[masonic]

A problem with the emphasis on CBT over the past couple of decades is that it cannot work for a fair percentage of chronically depressed people because it emphasizes challenging negative thoughts on the assumption that they are untrue.

The problem is, what if you have depressing thoughts that are totally rooted in reality? CBT doesn't have a very good answer for that.

There are other strategies and models. IPT. Psycho-dynamic. ACT (which does address the gap I refer to above).

So, a patient may well have to shop different practitioners, clinics, and models to find one that addresses your needs. After all, the response to a bad haircut is to find a different stylist, not to give up on haircuts forever.

Out of pocket costs can get excessive. If price is a major factor, consider university teaching clinics, which can often provide talk therapy (generally with student therapists, and quality/interest can vary a lot) on a sliding scale based on ability to pay. In SV, for example, there is the Gronowski clinic staffed from Palo Alto University).

[metabagel]

“ The problem is, what if you have depressing thoughts that are totally rooted in reality?”

I thought the point of CBT was to avoid making negative assumptions or falling into thinking traps. For example, “I’m on the street and hungry. I’ll probably be like this for the rest of my life.” This is a thinking trap - thinking that bad situations will last indefinitely. Instead, we can think, “I’m on the street and hungry, but I’m alive, and I can probably turn things around.”