Can Individual Focus of CBT Harm Those Facing Systemic Discrimination?

Researchers highlight potential risks when CBT psychotherapy overlooks systemic issues in favor of individualized solutions, especially for marginalized communities.

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The practice of individual psychotherapy has been criticized for potentially perpetuating systemic oppression, particularly in cognitive behavioral therapy (CBT) methods. Critics argue that by emphasizing individual factors over structural ones, CBT may inadvertently marginalize those who already face systemic challenges due to race, sexuality, or other stigmatized identities.

A recent article, to be published in the October 2023 issue of The Behavior Therapist, authored by Isaac L. Ahuvia from the Department of Psychology at Stony Brook University and Jessica L. Schleider from the Department of Medical Social Sciences at Northwestern University, expands on this argument.

“Experiences of oppression and stigma contribute to poor mental health among a wide variety of marginalized groups. Examples in the United States are not sparse. Race-based discrimination is associated with poor mental and physical health outcomes among African Americans. Exposure to interpersonal victimization, structural discrimination, and negative social attitudes are all associated with poorer mental health among LGBTQ+ youth. On college campuses, women and LGBTQ+ individuals are the most likely to be the victims of sexual assault, which can have severe consequences for mental health. Multiple overlapping stigmatized identities confer additional risk. While oppression and stigma impact the mental health of individuals, their causes are structural,” Ahuvia and Schleider write.
“This poses a challenge for cognitive behavioral therapists who seek to help clients affected by oppression and stigma, as the ultimate cause of the clients’ problems are largely not within the control of either the client or the therapist.”

CBT, a popular form of psychotherapy, often centers on addressing and changing negative patterns of thinking and behavior in individuals. Its strength lies in focusing on factors within an individual’s control, thus empowering them to change their reactions to external events. However, the authors suggest that such a focus might be detrimental when applied to those facing structural discrimination. By focusing too intently on the individual’s response to oppressive experiences, CBT may overlook the more significant systemic issues at play, unintentionally placing the onus of change on the oppressed rather than addressing the oppressive systems themselves.

The authors acknowledge that many cognitive behavioral therapists have developed interventions designed explicitly for marginalized groups and strive to validate their experiences in a culturally responsive way. Nevertheless, they caution that even these culturally adapted practices might inadvertently lead to unintended consequences when the overarching emphasis remains on individual-level factors.

In their words, “there may still be ways that the individual-level focus inherent to cognitive behavioral therapy leads to unintended consequences for clients—even when it is applied in a culturally responsive manner.”

Typical CBT practice would have a therapist find ways for individuals to take care of themselves better, view themselves in a better light, and self-affirm themselves in ways that encourage growth and provide grace. Rather than thinking, “I did poorly on a test; I am stupid,” CBT could help someone frame it as “I did poorly on a test; I can yield change by talking with classmates or my teacher and giving myself a better foundation for next time.”

This would be a positive result of CBT, but the same solution cannot be found in a scenario where someone’s negative self-appraisal stems from stigmatization or othering. For example, LGBTQ+ youth may be led to make harmful decisions about coming out. Someone who thinks, “I am bullied because I am queer,” cannot necessarily, strictly positively change their behavior to amend the situation.

Where CBT asks someone to reexamine what is in their control, LGBTQ+ youth may be guided towards outness decision-making. In other words, if CBT frames systemic oppression (human rights violations, bureaucratic neglect/abuse) or interpersonal stigma (bullying, abuse) as something the individual can control, LGBTQ+ youth might hide their sexuality/gender/queerness to improve their negative experiences. Or, in the opposite direction, LGBTQ+ youth may come out in situations where their safety/housing is not guaranteed.

The authors make clear that another potentially harmful result of CBT that places undue focus on the individual is a rift between the therapist and the person seeking mental health treatment.

“Focusing on individual-level stigma processes as a cause of the client’s problems may cause harm when the client sees their problems as the result of higher-level structural forces. Misalignment between client and clinician in their explanatory models—the way that they understand the client’s distress—can damage the therapeutic alliance and reduce treatment engagement.”

Stigmatized individuals are made to feel ostracized to begin with. When they are provided with an opportunity to meet with a therapist, which in and of itself can be rare, therapy that does not align with their views of their problems can make them feel as though there is no one in their corner. Community and collective action are incredibly beneficial for minority groups, especially LGBTQ+ people. However, not all minority groups in America can find community wherever they go, and isolation can lead to worsened mental health.

