Ensuring your Cognitive Behaviour Therapy (CBT) Practice is Anti-Oppressive, LGBTQ+ Affirming, Neurodiversity Affirming, Anti-Racist, and Trauma Informed
CBT is often critiqued for its lack of consideration of oppression, devalued groups, structural and systemic problems and trauma. We have to work hard when using CBT not to become robotic and in order to avoid causing harm. Here is an non exhaustive list of what you should and shouldn’t do to ensure that your Cognitive Behaviour Therapy (CBT) practice is anti-oppressive, lgbtq+ affirming, neurodiversity affirming, anti-racist, and trauma informed.
Do :
Understand the origins of CBT and their implications. This model was developed by a white male psychiatrist. It stemmed from a medical model. Though this approach is often seen as the gold standard in treatment, this is due to the vast amount of research that has been made possible. Let’s not forget who historically have had the loudest voices and the most access to resources; white men. This does not necessarily mean that other therapeutic modalities are inferior, they may have had less access to resources for research.
Make sure that cultural considerations are at the forefront. The vast majority of CBT research has been focused on European Americans which can cause problems in practice. Make sure there is space for the client to share how their cultural experiences have impacted them, not just once, but over and over throughout the therapeutic experience.
Ask for consent before looking to “work on” something a client brings up in session. Do they consider this to be a problem? Do they want to work on this or are they just wanting to be seen and heard?
Ask for consent to do exposures or behavioural experiments. Ask individuals if they feel strong enough to challenge themselves, or to push their edge, do not impose this on them.
Help clients build safe communities. Support clients in finding communities that align with their culture, religion and values as a way of building resilience and connection so that they are not to face their difficulties in isolation.
Do not :
Forget the emotional component of CBT - it is not in the title, but this model is meant to encompass the relationship between thoughts, emotions and behaviour. If we do not address the emotional component of the client’s experience we may be re-enforcing an intellectualisation of their experiences and keeping them stuck in harmful states also re-enforcing a neo-liberal way of being : detached from our bodies and in productive mind mode.
Look to change a client’s perspective or call out “thinking errors” when a client is describing true risk, true harmful situations, systemic or structurally imposed suffering. I.e. a trans person scared to go clothing shopping. Help them find ways to increase safety and support in this environment. A neurodivergent person fears unmasking will result in stigmatisation - help them identify environments where they can safely unmask or to have the ability to determine risk and to assess whether they are comfortable with the level of risk.
Impose diagnostic criteria on clients without knowing their stance on diagnoses/the DSM. Really consider how this knowledge will impact them or if it will impact the change they are able to make through therapy. Some clients find having a diagnosis helpful to self acceptance and understanding, others find this to be pathologizing.
Skip validation before moving into change interventions.
Use behavioural activation in the way that many understand it ; as a “get off the couch and you will feel better” type approach. Instead, look at what is blocking the client from being able to engage in the things that they used to enjoy and address these factors.
Have the client turn every negative thought into a positive thought.
Have the client challenge beliefs that have kept them safe before validating why these beliefs came to be - especially if these have a route in trauma .
Stick to the agenda/structure of the session at all costs. For example, when the client is dysregulated/crying/highly distraught it is important to first be with this person, help them feel their feelings, validate, help them come back to baseline before moving back to their previously set out goals.
Impose behavioral experiments on clients - have these flow from their change in perspective and have them give themselves a challenge based on what they have learned.
I myself mostly utilize CBT in my sessions with individuals, but it feels of utmost importance to be responsibly implementing it. I hope that this article gave you some concrete ways to increase the inclusiveness of your practice.