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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 93. Go back in thread:
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
Posted by tabitha on December 26, 2003, at 20:49:09
In reply to Re: You know what might be interesting? » Dinah, posted by mattdds on December 26, 2003, at 20:01:24
Hi Matt. I don't think anyone does that Freudian stuff anymore. There was one thread here about someone having classic psychoanalysis, but it was the exception. My therapist uses a whole mixture of techniques. I see influences from cognitive, interpersonal, transactional analysis, gestalt therapy, EMDR, client-centered, re-parenting techniques, and I don't know what all else. Maybe it's a regional thing-- Southern California eclectic.
Posted by mattdds on December 26, 2003, at 21:25:33
In reply to Re: You know what might be interesting? » mattdds, posted by tabitha on December 26, 2003, at 20:49:09
> Hi Matt. I don't think anyone does that Freudian stuff anymore. There was one thread here about someone having classic psychoanalysis, but it was the exception. My therapist uses a whole mixture of techniques. I see influences from cognitive, interpersonal, transactional analysis, gestalt therapy, EMDR, client-centered, re-parenting techniques, and I don't know what all else. Maybe it's a regional thing-- Southern California eclectic.
You may be right, could be a regional thing. Here in the Northeast (well, at least NYC), I have noticed there is much more CBT influence than when I lived out West.
Best,
Matt
P.S. As an aside, I personally don't think EMDR is much more than CBT with a pseudoscientific gimmick added on. I read some stuff that showed that the eye movements + CBT had no additional benefit over CBT alone. I'll post an abstract below, from www.quackwatch.com:
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is promoted for the treatment of post-traumatic stress, phobias, learning disorders, and many other mental and emotional problems. The method involves asking the client to recall the traumatic event as vividly as possible and rate certain feelings before and after visually tracking the therapist's finger as it is moved back and forth in front of the client's eyes [6]. EMDR's developer and leading proponent, Francine Shapiro, Ph.D., received her nonaccredited doctoral degree in 1988 and established the EMDR Institute to train mental health professionals. She and her associates have trained more than 22,000 clinicians worldwide in workshops that in 1997 cost $385 [7]. EMDR resembles various traditional behavioral therapies for reducing fears in that it requires clients to imagine traumatic events in a gradual fashion in the presence of a supportive therapist. However, controlled research has shown that EMDR's most distinctive feature (visual tracking) is unnecessary and is irrelevant to whatever benefits the patient may receive [8]. Recent reviews have concluded that the data claimed to support EMDR derive mostly from uncontrolled case reports and poorly designed controlled experiments and that the theory of EMDR clashes with scientific knowledge of the role of eye movements [9,10].
Posted by Dinah on December 26, 2003, at 23:01:56
In reply to Re: You know what might be interesting? » Dinah, posted by mattdds on December 26, 2003, at 20:01:24
Ok, let me try one. Mind you, my therapist is by no means a analyst, Freudian or otherwise. He's not at all a blank slate. Perhaps someone with a more classically trained analyst could provide some examples there.
Scenario 1 (using the relationship between therapist and client): My therapist and I are having a disagreement. I'm upset that we are angry with each other. From a cognitive behavior standpoint, there's plenty of ground that could be covered. I'm quite probably filtering and overgeneralizing, possibly catastrophizing. I might be assuming that if my therapist is angry with me right now, he'll always be angry with me, and if he is angry he doesn't like me, and if he doesn't like me I must be a miserable wretch of a human being. I might be thinking I "shouldn't" ever be angry with someone I care about, or they shouldn't be angry with me. A CBT therapist might go over my irrational thoughts with me, carefully countering each one, perhaps with a whiteboard for emphasis (sorry, Bell, but I like that whiteboard image). He might assign me homework to see other instances in my life where I might have the same sort of thoughts. He might also teach me some behavioral steps that can keep my arousal level down.
