Why traditional Cognitive Behaviour Therapy (CBT) doesn't always hit the mark after baby loss

I recently finished reading a self-help book in the world of baby loss. The author was a strong supporter of Cognitive Behavioural Therapy (CBT) and recommended it regularly. It made me wonder what this might be like for those people who reach out, receive CBT, and find that it misses the mark — especially those who have suffered baby loss.

Now, let me first make this clear: I don't think CBT is a bad therapy. In fact, we know from scientific studies that it can be incredibly effective in treating some mental health conditions for some people. It is one of the most widely known therapies because, for a long time, it had some of the strongest evidence behind it. But it doesn't work all the time for all people with all types of problems. And sometimes, its delivery from a traditional, textbook-style approach can do more harm than good.

Baby loss brings with it a complex maze of mental health struggles. Whilst grief isn't necessarily a mental health disorder, it is true that many of us may benefit from psychological support during this deep fog. For some, the shadows can morph into further suffering, such as depression, anxiety, or post-traumatic stress, making it even more important that we seek help. No one should be left to wander in this darkness alone.

But what do CBT psychologists offer? The behavioural part of CBT can be broadly helpful. Suggestions around movement, engaging in soothing or pleasant activities, making changes to promote sleep, connecting with family or friends, targeting avoidance, and practising relaxation strategies can all be helpful — if offered sensitively and timed well.

The cognitive part can be trickier. In traditional CBT, we would suggest tracking our thoughts and essentially weighing up whether they are facts or not. So, for someone with a fear of flying, we might ask them to identify their underlying anxious thought. Maybe it is: “The plane will crash, and I will die.” We could then ask them to challenge this thought by weighing up the facts: What is the probability of this happening? What are the odds of this not happening? What is a more realistic thought? Let's simply swap that out.

But with baby loss, this can be more complicated. How can we challenge our thoughts about the death of our baby, our loved ones, or our next pregnancy when we have been on the wrong side of statistics before? Suddenly, the probabilities feel biased. Weighing up the odds just doesn't cut through our grief, anxiety, and deep despair.

Maybe it’s a bit like being in multiple plane crashes; no wonder our anxious or sad thoughts feel more powerful. Our baby died. There is no way to swap that out with a more realistic thought. It's as real as it gets.

Of course, for some people, CBT can offer comfort. Perhaps the thought they identify is: “I can't cope.” There may be ways to challenge this type of thought; after all, if you have survived the raw grief from the death of your baby, you’ve already been through the worst experience imaginable. But this doesn't quite reach the depth of how baby loss rocks our foundations. Suddenly, we may think about the whole world differently and our place within it. These are not simple cognitions with simple solutions. At worst, if the suggestion of challenging our thoughts is poorly timed or insensitive, it may leave us feeling unheard, misunderstood, invalidated, and alone.

So, what do we need? My answer may sound straightforward, but it's sometimes not so easy: we need to find support from someone who listens. If we choose to connect with a psychologist, we need one who is able to hold the evidence, therapies, and theories in mind while flexibly applying them to our treatment. We need someone we feel we can trust, who is warm, and with whom we can build a bond. If we don't have the basics of a connection, nothing they offer will work. Perhaps if they have some knowledge or experience in working with grief or baby loss, even better. The brand name of the therapy they use is generally less important than our relationship with them.

So, if you reach out for support but find yourself boxed into a textbook treatment, or you just don’t seem to get along, find someone else. I recognise that it is a leap of faith to even make an appointment, let alone go and tell your story. The idea of needing to do that again with someone else may feel incredibly daunting. But there are lots of other evidence-based therapies out there, and lots of other psychologists. Finding the combination that is best for you may be a flashlight to hold onto in the dark. It won’t necessarily take the fog away, but it can make it more bearable.

Tommy’s Mum x