![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 93. Go back in thread:
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
Posted by DaisyM on December 28, 2003, at 0:07:30
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by LostGirl on December 27, 2003, at 22:22:52
Just finished "Pregnant Man" which is about hypnotherapy. It seems that this is often combined with both CBT and Psychodynamic techniques. I have no experience with it but in reading it seems that the emotions (attached to memories) come first, then coping techniques. But, a base of safety is established initially. (Ok, is this the cart or the horse?)
I can see how Psychodynamic techniques would work in a group, but how about CBT? I think it might feel confrontational. Again, not my experience, just curious.
FYI, my son reports from his classes at UC Berkeley that the trend in psychology being emphasized there has shifted back to Psychodynamics, especially Kohut/self theory and away from the behaviorists.
Posted by DaisyM on December 28, 2003, at 0:16:55
In reply to Re: You know what might be interesting? » DaisyM, posted by Dinah on December 27, 2003, at 11:26:05
Thanks. I hope that my post wasn't too pathetic. I was trying to make a point. I try not to whine, I know so many people who are dealing with worse.
I'm must say though, therapy itself is so "hard" that I can't imagine doing it without the ongoing support of a good therapist. I guess if you didn't have it, you either wouldn't stick with it or you wouldn't classify it as hard.
Sometimes I wonder if I had chosen a more CBT oriented Therapist if it would indeed have gone this deep... It is interesting that the Therapist who essentially dragged me into therapy classifies himself as CBT yet he sent me to someone who definately is Psychodynamic.
Posted by Dinah on December 28, 2003, at 8:36:38
In reply to Re: You know what might be interesting? » Dinah, posted by DaisyM on December 28, 2003, at 0:16:55
Not at all, Daisy. I pointed your post out to Matt as probably a better example than mine were, since mine were more artificial.
(But just for the record, I've never much liked the feeling that one must justify one's pain. Your pain is your pain. Please don't minimize your own pain, Daisy.)
Posted by Dinah on December 28, 2003, at 8:38:43
In reply to Re: You know what might be interesting? » Dinah, posted by DaisyM on December 28, 2003, at 0:16:55
Whoops. If it helps you to feel that way, then please ignore my above post. I should recognize that others find it a helpful coping mechanism. I always feel angry at adding feeling guilty on top of whatever other feeling I have. But I shouldn't assume that others feel as I do.
I apologize. It's too early in the morning. :(
Posted by gardenergirl on December 28, 2003, at 9:21:06
In reply to What about Hypnotherapy? And groups? , posted by DaisyM on December 28, 2003, at 0:07:30
Daisy,
Most of the faculty in my program tend to classify the program as very CBT-based, but we also get some good exposure to Kohut's theory. It really resonated with me. There are also a good number of us who are turning out to be psychodynamic or humanistic/existential despite the emphasis on CBT. That seems to further validate the idea that people tend to migrate towards the approach that speaks to them the most.Enjoying this discussion...
g
Posted by mair on December 28, 2003, at 10:40:44
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by gardenergirl on December 28, 2003, at 0:01:55
I was referred to my current therapist for CBT. At that time I didn't know enough to understand the difference or to ask about differences for that matter. Initially it helped quite a bit, particularly with anxiety. I learned how to work through a "what's the worst thing that can happen" scenario which is a technique I still employ. However, it didn't help a bit with the fact that I had developed this very subjective self-hatred and it didn't help me curb persistent suicidal ideation. After awhile, my therapist switched to a more psychodynamic approach. After a few months of telling me that she didn't care about my past, it seems that we evolved into talking about nothing else. When we've talked about her shift in approache, she has told me that she didn't think CBT was particularly effective for me because I just "didn't buy it." (her words not mine). I've also discovered however that while she started out as a behaviorist in her own training, she has alot of doubts about the general effectiveness of behavioral approaches and I think does alot of psychodynamic therapy in which she incorporates some CBT stuff when needed. Therefore I think she might be more prone than more dedicated behaviorists to abandon CBT as the sole approach.
As with Dinah's therapist, mine aims to give me corrective emotional experiences which hopefully will alter my self-view. I understand what she's doing in theory, but with me it's such a long drawn out process and it's frequently very difficult for me to imagine a successful ending to this therapy.
Mair
Posted by Dinah on December 28, 2003, at 10:42:16
In reply to Re: What about Hypnotherapy? And groups? , posted by gardenergirl on December 28, 2003, at 9:21:06
I am thoroughly enjoying your posts. They bring a practical viewpoint to this theoretical discussion. I liked your description of process-experiential approach, and although my therapist doesn't use that term, he does a lot of what you describe. Especially in terms of my favorite and overused coping mechanism, dissociation.
"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."
I like that in a couple of ways. First it brings some validation to the ways that we are currently doing things by explaining them in terms of how they were adaptive in previous circumstances in our lives. It also seems to emphasize learning through experience? That appeals to me because unless something reaches both my brain and my gut it's unlikely to work.
I too enjoy the ideas behind self psychology and even more, object relations. And of course attachment theory. Since attachment theory works directly on my area of weakness - a desire for safety above *anything* else, it speaks to me far more than Freud's talk of agressive and sexual drives. But I must confess that I do better reading the translations to semi-layman (and more practical) terms than the originals so I might be missing the subtle nuances.
What do you think of my basic theory that most therapy orientations bring you to the same point, albeit through different learning mechanisms? If that is true, it would seem to suggest that an eclectic approach geared toward the client might be the best solution. Either that or an awful lot of referrals. I'm glad that your training program introduces you to more than one approach.