Therapists represent a safe and healing space for people who feel they are facing stigma alone. A lack of awareness – the authors call “structural competency” – can destroy that safe and healing space. The researchers emphasize that future research needs to empirically investigate the potential for harm by asking stigmatized people about their experiences with therapy, ostracization, and the degree to which they have found healthcare professionals structurally competent. They suggest that therapists update their understanding of structural problems to safeguard the well-being of people with problems that cannot be fixed through internal changes.

 

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Ahuvia, I., & Schleider, J. L. (2023). Potential Harms from Emphasizing Individual Factors Over Structural Factors in Cognitive Behavioral Therapy with Stigmatized Groups. PsyArXiv. https://doi.org/10.31234/osf.io/n65fj (Link)

20 COMMENTS

  1. A positive advance. But it does show that some interventions are implemented without damage control, without knowing before hand what the harms of implementing it are.

    The research proposal going forward feels overdue, given CBT is apparently over 60yrs old. And it might be difficult to address the inner structural issues of the therapist. Maybe at the end it will wait until new generations of therapists become structurally competent, in college…

    And maybe it is why, perhaps, until now, recently?, structural competency as defined is in vogue: diversity might be more open, frequent and widespread among candidates to psychotherapist.

    Although the article at the begining gives me the impression is an already acknowledged problem.

    And it seems to acknowledge, maybe not explicitly, that addressing the clients issues, require a way bigger toolery than psychology. Maybe a new new generation of psychotherapists will finaly learn to coordinate ALL the interventions necessary, like a good GP and a social worker/community nurse were supposed to do. Hopefully. The psychotherapist becoming society…

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    • CBT as practiced by many often does encourage clients to ignore or minimize or intellectualize social causes of distress. I find it useful in certain contexts, but see it as a tool, not a therapeutic school. It works fantastic for some people in some situations (I use it all the time myself), but there are times when “empowering oneself” has to take a back seat to taking an honest look at what’s going on or has happened in the past. For instance, a domestic abuse victim might learn to “think different thoughts” so they find their abuser’s comments less upsetting. This might be a useful skill, but it does not BEGIN to address the needs of the client. If all we gave our DV victims was CBT, we’d be doing them a gross disservice. Same with folks with big tramua histories. Telling them to “think different thoughts” is a short step from “get over it, you wimp!” And lest you think I’m exaggerating or making this up, several people have reported on MIA that they are told by their therapists that they should “not think of the past” and that processing historical emotions is a waste of time and they need to “Be mindful” and “focus on the present.”

      A good therapist can use CBT to get good results when it is appropriate. A bad therapist can use CBT to create an emotionally unsafe environment for their clients and effectively make their “mental health” status worse.

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      • So basically history has no relevance to the present when it comes to feeling good now?.

        Oh, that sounds like disconnecting or disassociating from oneself. Like my me is something new, detached from my previous experiences, like ECT-light therapy with the use of mindfullness.

        And contradictory, because one of the benefits or effects of mindfullness, like focusing on one’s breathing, is precisely to perceive past, present and future, and all one’s previous lives as a single, impermanent stuff.

        Not classical description of mindfullness, but I think an effect might be that. To perceive the ultimate reality of existence unique to each of us.

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        • That does seem to be the message. At least from the incompetents. Just “think different thoughts” and your emotions will change! A bit of magical thinking, there. I mean, in the LONG RUN, it’s probably true, but to make out that a person can just “change thoughts” on command, especially after years of trauma or living in current danger, chronic or acute, is patently ridiculous. There’s a lot of trust building and examining patterns and detecting the purpose of certain behavior/thinking from the client’s viewpoint and a lot of “what ifs” and “Let’s imagines” before anyone gets around to saying something as monumental as “I’ve changed my viewpoint. I don’t need my mother’s constant involvement to survive.” People believe what they believe for a reason. It doesn’t work for a therapist to say, “That’s a bad belief, you need to change it!”

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    • And ironically, as this piece suggests to me very thinly, it does not address maladaptation of the therapists, of CBT promoters/defenders, victimizers of patients, or the society at large.

      So even if, it might look everywhere else but at the problem, as a rational sentient caring adult, even a kid, would. The whole picture, not just what I feel about it. Particularly if the looking is for solving a problem, even if its just the feeling.

      Like, try to focus not on how your life shortening job makes you feel, try insted to change your feelings about your job. Don’t worry, that cough won’t last long if the actuarial tables are accurate for you. (The worker was a miner in the 1920s). Assuming of course, CBT was available in the 1920s.

