practice is good to ensure that the therapist is internalizing the basics, however, excellent therapists can use the worksheets as a basis of practice using a wide variety of techniques, and homework to engage clients in a way that is appealing to them.
    I can attempt to accumulate several different methods of approach for the same topic or diagnosis, one activity may not engage all clients, and expect the clients to be the expert on themselves, Attempting to have them create the goals and collaborate with them on treatment modification. Additionally, I can stress the importance of basic attentive listing skills and other therapeutic essentials.

    CBT like all therapies relies on trust, these simple exercises are posed as a way to gradually increase cognition, emotions, and behaviors. Any client should be skeptical of a clinician who can not practice what they teach, which would cast doubt on the larger therapeutic relationship. Beyond that, A clinician who can not successfully implement these skills will naturally be weak in their instruction of them, as they may counter-transfer to the client. Group supervision is one of the most important aspects of good supervision, a time where peers can review and comment on work and progress. Additionally, good supervision includes direct supervision hopefully with the use of tapes. I’d like to hear feedback about how I can adapt my style to different clients, I hope to learn how to be flexible as a therapist, instead of falling into a pattern and not exploring more fruitful methods. As CBT is an evidence-based scientific practice, staying up to date on the latest research and methods can help inform the practice, as new tests are developed, better tools are published and corrections to mistakes are fixed. Failing to keep up to date with these things can lead the therapist to be issuing outdated psychoeducation that confuses the client, or waste time on methods that have low successes rates.

    Reply

  13. Sandra Karic
    Apr 21, 2022 @ 16:02:52

    One myth about CBT that I’ve heard frequently is that CBT is not personalized and that CBT therapists just follow a manual as opposed to getting to know and treating an individual. I do not think that is accurate at all and it’s kind of upsetting to think back on how often I’ve heard similar sentiments. I feel like it fails to take into account the entire notion of collaborative empiricism which is very important to CBT. Many of our professors have repeatedly emphasized that the interventions we use will not be effective if we do not have a strong therapeutic relationship with our clients. Clients will not be motivated to follow through with homework or even trust the therapist that they will work if there is not a partnership in place. This demands that you get to know a client. Moreover, CBT encourages malleability. I think most interventions will need to be tweaked in some way for different clients, even if it’s something as simple as giving virtual copies of a homework sheet or choosing a sillier relaxation/visualization technique for a client who enjoys humor. I think these myths stem from a lack of education on CBT. Most of what people hear in regards to CBT is stuff about the empirical evidence supporting it, cognitive distortions, frequent worksheets, or jargon heavy information. I think people hear so much about the science part that they don’t realize there is an art part to it as well. I think the main thing I can do to dispel these myths is to explain to other professionals/people how much CBT emphasizes collaboration, building rapport, and being malleable.

    I think it is problematic if a CBT therapist has a strong aversion to practicing CBT techniques on themselves for multiple reasons. Firstly, I do not think you can effectively teach and help someone with a technique that you’ve never tried on yourself. There’s a certain level of empathy that you gain from using techniques on yourself that I’m not sure you could get otherwise. Additionally, if someone does not want to use the techniques on themselves I’d wonder why they think those techniques are worth using with other people? There seems to be a high likelihood that such a therapist would have a negative attitude about therapy or maybe the “types of people” who are in therapy that would be detrimental to clients. I think quality supervision is very important! Some signs that I am receiving quality supervision is having a supervisor who is knowledgeable about CBT, gives frequent, specific feedback, and actually sees me interact with clients (whether through recordings or by actually being there in the moment). I also think having a well organized supervisor who takes an active interest in monitoring and educating me on how to complete/improve case conceptualizations, treatment plans, etc. is a good sign too. As alluded to earlier, I think specific feedback would be most beneficial for me. Additionally, I know I’m going to need constructive feedback. As much as I’d love to only ever receive positive feedback, I need a supervisor who can point out my weak spots and help me improve them. I think the biggest negative outcome of not staying up to date with your CBT skills is harming clients. However, a more common, and possibly more insidious outcome, is not being effective in treating clients. Therapy requires time and money, taking these things, requiring a client to be vulnerable with you, and then implementing ineffective or outdated treatment interventions would be a serious problem.