My therapist would more likely take a different approach. He would probably admit to being frustrated or maybe even angry, while telling me he also still cared for me. He would tell me it's ok for me to be angry with him. That our relationship was strong enough to withstand some anger. He might ask me about how my parents felt about anger directed towards them, or how I felt about anger from my parents. He might ask me about other relationships in my life and whether or not they had withstood anger. Perhaps he finds that when I get angry with people in my life, the relationship doesn't survive. Maybe he finds that anger is so painful to me that I disengage. Now he can talk about what I lose in life by not accepting anger as a part of a relationship. I might have told him stories that could have gotten to this point, but the immediacy of the therapeutic relationship gives an example that is still emotionally charged and that he can use to greater effect.
In effect, his interaction isn't that much different than a CBT therapist in outcome. He's shown me that he can be angry with me while he still cares about me (overgeneralizing and filtering). He reminds me that our relationship has withstood anger in the past and can withstand it now (catastrophic thinking). By admitting that I was perceiving his feelings correctly, he validates my reality, but in talking to me about what the feelings mean, he points out to me that while my perceptions are correct, my assumptions might not be. He not only gives me permission to feel angry (shoulds) but he also places my original should thought in context. In the past feeling angry has led to this or that, so I got the idea that I shouldn't be angry, but that feeling angry doesn't have to lead to this or that. That here is a relationship where it hasn't, that there could be other relationships where it wouldn't.
He doesn't tell me these things, but he gets me to realize them through experiencing the moment. It's not a didactic experience, it's an experiential one. And it takes longer, yes, because at the beginning of our therapeutic relationship he couldn't have used our relationship as an example. I wouldn't have *felt* that what he was saying was true because I wouldn't have yet experienced it.
But to some of us, the felt experience has a far greater effect than the rational understanding that a thought or idea isn't true.
Posted by Dinah on December 26, 2003, at 23:28:44
In reply to Re: You know what might be interesting? » Dinah, posted by mattdds on December 26, 2003, at 20:01:24
Ok, here's another one. This one doesn't use the relationship.
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.
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. But the result would be the same. I would come to a more reasoned view of what was happening and how I would react. Yes, it would hurt, but yes, I could live through it. I had lived through grief in the past, however much it hurt. He might let me remain angry that the world wasn't fair, even as I accepted the truth of it.
You might say that this isn't a general enough tool. That I wasn't taught the wider concept of challenging all my thoughts, not just this one. I wasn't sent home with a split journal to write the dysfunctional thoughts of the week and my counterthoughts. 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. 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.
Posted by Dinah on December 26, 2003, at 23:45:19
In reply to Re: You know what might be interesting? » Dinah, posted by mattdds on December 26, 2003, at 20:01:24
If you aren't sick enough of me already...
My much disliked biofeedback therapist told me at the first (and best) of our three sessions that there were three parts we would be dealing with - thoughts, feelings, and body. He said that the biofeedback portion would work on changing my body reactions and that doing so would change my feelings and thoughts. He said that the CBT portion of his therapy would work on changing my thoughts, and in doing so change my feelings and body reactions.
What he failed to say was that you can also work on changing your feelings, and that that would change your thoughts and your body reactions. The more traditional therapies work on changing your feelings. So in the first example I gave, I felt my anger and I also felt my therapist's caring stance towards me. I could remember the feelings of other fights and also the continued safe relationship. The current feelings and remembered feelings changed my body sensations by relaxing me, and changed my thoughts. Hey!!! You can be angry while you still have a caring relationship! I know this! I can feel it!
I've heard that there are different ways that people have to learn. That some learn better visually, some kinetically, some through hearing. Perhaps therapy is the same way. Some learn better through their body (behavior therapy?), some through their thoughts (cognitive therapy), some through their emotions (the other therapies). And perhaps most of us learn best with all three modes used optimally.