On the other hand, haven't I read outcome studies that therapists with strong theoretical positions tend to have the best outcomes? Of course, I'm a bit dubious about outcome studies...
Posted by Dinah on December 28, 2003, at 10:54:44
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by mair on December 28, 2003, at 10:40:44
We both had similar experiences then in terms of how we came to therapy. I don't think my therapist would have ever espected to still have me coming (much less at twice a week) nine years later.
I admit the subjective self hatred is a hard thing to conquer. My therapist and I have been talking about that lately. Because even though my self esteem is pretty good and based on a realistic appraisal of my strengths and weaknesses, I have pockets of self hatred that seem isolated from any appeal to reason whatsoever. I'm not even sure it's amenable to a corrective emotional experience, because it's so isolated.
This might be different from your own experience. Mine is that I generally feel realistically good about myself then totally surprise myself with a statement (or post or action) that reveals self loathing that seems ego-dystonic to me.
My therapist seems more confident than I feel that it can be addressed.
Has anyone had a successful resolution to this problem and can pass on some tips?
Posted by fallsfall on December 28, 2003, at 11:51:43
In reply to Re: Therapist Orientation? CBT or psychodynamic? » mair, posted by Dinah on December 28, 2003, at 10:54:44
Interestingly, my first therapist (a CBT therapist) worked with me effectively on self-hate. This does seem a little counter-intuitive, doesn't it? I know very little about how this came about because I believe that I dissociated from entire sessions for weeks while we worked on this.
It resolved when I was able to write a pair of poems that described the evil that lived in me, and how I could exit a cave filled with dangers into the outside world.
My journalling from the time contains very few clues - I have to believe that my unconscious was doing all of the work.
So, how did my CBT therapist, who was unable to help me go "deeper" later in our therapy, accomplish this? I don't know.
I probably still have some selfhate, but nothing like I used to have.
I'm happy to have muddied the waters for you.
Posted by antigua on December 28, 2003, at 14:39:20
In reply to What about Hypnotherapy? And groups? , posted by DaisyM on December 28, 2003, at 0:07:30
Daisy,
I've used psychodynamic for 12 years w/my individual therapist and this past year went through a CBT group program. It was disastrous for me, although it did help me resolve the main problem I went for. I could accept CBT to recognize the triggers that caused me emotional turmoil and to logically change my reactions to them, but the rest of it was awful as I was told over and over again I had to change my basic beliefs--mostly basic beliefs in myself that I had worked for 10+ years to develop into a healthy (o.k., just healthier) self-image. The group thought I was in denial, but I knew I wasn't, and I firmly believed that if I had to give up the good stuff I'd learned I would have nothing to hold on to. The experience was so bad that I became suicidal, and that's when I quit.So, for me, psychodynamic is the core of my therapy, but I do see benefits to CBT when used correctly.
antigua
Posted by gardenergirl on December 28, 2003, at 16:14:54
In reply to Re: What about Hypnotherapy? And groups? » gardenergirl, posted by Dinah on December 28, 2003, at 10:42:16
Dinah,
Thanks for the positive reinforcement!> That appeals to me because unless something reaches both my brain and my gut it's unlikely to work.
I feel exactly the same way! CBT alone just doesn't seem to reach my gut. And just sitting with my therapist (or sitting with a client) experiencing emotions without engaging the cognitive system also doesn't seem to really effect change. I really think it takes both.
>I doubt you are really missing subtle nuances. You may be just reacting to the flaws in Freud's theories. I think that practicing from a strict Freudian approach in this day and age, when we know his own biases and know more about psychology would not truly be effective. Many psychoanalysts have expanded on Freud and modified psychoanalysis to better fit clients today and to utilize the knowlege we have gained over the years.
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> What do you think of my basic theory that most therapy orientations bring you to the same point, albeit through different learning mechanisms? If that is true, it would seem to suggest that an eclectic approach geared toward the client might be the best solution.That's essentially my theory as well, although it drives my supervisor crazy. She talks about cognitive restructuring, and I talk about insight and reconstructing cognitive-affective schemes. I believe we are essentially talking about the same thing. We use the metaphor of backdooring or frontdooring in therapy to represent our different approaches to the same goals.
I also tend to agree with a more eclectic approach. I certainly would not attempt to explore affect and past trauma for someone with a simple phobia. CBT has been proven to work best in those cases. Now if something came up within the context of therapy which added complexity to the case, then I may be more likely to delve deeper or modify my approach...assuming the client wishes to work on that as well.
There is something we learned in school about eclectisism. It is appropriate for therapists to be eclectic in their approach as long as they understand the reasons behind using multiple approaches and interventions. The kind of eclecticism which is not effective is when the therapist is just using a technique because it exists. You need to be doing it for a theoretical reason, not just because you know the technique. That may explain some research which suggests that an eclectic approach can be less effective. The best eclectic approaches are those which integrate different aspects of theories into a more cohesive model. Process-experiential is an example in that it draws from humanistic, Gestalt, and CBT to form a new whole theory.
Posted by gardenergirl on December 28, 2003, at 16:21:39
In reply to Re: Therapist Orientation? CBT or psychodynamic? » mair, posted by Dinah on December 28, 2003, at 10:54:44
>I have pockets of self hatred that seem isolated from any appeal to reason whatsoever. I'm not even sure it's amenable to a corrective emotional experience, because it's so isolated.
I have worked on similar issues with the therapist using something called the two-chair technique. It allows different aspects of your Self, which may be in isolation from each other, to have a dialogue. You'd be surprised what comes out!
Good luck in working on this. In your head I am sure you know that we are all lovable. Now it needs to reach your gut in those isolated areas.
g
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