Often, how we feel is driven by a series of incorrect assumptions we make about other people, how they feel, what they think, and how they will react to a given situation. A man driving home wants to tell his wife he’s going away for a golfing weekend with his buddies. He’s rehearsing in his mind how the conversation will go. He assumes that she will tell him “we can’t afford it,” “you need to spend more time with the kids,” ” I had plans for this weekend…” He gets more and more upset over how he assumes she is going to react. As a result, he’s looking for a fight as he comes in the door, and with an attitude like that, it’s not surprising he often gets one. I find that patients who make assumptions about how others will act / overreact, are wrong more often than they are right, and that they spend an inordinate amount of time stewing about these assumptions. Cognitive therapy teaches you to challenge these assumptions, to test them, and to recognize when you are making assumptions so you can stop reacting to thoughts that they never had, or might not have.
Cognitive therapy provides you with tools to come up with better ways to look at events. These tools include things like charting, worst case scenario, experiments, making lists, etc. A patient might feel that they cannot lean on a friend, for fear of losing them, even though they themselves have “been there" for the friend on many occasions. The counsellor shows that this fear may be unrealistic and has the patient challenge that belief with an experiment, opening up a little to the end and observing their reaction – did it meet the pessimistic expectations and fears of the patient? In a different situation, the patient might express incredible fear of a bad outcome – If I ask for a raise, or ask for help, or say no to more overtime, I risk losing my job.” This logic is used to justify continuing to work 12 – 14 hour days to the frustration of both patient and employer. The counsellor might tackle this fear of losing the job with a question “What would actually happen if you lost your job?” Often when presented with questions like that, the patient describes an outcome that is nothing like as bleak as they feared – they realize that they could find other work, they do have talents, they’d actually enjoy some time off, they wouldn’t mind selling an expensive house and living within their means for a while, they’d actually cope. The counselor might have them evaluate the actual likelihood of losing the job. What evidence is there that if you said no, you’d be fired?
The same might be said of losing a loved one, that they actually end up pushing that person away. A counsellor might help the patient evaluate what the important things in their life are. Is this relationship they fear losing equal to 100 percent of what they do in life, their kids, their job, and their friends? So, despite saying that this person is everything to them, it isn’t really true and shouldn’t be thought of in those kind of terms – it ain’t healthy or realistic.
Recognizing thought distortions alone often helps patients feel better, but that is just the beginning. The therapist goes on to help you correct some of the core beliefs about yourself and your world. This involves some understanding of the past but does not dwell on it. For example, the daughter of a dominating father and a timid mother becomes very timid herself and lets people run all over her, especially her husband. The counsellor doesn’t need to go into great detail of how and when every hurt happened, just enough to recognize that there is a pattern in how you deal with the world, that there is a reason for it, and now that you recognize it’s a pattern, there are some things you can do about it. The counsellor shows you how to recognize these patterns and helps you take the first steps to changing some of these patterns. It may be that you were genetically predisposed to be timid, but lacking examples of how to assert yourself effectively, you are doomed to never change, unless you acquire the right tools.
Patterns of behaviour include things like pushing people away, letting others control you, being domineering yourself for fear of losing control, relying on alcohol to help you cope, or avoiding conflict to a degree that it only lets things fester. Anxiety makes us avoid doing things that are hard for us – if I do this I might get hurt – so I won’t, but often anxiety can build to the point you can’t leave home and can’t go shopping or can’t make a decision (in case it's the wrong one).
It’s at least possible to do cognitive therapy on your own – the books are certainly our there – David Burns, “Feeling Good, The New Mood Therapy” is a classic and there are many others, but cognitive therapy is a bit like learning to play an instrument – it really helps to have a teacher show you the right way. While they can’t do the playing for you, they can point out the right strategies. Depression in particular can make it very difficult to do something like this on your own because of the poor concentration, lack of motivation and interest, and the general pessimism with which depression is usually associated. The counsellor plays both coach and cheerleader.
It’s easy to be skeptical – how is it possible to change the way you feel just by keeping some lists. There is new scientific evidence that when you think in a different way long enough, the brain actually makes new connections and severs old ones -you literally change the wiring in your brain. You don’t have to tell yourself to feel better – you just have to do the homework and you will automatically start to feel better. The brain works by associations. How many of us can’t help but think of the Lone Ranger on hearing the William Tell Overture – cognitive therapists take advantage of the way the brain works to create new associations and new pathways to change you, possibly forever.
Depression is felt to be a combination of stresses, genetics, personality, and belief systems. Each individual with depression has differing ratios of these to add up to depression. So it is that the roles of counselling and medication vary in importance from person to person. Someone who has been fine all their life until losing their job may only need a six month prescription of an antidepressant and never looks back. Someone else with long-standing depression may well get more from counselling than from medication, while others won’t get better with either on its own--they need both.
Cognitive therapy works, it doesn’t take a lifetime of sessions, results can be seen within weeks, and it may just change your life. While most of us don’t have full medical coverage, and it is expensive, a financial investment in your future mental health may pay many times over.
Please call and discuss your own situation to determine if this therapy and the therapist you speak to can be of help to you!