Posted by mattdds on December 26, 2003, at 20:01:24
In reply to Re: You know what might be interesting? » mattdds, posted by Dinah on December 26, 2003, at 18:32:44
> Since my therapist has done both CBT and more psycho-dynamic therapy with me, I think I might post an issue, and how he might approach it from either side. And how I'm not sure there is that much difference in effect.
>I think that would be very interesting indeed. I'm not married to the idea that CBT is the *only* way. I think there's something deeper to therapeutic success, that I'm sure psychoanalytic therapy can attain. Part of the problem that I have with psychoanalytic therapy may in part be a misunderstanding. Perhaps I don't fully understand what "psychodynamic" means in the first place. I have it lumped together with classic "couch therapy", free association, psychoanalysis, sexual connotations for everything, dream analysis (which I think is pure bunk), oedipal conflicts, etc, etc. I'm sure psychodynamic therapy has come a long way since its Freudian roots. I'm also pretty sure it does not embody one "doctrine", but is highly variable depending on the school of thought.
>I'll bet that we find out there are more similarities than differences.
I bet you'd be right. But I would also bet it also all boils down to something similar to cognitive restructuring, the shifting of some paradigm, or a change in a core belief.
> I'm not familiar with all of the outcome studies. But I do remember reading recently that the therapist/client relationship as viewed by the client accounted for most of the therapy satisfaction rating. I'm not sure satisfaction is identical with success though. I also remember the grand rounds presentation on CBT outcome studies (linked from here) that showed that the outcome was better for people with some types of personality than others.
>Again, you're probably right here. Take me for example. I "happened" to choose dentistry as a career path, where there is a specific procedure for every problem. A patient comes in with a cavity, and you fill it. Missing tooth? Do a 3-unit bridge, or an implant. Simple. Remind you of CBT? Is it any wonder why I chose CBT as my therapy?
Unfortunately, we understand far less about psychiatric illness than we do about dental / periodontal disease (which we pretty much have figured out). But I still like the idea of working out tangible, practical soluble problems, and kind of not worrying about the rest.
> You might have to factor in other things as well. For example, I had excellent results with CBT for my OCD. I still have the occasional panic attack (one last night even), but I handle them much better. But when the OCD got under control, my mood disorder worsened. And it doesn't seem as amenable to CBT.
>What is your mood disorder? If it's bipolar, you probably won't have much luck with CBT without a mood stabilizer. I don't have OCD, but my experience was the same with panic disorder. I still get panic attacks (which I believe to be some sort of neurological glitch), but they occur much less frequently, and I don't have panic *disorder* now, with anticipatory anxiety about the panic attacks, or agoraphobia. Isolated panic attacks (the immutable part, IMO), did not cause me to break down mentally. Most of the suffering was from anticipatory anxiety and catastrophizing about the attacks, and was amenable to CBT. Actually, Klonopin killed all the residual panic symptoms that CBT didn't. Now I don't get ANY panic.
I've never heard of OCD "translating" into a mood disorder. Are you sure this isn't a post hoc, ergo propter hoc thing? There is no way to prove or disprove that your OCD improvement caused your mood disorder, but I can see how a belief that it did might set up a self fulfilling prophecy.
Don't get me wrong, I fully believe you have a mood disorder that does not respond to CBT, but are you sure it was *caused* by CBT?
> The brain is so darn complicated.
I think we can all agree on that.
>
> Dinah
>
> P.S. Matt. Though you might hear me complain about pure CBT sometimes, you'd equally hear me complain about pure Freudian psychoanalysis. Most of the books I own that I want to ditch are classic psychoanalytic books. I always read a few pages and my eyes glaze over when they're not rolling. And I did a consultation with a psychiatrist once who thought perfectly normal interpersonal feelings had to be transference - it made me as crazy as CBT biofeedback guy did. But that's just me. :) I'm sure they've helped plenty of people.I can't even read psychoanalytic stuff without laughing or rolling my eyes. In my mind it is nothing but colorful and imaginative conjecture that has been intellectualized for far too long.
Best,
Matt
poster:mattdds
thread:293462
URL: http://www.dr-bob.org/babble/psycho/20031221/msgs/293622.html