![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 57. Go back in thread:
Posted by frida on February 18, 2008, at 13:36:47
In reply to Re: Therapy - Bang for the Buck?, posted by MissK on February 18, 2008, at 10:07:46
Hi,
When I entered therapy I couldn't think of a future. I just wanted to be able to find life bearable and be able to feel safe for once...
I wanted to be able to trust someone for the first time ever without having that trust betrayed and abused.Frida
Posted by sunnydays on February 18, 2008, at 15:29:21
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 10:39:37
What is broken is that the patient has suffered severe trauma. I will not assume you haven't suffered trauma, but in my experience, some people who haven't suffered trauma don't understand the extent to which it can damage one's ability to trust ANYBODY. Being able to trust the therapist is the first step to being able to trust other people. And after 10 sessions of me not talking hardly at all, my therapist asked me if I wanted to continue, and I did. Because I WAS getting something out of the sessions - I was learning that people will sit with me and listen to what I have to say and not criticize me or hurt me. One can't assume that that is a given to everybody. For those who have been severely traumatized trusting is a skill that must be learned. And, like drawing, or those other skills, it is one that can take years to fine-tune and perfect. I don't think many would say that someone who takes drawing classes for 20 years would be wasting their money, even if the last 10 years they see only marginal improvements in their skills. What looks marginal to one person can be SIGNIFICANT gains to another person. I wish that everyone in the world could realize how severely trauma can affect people, and how long it takes to heal from that. Even connecting the dots is not as simple as it sounds. I can connect the dots in a session, but then when I go home and have to have contact with my abusers, it can call it all into question again, and I have to go back and reconnect the dots.
I hope that helps explain how long-term therapy can be beneficial to some. I truly, truly hope that you can come to accept that long-term therapy can be something beneficial and in fact VITAL to a person's mental health and personal happiness and well-being.
sunnydays
Posted by seldomseen on February 18, 2008, at 16:16:24
In reply to Therapy - Bang for the Buck?, posted by Hermitian on February 17, 2008, at 14:42:08
I've always thought of therapy in terms of the proverb:
"when the student is ready, the teacher will appear".While I do certainly think there are some lazy therapists out there who see us as cash cows, I think most of the speed at which therapy proceeds is up to the student so to speak.
My therapy has been punctuated by a series of what I call "holy crap you are so RIGHT!" moments. I just had to be ready to hear them and accept them. Developing a trusting relationship - dare I say - attachment to my therapist helped a lot. I can say that unequivocally.
I do think there is some merit in what you say about re-hashing the past ad nauseum. In my opinion, there is a fine line between wallowing and discussing.
But even that re-hashing seems to come in phases: the recognition, the anger, the mourning, the acceptance and finally, the desire for change. Each phase I think has its own time course for different people.Mine took about four years and was complicated by all kinds of therapy crap, but even that crap helped me in the real world. Then I got to work. The "teacher" appeared so to speak.
Looking back on it all, I'm not sure I could have gotten here any faster. The student just wasn't ready.
I still relapse and collapse back in on myself. It's such an old pattern, so so hard to break. But I'm working on it. We are working on it together I guess.
Seldom.
Posted by antigua3 on February 18, 2008, at 17:43:55
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 10:39:37
<<Re: antigua3: "Developing a trusting relationship with a therapist and can take years for many."
<<Many years? Really? So say I'm conservative and "many" is only three years. And there are say 40 sessions per year at $175/session. If I do the math, it would take a patient 3 years, 120 sessions and 7 thousand dollars to form a trusting relationship with the therapist? What is wrong with that picture? Isn't it the therapist's job to effectively dialog with the patient to minimize that treatment phase? I can't believe after say 20 sessions (which is a lot of dialog) and nothing really happening, the therapist would not suggest alternative treatment. Now I'm not saying 20 sessions and a cure here, I'm stopping way short at trust establishment. That's it. Half a year and the guy can't get the dialog going with his patient? Then a full year? Then 2? Then 3? And the patient keeps showing up and shelling out? Sheesh...
