The Mechanics of Genuine CBT

I’ve been posting on the power of Cognitive-Behavioral Therapy (CBT) when properly and faithfully applied to help ameliorate a variety of problematic psychological conditions (See also:  A Primer on Cognitive-Behavioral Therapy and Cognitive-Behavioral Therapy Primer – Pt. 2).  CBT is an especially helpful approach in dealing with character disturbance but it’s also proven its worth in many other areas including anxiety disorders and anxiety-related conditions, trauma recovery, mood disturbances, and impulse control problems.  But as I have noted previously, it’s not uncommon for the most important part of the CBT paradigm (i.e. the behavioral component) to be afforded less than optimal or even no attention.  As I have asserted many times, genuine change always occurs in the here-and-now moment, and for change to be properly promoted and reinforced, problem behaviors must be reckoned with at the very moment they occur.  Toward that end, over the years I developed worksheets that both individuals with character impairments and their relationship partners have used to confront and correct dysfunctional behaviors, thinking patterns, and attitudes (These behaviors, thinking patterns, and attitudes are also outlined in my books In Sheep’s Clothing and Character Disturbance, and to a certain extent, in The Judas Syndrome).  I developed two versions of each worksheet, one to assist the person with the thinking errors and problem behaviors both spot and self-correct them and another to assist a relationship partner with recognizing and calling out these dysfunctional habits.

To give you an example of how both problematic behavior and thinking patterns are targeted with CBT, here are some excerpts from the worksheets fashioned for persons with character impairments:

From the worksheet on Thinking Errors:

ERRORS IN THINKING

Adapted from the work of Stanton Samenow, Ph.D. and modified and expanded on

by

George Simon, Ph.D.    (Latest revision: 03-15-06)

NOTE:  There are many erroneous or problematic ways to think.  These are just some of the more common thinking errors.

1. EGOCENTRIC THINKING.  Thinking only about myself and what I want.  Thinking that the world revolves around me.  Not thinking about others or whether what I want is really right, good, legal, or might hurt someone.  This kind of thinking promotes a self-centered attitude and a disregard of my social obligations.

6. DECEPTIVE (WISHFUL) THINKING.  Seeing things as I want to see them, rather than as they are.  Lying to myself and trying to hoodwink others so I don’t have to take an honest look at things.  Distorting the reality of situations so I don’t have to change my point of view or ways of doing things.  This way of thinking causes me to live in a world of my own fantasies and promotes an attitude of disregard for the truth.

8, EGOMANIACAL THINKING.  Thinking I’m so clever, important, or bright that I can and should do whatever I please and get away with it.  Thinking I’m so special that I am entitled to have whatever I want just because I want it.  Thinking the world owes me because I am special and important, rather than being willing to earn the things I value. This way of thinking promotes attitudes of arrogance, superiority, and especially, entitlement.

And from the worksheet on problem behaviors:

RESPONSIBILITY-AVOIDANCE BEHAVIORS

 Behaviors that Obstruct the Internalization of Behavioral Standards and Controls and are often Used as Tactics to Manipulate Others

 By

George Simon, Ph.D. (Revised 1-28-11)

 NOTE:  There are many tactics a person can use to manipulate others and resist accepting responsibility.  These are some of the more common ones.

1.  Rationalization.   Attempting to justify a behavior or make an excuse for it despite knowing that most people would agree it is inappropriate, harmful, or wrong.  Having an answer for everything, so that when others confront a problem behavior on my part, they might begin to doubt the legitimacy of their concern.  Trying to get others to “buy into” my excuses so they can be manipulated into backing-off or backing-down.  Telling myself that what I really know is wrong is okay, so that I have false justification to do it again.

4.  Minimizing.  This is when I make a molehill out of a mountain.  It’s when I try to convince myself or others that whatever I did wasn’t really that bad or harmful.  It’s also when I admit only part of what I did wrong, and usually not the most serious part.  Sometimes this is a tactic to make others think I’m not such a bad person.  Sometimes it’s the way I keep myself from admitting the full extent of my character or behavior problems.  If I keep minimizing, I certainly won’t take seriously the problems I need to correct.

10.  Giving Assent.  This is when I pretend I agree or pretend to give-in on an issue in order to get someone off my back.  It’s when I say I’ll do something while I still know in my heart I don’t want to and probably won’t.  It’s a tactic I use to disarm others while still actively resisting the standards or controls I know they want me to internalize.