Posted by Speaker on December 27, 2003, at 0:04:49
In reply to Therapist Orientation? CBT or psychodynamic?, posted by mattdds on December 26, 2003, at 1:52:24
This board has been very informative for me! I had no clue how many types of therapy there were when I started I just knew I needed help! I have been in therapy for several years and CBT has worked well for me. I now have to find a new T and am finding how different they all are and seeing the different styles of therapy...I really just want my old T back :). I have been to a T about six weeks now and he has 3 PH.D's (how boring and expensive) so he does a little of everything and I find myself caught off guard...probably good for me but I don't like the fact I don't always know where he is going or what the RIGHT answer is :). Thanks to all of you who keep this type thread going as I learn so much and it is much more cost effective!!!
Posted by DaisyM on December 27, 2003, at 0:36:42
In reply to Re: You know what might be interesting? » mattdds, posted by Dinah on December 26, 2003, at 23:28:44
We could make it even harder:
My husband is essentially dying. We don't know whether we have 2 years, or 5 or maybe, even 10. What we do know is that it is going to be a slow, ugy, up and down process. We have kids to raise and we need to keep life as normal as possible for them.
I feel sad, angry and overwhelmed. I don't know how I will cope.
I know I am: fortunetelling, catastrophizing, overgeneralizing, guilty of emotional reasoning, and believing that the world should always be fair. I am also minimizing a great deal of the time because it isn't "actually happening to me. I'm not the one who is sick."
Instead of corrective thinking, my Therapist helps me recognize my own sadness and anger, allows it and offers support. Reality testing is helpful for the guilt. As one who strugges with thinking that she should do it all on her own, learning to accept support is a huge part of all of this.
It seems to me that any effective approach must be individualized, both for the situation and the individual.
Posted by Kalamatianos on December 27, 2003, at 1:17:27
In reply to Re: Cognitive vs Behaviorists » Kalamatianos, posted by mattdds on December 26, 2003, at 15:58:24
I feel I was out of line to post what I posted. Thanx for being patient with me and my naivete'.
Posted by tabitha on December 27, 2003, at 1:30:38
In reply to Re: You know what might be interesting?, posted by mattdds on December 26, 2003, at 21:25:33
I read that Quackwatch article after my therapist started wanting to use EMDR. I have the same hunch that the eye movement probably isn't the magical brain-integrating thing they claim it is. It does provide a little focal point or distraction though. Maybe it just helps focus concentration? Anyway my therapist is convinced it's useful. I go along with some skepticism-- I think it's the thought process and the talking that's important, not the gimmicky eye thing.
Posted by mattdds on December 27, 2003, at 2:19:20
In reply to Or to put it another way..... » mattdds, posted by Dinah on December 26, 2003, at 23:45:19
> If you aren't sick enough of me already...
Haha, nope. I think your posts are really thoughtful actually. I'm using this thread as a challenge to not get defensive or treat this as an "argument". I'm enjoying the exchange.
>
> My much disliked biofeedback therapist told me at the first (and best) of our three sessions that there were three parts we would be dealing with - thoughts, feelings, and body. He said that the biofeedback portion would work on changing my body reactions and that doing so would change my feelings and thoughts. He said that the CBT portion of his therapy would work on changing my thoughts, and in doing so change my feelings and body reactions.
>
> What he failed to say was that you can also work on changing your feelings, and that that would change your thoughts and your body reactions. The more traditional therapies work on changing your feelings. So in the first example I gave, I felt my anger and I also felt my therapist's caring stance towards me. I could remember the feelings of other fights and also the continued safe relationship. The current feelings and remembered feelings changed my body sensations by relaxing me, and changed my thoughts. Hey!!! You can be angry while you still have a caring relationship! I know this! I can feel it!
>To me, this does not seem like your emotion changed first, but your *cognitions* surrounding the emotion changed, then a subsequent change in emotion. Did I get this right? You realized that you can be angry and still have a caring relationship. No?