>>Your comments re: my post are unsettling to me. I don't think you have the knowledge of my situation to impose time limits for me as a value judgment. It took me YEARS to open up, and I never would have if my T hadn't been so patient. Her orientation works for me because we've built that trust. And to assume with "sheesh" that I'm a fool for doing so makes me feel insulted.
antigua
Posted by MissK on February 18, 2008, at 18:16:34
In reply to Re: Therapy - Bang for the Buck? » Hermitian, posted by sunnydays on February 18, 2008, at 15:29:21
>I was learning that people will sit with me and listen to what I have to say and not criticize me or hurt me.
Hermitian already said that being an emphatic listener is part of a good therapists job. You were discovering what it is a therapist does.
>I wish that everyone in the world could realize how severely trauma can affect people, and how long it takes to heal from that.
I do know how it can affect me. I also know that others can go through similar things in life and still approach therapy differently. Is it inconceivable to you that someone can actually frame it in mind that they are visiting a professional and do not need years to 'trust' that professional to do their job, which is to hear whatever your issues are and offer their trained and skilled therapy back?
For whatever reason you, and others apparently, need(ed) to have some kind of drawn-out relationship before you can / could get to the heart of the matter(s). I don't get that anymore than I would get it if you had to know and trust a dentist three years before you would let them near your mouth. As I said different approaches. I don't think it does anything to continually harp about "you haven't experienced it and so don't understand". Give people some credit. Some have experienced SA and other traumas and don't need years to trust a therapist to talk about their issues. Some do. Each in their own time, I guess.
Posted by Hermitian on February 18, 2008, at 18:57:45
In reply to Re: Therapy - Bang for the Buck? » Hermitian, posted by antigua3 on February 18, 2008, at 17:43:55
Well this sure isn't going anywhere. Of course you folks are going to defend your therapists and your treatment strategies. Otherwise you would still not be seeing them. If you were seeing psychics for years on end youd be issuing the same apologias for them too.
Now before you get too stirred up, I am not equating the competence of therapists to psychics. But how about this, how about we agree that I personally do not have a dog in anyones fight here on this forum? Does that make sense? Do I know anybody here personally? I have not criticized any specific individual regarding the choices they have made related to therapy. I merely made observations about the extended therapeutic strategies that some have subjected themselves to that from an innocent bystanders PoV, do not appear to have been all that effective.
Look at it this way. Say theres a sympathetic lurker who visits this forum occasionally for who knows what reason. And say he has personal experience with mental illness. And lets say that perhaps he lost his mother from schizophrenia. So he fully knows whats what. Now suppose too when he reads these posts, many of them appear to be from people who have acquired this terrible sense of learned helplessness. And they also have these inordinate and in some ways disconcerting relationships with their therapists whom they have seen for years. And their reports of their therapeutic dialogs suggest meandering emotionalism with not a whole lot of actionable guidance from the therapist. And this person finds all of that very disheartening. And in some ways disturbing.
So this lurking person is indeed very sympathetic to their plight. But with that sympathy he engages in a why are they so after so long? rumination. So yeah, if someone has been in intense therapy for years, and they do not have an organic brain disorder, why are they still so miserable? And after so many years, why are their therapy sessions sowhats the word?inchoate? ambiguous? ad hoc? I dunno, pick one.
If I were camped out on this forum like many here and was engaged with a therapist myself, Id be asking the same questions that this lurker is ruminating about. Apart from the electronic hugs, I'd be prompting those still miserable people to question the value of the service that they have been paying good American green for so long. By circling the wagons, you are doing a disservice to the poor people who actually are being professionally disserviced by therapists who have not proven themselves to be effective for whatever reason.
And let me make one last point and then Ill retreat back to the sports blogs where I belong. The fact that someone required very extended amounts of time to see positive results from therapy could indeed be a function of the complexity of their condition. But it could also be a function of a pedestrian skill set of the provider. You could hire somebody you really like to shovel the snow off your walk and if he uses a soup spoon but still does an adequate job, you could likewise sing his praises. But that does not mean he objectively did a good job expending resources. If a mechanic had your car in his shop for 3 months, youd start asking questions, wouldnt you? Why should a therapist whos lassoed a patient for years be exempt from the same kind of professional criticism?
