Posted by Dinah on December 27, 2003, at 9:29:31
In reply to Re: You know what might be interesting? » Dinah, posted by mattdds on December 27, 2003, at 2:43:05
> Good, because I can think of a number of potential problems with depending on your relationship with your therapist for experiential-emotional change.
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Yes, there are. But there are also a heck of a lot of benefits. No other relationship or situation is quite so open for work as that one, because first of all there is emotional immediacy, and second the therapist is more familiar with what really happened, unfiltered by a secondary reporting. That's why the much maligned transference is important in therapy, because it is a microcosm of the rest of our lives. Many of our irrational thoughts and dysfunctional coping mechanisms crop up in that one relationship, especially if it is highly charged emotionally on our parts.All this is assuming that a therapist is aware of and in some control of his own behavior. Biofeedback guy considered himself direct (he called my therapist a narcissist after two sentences from me, and told me I liked to be annoying to gain control). While he considered me hostile. He'd have a lousy time trying to use the therapeutic relationship, because he didn't own his role in it.
> 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!
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I know. And I was oversimplifying for the purpose of pointing out the basic similarities of the two approaches, for which I apologize. I know how much, for example, lifestyle changes and a myriad of other things come together for anxiety disorders, right down to skipping the caffiene.And the whiteboard was just a technique that Bell mentioned that my therapist hadn't thought of, but I wish he had. It really tickled my fancy. My therapist used his worksheets and handouts.
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> 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.
>Well, there is a problem I have with CBT, or at least CBT as it was practiced with me. Perhaps since it's often short term, the therapist wasn't always wise in choosing teachable moments and ended up angering by mentioning technical terms for thought distortions when I was too emotionally aroused to take them kindly, or worse yet (and this made steam rise from my ears) mentioned lack of motivation or secondary gain.
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> > You might say that this isn't a general enough tool.
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> 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.Well, again I'm overgeneralizing and getting through the process rather quickly. The specifics of my irrational thoughts wouldn't be mentioned or countered directly. None of the CBT words for ways of thinking would be mentioned. The conclusions would appear on the surface to mine, although if I were thinking about it, I'd realize that my therapist was guiding me to it.
> Burns refuses to talk to patients on abstract, global levels, he encourages specific, real, definable problems. Actually, what you are describing, *is* CBT.
Well, after all my therapist is CBT oriented. :) He just discovered that a textbook presentation of it wasn't the best method with me. But again, I probably summarized a bit too much in the example. In session, it would look more like a discussion with an empathetic listener of my grief and fears.
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> 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.Exactly! And my theory is that non-CBT therapy is not that different in the end result than CBT therapy, but without the teaching component and without the homework assignments. It works with what comes up in therapy. And it does explore the past more, helping us understand why we do the things we do, and validating our experiences and our resulting reactions while still gently pulling us towards change.
> Great analogy about the inner therapist. I have mine, which is better some times than others, but his (her?) skills are improving over time.
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:) I still have an absolutely rotten problem with internalizing my therapist. That's why I've been in therapy so long. But I may be doing myself a disservice there.I really didn't like this example as much as the other one, and in both I collapsed the process perhaps a bit too much to point out the similarities.
Daisy's post gives a much better example, I think, of learning by feeling.
I'm enjoying our discussion too, and hope people keep it going. Discussing theory of psychology is fascinating to me.
poster:Dinah
thread:293462
URL: http://www.dr-bob.org/babble/psycho/20031221/msgs/293728.html