CBT session #3 : I don't fit into the process

Today in my CBT session the therapist talked me through the 'vicious flower'. She said that suicidal thoughts are not instinct - they are intrusive thoughts, not instinct.

She meant that the way that they talk about it in CBT is that they call them intrusive thoughts. However, this differs from my personal experience - suicidal urges to me have been self destructive instincts. They come from seemingly nowhere. I have to fight against this instinct. (I am successfully fighting against it by the way.)

When we had this conversation about semantics I felt disengaged. I had to just accept that my personal experience is different from how CBT is theorised. It suddenly felt less relevant to me.

There's also a bit where she was expecting me to say I isolate myself and go out less to see friends because I am depressed. But this isn't the case. I felt like I wasn't fitting into the normal boxes. I felt like I didn't know what to say in response to her questions; they didn't seem relevant to me. I don't think the whole world is terrible, I don't think everyone is horrible, I don't think very badly of myself, I don't isolate myself. These are the responses she was expecting and I didn't give them to her. So now what?

Also she brought up sore points that I had managed to avoid thinking about since the last session, so that was a bit hard for me.

And we discussed me believing that being depressed is part of who I am. It is - this is who I am right now. She said it's not. I thought that accepting that I am depressed, that this is where I am right now, would be part of me getting better. I believe that I will get depressed again even if I recover now. I believe that one day when I die it's pretty likely it will be by my own hand, even if that day is 60 years from now. Believing that isn't nice. It's actually quite painful. And painful to talk about.

I left the session crying. I felt like I couldn't really make the most of the process she was taking me through - I found it so hard to think about, and come up with the answers for. I don't seem to fit.

Has anyone else had that sort of experience?

I have found some cbt and counselling really difficult. One session with a counsellor that I never went back to, I was crying and angry for the whole day after as she tried to blame all my problems on my mum! Made me so angry and guilty and defensive of my mum!!
Also with cbt, my therapist has said this to me too, it really tends to just scrape the surface and deals with the worst of the issues. Like cbt has helped me get past my fear of leaving my house and driving, but it hasn't even touched my ocd and phobias. I also took a really long time to feel comfortable with my therapist. I've seen her for almost a year now and finally I think she is starting to understand me a bit more. Sometimes I used to come out of a session and wonder what good it even did!
As for your 'intrusive thoughts' I'm the same but with ocd thoughts about germs or illnesses. They tend to come from no where and are so frequent it seems hard to imagine that they aren't instinctive. I couldn't say if yours are or not, but I can see your thinking behind it.

I understood instincts to be an urge to do something in response to something else. So when there's danger, you run away or find another appropriate response, and that becomes your instinct. You learn instincts as a driver, and you learn to not drop hot mugs of tea but to put them down so the hot water doesn't splash on you.

So my instincts can be to self-destruct because the pain is not worth living in the time, I reckon. I'm not suffering from this at the moment, but I reckon that's what happens. And your instincts are to get rid of potentially harmful germs. Maybe we have to tackle the core beliefs that those instincts are rooted in, that the pain is too much to bear, and that germs are totally harmful.

Lior, you are you. You're a unique person and there isn't another Lior just like there isn't another me. You have all the negative thoughts because of other influences and not because of who you are. Try to separate yourself from other negative influences and just get right back to being just you.

ISB x

I felt very much the same as you. I feel desperately depressed at times, but I don't believe, at the same time, that the world and the people within it are all cruel and bad. I also don't feel any dislike towards myself and I love other people. I love interacting with strangers, making people laugh or doing nice things for them. I appreciate that I am depressed, but I don't consider myself "unhappy" if that makes sense? I don't withdraw from life or situations because of my depression.

Try not to think about what you should be answering or what she is expecting as a canned reply from you. Answer as honestly as you can. If you feel differently from the path she's taking you down then be sure to tell her as this can help her to help you more effectively.

That being said there do seem to be some therapists who have little experience with people who fall outside of the box a little. Maybe have a discussion with her about it? One thing I do agree with her on, however, is the whole suicide not being an instinct thing. Everything a living creature does is geared towards survival. It's why we feel hunger, thirst, tiredness etc. it's our body's way of telling us to perform an action that will keep us healthy, alert and alive. That's not to say, however, that suicidal thoughts are not *incredibly* powerful and very much feel like instinct.

I'm not sure what else to say but know that you aren't alone in being this way :)

You people have some weird Therapists, that is not CBT as I know it. CBT is tailored to the person, not the other way round.
As for suicide, people I talked to in the psych ward who tried all said at the time it seemed like the right thing and I felt that way too. At the time it seems like a logical way to deal with mental pain since i'm good with physical pain.
Anxiety disorders turn all logic on it's head so all our survival thoughts become much harder. And some times it is survival, not ours but those left behind if we feel they would be better off without us. Inuit (eskimos) accepted this.

I agree, Davit.

There is a difference between intrusive thoughts that come out of nowhere and a more cognitive thought based on the evidence presented to the conscious mind.

The conscious mind can review all the negatives and decide that suicide would be the best option. This way there isn't anxiety because I suspect it just feels as normal as decided what to have for breakfast!

Intrusive thoughts on the other hand are scary. They are reviewd by the conscious mind and rejected as bad, hence all the infighting causing the anxiety.

CBT has its models but disorders & conditions are not determined by CBT, they are determined by a greater separate model from the medical manuals. CBT has to accept them as they are accepted by the medical community at large. They are central.

Not fitting something is common anyway otherwise treatment wouldn't need to be bespoke. My OCD doesn't completely fit as I can feel the opposite to the ecpect outcome but if you read more comprehensive literature from experts, this is found to be accepted.

I think its just a poor therapist in this regard.