I dunno, I surely do not know what goes on in anyones therapy session. You if you want to dump on me for hearing a duck quack and suggesting it is indeed a duck, no big deal. Have at it. And if hand holding for years provides the therapeutic value that you need for whatever reason, well have at that too. I'm just speaking as somebody whos been around the block with mental illness. And I really think that there are some people who visit this site that are tragically captured in a therapeutic road to nowhere. And that indeed is a lousy way to live.
Dinah do you worst. Feel free to suspend me, ban me, shun me, even sentence me to multi-years of ineffectual therapy. I can take it...
Out.
P.S. How come when I cut and paste from Word to here, it screws up the punctuation marks?
Posted by rskontos on February 18, 2008, at 20:41:34
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 18:57:45
Hermitian,
I was not going to engage in this discuss for not wanting to get sanctioned myself for not being diplomatic. I myself find it hard to think however hard the struggle to watch someone go through having a loved one with MI and losing them still allows you to have an objective perspective on how beneficial the therapuctic relationship is or is not unless the experience is more direct. Empathy is one thing and sympathy is another thing all together.
Lurking on this site, has taught me a great deal about therapy. So I beg to disagree humbly with your viewpoint. And jumping in from time to time, is just a snippet of a moment in time of what truly goes on here and what goes on in the therapy of any one person's therapy.
If you look at any one person's life, you could say that what they are doing at any one moment in time might be a waste of that particular moment, however, in context to the whole of the life, it is fits. This can be said of therapy. No part of therapy is snippets however you look at it.
The length of time it takes for any one person to make progress is not up to the provider anymore than a doctor's diagnosis of someone with a medical condition saying you will be well by x date. The progress a person makes in therapy is a mixture of the therapist along with the patient, the meds they may be on, the life experiences, the current life condition, and a numerous other factors that just can not be broken down into money, time and therapist qualifications as you seem to think it should be. It is hard I think, to break it down like you seem to want to in order to identify as these people are here to long and are still having problems so therefore their therapist are either a quacks or their conditions are too hard to define for therapy. It is just not that simple as life is not a simple process to live or break down.
I wish it was. It is not. Therapy is not about money. It is time about time. It is not about applying values of belonging to anyone except those belonging to those in the room at the time therapy is occuring. And I think you must be involved in the process to truly to appreciate its merits.If you disagree I respect that and I hope you respect the rights of all here to have their opinions and express their views as well with respect of the therapy process itself.
And where exactly did you want it to go?
rsk
Posted by Deputy 10derHeart on February 18, 2008, at 20:45:19
In reply to Re: Therapy - Bang for the Buck? » sunnydays, posted by MissK on February 18, 2008, at 18:16:34
>I don't think it does anything to continually harp
>Give people some creditPlease don't post anything that could lead others to feel accused or put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Psycho-Babble Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
-- 10derHeart, acting as deputy for Dr. Bob
Posted by Deputy 10derHeart on February 18, 2008, at 20:45:30
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 18:57:45
>people who have acquired this terrible sense of learned helplessness
>meandering emotionalism
>those still miserable people
>you are doing a disservice>there are some people who visit this site that are tragically captured in a therapeutic road to nowhere. And that indeed is a lousy way to live.
Please don't post anything that could lead others to feel accused or put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be directed to Psycho-Babble Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.
>How come when I cut and paste from Word to here, it screws up the punctuation marks?
I'm not sure, but I'm always noticed that, too. Feel free to post that question on the Admin board, and I'm sure a poster who knows, or Dr. Bob, will be glad to explain.
-- 10derHeart, acting as deputy for Dr. Bob
Posted by Dinah on February 18, 2008, at 20:55:09
In reply to Re: Therapy - Bang for the Buck? » MissK, posted by Dinah on February 18, 2008, at 10:17:22
In this post.
And probably many others.
I really am on a roll in this role. Dinah is an idiot.
Posted by MissK on February 18, 2008, at 21:11:17
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 18:57:45
>The fact that someone required very extended amounts of time to see positive results from therapy could indeed be a function of the complexity of their condition.
I just wanted to point out that is a very good point.
There are some conditions that I do not understand very well here on the boards, like dissociation in particular, that do seem to require a much more protracted time of getting to one's issues and requiring a much more intensive and complex dynamic with a therapist. I try to refrain from commenting on that.