      Which to me sounds laughable having the word cognitive in the mix.

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    • As a practicing therapist (LPC) that has (from a young age) and is currently surviving poverty and navigating systems of oppression based on skin color, race, social class, and sexuality, I very much agree with your comment. A competent therapist can help individuals navigate the unfair environments that people are surviving and it can serve as a tool to help people determine what’s perception vs what’s the likely objective truth of any stress inducing trigger that is generated at the individual level or as a result of something objectively negative (i.e., a discriminatory attack) the client may have actually survived. Afterall, the goal of counseling is to change the person rather than the environment as therapists are not politicians or law/ethics enforcers; if the person is unable to change the environment, then the next best thing is finding out how to navigate the environment or make a plan to eventually get to a different environment and/or contribute to any changes in the environment however possible.

      As a member of oppressed groups, I know that it can be hard to separate out communication challenges/misunderstandings vs what was intentional harm towards me, at times. CBT can be very effective at sorting this out and any of the distortions such as avoidance/unhealthy distractions/unhealthy coping or fear-based thinking that can run rampant as a result of living in perpetual trauma that a person from an oppressed group may have been exposed to for most of their lives.

      I find CBT very effective for myself and the clients Black or White (and anyone in between) that want to take responsibility for how they navigate an inherently unfair world all of us live in and survive

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  2. CBT in my youth lead me to believe everything around me was my fault. I was abused and I had no control, and being told by a therapist that it was because I reacted poorly to the abuse caused me to isolate myself rather than “hurt people”. I wasn’t hurting people. I was fighting back when people hurt me. I spiraled into a deep depression and nearly didn’t survive it. I’m an adult now, and I’ve done a lot of healing from the pain CBT caused me. But I no longer trust therapy at all. It’s not for me. I’m glad people are starting to see it for what it is. This article was affirming to me.

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  3. “A good therapist can use CBT to get good results when it is appropriate. A bad therapist can use CBT to create an emotionally unsafe environment for their clients and effectively make their “mental health” status worse.”….from Steve McCrea, in reply comment above….

    According to his own definition, ALL PSYCHIATRISTS and psychiatry itself meet his definition of “bad therapists”….

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      • So that happens too to clinical psychologists, eh?. “Why I am not surprised?” 🙂

        Now I don’t feel so “ronery” (from “Team America: World Police”).

        And yeah, I quit because medicine became imposible to figure out for me (hehehe, “weary but not reary” generalization, also from TAWP), simplifying, from the published literature. The garbage analogy used at around meta-analysis seems more than apt.

        And I didn’t want to become “El Ecoloco” with his “Ecoloquito”, which in this case would be the next generations of physicians…

        But if I rmember correctly, this is from decades ago, “El Ecoloco” wasn’t always like that, living and thriving, yes thriving in garbagge, despite his for the most part “evil” intentions. But, “El Ecoloquito” might not be able to tell the difference even if he were to live for a good period of time out of the garbagge. I imagine.

        Funy to me how art for children from decades ago translates so well, from my POV to meta-analysis, at least…

        And in another language and cultural background! “Amaaaazing!” (from “Archer” the TV series).

        Maybe it’s aptness comes from foretelling the climatic catastrophe not really elaborated in the story of “El Ecoloco”, which seems to me way to analogous to me to not reflec something underlying the parallels to medicine, and way more aptly to psychiatry.

        There are a lot of “Ecoloquitos” in psychiatry.

        And to draw more parallels, even funnier that the Director of the “Fray Bernardino” psychiatric hospital in Mexico, the biggest one there, said: “people think we [psychiatrists] are a little crazy…”, using the word “loquitos” diminutive of crazy.

        When, following the parallel She would more apptly could have said: “People think we are Ecoloquitos…”

        Because they are destroying the ecosystem, as el Ecoloco y el Ecoloquito were doing in the TV series “Burbujas”. Just in the case of the director refers to the ecosystem of humans, of people…

        And if me becoming an Ecoloco seems grandiose since I after around 15yrs haven taught anyone anything explictly about my art and science of medicine. Then read me out:

        Some of my case approach to patients was even copied in writing in at least the last biggest and better in town hospital more than 10yrs ago. True, it was, I saw the notes.