    Reply

    • Moises Chauca
      Apr 24, 2022 @ 14:41:01

      Hello Sandra,

      Great post! I have heard the myth you mentioned in my first psychology class in high school. At the time, I did not know about CBT. However, as you said personalization is one of CBT’s main principles as there is a collaborative relationship with the clients, and without this relationship, no therapy would work. I totally agree with your points about therapists practicing CBT techniques on themselves. One of the biggest benefits is to gain empathy and experience so we can teach our clients most efficiently.

      Reply

    • Pilar Betts
      May 03, 2022 @ 12:05:00

      Hey Sandra
      Great Post!
      I agree that education on CBT is important because it can be seen as heavy on jargon and empirical evidence because that’s what it seems like on the service. Even being in a CBT program I feel that way sometimes, but I really do enjoy the aspects of CBT that focus in on the client- therapist relationship and building rapport and use of techniques to challenge their thoughts and behaviors. If more people saw that side of CBT, they would probably think more highly of it. The emphasis on collaboration is what the introduction to CBT to people should lead with.
      I agree that having an aversion to doing CBT techniques on yourself you may lack the empathy and have a negative attitude about their clients, as if they are separating themselves from the client putting them on a different level. There is a lot of value in doing the techniques on yourself especially in regard to self-reflection and awareness which is super important to be mindful of as a therapist.

      I agree a good supervisor should be organized and has knowledge of CBT and encourages your growth is super valuable.

      Reply

  14. Pilar Betts
    May 03, 2022 @ 11:52:28

    I honestly don’t know any CBT myths, but I did see a post on Instagram recently about using CBT on yourself which was interesting because this is not really something I thought someone could do on your own because you have to be able to challenge your maladaptive thoughts and beliefs and sometimes it can be hard to be honest with ourselves about our thoughts and emotions. This connects best to the myth that CBT is easy to learn and easy to practice. I do think when people think of CBT they think it is very structured and rigid and not very personable. Which at times I am not going to lie, it feels very structured but that’s probably because I’m not applying it with actual clients yet and I’m a more hands on person I’m not a read a book and understand person. I need to be able to do it to understand it fully. I think CBT myths exist because people don’t really fully understand what it entails, even with this being my career path and being in a CBT based program I still sometimes struggle to explain what CBT means all I ever come up with is changing your thoughts and behaviors. To help dispel some of these myths I can continue to become familiar with CBT and discover a way to explain it in a style that is my own and then use it with future clients.

    If CBT therapists have a strong aversion to practicing CBT on themselves then they will not gain the valuable insight of having the experience of doing the techniques. It can be extremely helpful to explain the purpose of a technique if you went through the process and saw the results for yourself. It will make it easier to psychoeducate in a clearer manner and to better understand some of those process questions and frustrations may have come up for a client. I know in doing the daily activity schedule I did not like it and didn’t really want to do it and for me to experience what clients may experience in their own process. Some good indicators that you are receiving quality supervision are quality feedback, opportunity to learn additional skills through trainings and workshops, being able to observe a session and access to group supervision as well as individual supervision. Having quality feedback and being able to watch yourself giving therapy through a recording is super helpful to learn from what you have done, it also is super helpful to watch other people do a session so you can get an idea of how they may approach it and then make it your own. The type of feedback that I personally would be beneficial to my growth as a CBT therapist is to get specific feedback as well as positive feedback, I want to know exactly what they think I can work on and what I did well. I want to feel encouraged, like they want me to grow and learn. It is important to stay up to date on CBT knowledge and to refresh your skills because if you aren’t using certain techniques as often doesn’t mean they won’t become useful at some point so it is important to stay familiar with the general idea of different areas in CBT. It also is important to keep up with new techniques and information that comes to pass in the field because you may want to look to go do a workshop to keep your skills sharp and you want to be using the most effective approaches.

    Reply

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Adam M. Volungis, PhD, LMHC

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