Posted by MissK on February 18, 2008, at 21:15:56
In reply to Please be civil » MissK, posted by Deputy 10derHeart on February 18, 2008, at 20:45:19
Posted by MissK on February 18, 2008, at 21:22:29
In reply to Re: Therapy - Bang for the Buck?, posted by rskontos on February 18, 2008, at 20:41:34
>Therapy is not about money.
It can be a consideration and, for some, a determining factor whether, if and for how long one can do or continue therapy.
Posted by Phillipa on February 18, 2008, at 21:26:52
In reply to Re: Therapy - Bang for the Buck?, posted by MissK on February 18, 2008, at 21:22:29
It sure is for me. Love Phillipa
Posted by MissK on February 18, 2008, at 21:48:33
In reply to Re: Therapy - Bang for the Buck? » MissK, posted by Dinah on February 18, 2008, at 10:17:22
>My therapist and I, have discussed this topic at enormous length and excruciating detail. And to me, what we have concluded is the important thing.
And so my original statement of : I think there are those that want it as a part of their life for a long time. As long as they distinguish that is what they are doing and distinguish who this person is in their lives, I won't say it is wrong or right.
And you know what? Even when I terminate therapy, I may have a mind to continue it in a 'maintenance' sort of way, perhaps once a month or once every six weeks or two months because I do recognize and appreciate what 'having a talk' with a professional therapist provides. By then though it will serve a different function for me; I hope I would no longer see it or experience it as needing it to cope.
>And that a more efficacious response might be to extol the virtues of focused short term or medium therapy. Or to talk about how one is looking forward to termination and to moving on in life.
Good point. I hope to be able to do that in the next few months or so.
>After all, few people are likely to say "My god, you're right! I've been a bloody fool. I shall go immediately and fire my therapist of fifty years, because no one else has ever pointed out with such eloquence the folly of my going to therapy for fifty years!"
That made me LOL.
> in that we both seem to be quite pragmatic. And expressing a gladness to get the chance to talk to you on Babble. So I'll just include that here. :)
Well, believe it or not, I am more of a dreamer and feeler and emotional sort. Sometimes though dealing with hard things in life demands a certain pragmatism.
> And expressing a gladness to get the chance to talk to you on Babble. So I'll just include that here. :)
Thank you, for the kind sentiment. :)
Posted by Hermitian on February 18, 2008, at 21:51:24
In reply to Please be civil » Hermitian, posted by Deputy 10derHeart on February 18, 2008, at 20:45:30
You got me. I surrender in abject remorse. Having been slapped twice in one day. First by Dinah and now by (not) so 10derHeart. Let me itemize my updated understanding based on these refreshing correctives.
1) Of course epoch long therapy engagements are always appropriate.
2) It is totally inappropriate for me to evaluate a circumstance that I have not personally experienced. And by extension that implies that common inferential reasoning is mistaken is all aspects of life. I'm glad I found that out. Now not having to engage in the critical thinking which is pointless, I can sit back and relax.
3) My observations that were obviously wrong in the first place, still transgress the civility bounds of this group even though they apply to no one who frequents this it. (See mea culpa 1 above which documents my initial error.) Let me think for a moment and try to parse out this bit of circular logic...
4) Oh, and therapists are universally competent and supremely and sublimely and hugably altruistic. Even the thought of subjecting them to any kind of standard is beyond the pale.
So let me offer my sincerest apologies and say how thankful I am for the insights you have afforded me. So please let me retreat to the dull dungeons of illusory rationality and find a petard on which to hoist myself up on. And while I am doing that, you can continue of course to talk amongst yourselves...
Best Regards
Posted by obsidian on February 18, 2008, at 21:54:33
In reply to Re: Therapy - Bang for the Buck? » MissK, posted by Phillipa on February 18, 2008, at 21:26:52
it's just a choice isn't it?
I'm not sure I get it.
If you want to be in long term therapy, then be in long term therapy.
If you want to be in short term therapy, then be in short term therapy.I am not sure why there seems to be a need to set somebody else straight.
That being said, most of this conversation pisses me off.
