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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 51 to 75 of 93. Go back in thread:
Posted by tabitha on December 28, 2003, at 16:36:38
In reply to Re: self hate » Dinah, posted by gardenergirl on December 28, 2003, at 16:21:39
Mine does something similar to the chair work-- sometimes actually involving chairs, sometimes not. She makes me do dialogues between the Critical Parent, Adult, and Child. The point is to get me to empathise with the Child who is being told the hateful message, and to talk back to the big mean Critical Parent as an Adult, in order to refute the unfair criticism and protect the Child. It really does lift my spirits.
Posted by DaisyM on December 28, 2003, at 18:32:58
In reply to Re: You know what might be interesting? » DaisyM, posted by Dinah on December 28, 2003, at 8:38:43
no need to apologize. You sound like my Therapist...:)
Posted by DaisyM on December 28, 2003, at 18:56:18
In reply to Re: self hate, posted by tabitha on December 28, 2003, at 16:36:38
Since termination, voluntary and involuntary, looms large for so many of us in therapy, do you think there is a difference between orientations and how they handle termination?
I'm pretty sure transference is handled differently, but what about "flights into health"?
Do CBT's typically "back out", cutting down on sessions? Or is there a mutual agreement about "cure" or having gone as far as possible.
Posted by DaisyM on December 28, 2003, at 19:00:20
In reply to Self-Hate » Dinah, posted by fallsfall on December 28, 2003, at 11:51:43
Maybe this is a good example of being ready to resolve an issue, and having a caring person to do it with. I still think that like most things in life, trust is 50% of the equation when you are attempting something new.
Posted by DaisyM on December 28, 2003, at 19:02:59
In reply to Re: What about Hypnotherapy? And groups? DaisyM, posted by antigua on December 28, 2003, at 14:39:20
I'm sorry for your experience. I can't see myself EVER in a group but I know people benefit. Support groups maybe, but I'm usually so "in charge" of myself and my emotions, I'd probably smack someone who tried to tell me I was in denial!
Posted by DaisyM on December 28, 2003, at 22:14:58
In reply to Therapist Orientation? CBT or psychodynamic?, posted by mattdds on December 26, 2003, at 1:52:24
I thought the following was interesting from talkingcure.com:
An Introduction . . .
Since the mid-1960's, the number of therapy models has grown from 60 to more than 250. At the same time, virtually all of the research data finds that the various treatment approaches achieve roughly equivalent results. This is true of both the biological and well as the much bally-hoed cognitive and cognitive behavioral revolutions. When all is said and done, virtually all of the data find that the various approaches work about equally well. As leading outcome researcher Michael J. Lambert, Ph.D. summarizes, "Research carried out with the intent of contrast two or more bona fide treatments shows surprisingly small differences between the outcomes for patients who undergo a treatment that is fully intended to be therapeutic" (p. 158, 1994).
Such evidence makes clear that the differences between the various models--much promoted by the developers and marketers of the different approaches--can not account for the effectiveness of treatment. Rather, the mountain of evidence for equivalent outcomes makes it clear that the similarities rather than differences between models account for the effectiveness of psychotherapy. The question, of course, is what similarities approaches share that account for success?
The Facts . . .
Research points to the existence of four factors common to all forms of therapy despite theoretical orientation (dynamic, cognitive, etc.), mode (individual, group, couples, family, etc.), dosage (frequency and number of sessions), or specialty (problem type, professional discipline, etc.). In order of their relative contribution to change, these elements include: (1) extratherapeutic [40%]; (2) relationship [30%]; (3) placebo, hope, and/or expectancy [15%]; and (4) structure, model, and/or technique ([15%] For more info/references: Escape from Babel (Norton, 1997); The Heart & Soul of Change (APA, 1999).
Research on the four common factors makes clear that various therapeutic techniques (e.g., confrontation, the "miracle question," EMDR) are better viewed as different means of empowering one or more of the factors responsible for treatment outcome rather than unique to a specific treatment model. Incidentally, this ămeta-view of therapy models also happens to fit the way experienced clinicians actually practice. Surveys conducted over the last several decades have consistently found, for example, that clinicians tend to identify less with any one approach the longer they have been in the field. Rather, experienced therapists tend to pick and choose from a variety of approaches in an effort to tailor treatment to the makeup and characteristics of the individual client.