> I've heard that there are different ways that people have to learn. That some learn better visually, some kinetically, some through hearing. Perhaps therapy is the same way. Some learn better through their body (behavior therapy?), some through their thoughts (cognitive therapy), some through their emotions (the other therapies). And perhaps most of us learn best with all three modes used optimally.
This is so true. If you're feeling a certain way, you are more likely to think certain thoughts. Same is true if you are behaving a certain way, you are likely to feel and think certain ways that would correspond with the behavior. Emotion-cognition-behavior is a complex interplay, not a one way street. Any honest CBT-ist will admit that. It's kind of like one big equilibrium problem in chemistry. The equation can go back and forth. The problem is that we really only have *direct* control over a couple of variables - behavior (most obvious) and cognition.
I find it really hard to change feelings directly. I've tried relaxation, yoga, acupuncture, etc, all to no avail. The only form of emotional control that I know of is the control of my metacognitions surrounding my mood state. But this is still indirectly controlling emotion, and it follows a change in cognition, in my view.
If you know of any reliable methods of directly changing emotions, please let me know. I'm not being sarcastic here, I'm serious! This would be the missing link for me. Because in the end, we all just want to *feel* good. Period.
But this is the reason I sought treatment...I can't directly control my emotions. I can accept them, and not catastrophize about them. I can control the metacognitions that appear surrounding them (acceptance paradox, not magnifying). I can even pry my butt out of bed after 2 hours of sleep that was interrupted with panic attacks and attend a pharmacology exam (behavioral activation), despite my horrible mood.
But for me at least, there is no knob or button to control my emotions. That's the whole problem!!
This thread is getting good, thanks for the exchange, Dinah!
Best,
Matt
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
Posted by mattdds on December 27, 2003, at 2:45:29
In reply to Re: Cognitive vs Behaviorists » mattdds, posted by Kalamatianos on December 27, 2003, at 1:17:27
> I feel I was out of line to post what I posted. Thanx for being patient with me and my naivete'.
>I wasn't offended or put off, but thanks for being concerned. I appreciate it! I don't consider you or your post to be naive in the least.
Regards,
Matt
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.
>
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!
>
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.
>
> 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.
> >
> > 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.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.
>
>
> 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.
>
:) 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.
Posted by Dinah on December 27, 2003, at 9:30:26
In reply to Re: You know what might be interesting?, posted by Dinah on December 27, 2003, at 9:29:31
Posted by Dinah on December 27, 2003, at 9:58:34
In reply to Re: Or to put it another way..... » Dinah, posted by mattdds on December 27, 2003, at 2:19:20
>
> To me, this does not seem like your emotion changed first, but your *cognitions* surrounding the emotion changed, then a subsequent change in emotion. Did I get this right? You realized that you can be angry and still have a caring relationship. No?No, not exactly. First I felt the anger, and felt the caring. Not until I was able to feel both at once, and recognize that I was feeling both at once did I entertain the cognition that I *could* feel both at once. The feelings came first, recognition of the feelings brought about a change in my thoughts. No one could have convinced me that I could feel any differently (changed my cognition on a fundamental level) until I *had* actually felt differently.
Now, I suppose you could say that that resulted from behavior therapy, except that I hadn't done anything really differently than usual. I hadn't forced myself to behave differently. I just got a different response to the behavior I normally exhibit. And that different response allowed me to feel differently. And feeling differently allowed me to think and behave differently in the future.
That can happen in other places than therapy. For example, when I switched to a new high school, I didn't behave differently, but I found that the students were more accepting. So my feelings about school changed first, then my thoughts, and then my behaviors. But in therapy, it isn't happy coincidence, it's a planned endeavor.
>
> This is so true. If you're feeling a certain way, you are more likely to think certain thoughts. Same is true if you are behaving a certain way, you are likely to feel and think certain ways that would correspond with the behavior. Emotion-cognition-behavior is a complex interplay, not a one way street. Any honest CBT-ist will admit that. It's kind of like one big equilibrium problem in chemistry. The equation can go back and forth. The problem is that we really only have *direct* control over a couple of variables - behavior (most obvious) and cognition.