Posted by sunnydays on February 18, 2008, at 22:23:51
In reply to Re: Therapy - Bang for the Buck? » sunnydays, posted by MissK on February 18, 2008, at 18:16:34
I agree, each in their own time. But I seriously didn't trust a single person in my life at the time I met my therapist. It wasn't just finding out what a therapist does - it was seriously for me about learning how to trust another human being. I'm glad that other people don't have to work so hard at trusting, because it gives me hope that the world really is an ok place. But like I said, trusting is a skill, and when you don't learn it in infancy, it can take a really long time to learn how later. And that it is safe and ok.
I knew I was seeing a professional - perfectly aware of that. I knew what his job was. But what I could not grasp was that there were people in the world who would not hurt me or criticize me. Even knowing that was my therapist's job, I still could not trust that. It was not about making a decision in my mind to trust. I wanted to talk about things, but the words literally would not come out of my mouth, I was so scared at the thought of being open with another human being.
I said that I don't assume that everyone with trauma history needs long-term therapy, or I meant to. I know people with trauma history who don't need any therapy. I have already said that many many people benefit from short-term therapy - I have seen the research and I believe it. But it does not work for me, and wouldn't have. As my therapist said a week ago when I asked why this was taking me so long, "We had no choice, we had to take this path. It was the only way for you to heal."
When I was too scared to tell anyone even the simplest thing about me, it took a lot to get over that. I wanted desperately to trust, but I COULD NOT do it (the capitals are supposed to be italics, not shouting, I wish we had that here).
I said I wish that everyone could understand how severely trauma CAN affect people - that includes severely enough to not even be able to trust a professional to do their job. Not everyone with trauma background has that experience for sure. I'm in a group with plenty of people who are different from me in that respect.
sunnydays
Posted by rskontos on February 18, 2008, at 22:43:43
In reply to Re: Therapy - Bang for the Buck? » Hermitian, posted by MissK on February 18, 2008, at 21:11:17
>>here are some conditions that I do not understand very well here on the boards, like dissociation in particular, that do seem to require a much more protracted time of getting to one's issues and requiring a much more intensive and complex dynamic with a therapist. I try to refrain from commenting on that.
**I do understand dissociation as this is my condition and without therapy I would be a lost soul and so the money for me cannot be a point, I am paying out of pocket since my p-doc is out of network and he is too much according to how much they allow, but so far, I feel his worth it. I cannot discuss at this point how therapy went today although pdoc says you are on your way to getting well, with dissociation and how severely I do this, this is great news, I am not sure I am totally believing it, but without him, I would be a mess. So whether or not my therapy is deemed relevelant by an outsider, which is increasing beginning to upset me, it is highly necessary to be. I was lock into isolation without my therapist. I was locked inside my head. Now with his help I might be able to set free. It might take a while but otherwise, I might be lost forever. I have DID. I need therapy. IT has taken me a great deal to admit this. It will take a great deal to get where I need to go. Money is an issue in everything in life. It still should not be an issue motivating therapy and I stand by that statement.
rsk
Posted by rskontos on February 18, 2008, at 22:55:32
In reply to Re: Therapy - Bang for the Buck? » MissK, posted by sunnydays on February 18, 2008, at 22:23:51
Sunnydays, I am with you on this. Just in the last two days, I have rec'd information from family members that is in conflict with each other. So whom do I trust. I throw my hands up. I don't know who to trust. So in this instant, I ran to my therapist and said here it is, I am dumping this in your lap to help me. At least with him, he has committed to me, to help me. And he did . He helped me sort it out. First time in my life, I have had anyone that is objective in this area that helps me sort things out without an hidden agenda, that helps me sort things out like this. Who is committed to helping sort things, wants to help me trust, understands my background of severe trauma, understand my DID, knows what that is about, isn't afraid of it, believes it and in me, and is committed to stay around. Wow, I have NEVER had that in my life. I have found out things in the last two days that have knocked my socks off. You see my DID have robbed me of my memories in totality. So I have to depend on family members to tell me or flashbacks to fill me in. So if they are in conflict what do you do, who do you believe. Without a third party I would have thrown in the towel and gone off the deep end. I need to depend on him to help me, I am beginning to finally trust him. I cant trust my family. They are the ones that abused me in the first place. The pay part is irrelevant. The time is irrelevant. The commitment and trust is priceless. And it is the first time is have been in my life.
rsk
Posted by Deputy Racer on February 18, 2008, at 22:55:39
In reply to Re: Please be civil, posted by Hermitian on February 18, 2008, at 21:51:24
> > 1) Of course epoch long therapy engagements are always appropriate.
