Posted by antigua3 on February 17, 2008, at 19:32:00
In reply to Therapy - Bang for the Buck?, posted by Hermitian on February 17, 2008, at 14:42:08
OK, I'll take a stab at this, knowing that i'm not an expert, but certainly have had a lot of therapy and dealt w/probably every aspect of it that is helpful and unhelpful:
>there are a few things I dont get from reading the posts here.
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> One is the length of time of some therapist patient relationships. Some of them apparently last for years. What exactly are the therapeutic goals in those relationships?<<Developing a trusting relationship with a therapist is very important, and can take years for many. Many people need/require the trust until they can open up and explore how past events are influencing their lives today.
>> Does the therapist ever explicitly spell those out? At what point is a therapist obligated to tell a patient that he/she has taken them as far as they can go?
>>Yes, I think many therapists tell patients they've taken them as far as they can go, and hopefully it's a mutual decision.
<<In my view, the implied open ended therapist-patient relationships border on malfeasance. I.e. the therapist using a patient as a cash cow without providing any real additional clinical benefit.
>>I used to accuse my therapist that I was just an appt. time/money for her, but once I got past that point and realized she was there because she cared, I was able to really get into my therapy, knowing that she cared.
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<<The second question I have is related to the apparently excessive focus of session dialogs on past events.>>This is definitely the psychodynamic approach and not all therapists use it. Some use CBT, which is focused on changing behavioral reactions to current events that bring up past events. It works for many, not so well for others who need to explore the underlying event fully before they can make the behavior change in current life.
<<Once what has happened in the past is acknowledged to be true, whats the point of rehashing old ground?>>Acknowledging what has happened in the past to be true is a huge thing. at times, I still don't belive (irrationally, of course) that some of these terrible things could have happened to me. So acknowledging and dealing with the pain that it has caused can take a very long time. Sometimes outside verification is needed to point out the truth, and dealing with that can be very difficult.
<<At what point does the dialog become future focused? Apart from the hugs and soothing conversation, what therapeutic mechanism drives improvement in the patient? In fact, if the therapist consciously steered the dialog into a future seeking direction, maybe the hugs and soothing would not even be necessary because the focus is positive.
>>in many ways, my therapy is always future focused. How can I deal with the past so it quits interfering with my future relationships, etc. It's not as easy as it sounds. Breaking old abusive patterns can be a life-long commitment--to recognizing that they are occuring and stopping youself from engaging in them.
IMO, while many therapists deal with the past, their goal is to make us functional in the future. My pdoc doesn't focus on the past, unless it gets in the way of a present event and we work together to see how I can behave differently. But that never could happen unless I had already explored the underlying issues with my T. My pdoc's approach can be very harsh, and I would assume very damaging to someone who is just skimming the surface. Those old demons come back to bite you if you don't deal with them and put them away.
<<Is it so hard to understand that you get what you focus on? You focus on pain, you get pain. You revisit the same crummy life experiences over and over with a therapist, all it gets you is poorer. Does it not make sense that if you change your focus to a positive outcome and you are much likely to realize one?
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>>Again, for full recorvery for many, dealing with the pain allows them to move forward. There is no time set for this; it's different for everyone.
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<< Thirdly, do any of these therapists treat a patient holistically? I mean suggest they exercise and diet properly and engage in an active social life? And even beyond suggesting, actually challenging them in an appropriate way to step up holistically.
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>>I think plenty of Ts and pdocs take this approach. I don't know many who don't. Taking care of the whole self is very important, but you can't MAKE anyone do anything; it's up to the individual person, but the T or pdoc does point out how much better a person might feel if they took a full body approach to the problem.<< Now where do I come from dropping out of the sky, issuing these kinds of comments? Well I started seeing a psychiatrist for ADD in the beginning of 2007. And of course I carried along some other baggage with that. So I then had talking sessions with him every two or three weeks for the better part of the year. And the discussion framework focused around one implicit rule and one objective. The rule was to minimize past thinking because it provides no value once it has been harvested for understanding.
<<There's a key point here: "past thinking...provides no value once it has been harvested for understanding."
Who is it to say when a a past thinking has been fully harvested for understanding? You seem to be very lucky that this happened quickly for you. It doesn't happen that way for many othr people. It can be a very long-term, painful process for others, like me.
>>So the past was surfaced, acknowledged and then put in the back of the closet where it belongs. And planning a future around complexity takes too much energy. Why not make it simple? So we disassembled the architecture into more simple components of connecting activity to objectives. I asked my guy one time early on why I was behaving in an unproductive manner even though I was taking medication and it was working. He looked at me straight on and told me, Because you want to. Youd rather do that than do something productive. The only thing thats going to change that behavior is you finding a more compelling reason to spend your time another way. I cant tell you what you want fundamentally. Thats your job to figure out. So why dont we talk about future objectives that are more compelling?
<<I'm glad you found a way that works. But it's different for everyone.
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antigua
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poster:antigua3
thread:813285
URL: http://www.dr-bob.org/babble/psycho/20080210/msgs/813340.html