Now, these are just a few selections from each worksheet.  And the biggest reason I crafted the worksheets is that the responsibility for change rests truly with the person, not the therapist.  At the outset, a fair-minded therapist might call to attention certain behaviors, tactics, and thinking patterns but eventually the issues of concern have to be self-monitored, self-caught, and self-corrected by the person who exhibits them.  Providing someone a worksheet and reinforcing them for faithful practice (reinforcement being the most essential aspect of behavior therapy) is how good therapeutic “leverage” is maintained.

To the many out there who’ve written me to say they had experience with CBT but got no help:  When’s the last time you can remember getting tools of a nature similar to this or being coached on how to use them to change dysfunctional patterns or to empower yourself?

In next week’s concluding article, I’ll provide some excerpts from the worksheets custom-crafted to help folks in a relationship with a disturbed character, are recovering from such a relationship, or have other issues of their own that CBT has been shown to be helpful in addressing.

This week’s Character Matters Program will again be a live broadcast, so call-ins can be taken.

27 thoughts on “The Mechanics of Genuine CBT

  1. I can’t ever imagine the xnh thinking he needs to change.

    When he had sexual relations with someone else………..”it was only one time.”
    When he had an affair with one of my friends…………….”we shouldn’t have gone to that party.”
    When he went to topless bars………………”you should be glad that I’m coming home to you.”
    When he told me he wanted to marry someone else…………”you shouldn’t have asked the question.”
    In counseling, he made several promises to me………..”I guess I’m not good at keeping promises.”

    And on and on………………

    1. Noel,,,,, what a herk he is! Someone that dug into his beliefs will never change in my opinion. I’m sorry for you. Is he gon? Out of your life?

  2. Noel,

    I hope you aren’t with this man? It sounds like he has been preaching from the book of Narcissism and singing a song based on a scale that stops at me, me,me, me. Do, ray, me, me, me. Pretty jazzy!

  3. So, Dr Simon, I am not sure I get it. You give these worksheets to the person in therapy, the CD person, say, and they are supposed to circle what they had just done on the sheets?

    Or is their mate supposed to do it to learn to catch it?

    1. Sorry if this was not clear, Vera. Relationship partners get a sheet fashioned in a different manner (This will be highlighted in the wrap-up article) and they are coached to not only spot tactics and behavior but also not to correct but rather use their tools of empowerment (e.g., accept no excuses, set firm boundaries, limits, and hold the other person to account, etc.). The sheets in this article are strictly for the CD person to digest and they’re expected to both heighten their awareness and to self-monitor and self-correct these errors. In short, they’re supposed to get well enough versed in self-awareness and correction that they don’t need the sheets.

      1. Dr. Simon, the thought of a CD being willing to self assess in any way that shows their hand for what it is seems like a direct opposition to what they are all about, at least the one I was mixed up with. I just can not not not imagine it happening with Spathtard. I have to remind myself when I read your vignettes about the some who are willing to change, that they come in all shapes, sizes and levels of disorder.

  4. Thanks for all your concern. He left 8.5 years ago and we are divorced. He married his long time girl friend. Get this, she wants to be friends with me so we can have family get togethers. She had no desire to meet me when she was seeing him behind my back. I have no desire to see them or talk to either one of them.

    1. Noel, good choice. Just mind boggling how utterly clueless it is to expect you to have ANYthing to do with her or them. I’m assuming their are children involved? 🙁 Children in the mix with one of these idiots is just so much harder.

      1. Oops!
        At least I can wash my hands of the idiot I was entangled with and all that hoes with him. We have no common ties what so ever and for that I am so grateful. Just bye bye Spathtard. It’s taken me a long time to get to that place but for quite a while I have had no desire what so ever to ever even be near him.

      2. They each have 3 grown daughters. He has less and less contact with our daughters and grandchildren as the years go by. He has all kinds of excuses as to why he is so busy. He treats his two sisters the same.

        1. Noel, the older their children get the less they have to offer a CD because they start expecting adult behavior from their parent……….your know, responsibility? When they are young they accept more and are fun to be with for the CD because they are at the same emotional maturity level. They are like toys to the CD but when they start to grow up under the influence of a responsible mature parent they learn that the CD is not there to meet their needs. They figure it out.

