Why CBT alone does not help in a crisis.

First, we need someone to witness our turmoil

Why CBT alone does not help in a crisis (c) KarinSieger.com

CBT (or cognitive behavioural therapy) did not help me in a crisis. While it is a valid type of therapy and counselling, which at times I integrate into my own work as a therapist, it did not help me FEEL my anxiety and pain, which has to happen first, before emotional change and improved wellbeing is possible.

From experience, I find that for this well proven technique to work best, certain other boxes need to be ticked first.

We need to be emotionally and mentally ready for CBT.

Let me explain.

Imagine the last time you were in a crisis (eg relationship, physical health, work, finances, bereavement etc). What did that feel like?

Like most people, I have had several crisis points in my life, and many more are bound to happen. The biggest one was my cancer diagnosis. Because everything in my life was thrown into turmoil, chaos and uncertainty. There was no safety net and very little direction. My anxiety and that of those nearest to me rocketed sky high.

You don’t need to be affected by cancer to understand what I mean. It’s just an example.

At a crisis point, feelings and often thoughts are confusing. Our body and mind go either into fight or flight. Some people may switch between both.

Do you recognise those feelings? Often there is an emotional numbness and / or determined focus on only one thing in order to avoid the rest. Or we just crumble and give up.

There is no right or wrong.  Some coping mechanisms at moments of heigthened anxiety, trauma and depression are more helpful than others. We do the best we can, while we are either frozen or flooded with a weight of confusing emotions.

Now imagine doing CBT therapy or counselling, when you are in that place.

To put it into a very simple nutshell, CBT helps us look at things in a different way.

The idea is that with a different attitude and understanding, we will behave differently, and therefore also feel differently.

Now, I am not arguing with that premise. I am sure a lot of good is done with CBT. But it is not the answer to all our mental health problems.

When I was at my cancer crisis point, I was mentally and emotionally too overwhelmed, confused and closed to be able to try out new ways of looking at it.

And what’s more, I did not want to look at it, never mind differently!

I was distraught, angry, and stuck in disbelief. Neither did I have the mental capacity nor the necessary attitude and willingness for the change that cognitive behavioural counselling helps facilitate.

For CBT to work, I would have needed an acceptance of my new reality and willingness to face it and work it through.

All of that did happen for me, a lot later, and not with CBT.

What I needed first and foremost was someone to 

  • listen and witness my turmoil;
  • just give me space to let out my confused thoughts and feelings;
  • accept and not want to reshape my anger and anxiety;
  • back off instead of giving advice or rushing ahead of me with solutions;
  • put up with my feelings;
  • be strong, so I do not need to take care of and protect from my feelings;
  • be grounded enough not to flinch, when I say cancer or death;
  • respect my distress and confusion.

Someone that gives me just a bit of hope, just sits there and does not do much else.

Another human being who sits with me, and sits through it all and somehow holds it all together for me.  

And in doing so holds me together, until I am strong enough to hold myself together.

When that is in place (and often that someone is a counsellor or therapist, and some of these approaches might be called relational, person centred, integrative, humanistic, transpersonal), then we can eventually move the lid off the emotional pressure cooker, without fear of a destructive explosion or self combustion.

Because the calm and steady listening and being with us of the other shows that they can. They did not break and did not explode and did not run away.

So perhaps I can do that too and can contain and deal with my anxiety, rage, grief, hopelessness and sense of depression.

It did take me a while to get to that place, where I could feel all that without fear.

For CBT to work, we need to have done the feeling part first.

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Based on an article published by Huffington PostImage courtesy of Engin_Akyurt


  1. I quite agree. CBT may surely be useful in cases such as specific phobias, but in my view and self experience, an integrative therapy is needed in crisis such as losses, serious illness, and others. Clear and complete article.

  2. I wish more people realised this. CBT is seen as a panacea and it is not. You need to be in a fairly good place before you can think about it and then apply it.

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