>
> I find it really hard to change feelings directly. I've tried relaxation, yoga, acupuncture, etc, all to no avail. The only form of emotional control that I know of is the control of my metacognitions surrounding my mood state. But this is still indirectly controlling emotion, and it follows a change in cognition, in my view.
>
Well, in my humble opinion, relaxation, yoga and acupuncture probably work on the body part, not the feelings part, just like biofeedback.> If you know of any reliable methods of directly changing emotions, please let me know. I'm not being sarcastic here, I'm serious! This would be the missing link for me. Because in the end, we all just want to *feel* good. Period.
>
I don't think therapy works quite that directly. My therapist would be the first to admit that I can't decide to wake up feeling happy and excited tomorrow. But therapy does provide a controlled environment designed to change your feelings. Not global ones, cerntainly. But in small increments.> But this is the reason I sought treatment...I can't directly control my emotions. I can accept them, and not catastrophize about them. I can control the metacognitions that appear surrounding them (acceptance paradox, not magnifying). I can even pry my butt out of bed after 2 hours of sleep that was interrupted with panic attacks and attend a pharmacology exam (behavioral activation), despite my horrible mood.
>
Yes, and all those things are wonderful, and very helpful. That's why I think CBT should be required for everyone.
> But for me at least, there is no knob or button to control my emotions. That's the whole problem!!
>
No, there's not. And I certainly can't say my therapist can help me control my emotions directly. But there are reasons for many of our emotions. Some are purely cognitive, but others come from our life experiences. And sometimes the emotions that come from our life experiences are best changed by having new, different, life experiences. Admitting something that we have always been ashamed of and feeling the person with us exuding acceptance can help us let go of the shame. Growing up in a household where it was necessary to perform to receive attention and "love" leave us feeling that we are what we do. Feeling someone accept us without the necessary performance first can help us feel differently about our worth. The therapist is providing us with new experiences and helping us feel differently. Once we start to feel differently it affects our thoughts and our bodies.Oh, by the way, I wanted to clear up something I said in another post. I don't in any way think that having my OCD brought under control by CBT caused my mood disorder. I do think that OCD masked, diverted, and drained the energy from a previously unknown mood instability. Not completely true. My mood instability was obvious in my early teens but was rigorously under control after that point. The OCD was possibly a side effect of that control? Or a mechanism that helped the control? At any rate, I was too out of touch with my feelings to recognize the mood instability. And ironically, one of the things CBT for anxiety disorders does is try to get you in touch with your feelings. :)
Ok, can some others with better examples or who might be better at explaining the processes jump in here?
Posted by Dinah on December 27, 2003, at 11:21:26
In reply to Re: You know what might be interesting? » mattdds, posted by tabitha on December 27, 2003, at 1:30:38
I was guessing it was a form of hypnosis. Selected narrowed attention and all that.
I'm rather good at self hypnosis, though I've never had guided hypnosis. So I don't know that it will open the floodgates to anything. But I want those floodgates open, so I'm willing to try.
Posted by Dinah on December 27, 2003, at 11:26:05
In reply to Re: You know what might be interesting? » Dinah, posted by DaisyM on December 27, 2003, at 0:36:42
((((Daisy))))
I'm really glad that your therapist is not only meeting your immediate needs for a safe place to take care of yourself without having to worry about how it will affect others, but also showing you new more accepting ways to see your needs.