          1. I hear he is infatuated with a cat at the moment. He can play with it and act like a kid. Don’t get me wrong, I love cats, but I also love my grandchildren.

  5. I’m sure most CDs are aware of the devices they use in managing their relationships (lies, deception, denial, minimization….), but I don’t think they are aware of the ramifications. They just aren’t that deep. You can’t know what you don’t feel, and to me, they all seem to lack the capacity for real emotion.

    I don’t doubt some of them go for treatment, but I’m guessing they are the ones that fall on the less-extreme end of the spectrum.

    1. Hi Einstein, I often had the feeling that he just didn’t “get” how much I was really hurting or that he thought I was faking my emotions. Now I think he really may have thought that because he WAS.

  6. I have ongoing issues with a good friend who lives in a little second home on my property. In exchange for free rent and some meals, he walks my dog and does some chores around here. Yesterday I woke up to find my vehicle missing after I told him not to use it, until he or I received email verification from insurerer that it’s properly insured for his use.

    Here is where wishful, deceptive thinking enters into it. While I was away this winter the insurer emailed me and expressed doubt about whether other drivers would be insured under my late husband’s auto policy. I forwarded this onto tenant with improviso that when I returned he could probably drive it. A few days ago, I told him that having rethought issue I felt to be on the safe side i really would require email verification that he could drive because it was too grey an area for me and was making me uneasy. He responds,”I see no reason to escalate this situation. Do you think your hyper-vigilance is the real issue?” Anyway, won’t bore you with anymore details. Needless to say, we talked yesterday and he told me that I had confused him by reversing myself and that what he remembers clearly was my telling him he could probably drive the car when I returned from down South.

    A pretty clear half hour discussion where I was obviously very tense about his using my car, clearly setting limits and boundaries and he was ‘confused’ by it. Stubborn stubborn. And it so feels like he simply doesn’t like being gold what to do by anybody, particularly a woman. I feel this weird undercurrent of his attempting to dominate me but feel compassion for his situation so am trying not to blow a psycho on him.

    He is very helpful in other ways. And has health issues that may be impacting his thinking and memory. But, I don’t know. What part of,”don’t drive my car!” Does he not get??

      1. Lauren,

        He had been using my car, with my permission, before I found out he may not be covered. I plan to get the keys from him today. I simply forgot to ask for them back.

  7. I feel too, that he often minimizes my concerns as a way of rationalizing his way around me. The car issue is just the latest example. I have been advised to scream at him as he ignores reasoned logical requests. I don’t like to do this. Screaming at somebody who is already having major problems would feel like I am abusing my power. But… On the other hand, it does feel a bit like the movie, ‘The Servant’. Sixties movie starring Dirk Bogarde and Sarah Miles. The servant slowly but surely manipulates and maneuvers his employer, so that the roles are reversed. It’s not that bad here but I can see his it could happen, particularly to a woman who is naive vulnerable and alone.

  8. Edit–Can see HOW this could happen to ANOTHER woman who is naive, vulnerable and alone. Sheesh. Hope I am no longer naive! LOL