>
> 2) It is totally inappropriate for me to evaluate a circumstance that I have not personally experienced. And by extension that implies that common inferential reasoning is mistaken is all aspects of life. Now not having to engage in the critical thinking which is pointless,
>
> > 4) Oh, and therapists are universally competent
>
> So please let me retreat to the dull dungeons of illusory rationality and find a petard on which to hoist myself up on. And while I am doing that, you can continue of course to talk amongst yourselves...
You have been asked to abide by the civility guidelines of this site, which include not posting anything which could lead others to feel accused or put down. The guidelines also prohibit sarcasm, and over-generalizations, both of which I find in your post. Therefore, I am going to block you for posting for one week.If you have any questions regarding the posting policies on this site, please read the FAQ, located at http://www.dr-bob.org/babble/faq.html#civil Follow ups to this action should be directed to the Administration board and should themselves be civil.
Dr Bob has ultimate authority over all administrative issues on this site, and may choose at any time to revise or reverse any action taken by a deputy.
Deputy Racer
Posted by Daisym on February 18, 2008, at 23:42:00
In reply to this type of discussion, never seems to go well..., posted by obsidian on February 18, 2008, at 21:54:33
Well said.
I think Dinah tried to say that too when she suggested talking about the positives of your favorite type of therapy instead of the negatives of someone else's type.
I have teenagers. Often they say to me, "I don't understand" when what they really mean is, "I disagree." I usually point this out to them and offer to explain any decision I've made, if they are really interested in understanding. I also tell them that if they want to disagree, that is OK too. But I'd rather not go through all my reasons if we'd be better off just agreeing that we already disagree and neither of us are likely to change our minds. That way we have honesty, respect and less conflict overall.
It works most of the time.
Posted by Cecilia on February 19, 2008, at 2:20:18
In reply to Therapy - Bang for the Buck?, posted by Hermitian on February 17, 2008, at 14:42:08
I can see both sides. I wasted 7 years and a lot of money in long term psychodynamic therapy that only made me more depressed. My T told me to trust the process and I really tried but I never trusted her or the process and eventually she gave up on me, causing me excruciating pain. But on the other hand I certainly can't see how a T just telling me to diet, exercise and engage in more social activities would have helped me in any way. I'd been telling myself the same things for years. Obviously if I could have done them I would have. Well, I did do them periodically and never felt any less depressed. I guess the reality is that therapy, like meds, works for some people and not for others. The hard part is knowing when to cut your losses, that something is not going to work for you. Cecilia
Posted by mair on February 19, 2008, at 11:32:55
In reply to Re: Please be civil, posted by Hermitian on February 18, 2008, at 21:51:24
This isn't fair, particularly since Hermitian can't respond, but these issues are so loaded for me largely because I'm constantly conflicted about the very arguments he raises.
I'm a product of long-term therapy, having seen the same therapist for about 10 years, twice per week for most of those years. She and I have been over this ground alot, but never to the pont where I've felt any sort of resolution about the continued value of so much therapy. But here's what I think my T would point out as valid reasons for long term therapy:
1) Like many on this board, my response to medication has been only partial. This is not for lack of effort - I've probably tried 20-25 different medications over the last 12 years. I'm pretty satisfied with my current combo of 4 drugs although it's by no means perfect. When I'm feeling pretty good, it's seems more than adequate, at other times, the combo seems woefully inadequate.
2) Depression for me is not curable, but hopefully mostly manageable. I've had too many major episodes, and the picture is complicated by the fact that I'm probably dysthymic too, or suffering from some sort of anxiety disorder.
3) In an attempt to better manage my depression, my T and I have tried lots of CBT stuff, mostly not very successfully. She is constantly on me about exercise, so I'll throw my hat in with others on that - all the harping in the world doesn't make it happen. When I feel up to it, I really do try to make it a more important part of my life. I don't think regular exercise is going to make the demons go away - it will make me feel a little better about myself - like I'm not a total slug.