        So even if I didn’t teach, I was understood and reapplied, heck even emulated, but that would be grandiose to me. But I changed a little the approach to the patient at least in that hospital, who knows!. True story…

        A good example is for that as a bad example: something just to copy… or not…

        Ecoloco or Ecoloquitos…

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      • And following somewhat implied analogies:

        ——-The Director of the Fray Bernardino, Dra. Pazaran, might have been trying to say: “Maybe then they will take us seriousryyyyyyy!! with a high pitch end, also from “Team America: World Police”.

        Which, “jebus!” (from “The Simpsons”), sounds like another too apt to be coincidence analogy to me: “World Police”.

        Hahaha, today I fell in to the “wilderness of mirrors” of James Angleton (from “The Good Shepherd”).

        “I’m throwing rocks tonight!” (from “The Big Lebowsky”).

        And as a disclosure to acknowledge my conflicts of interest: I have a couple of documents that do suggest the Dra. Pazaran could have violated the law in her previous public office. One in original with her signature, address, professional registration number (Cedula Profesional), etc.

        And one a copy from the “damn internets” (also from “Archer”), for the “license” she held as responsible in her, AFIK, public office. She omited putting, at least, her FULL name, which AFIK is/was an ofense with up to 180 days in prison for each case. I am no lawyer, and I am not charging or imputing anyone nor anything, just my analysis for purposes of disclosure.

        I imagine if she wrote THOUSANDS of prescriptions for controlled medication without her FULL name? that would mean over 180,000 days of prision as a possibility.

        I no longer wonder why she was promoted from her public office in a small city to the biggest public psychiatric hospital in Mexico.

        Just the colusion, omission and complicity might have been damaging to a lot of people, from the pharmacists, the pharmacy chains, the supervisory authorities of health at least in her town, the official who “stamped” the license for the place she held office, even the Governor, etc.

        And I imagine a cursory journalistic investigation to unearth the license for the CISAME of Torreon might prove that, unless my copy is forged, innacurate or else…

        And that would leave to explain why my copy is innacurate, admiting and accepting it was provided to me, and I am no journalist either… and that is only a partial, by reference copy…

        And as for the other document with her signature, I bet after some scandal that led to her “promotion” a lot of insiders willing to talk, heck!, a lot of her former patients!, might mention and confirm if in fact some or a lot, or ALL her prescriptions in a period of time, for dangerous substances like parenteral neuroleptics, clozapine, and lithium were not only signed, but supplied in pharmacies WITHOUT her FULL name.

        Not only in violation of health law, but of criminal law, AFIK, as “variation of name” (“variacion del nombre”). But I am no lawyer and given the implications I fear, yes fear, even the judiciary might not look at her actions with the at least indignation I do.

        And to add insult to injury as part of my disclosure of conflicts of interest: Even the 2nd “cappi di tutti cappi” (cultural reference) congratulated Mrs. Pazaran on her new prestigious job.

        Apparently unaware of her omissions in providing her full name in controlled prescriptions AND probably a health license required to treat some of the most vulnerable individuals in her previous town of residency: Torreon, Coahuila.

        And the injury comes because Mr López-Gatell, PhD López-Gatell, is alredy in hot water as imputed responsible for the bad outcomes of the Covid Pandemic in Mexico, and the unavailability of cancer drugs for minors. And is now a precandidate for the governorship of the biggest city in Mexico, where Mrs Pazaran also works…

        Hence my disclosure, nothing more, nothing less.

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      • I had made a comment about how driving the rare exception to bad therapists out of to profession reminds me of the movie Team America: World Police. With emphasis in Team and Police.

        Using the example of the director of the Fray Bernardino, the biggest psychiatric hospital in Mexico, whom according to documents in my posession at least once, and given that prescription pads are produced in quantities of at least 50 or a 100 sheets went against the text of health and criminal law by apparently signing at least one prescription, in my posession, with her incomplete name for controlled, i.e. risky or dangerous parenteral psychiatric medications.

        And she got promoted after doing that who knows how many times at least from a comunity MH care center to the biggest hospital.

        How that could involve health authorities, pharmacies and even the Governor.

        And how apparently from another document provided to me, the sanitary license where she used to work before moving into the Fray Bernardino could also have her incomplete name as “responsible” person to a mental comunity care center, where she was as I understand a public official. This one without her signature, and it’s not an original, it’s a quote from an internet directory of mental health facilities in Coahuila, Mexico.

        And how that now is mixed with the allegations in the press/media of the problematic shortage of chemotherapy for children and the alleged poor outcomes of the Covid pandemic in Mexico by the person who congratulated her publicly on becoming the Director of the Fray Bernardino.

