Blog: Why Flexible CBT?
Early in my career at McLean Hospital, I saw the power of CBT for patients who otherwise were languishing with non-directive, interpretive therapy. It seemed obvious. CBT offers practical skills for patients struggling to function better and get life back on track—thought record/mood monitoring, cognitive restructuring, behavioral activation, and structured problem solving, but I was getting stuck when I tried to use the protocols that were validated in the research studies.
Back then around 1990, my typical patient did not fit into any neat category. It was usually some combination of diagnoses: a mood disorder, almost always some anxiety, often a personality disorder, and frequently a history of trauma with PTSD symptoms.
The typical path to develop CBT protocols is to test them with a diagnostically homogeneous patient population, such as depression, or panic, or social anxiety. Protocols are designed with a specific timing and sequence as inherent components for validation, and with the implicit assumption that patients would cooperate and adhere with the protocol, thus leading to desired outcomes.
The big challenge for me was the patients I was treating were very different than the patients in the research studies. They were diagnostically heterogeneous, wanting change but also resistant to it, and often at more severe levels of impairment than the patients in the research studies. And, I was trying to fit the protocols to these patients and getting frustrated. I needed to figure out a better way to work with the patients sitting across from me.
At the time I didn’t know it, but this was the start of my path to develop Flexible CBT.
Atheneum Learning Blog Feed for your RSS reader.
Posted by Ed on Dec 14, 2010