Posted by judy1 on December 27, 2003, at 12:07:02
In reply to Re: You know what might be interesting? » DaisyM, posted by Dinah on December 27, 2003, at 11:26:05
my belief is that the neural component isn't addressed enough (even though Matt mentioned it). as someone who suffers from both panic and mood disorders, I know stress hormones are constantly being released, I know my hippocampal volume has decreased as a result of that (as shown on an MRI), and I know that directly affects how I relate emotionally. so all the therapy in the world can't change what has already occurred physically-but it can reduce the future release of stress hormones and prevent further damage. it also can help me accept what has already occurred- which is done (as Tabitha wrote) through 'west coast eclectic' (I really like that by the way). thanks for this thread- I'm really enjoying it- judy
Posted by Speaker on December 27, 2003, at 16:33:55
In reply to Therapist Orientation? CBT or psychodynamic?, posted by mattdds on December 26, 2003, at 1:52:24
Do you just ask a new T. what kind of therapy they do? Can you tell from the school they went to or are they all trained in several kinds of therapy and just choose what they think is best? I have learned a lot from reading this thread now I just want to know how to go about finding out what is best for me.
Posted by fallsfall on December 27, 2003, at 18:05:33
In reply to Re: CBT or psychodynamic?...how do you know, posted by Speaker on December 27, 2003, at 16:33:55
I did 8 1/2 years of CBT. I am good at analyzing and organizing and intellectualizing. So the CBT made me feel really comfortable. I learned some great coping techniques, and when and how to apply them. These techniques allow me to be so much more in control of my life.
But there came a point where I felt like I needed to "go deeper". Sort of like my therapist wanted me to "decide" that a particular feeling wasn't helping me, so I should "change" it. Somehow, this doesn't work for me. I don't seem to be able to change my feelings even if I think that it would be logical to do so. I felt that I needed a different approach - one that would use my intellect less (because I think that I often "think" too much). My CBT therapist was not able to do that with me.
I switched to a Psychodynamic therapist (actually, he follows Kohut's Psychology of the Self). With him I do find that I am able to reach deeper inside me, to see what is really causing the reactions that I have. We've only been working together for 6 months, but I have seen things that make me believe that this will be a more effective therapy for me than CBT would be at this point.
That said, though, I don't know that I could have started with my current therapist. I was so out of touch with my feelings and how to survive despite my feelings. I think that I would have crashed if I had to face the kinds of things that I'm facing now without the coping techniques that I have.
So, for me, I think CBT was very important when my therapy started, but I think that the Psychodynamic strategy is more helpful for me now.
P.S. You will see some negative things from me on this board about CBT. These arose late in my CBT experience and have been very painful. I think that my therapist made some mistakes, and I think that I had (have) some unreasonable expectations of therapy, myself and the world. But I do not think (and I hope I never say) that CBT is not useful - it clearly is. I do think that both CBT and Psychodynamic therapy have weak points. I guess which you would benefit most from depends on where those weak points match up with your needs at this particular moment.
Posted by Dinah on December 27, 2003, at 21:27:41
In reply to and to add more to the discussion :-), posted by judy1 on December 27, 2003, at 12:07:02
Judy, I've read some encouraging things lately about neurogenesis or whatever it is. That the brain can repair itself a lot better than they thought even recently. So there is hope that the damage can be reversed if the underlying problems are addressed adequately. Aye, but there's the rub isn't it? My stress hormones are still being pumped out at an alarming rate, even though I'm getting better at reducing the time it takes to return to baseline (I suppose). And I just can't imagine that the psych drugs that stop the cascade of chemicals are doing my brain all that much good either. But there's hope I guess.
Posted by Dinah on December 27, 2003, at 21:47:52
In reply to Re: CBT or psychodynamic?...how do you know, posted by Speaker on December 27, 2003, at 16:33:55
I didn't have the knowledge to ask when I started with my therapist. But if I (gasp!) had to start over, I would ask straight out about their orientation, their familiarity with dealing with my problem, and how long their therapy usually lasted. Along with a host of other annoying questions.
But I'm not sure how clear an answer you'll get. I think my therapist would say something about providing a corrective emotional experience. Which is more or less what I described. He would provide a different response than I was used to getting, do it consistently, and thus change my expectations of the world around me. The main one being that he is there week after week, relatively consistent. And he'd also probably use some attachment terms, providing a secure base or something. But he'd probably say it so obscurely that I wouldn't have the slightest idea what he was talking about. And if I had asked him in the intial interview he would have had something completely different to say, because he didn't yet know me and my needs.