4) The sympton which has been most resistant to medication is intrusive, always negative, sometimes self-destructive thoughts. These thoughts tend to paralyze me.
5) I'm high functioning only in the sense that I put on a really good act and only a handful of people know that I have depression and have had to deal with it for eons. People also don't realize that while my work product probably looks ok, I get about half as much done as my colleagues. Putting on a really good act also means that I'm very much a silent sufferer. Even the few people who know about my depression ever ask me about it. If I wasn't able to talk to my T about what goes on in my head, no one would know.
6) When depressive feelings get triggered, I tend to spiral downward very quickly. Therapy can be a safety net, because on some occasions I've been able to stop the spiral by quickly addressing it in therapy.
7) Because of the great difficulties I have talking about emotional things and holding onto an emotional connection with my T, once per week therapy has always felt pretty worthless to both of us.
8. At this stage in my life, most of my triggers can be found at work. I am not my T's longest-running patient, but I am the longest-running patient when it comes to the frequency of sessions. She tells me that the real difference between me and the 2 other patients that she's been seeing longer than me is that their circumstances allowed them to stop working.
Given all of this, I think I'll keep going through alot of ebbs and flows until I don't have to work anymore.
ON THE OTHER HAND, my judgmental alter ego views the facts a little differently.
1) I've made progress but it's been very incremental, and thus at a very high price ($$). So if you look at it in the way insurance companies do - strictly a cost/benefit analysis - it probably hasn't been "worth" what I've paid for it. I'm pretty sure disinterested third parties might say the same thing.
2) My years of therapy have led me to spend too much time pathologizing myself. Maybe if I didn't spend as much time thinking about myself, some of the destructive thinking would go away.
3) Maybe CBT stuff hasn't worked well with me because neither my therapist nor I really stuck with it. If I had no other choice, would it be more effective than it has been?
4) While my T always says she'll support any decision I want to make about terminating therapy or cutting back, she also points out all of the fears she has for me if I'm not in therapy, or for that matter, don't come to therapy as often as I do now. I think her litanies make me afraid of quitting. What if she's right?
5) Last year my T went through breast cancer surgeries and awful chemotherapy. I continued to see her, but on a very truncated schedule. For the most part, I fared very well. So I know that if I'm otherwise fairly stable, not seeing her is not the end of the world.
6) Nothing seems to trigger anxiety-laden depressive feelings quite like the times when I feel pretty disaffected from her and from therapy and I start thinking about quitting. I'm in that place now. It makes me wonder if i don't trigger depressive feelings to justify therapy. (She really disagrees with this, but I'm not so convinced).
7) Monitoring me over the years has led both my T and me to feel pretty secure in the knowledge that while suicide can be a real preoccupation, I'm probably never going to give it a real try. So strictly from a medical perspective, I'm not sure I need the safety net of therapy to keep me safe.
8) When you've been on long-term drug therapies, it starts to get hard to quantify the effect of each drug because you can't remember what it was like before you started taking it. I've had some bad experiences making drug changes so I'm really leery about attempting to get off a drug I take now so I can try a different one. Maybe therapy is like that - I can't quantify it any more because I can't remember how it was without it.
I think everyone has to engage in whatever type and duration of therapy which seems right for them. And if you do trust your T, you have to give some credence to what he or she says about where they can "take you" in therapy. I would never question anyone's decision to continue with long term therapy psychodynamic therapy particularly given the amount of suffering I've read about on this Board. What others struggle with makes me, with my non-traumatic childhood, feel like an imposter. So although I wish Hermitian hadn't started (and perpetuated) this discussion in quite the way he did, I'm an easy mark for questioning whether I continue to get a bang for my buck.
Mere
Posted by raisinb on February 19, 2008, at 15:46:54
In reply to this type of discussion, never seems to go well..., posted by obsidian on February 18, 2008, at 21:54:33
I agree--they never go well! I tend to start writing replies, then delete them because it seems like I'm perilously close to serious incivility. It is tough, because I think everyone ends up feeling judged.
Everyone has a right to his/her own therapy-type, as with other life choices. I often find that online, or IRL, there will always be people who rush quickly in to challenge others' choices. I like to tell myself that their opinions--and their need to express them--are about them, not me. Sometimes it works...when I'm having a very peaceful day ;)
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