Posted by mattdds on December 27, 2003, at 2:43:05
In reply to Re: You know what might be interesting? » mattdds, posted by Dinah on December 26, 2003, at 23:28:44
> Ok, here's another one. This one doesn't use the relationship.
Good, because I can think of a number of potential problems with depending on your relationship with your therapist for experiential-emotional change.
>
> I report that I have been upset this week because I discovered my dog is dying. I break my thoughts down with my CBT therapist and, while they contain a certain amount of realistic grief, there are also some dysfunctional thoughts. My dog is dying. I will be bereft and suicidal when he dies. I won't be able to stand the pain. I will never again know the love that I have known with this dog. It's not fair! He shouldn't be dying! I'm fortunetelling, catastrophizing, overgeneralizing, guilty of emotional reasoning, and believing that the world should always be fair. My CBT therapist could pull out his blackboard again, point out the myriad flaws in my thinking, have me question each thought, and come up with counterthoughts for each of them.
>This really (I hope) is a straw-man CBT therapist, and does not represent how they really are in general. This really is not all there is to CBT, and the chalkboard thing you keep bringing up is really oversimplifying it. For example, David Burns suggests attacking the problem from 15 or so different approaches. The negative thought - counterthought method is only *one* CBT technique! There are myriads, literally. If this was all the treatment you got, you were done a disservice!
> Now at this point, I'd probably be ready to break the whiteboard in two and storm out. And my therapist (if he were a particularly unwise CBT therapist) might be asking me if I want to keep feeling this way, what is my secondary gain. And then I would storm out. But that's just me. :)
>
> My therapist would reflect that my dog obviously meant a lot to me. And I might tell him funny stories from his life, and how he makes me feel. He might guide me to point out the needs I have met by the dog. I might tell him about previous grieving experiences I had, where I did feel the things I was now afraid of feeling. We might talk about how we could spend our remaining time together. He'd guide the conversation to the points he wanted to make, while not rushing it.
>
> Again, the presentation would be less didactic, more experiential.Again, there is much more to CBT than just didactics. As I mentioned before, therapeutic empathy also predicts success with CBT. But what your therapist (the good one) did sounded like it *was* CBT, but wrapped in a very warm, empathetic package.
>
> You might say that this isn't a general enough tool.Actually, I would *not* say that. The emotional brain does not do well with abstract concepts. That's why it's best to work with specific, real life problems, rather than on a vague, abstract level.
>>And that's true enough. And for those who do well with the teaching approach of CBT, it would certainly save time to start with the global and apply it to the specific. But you get to the same end starting with the specific too.
Burns refuses to talk to patients on abstract, global levels, he encourages specific, real, definable problems. Actually, what you are describing, *is* CBT.
>>After you've gone through the process enough times, you start to internalize it (or so the theory goes, and I have noticed it to be true). You begin to have an internalized therapist, who guides you through the steps that your real therapist would have.
Yes, exactly. It is developing coping strategies that become second nature over time. I definitely agree that using specific problems helps to drive it home emotionally much better than didactic education. I think the didactics just provided me with a framework, but you really must use specific examples. Also, this is why most good CBT therapists prescribe behavioral experiments as well as didactic. It is another modality to access the problem.
Great analogy about the inner therapist. I have mine, which is better some times than others, but his (her?) skills are improving over time.
Best,
Matt
poster:mattdds
thread:293462
URL: http://www.dr-bob.org/babble/psycho/20031221/msgs/293696.html