But that doesn't mean that you shouldn't ask. :)
Posted by LostGirl on December 27, 2003, at 22:22:52
In reply to Therapist Orientation? CBT or psychodynamic?, posted by mattdds on December 26, 2003, at 1:52:24
Psychodynamic, once a week.
Wouldn't even know where to find a behavioral one. I feel behavioral isn't deep enough, although you can't get very deep with once a week in any kind of therapy. But I am still wounded from a bad ending in rather deep psychodynamic therapy. I never want that kind of attachment again (whether or not we call it transference).
Posted by gardenergirl on December 28, 2003, at 0:01:55
In reply to Re: Therapist Orientation? CBT or psychodynamic? » gardenergirl, posted by mattdds on December 26, 2003, at 17:59:34
This is a great thread! To answer your questions and perhaps respond to later posts at the same time...
>
> I just had a question about that statement. I was unclear about a couple of things. How does being "introspective" relate to the type of therapy that will work? Also...introspective as opposed to what?By introspective, I meant that I tend to turn inward in understanding myself and my world. I use this in opposition to extroversion, which to me means turning to the external world--other's reactions to you and/or your reactions, your own experience of your actions and their effects, etc. It's somewhat hard to describe at this time of night. I don't mean that introspective is deeper or superior to extroversion. Rather I view them as two processing styles which exist on a continuum.
> Also, what do you mean by "feeling-oriented"?
By feeling-oriented, I refer to my own tendency to emphasize and experience my feelings more so than my thoughts. If something does not engage me emotionally, it does not seem to stimulate me as much as when affect is involved. I believe this is why I felt so dissatisfied with my brief experience with CBT--I kept wondering "Is this all there is?"
In my training, I am often torn between working with the affect and feelings presented in exploring past experiences as they relate to the current Self or focusing on irrational beliefs and maladaptive behaviors. My supervisor and I would focus on very different things when reviewing my sessions in supervision. In searching for a model which incorporates both the experiencing and exploration of affect and the associated cognitive aspects, I found the Process-experiential approach.
This approach emphasizes that we are all composed of cognitive-affective schemes or combinations of thoughts and feelings related to our past experiences. These are constantly being revamped and reconstructed as we encounter experiences which may conflict with our schemes or may validate them. What I like best about this type of therapy is that it focuses on the experiencing and exploration of emotion, but also adds the cognitive aspect of it. Because we all attempt to make sense out of our feelings and experiences. This involves using cognition to label and associate the feeling with the concurrent event. We did this in the past, and we continue to do this. What may have made sense in the past, such as the child of an alcoholic learning to suppress negative feelings in order to avoid setting off the intoxicated parent and risking a beating, is maladaptive in the present when faced with justifiable anger say towards the drycleaner who ruined your skirt. If the adult with the maladaptive scheme represses the anger instead of assertively communicating with the drycleaner, they are less likely to get their needs met. This can then lead to feelings of hopelessness or resentment, depending on the current construction of the scheme. It seems like in this approach you are processing on a more effective level versus focusing on one or the other, cogntitions or emotions.
> In short, what I used to call introspection, I now call rumination.I would agree with your calling it rumination. In viewing introspection/extroversion on a continuum, I tend to think that if one focuses most on just one end of the spectrum, i.e. ruminating in order to avoid action or acting in order to avoid thinking, then it may be likely to cause problems. But then my current path for my own life is to become more balanced in all aspects and to focus on being in the moment more. To that end, yoga and meditation have helped me to focus on my current experiences. This is leading me to ruminate less (I did/do that too!) and to value each moment more. But that is what's working for me.
As has been said by many--we are all different, and thus it's good that there are many approaches to the same goals.
Thanks for starting this thread and for stimulating my thinking about why I am doing what I am doing.
Happy new year to all!
g
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