  9. Dr. Simon,
    I have spent the better part of a year doing research on what was going on with my current husband asides from his life drastically changing due to a traumatic injury on a pre-deployment jump in which he broke his back (long recovery, still in pain with disc issues, but is fully able to walk/ although he was medically retired due to the injury) And as to why our loving relationship turned into for me a true living hell to the point of my health seriously suffering from what seems to all stem from severe stress. Throughout the separation process for assessing VA benefits you see a variety of practitioners and as it is now a well known problem for getting the proper medical diagnosis and care needed in a timely manner through the VA medical system. I have had to become deeply involved in these appointments due to his (thoughts and his lack of concern/ questions note keeping etc) Basically being like his mother to oversee and know what is going on and that correct information is given. Multiple practitioners you get pushed through in the system all had different assessments of him and their referral of treatment & prescriptions from adjustment disorder, to GAD anxiety with depression, to TBI- to ADHD, to PTSD to most recent unspecified Bi-polar. None of their diagnosis seemed even remotely accurate to what my children and I saw in his action and behavior. I just know that they were all incorrect and to keep trying to talk to whomever we saw to voice my concerns and what was really going on and to push for help to really care to figure out what’s going on in his head and not just from their impersonal q&a forms to read off on the computer say in 5 minutes here’s my confirmed diagnosis and take this med and go to a stress class or group counseling. I have no formal psychology background mine is I was a child of exterme abuses, married a wolf in sheeps clothing and continued to live as someone’s victim I never thought I deserved it I was kept in a position unable to go to school to get a degree or to get a job and that his wants and desires out rank me. I was utterly financially dependent upon him. Then one day after 19 years I finally told him I want a divorce and stood by the decision. My faith carried me through my life and has given me the strength through my circumstances to fully self evaluate, get healthy, to stand firm, to see past the smoke & mirrors in people’s manipulating behaviors and to speak the truth and confront the action/behavior and their excuses in the moment they are happening to attack the problem not the person and It’s definatly not a favorable stance but a necessary one. After meeting my husbands mother and seeing her behavior listening to her stance and looking at the link between their behavior. I realized what the behavior was like was truly that of an oppositionally defiant, selfish bratty child who not going to comply to anything and was going to have their way no matter what and use what ever tools necessary to get it. As I didn’t cave into my own children and reward them for bad behavior, I’m not about to cave into being bullied by a bratty terrible child who is supposed to be a 44 Year old man who is pulling out all the tricks above and beyond to win because he has not had anyone hold and make him accountable. He’s been in marital and personal counseling before with his x and is able to snows/charm the therapists. He was in CBT last year but didn’t do hardly any of the homework and sat in private session stuck to the blaming me. I came across your articles and you are a God send you make this information so clear and it has given me room to breathe it gives validation and rejuvenates the soul to continue. I know he can change I truly have seen his genuine heart and he hates feeling powerless to his thoughts & emotions especially the agression and combativeness but does not know how to stop. We spent the entire day yesterday where he read articles of yours I printed out and highlighted for him he saw it, understands the need for change and the destruction his behavior has brought. And YES,, WORK is a dirty word. But we know to strike while the iron is hot and his mind is wanting to be open. We will not be able to get any type of VA therapy referral for some time and we don’t want to (I don’t want to miss this chance) I love him and I am a Christian so I need the help to keep in faith of my Godly wife roll and commands. But I also know I’m not expected to stay in abuse and to suffer and would leave vs stay in a situation like my last but I know I need to give my best last efforts and give him the chance to truly take action and put in the work to change. Where can I get your forms that you discuss in this article so that we can get to work on this Hell ASAP that will help to enable him to take control and change his life and not on the VA wait list to get a new consult for his behavior instead of the meds and multiple misdiagnosis. I’m terribly sorry for the length of this, but thank you if you choose to take the time to read this and respond.

    1. Lulu G, welcome. I’m really not sure I’m following your story. It’s quite a bit to digest. It sounds like you have really been through the mill though and I’m glad you found this site and that it has been helpful to you. Dr. Simon is a good man and I hope by reading more of his articles you will continue to find answers and more clarity.
      I’ve never had to deal with the VA but I’ve known several people who have and I know from their stories it can be a very frustrating experience to say the least. I also know a friend who has had many good experiences but he seems to be the exception. I’m sorry you are struggling with not getting the help you are desperately seeking through them. I wish I had something more helpful to tell you but you are free and safe here if you need to vent and express your emotions and frustration. Maybe somethin will click into place in time for you but I do understand uour frustration and hear how badly you are wanting some help.
      So to clarify, are you speaking of two separate men here, correct?

