Posted by mattdds on December 26, 2003, at 16:25:42
In reply to Re: Therapist Orientation? CBT or psychodynamic? » mattdds, posted by Dinah on December 26, 2003, at 9:49:25
Dinah,
You make some good points here.
I agree that a lot of CBT purists do not express enough empathy and are somewhat mechanical in their therapy. It's as if they're rewiring some soulless electronic device. Albert Ellis, and the REBT types are more this way.
You might be interested to read a study done by none other than David Burns (Stanford) and Diane Spangler (Brigham Young Univeristy), that showed CBT success was greatly enhanced by the patient's feeling that the therpist was empathetic.
I agree that there has to be some show of empathy, or the patient is likely to resist or not be receptive to it. But I think that empathy alone is not enough, as evidenced by people who never get better even with all the empathy in the world from their families, friends, etc. I think there has to be a change in thinking patterns to have real success. I'm not saying that this can't happen in other types of psychotherapy, it certainly does. It's just that CBT was "made" to do this, while the others might do it in a more roundabout way.
>>I have always said that CBT or DBT should be required for everyone - maybe taught at school. They give you a very good set of coping skills and a way to do some reality testing
Wow, couldn't agree more. I think I could have avoided the bulk of my crises if I had gotten some elementary school training in CBT, or if I had gone to CBT school instead of Sunday school and learning about Jesus (not meant to be sacreligious). I didn't even learn about CBT until I was about 22.
>>So CBT therapists who do any but the briefest therapies should have some training in how to effectively and sensitively deal with the feelings that arise in the client. Otherwise they can do a fair amount of damage. They don't need to encourage transference, but they shouldn't be appalled or at a loss if it crops up. It's part of their business and they should be trained.
Agreed, I think sometimes CBT types can have knee-jerk reactions to anything old-school, like transference issues. They just tend to ignore them or get flustered. I'm not saying transference doesn't occur or shouldn't be dealt with. I'm just not convinced it is as significant or meaningful as the psychodynamic ideology makes it out to be. I also wonder if so much time should be spent trying to "work it out". I'm not so sure it can be, and I'm not that convinced it's such a huge problem. My idea would be to acknowledge it, accept it as normal, and move the hell on!
>>>When he first started with me, he was almost purely CBT with a lot of it straight from the "Anxiety and Phobia Workbook" complete with homework assignments.
Wonderful book, IMO. A must read for everyone with anxiety issues.
>>>...for those clients with the temperament to respond to it ideally.
Yes, there are many personality types that "clash" with CB therapy. But I think that if these differences can be negociated (and this is where the good CBT therapists are distint from the not-so good - managing these differences in personality), almost *anyone* could get at least *some* benefit from it.
>>>DBT should be required for everyone
I'm not familiary with DBT, other than it's purported to be similar to CBT but with an emphasis on personality disorders, like BPD? Am I right here?
Thanks for your thoughtful post, Dinah.
Matt
poster:mattdds
thread:293462
URL: http://www.dr-bob.org/babble/psycho/20031221/msgs/293565.html