CBT Patients Want Understanding, Not Homework

CBT interventions were perceived as superficial, while therapists' positive personal qualities were essential.

A recent study published in the Community Mental Health Journal has shed new light on the patients’ experiences of Cognitive Behavioral Therapy (CBT) for anxiety and depression.

Becky Yarwood and her colleagues from the University of South Wales and the University of Liverpool conducted a comprehensive review and meta-analysis of Cognitive Behavioral Therapy (CBT) treatments. The study revealed that many patients undergoing CBT found the treatment techniques to be challenging, burdensome, and superficial. However, patients also appreciated the personal qualities of their clinicians, such as being empathetic, impartial, and reliable, which helped in their recovery process.

According to the researchers:

“This review supports the delivery of in-depth clinician-led CBT for anxiety and depression. A nonjudgmental, trustworthy, and understanding clinician appears to be highly significant to the recovery process.  CBT being not in-depth or long enough and being too demanding were considerable barriers to engagement with therapy.  This supports the provision of therapy, which is not limited to a pre-determined number of sessions but rather a natural stopping point for therapy upon reaching recovery goals. This may allow service users to reach goals without the pressure of the need to make progress in a time limited setting. Overall, despite its perceived flaws, CBT was mostly well-received and facilitated positive changes relating to mood, confidence, and self-discovery, with a proficient therapist playing a significant part in the recovery process.”

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José Giovanni Luiggi-Hernández, PhD
José is an instructor and qualitative researcher who received his doctorate from Duquesne University. He also has a background in public health, receiving his master’s from the University of Puerto Rico, Medical Sciences campus. His research and clinical interests involve understanding the lived experiences of colonized people using phenomenological, psychoanalytic, and decolonial frameworks. He has also studied LGBTQ issues, psychotherapy for physical health concerns (e.g., chronic pain and diabetes), among other projects.


  1. “the ruling dogmas of clinical psychology, usually referred to loosely as ‘cognitive behaviourism’, embody an, in my view, extraordinarily simplistic collection of ideas about how people come to be the way they are and what they can be expected to be able to do about it. For example, how people learn things, how they form and change ‘attitudes’, whether and how they can control their ‘thoughts’, are often dealt with in psychology according to models that have been constructed from a combination of everyday, common-sense (and occasionally contradictory) assumptions and simplified laboratory experiments which scarcely do justice to the complexity of human experience. Such ideas, acceptable enough perhaps to undergraduate students learning the experimental ropes, ring particularly hollow when they come to be applied in the clinical setting, where people’s difficulties are often complicated and intractable.”

    David Smail in his book How to Survive Without Psychotherapy

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    • Gerard, as I was looking up “How to Survive Psychotherapy” I came upon a book called “Manufacturing Victims: What the Psychology Industry Is Doing To People”, by Tana Dineen. Both sound like good reads.

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      • Big thanks Birdsong for the book recommendation, and I totally concur that Gerard’s quote is a gem. FWIW, I think CBT, within the context of critical psychology and other critically informed process, can be pragmatically useful and even leading to long term benefits. But in my estimation, viz personal experience and lost of like stories from others, CBT has a fundamental propensity to suppress critical consciousness, i.e., memory, experiences, power abuses, etc… especially when CBT is facilitated by conventional professional mental health practitioners…

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    • Wow so well put I’ve been struggling to say this for years. CBT is the worst offender by far in this regard. Events cause emotionless automatic thoughts which cause emotions? Ridiculous. And cognition is linear sentence construction, open to the same correction scheme as analytic argument? Insane. I was subjected to infinite CBT and was always recriminated for not benefiting. Now I know a thing or two about philosophy and neuroscience and life and realize how unbelievably stupid and reductive cbt is. It’s literally been repudiated by cognitive science! With all its flaws and shortcomings, cognitive science can’t even be marshaled to support this intervention, which is based on a theory of cognition! I remember reading a cbt therapist defending against this charge saying ‘well, cbt is not meant to be a rigorous or accurate model of the mind.’ WHAT? And now we’re finding out what we always knew: therapy is actually just an instance of human connection that can be successful or unsuccessful based on the same relational qualities that matter across the board when someone is suffering. At this point all my friends, who’s suffering was not quite as destructive as mine, have tried cbt of their own volition and I feel affirmed by the ubiquitous reaction: this is unhelpful and in fact dumb. They simply cut the cord on the therapy because they found it unhelpful, no
      One to coerce them into it infinitely because it must be on them if it’s unhelpful. Anyway thanks for this very validating.

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  2. A likely more comprehensive approach is in Acceptance and Commitment Theray. The problems noted by the author could be true with using any “theoretical model” not taking the unique situation and history of the person who is seeking Therapy.

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