  10. Hi Puddle,
    I totally get my post as being to follow and not much solid direction which is putting it mildly LOL!! I guess it’s when you finally attempt to speak/reach out this extremely difficult and emotional area of ones life that it comes out a bit like a volcanic erruption hopefully now though I can give more of a clear summation. I grew up the child of abuse who was very naive, I didn’t really date because of the abuse and there were only a few boys & it was short term. I was 19 and literally the first “adult Man” I dated I thought he really had it together (he was 7 years older) and I married him when I was 20. I endured years of his narcissim, manipulation, covert-aggression, Gas lighting, & physical abuse finally found the courage, strength and healthy mental stand to know it was NOT me, it was him and I finally left him at 41. I now know his behavior is best described as a a sadistic sociopath. I have since remarried a highschool crush who was charming, compassionate, respectable, and treated me like a queen and things were amazing. Our relationship consisted of skype, email, & phone calls the first year as he was deployed, then he formally requested to transferred bases from out of the country to the state I lived in. Things were still great, his 1st year here then had an accident just weeks prior to another deployment. A year into his recovery is when everything went south when the military scheduled him to start proceedings for a medical separation and the behavior for a little bit was what one would expect, normal grieving, sadness, some depression. We had a string of bad luck situations that were taking a financial toll during the separation process and his behavior went from being a respectable “responsible Man” and slid into the exact myriad of the Disturbed Character traits Dr. Simon describes. The smoke and mirrors of the blinding charm gave way to fits of rage, temper tantrums, laziness, combative beyond allowing my getting a point across oppositional defiant, obstructionist, shirking the expectations. Acting out in doing his best to sell the denial, excuses, blame, lack of responsibility and lies to me and my kids. They are the first ones to have said to be he’s acting like a baby, a child, a brat more so then then even did. ( that’s Bad when you have kids shaking their heads and can identify the DC.) During what is about a 3-6 month lengthy process to go through in a medical separation from the service especially if you disagree and go through appeals all the way to a face to face in Washington DC in front of the board. There are MULTIPLE psycician appointments you have to go through with a variety of specialties. I have seen first hand abhorrent medical record keeping with inaccurate information beit lacking info or incorrect information and that the practitioners base their “assessment/diagnosis” from that information regardless of what you try to say to inform them of otherwise, if one PA made an assessment the others either stand by it or ignore it all together and say well I think it’s this “classic expected military issue say PTSD” and label it that in a matter of moments instead of hearing what’s really going on and yet prescribe medications for mental health issues psychotics/anxiety/depression and the like with out really caring to get to the bottom of it and that all this has exacerbated and given the behavior a crutch and more excuses. From research on what I know now about personality disorders,& the criteria for true mental disorders he does not fit the criteria for bipolar/anxiety/depression/PTSD but the description of Dr. Simon’s DC behavior absolutely nails it. So I have my hands full in trying to get him the right type of help/therapy to give him the right tools for his change, personal growth and happiness and ultimately to save our marriage. The VA psychologist we saw was so condescending to me when I said I did not agree with the all the various “assumptions” of his “diagnosis” as I live with him and he does not exhibit the listed characteristics and he literally said of yeah, and what is your diagnosis “I gave my I have researched my butt off for 2 years informed answer and I think because it made absolute sense he got very condesending with me well I have 40+ years experience and you have none and that he’s not treating me or dealing with me etc. to the point of disrespect and my husband stepped in and said she lives with me 24-7 and knows all about my behavior and you’ve just met me just now glanced at my records oand have only asked me the standard basic form questions give me a mental health diagnosis & prescribe meds. Needless to say it’s a VERY lengthy wait to request a new VA psychiatrist almost 8mos and still waiting (and we heard were no where near the first to request also found out he’s no longer working there.
    The bottom line is being a medically retired disabled veteran only able to work part time and now not even able to financially keep our heads above water, the drastic wait for health care appointments with the VA and lack of concern in correct diagnosis and treatment and we cannot afford to go see any therapists outside of the VA I would desperately love to get my hands on the worksheets that Dr Simon gave us a tidbit of in this article as I know beyond a shadow of a doubt that it would help to transform our lives. I didn’t know any better in my previous marriage the enduring pattern and need for the right help and honestly he never apologized or saw anything as it ever being him. This husbands CD he always knew something was wrong thought mostly the people he was with until as of late by learning about Dr Simons CD and he can now put the name with the face so to speak and knows he has to change. That’s why I’m wanting to know how or where we could get the worksheets.. To get to work ASAP vs. the waiting of almost a year just to get a new dr through the VA then we still will have to get a referral after that

    1. LuluG, please use the “Contact Dr. Simon” link at the bottom of this page on the right hand side. I’ll try to write more later. Hang in there!