        Alleged responsible in the press/media of the shortage and the alleged bad outcomes. Just by a handshake, congratulation and the perceived omission of due diligence in appointing her, if what I narrated were to be corroborated, further documented in journalistic or official manner. The implied or perceived colusion, omission or disregard, among others.

        Impunity might be the perceived message. Similar to allegations of plagiarism involving the mexican Supreme Court, with the difference what I am narrating, with its documentary support, hasn’t reached the mexican press.

        Knowing that by using an incomplete name in said documents, or even some other documents could imply up to 180 days in prision for each instance. And for 50 prescriptions that could be 9,000 days, or 24.5 yrs of prision. Asuming some things, with caveats subject to law interpretation, but oddly, apparently not to intent, to “mens rea”, not to guilty mind.

        Promotion, not exposure. not investigation, not justice in legal maters, I am no lawyer nor providing advice, of illegalities that are formal, that is where intent is not a relevant, if at all consideration.

        As I understand it, and how that is SO relevant to psychiatry at least in Mexico. And might be easy to be corroborated journalistically by procuring a certified copy of the sanitary license for the CISAME of Torreon when she was the responsible “official”, and talking to patients to whom the now director of the Fray Bernardino signed the prescription pads for probably benzos, neuroleptics, estimulants, etc. Speaking to the most vulnerable at least at some period in Torreon, Coahuila, Mexico. Even if just “50 pads”, even 20/25, with an incomplete name.

        What I did not wrote is that such information I have trouble commenting it, making it public anywhere else than in MIA.

        Thanks again for at least making it “possible”, for giving me a chance, to perhaps help someone with my comment. For me it would be very difficult doing it anywhere else, aware it might have a bigger impact.

        But I was driven from things, places, forums, rights, even opportunities to help, bigger than a profession…

        Hence the motivation for this comment and its relationship to the one I am “replying” to.

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  4. It is imperative to establish a clear distinction between individual factors and structural factors. Individual factors encompass aspects such as cognition and behavior etc, while structural factors predominantly pertain to the legal framework (politics) and its intended application, which may or may not encompass individuals categorized as “others” within the system. It is noteworthy that the focus of therapy often centers around individual dynamics, as therapy inherently involves a structured framework where individuals seek assistance and are required to compensate for the services of a professional who provides a receptive ear.

    It is essential to acknowledge that the field of psychotherapy operates within the framework of capitalism and is fundamentally a business endeavor. This is not inherently problematic, as capitalism underpins various aspects of our society, including the provision of mental health services. However, it is pertinent to recognize that many therapists may not receive comprehensive training that encourages critical examination of their role within this system. The integration of this awareness into their practice is an area that warrants greater attention.
    In the simplest form: therapy focuses on giving “love” and “care” rather than empowering and encouraging non-compliance in others because that is seen as “disruptive” to the system. I am not recommending chaos only that people understand the system and its weakness and how to maneuver when one needs it as well as those the system was made for. Balancing act of privilege and tokenisms which are same in the scheme of things.

    Therapy businesses are to psychiatry like nurses are to the surgeons. They regulate the society to follow rules, regulations, and what we may sometimes call social cohesion and social construction so they do what they were designed for.

    A personal example: In my country of origin, I faced limitations in choosing my life partner, maintaining single status, living independently, and managing my finances. However, upon moving here, I found the freedom to marry the person of my choice, remain single if I wished, live independently, and exercise control over my finances. This notable shift in circumstances not only led to a substantial improvement in my quality of life but also enhanced my sense of assertiveness and ambition as a woman here both economically and politically. I do not view myself primarily as a woman subjected to oppression in this new environment because I am looking in from outside and move systems to my liking by ignoring certain behaviours that are cultural not universal. imagine when in therapy and I was cornered to see how oppressed women are here and I should be – I could not relate because I gained success in this area but see dis-empowering in other areas. Even my opinion that therapy is capitalism was seen as barbaric!

    Ultimately, it is not so easy to live in diverse world but this is a good start!

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  5. Fuck CBT. Fuck therapy. Fuck the whole fucking “mental health system”.

    Why not just say to yourself, “My feelings are valid, but better to wait till I’m in a safe place before sounding off. There’s other ways of handling myself in certain situations.” No therapist required.

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    • CBT is part of psychotherapy. Psychotherapy is part of clinical psychology, etc.

