Cbt

Former Member

So I went into this feeling quite positive. I've just finished my first telephone session and feel really disappointed.

The big thing that bothers me is that she made me promise to not hurt myself. She kept repeating that if I hurt myself or if I had suicidal thoughts then I would be too high risk for the service. And when asking me about thoughts about harming myself, I said yes - I said that I often have thoughts about self-harming and that I do think about suicide. And then she would repeat the thing about risk and say 'so only really thoughts about hurting yourself superficially?'

How the hell is therapy going to work if I have to constantly lie about feeling these things?

Former Member

CBT isn't a talking therapy. You're not doing it to talk about your problems, you'll be doing it to give you tools to improve your own mental wellbeing.

It's based on this sort of diagram


For example:
Situation You are at work, you were 15mins late and you missed the morning briefing. Your immediate boss asks to talk to you immediately.

Thoughts
"Am I in trouble?"
"Are they angry?"
"What is this about?"

Feelings
Anxious
Angry
Calm

Behaviour
Ask workmates what you missed
Boot up your PC
Make tea

Physical Reaction
Sweat
Churning tummy
Shaking hands
Heart pounding.

Now, you can't control your physical reactions directly, so CBT helps you rethink your thoughts and behaviours to keep your mood stable and your physical wellbeing in a good state.

If you have negative thoughts, it can help you self-challenge. So if you thought "Are they angry?" you could challenge yourself with "I've never been late before, and we have a good working relationship, so they shouldn't be angry". If you feel nervous, you can do something to calm you like make tea.


Make sense?

Former Member

That all makes sense, and its what she went through today.

However I disagree with the no harm contract she's made.

Former Member

Its not unusual, or at least, it's not unheard of to be put under a no-harm contract. What's the problem with it specifically?

Former Member

Fiend_85 wrote: »

Its not unusual, or at least, it's not unheard of to be put under a no-harm contract. What's the problem with it specifically?

I think I'd have a real problem with it and I don't self harm often.

I think the real issue I see with it is that one of the questions on the questionnaire they make you do every session is "How often over the past x weeks have you had a problem with thoughts of harming yourself or that you would be better off dead?" (paraphrasing a bit because my form for next session is ALL THE WAY OVER THERE, but that's essentially the question), and if ysh wants to be honest about that then at this point she risks being discharged for it. And if she's not honest then the help she'll get won't be exactly what she needs.

I know CBT is about working on thought processes, but clearly she needs help with the kind of thought processes that lead her to feeling suicidal or like she wants to self harm. And by telling her she'll be discharged if she shows how bad she actually is that means she isn't going to get help with that.

Former Member

frankipanda wrote: »

I think I'd have a real problem with it and I don't self harm often.

I think the real issue I see with it is that one of the questions on the questionnaire they make you do every session is "How often over the past x weeks have you had a problem with thoughts of harming yourself or that you would be better off dead?" (paraphrasing a bit because my form for next session is ALL THE WAY OVER THERE, but that's essentially the question), and if ysh wants to be honest about that then at this point she risks being discharged for it. And if she's not honest then the help she'll get won't be exactly what she needs.

I know CBT is about working on thought processes, but clearly she needs help with the kind of thought processes that lead her to feeling suicidal or like she wants to self harm. And by telling her she'll be discharged if she shows how bad she actually is that means she isn't going to get help with that.

:yes: I think this is pretty much it.

Plus one of my "behaviours" is self-harm. So it's not exactly like I'm able to talk of examples of emotions/thoughts leading to that really, because then she'll know I've self-harmed

Former Member

Actually self-harm was mentioned during CBT that I had. I think what she's driving at is that if you're in crisis it's not right, but tbh, you seem to be managing and I think you should proceed with CBT.

Former Member

It also sounds like she's trying to help you stay within the service of what they're offering.

CBT might not solve all of your problems - but it's a good tool to have in the toolkit for dealing with life. Sometimes you have to play along with the system to be able to get stuff out of it (I'm sure you know this). If it was a talking therapy, then would be more of an issue, but it's a skill to learn.

Former Member

To be totally honest - I really don't understand why some people support the use of no-harm contracts.

I'm pretty sure I have a good idea of what CBT entails - and I don't think my unhappiness with being forced to agree to this is a sign of my reluctance to engage with CBT. As I said I was feeling positive going into this, and I've spent YEARS trying to get some help.

Former Member

The no harm contracts thing is likely to all come down to risk management. By doing that - they can then spend time trying to actually do things that might help you in the long term, rather than having to devote all their energy to making sure you don't harm yourself at all.

Which might not make much sense, but generally the system can't cope with accepting that people harm themselves. The people involved generally can - which is why rarely enforced in anyway, but to be 'allowed' to do the useful stuff they need to have covered that base first.

I wasn't meaning to suggest that you were trying to avoid CBT. Just trying to encourage you to play the game at least enough to be able to access the CBT. Sounds like the person on the phone has a similar attitude, otherwise wouldn't be giving you the 'superficial' let out when stuff got mentioned, rather just trying to discharge you ASAP.

Former Member

Hi YSH,

When I was first put under CBT, I was put under a no harm contract and she specifically forbade overdosing. This is because, as others have said, to manage the risk. I didn't finish the CBT because I broke the contract over 8 times within 2 weeks when the therapist was on holiday and as a result I was hospitalised.

The best thing to do if you're unhappy with the contract, is to tell your therapist exactly how you're feeling and they may explain it in more detail, or come up with an alternate contract with your input.

Former Member

I think people just do it to trick themselves into a false sense of security and to cover their backs. I doubt it actually helps with risk, it damages the relationship and is a sloppy way to deal with the whole issue of risk.

My best therapeutic relationships have been the ones where I'm able to be completely honest. This won't be the case here.

Former Member

I doubt it helps with actual risk at all. I'm confident however that it helps them provide a service.