yeah! it isn’t always but because a lot of us do get other diagnoses first, doing CBT first is really common.
CBT isn’t inherently bad, but it can do a lot of damage sometimes. Like, part of why i struggle to control my emotional responses is because i struggle to see my emotions as real or valid, and its given me some really maladaptive processes. so being taught to delegitimise the thought processes behind my feelings made it much, much worse. i’ve spoken to a lot of other bpd people who feel the same! we question and doubt ourselves a lot already, so being told to do that more is counterproductive. i also found that a lot of cbt required focusing so much energy into small tasks that i’d stop focusing on myself and it made me dissociate more.
also, bpd tends to be associated with a history of trauma or abuse. so when you’re told to doubt yourself more, in any way, it can lend you to be more susceptible to further abuse. because we’ve already been taught to trust someone elses take on our lives. and the psych field is full of people who abuse patients- bpd patients can often take the brunt of that! being taught your psych knows your brain better than you (like, being told you have distorted thinking) is a fairly easily weaponised tool of abuse.
As one psych, Fancher, wrote: “The basic norm of cognitive therapy is this: except for how the patient thinks, everything is ok.” That can be isolating and painful for patients dealing with thought patterns running deep enough that they cant be changed (for me at least, personality disorder has meant that this is pretty much 100% engrained in me, and what I can control is how I respond to the thoughts, not the thoughts themselves) or for people who are actively experiencing things outside of their control- and given how bpd tends to lend itself to getting ourselves into messed up situations a lot, that is a huge problem.
A lot of psychs do still encourage the use of CBT for BPD treatment! And if it works for you, that’s great. But I don’t like that it’s the first stop especially. When we haven’t been taught to validate ourselves, creating more room for invalidation is dangerous.