  11. Hi Puddle,
    I totally get my post as being to follow and not much solid direction which is putting it mildly LOL!! I guess it’s when you finally attempt to speak/reach out this extremely difficult and emotional area of ones life that it comes out a bit like a volcanic erruption hopefully now though I can give more of a clear summation. I grew up the child of abuse who was very naive, I didn’t really date because of the abuse and there were only a few boys & it was short term. I was 19 and literally the first “adult Man” I dated I thought he really had it together (he was 7 years older) and I married him when I was 20. I endured years of his narcissim, manipulation, covert-aggression, Gas lighting, & physical abuse finally found the courage, strength and healthy mental stand to know it was NOT me, it was him and I finally left him at 41. I now know his behavior is best described as a a sadistic sociopath. I have since remarried a highschool crush who was charming, compassionate, respectable, and treated me like a queen and things were amazing. Our relationship consisted of skype, email, & phone calls the first year as he was deployed, then he formally requested to transferred bases from out of the country to the state I lived in. Things were still great, his 1st year here then had an accident just weeks prior to another deployment. A year into his recovery is when everything went south when the military scheduled him to start proceedings for a medical separation and the behavior for a little bit was what one would expect, normal grieving, sadness, some depression. We had a string of bad luck situations that were taking a financial toll during the separation process and his behavior went from being a respectable “responsible Man” and slid into the exact myriad of the Disturbed Character traits Dr. Simon describes. The smoke and mirrors of the blinding charm gave way to fits of rage, temper tantrums, laziness, combative beyond allowing my getting a point across oppositional defiant, obstructionist, shirking the expectations. Acting out in doing his best to sell the denial, excuses, blame, lack of responsibility and lies to me and my kids. They are the first ones to have said to be he’s acting like a baby, a child, a brat more so then then even did. ( that’s Bad when you have kids shaking their heads and can identify the DC.) From research on what I know now about personality disorders,& the criteria for true mental disorders my current husband does not fit the criteria for bipolar/anxiety/depression/PTSD but the description of Dr. Simon’s DC behavior absolutely nails it. The VA psychologist we did see was so condescending to me when I said I had questions for him about his “diagnosis” as I do not see my husband exhibit the listed characteristics and he literally said of yeah, and what is your diagnosis “I gave my I have researched my butt off for 2 years” informed answer and I think because it made absolute sense he got very condesending with me well I have 40+ years experience and you have none and that he’s not treating me or dealing with me etc. to the point of disrespect and my husband stepped in and said she lives with me 24-7 and knows all about my behavior and you’ve just met me just now glanced at my records oand have only asked me the standard basic form questions give me a mental health diagnosis & prescribe meds. Needless to say it’s a VERY lengthy wait to request a new VA psychiatrist almost 8mos and still waiting (and we heard were no where near the first to request also found out he’s no longer working there.
    The bottom line is being a medically retired disabled veteran only able to work part time and now not even able to financially keep our heads above water, the drastic wait for health care appointments with the VA and lack of concern in correct diagnosis and treatment and we cannot afford to go see any therapists outside of the VA I would desperately love to get my hands on the worksheets that Dr Simon gave us a tidbit of in this article as I know beyond a shadow of a doubt that it would help to transform our lives. I didn’t know any better in my previous marriage the enduring pattern and need for the right help and honestly he never apologized or saw anything as it ever being him. This husbands CD he always knew something was wrong thought mostly the people he was with until as of late by learning about Dr Simons CD and he can now put the name with the face so to speak and knows he has to change. That’s why I’m wanting to know how or where we could get the worksheets.. To get to work ASAP vs. the waiting of almost a year just to get a new dr through the VA then we still will have to get a referral after that

  12. Hi Lulu G,

    Did your husband sustain any brain damage in his jump? There is so much going on here. It is very unusual for a CD to defend a partners diagnosis of CD (complete selfish immature ass-clown). I think most if them prefer a diagnosis that lets them off the hook like ADD, bipolar, PTSD, etc… Easier on the ego, too. I think?? I would suspect brain damage if he is copping to being a jerk. Most CDs would enjoy seeing a doctor belittle their wife, too, particularly if there were hostility between CD and wife

    I hope you don’t mind me inquiring along this line, like maybe he fell on his head? Don’t mean to call your judgement into question.. but really want to draw attention particularly to symptoms of brain damage. Chief among those symptoms is being very quick to anger and impulsiveness

    Whatever is going on, Lulu G, you appear to have had a truckload of misery dropped on you and I so hope you benefit greatly from the blog and Dr. Simon ‘s great wisdom.

Leave a Reply

Your email address will not be published. Required fields are marked *