When Reality Bites

pizza bites

I’m back from vacation and despite being away from the blog for a while, a few folks posted some interesting comments that had nothing to do with the post they were commenting on.

One had a link to a website selling table saws.

Fascinating.

A significant part of CBT work involves challenging distorted thinking;  patterns of thinking that can lead a person to unreasonable and usually negative conclusions about events, themselves and other people.  I’ve written a good deal about negative thinking and how to use Socratic methods and evidence to challenge distortions that typically lead to unreasonable distress and maladaptive behaviors.

But what happens if the negative belief or thought is true and unchangeable?  For example,  “I got written up because I played computer games at work all week and missed an important deadline.”

Contrary to the stereotype that therapists tend to push clients into endless positive affirmation mantras we actually have a few ways that can help clients think about and handle difficult situations that involve strategies other than repeatedly saying “I love myself and the world is in harmony”. Because, really, the world is rarely in harmony and if you love yourself that much then therapy needs to have a bit of a different focus.

One strategy involves consciously using the distress related to the event as a catalyst for increased awareness and knowledge about the problem and increased desire to change the behavior that either led to the problem or may be making the problem worse.  The Systems theory folks view crisis as something that can act as a catalyst for change in families and what’s true for systems is true for individuals.  Emotions are really neutral entities; “good” and “bad” emotions can both lead to negative outcomes; it’s not so much the emotion that matters as much as how you use it.  During times of distress, folks are typically more motivated to change just so that they can feel better. Changing our behaviors may not reverse a specific consequence that already occurred but it can help prevent the situation from getting worse while giving us a greater sense of control.  Changing behaviors can also have reparative effects on relationships; people tend to forgive more easily when they have evidence that someone is trying to turn their behaviors around. However, acting without awareness can leave us vulnerable and may lead us to bigger problems than what we started with.

Before pushing a client to action, many CBT therapists engage their client in a simple yet comprehensive pros and cons exercise.  Pros and cons can help us put a negative event or life circumstance in perspective.  Using the example of being in a job you do not like; there are reasons why a person may still show up – there are things about the job that have a payoff otherwise they wouldn’t be going there every day.  Going through the pro’s and cons of staying at a job, leaving a job, changing aspects of a job, etc. can, at the very least, help a person recognize the reasons why things are the way they are. Understanding the reasons for a negative event or situation can help us balance out the narrative; it pushes us to more reasonable and evidence based conclusions about the part we played, our conclusions about other people who may be involved and the situation itself.  Pros and cons can also shed light on new strategies or may correct faulty equations that make the situation appear more distressing than it deserves to be.

From here, strategies revolve around adaptation and acceptance which involves understanding that the negative that cannot be changed is only one part of many.  Using the example of a dead end job, you may want to leave it but jumping ship right now may not make sense for a variety of reasons (benefits, the market, seniority etc).  Adaptation may mean recognizing that while you may not like your job there are facets of it that are enjoyable or at least more enjoyable than others.  Adaptation could involve focusing more on the areas of your work that you find enjoyable both in what you do and in your thinking, setting up  workspace in a manner that helps you cope, making breaks more active in leisure (going for a 15 minute walk or calling a friend on a break and talk about sports instead of staring at your computer monitor endlessly repeating the word “hopeless” in your head) or taking small steps to another job or career while staying in your current job. Acceptance means letting go; if you hate your job thinking about it after you leave the office only means you’re keeping yourself in that environment longer than you need to be.  Life doesn’t have to be perfect in order for it to be worthwhile or enjoyable; having a bad job doesn’t mean you can’t enjoy your family, friends leisure or faith. Hint: mindfulness might be helpful here.

Although thought records and Socratic questions can’t miraculously change a negative event into something positive, they can be useful in helping us determine whether our reactions to the negative event are reasonable. While there may be evidence to support a negative outcome or less than positive conclusion about our behavior, thought records can help us think about next steps more effectively and can act as a brace against turning a mistake or bad judgment into a broader condemnation of our character or capacity.

If you struggle with a mental health issue like depression or anxiety, you may want to  consider that while the situation stinks the thought patterns associated with your issue may make it seem like it stinks way more than it actually does.

So therapy isn’t always about extinguishing the negative; usually it’s more about putting the negative in perspective, helping someone understand their options and that even if what’s uncomfortable doesn’t change, it does not have to define their life.

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