      I think that the current situation that leads to anger, defiance, resistance, critique, criticism, censorship, disqualification, etc., holds a lot of parallels with the times when psychoanalysis was being questioned. Which was always…

      With the difference there are TWO cults pretending to fight for the lucre, the money, the dough: clinical psychologists and or vs psychiatrists.

      CBT is the go to horse for the first, medications is for the seconds.

      Split, diversity of offerings, represent market forces: those harmed by psychiatry go to psychotherapy, those unacceptable, complaining or annoying to the first are pushed to the second. Folks with no money and no support go to jail or the street. Our way or the highway.

      Seen that way, one with CBT the other with Meds, both serve the same purposes: provide profit and serve the larger interests of society. Evil and harmfull as they are. Pretending to disagree without admission of wrongness and harm either way is at least disingenous. But it serves to maintain the status quo.

      That’s an economic, market driven use of CBT, regardless whatever arguments the pros say about it. It’s social value and use trascends clinical psychology. And in that sense debate does not belong exclusively to specialists. Their disagreement is irrelevant to where CBT fits in society at large. Their opinion is valid and usefull, but carries little, if at all, weight outside their “clica” and the patients convinced, sometimes bamboozled by it.

      It’s a polis issue, not a philosphers issue to use a classical analogy. Even old Temistocles had something useful to say and show about CBT…

      And the peripheral industries that feed, fuel, profit and manipulate the apparent fight have their word but their word can’t be dealt uniquely by appropiateness in the eyes of either of those parties: It still is a citizens issue, since where each and the mix fit in society is again an issue for citizens to decide, not specialists in each field.

      Hence silencing voices on grounds of “innapropietness”, “irrelevance” of “off topic”, misses at least the point that specialists have a saying but their opinions and judgemnts carry no more weight that citizens voices about where in society and it’s discourse the specialists’ hits and misses belong.

      They even have a notorious conflict of interest in quashing someone else when it comes to appropiate, relevant and the like. They have personal and guild interests, admited or not. Imagine the folk studying 10yrs of post highschool to find utility, profession, carrier and income where there is no decent, scientific, useful one. Is it expectable for this folk to become like the “others”?.

      To me there is no fight, it looks like wrestling. And as in wrestling there are good people, serious people, propostive people, etc.

      Even forums that intend to move to quash psychiatry can fall prey to clinical psychology’s false facts, bad hypothesis, etc. So at least one average citizen starts to question if joining with even worse fellows, at least more honest in the fight makes more sense than trying to bring rationality to such debate. Same incentives, same response: CBT vs Meds.

      Even debating/commenting clinical psychology feels like pointless, same as talking to a practitioner of either…

      I am not encouraging to join anyone: “There are vultures!, vultures! everywhere, everywhere” (from the movie: “Casablanca”).

      So, to land on relevance, CBT is around 60yrs old, and still finding out “its problems”, really?. Some folks are still peddling psychoanalysis despite being thorougly debunked by even it’s practitioners as Lacan close a century ago!.

      And I would would have imagined that using reasoning and its fails, its fallacies, might have catch 60yrs ago what this review brings forward, but the fail speaks volumes about how to reason with CBT, without, precsely closing the circle, getting into the details, without using the props, the specialized discourse of psychology, or clinical psychology.

      In that way easy to dismiss even the intersectionality and its calo, its lingo, its “barrio” speech, which in citizens I adore, can’t have enough of it, btw. Without calling for anti-science of course, nor antihuman: I am an idiot not antibussiness. Irony…

      That to me is the value of citizenship:

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  6. I feel mixed, as I don’t think this article goes hard enough on understanding that CBT is oftentimes used (intentionally or not) as an active tool reinforcing white supremacist, ableist oppressions. An ACTIVE tool. I think that’s been a bit buried and sanitized in the academic language here. Which, maybe that’s what it takes to be published.

    This feels so incremental. I simultaneously appreciate attempting to critique CBT. I still also feel minimized as a person who experienced astounding personal harm from CBT, and know dozens to thousands of others who feel similar.

    This is ABUSE. This is OPPRESSION. Labeling it as anything else does a disservice.

    And yes, we need to not erase those who it helped. That is both a real concern, and also at times a strawman used to weaponize and dismiss very valid critique. So many CBT abuse survivors face astoundingly amounts of being doubted, outright despised, constantly gaslit, etc.

    I thus call on researchers to not ignore that environment of hostility. Lean on ethnographic studies. Incorporate lived experience survivor perspectives. Don’t minimize or excuse direct abuses.

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