Of course, the challenge to practicing clinicians--owing to the many choices available--is which technique(s) or approach(s) to adopt when working with a particular client? In this regard, research conducted by Duncan, Hubble, & Miller (see Psychotherapy With Impossible Cases [Norton, 1977]; Changing the Rules) as well as others (for a thorough review see Chapter 14, The Heart & Soul of Change [APA, 1999]) shows that the clientâs view of the presenting complaint, potential solutions, and ideas about the change process form a theory of change that can be used as the basis for determining, ăwhich approach, by whom, would be the most effective for this person, with that specific problem, under this particular set of circumstances. This same research shows that the probability for success is greater when the treatment offered fits with or is complementary to the client's theory.
Posted by gardenergirl on December 28, 2003, at 22:21:23
In reply to Therapist Orientation? CBT or psychodynamic?, posted by mattdds on December 26, 2003, at 1:52:24
mattdds,
I'm hoping that the turn this thread has taken has not further turned you off from this board. There may be something about those of us who have selected ourselves to participate in this type of support which leans more towards psychodynamic or humanistic approaches. I still think there is a place for discussion and support about CBT. Perhaps you could talk more about your own experience and how it has been helpful?
g
Posted by mattdds on December 29, 2003, at 1:50:23
In reply to Re: Therapist Orientation? CBT or psychodynamic? » mattdds, posted by gardenergirl on December 28, 2003, at 22:21:23
> mattdds,
> I'm hoping that the turn this thread has taken
has not further turned you off from this board.It's very thoughtful of you to be concerned. Thank you!
>>There may be something about those of us who have selected ourselves to participate in this type of support which leans more towards psychodynamic or humanistic approaches. I still think there is a place for discussion and support about CBT.
There may be a place for discussion, but I think it's unlikely to be the type I was looking for. The discussion has been fascinating, but it I always wind up feeling like I can't relate. And with the constraints of this board (and my own tempermental shortcomings), I just can't seem to find a niche here. I know it's nothing personal, it's just that people have different ways of seeing things. Apparently, mine is not compatible with this boards.
Perhaps you could talk more about your own experience and how it has been helpful?
> gI've done that before, but feel preachy, and I've even had people ridicule my progress, saying it's not possible. It's just not worth it to me anymore. However, I thank you for your concern.
regards,
Matt
Posted by Medusa on December 29, 2003, at 6:44:12
In reply to Re: Therapist Orientation? CBT or psychodynamic? » gardenergirl, posted by mattdds on December 29, 2003, at 1:50:23
I have a therapist situation to post, and I'd really, really appreciate your take on it.
Posted by Speaker on December 29, 2003, at 8:57:21
In reply to Re: Therapist Orientation? CBT or psychodynamic? » gardenergirl, posted by mattdds on December 29, 2003, at 1:50:23
Matt,
I hope you hang on for a while for some of us that are new to this board. I too have CBT for several years and it has been a life saver and I have grown a great deal. I now have to change T and am trying to find out what would be best to try this time. However, I have felt CBT is a good fit for me and can't imagine another approach. I have PTSD and have worked through several trauma events...the easier ones - husbands death, killing a child that ran in front of my car and a few others. I am now approaching the most difficult that happened when I was quite young. This has been difficult to even approach and talking has come very slow for me. I guess I am being selfish but your input has been very good and maybe a few of us that are successful with CBT should hang around. I have found everyone to be very supportive here but I have only been posting about six weeks.
Posted by Poet on December 29, 2003, at 10:46:26
In reply to Re: Therapist Orientation? CBT or psychodynamic? » mattdds, posted by Speaker on December 29, 2003, at 8:57:21
I don't want to have separate boards for different therapy types. I wouldn't know where to post as my therapist isn't really CBT or psychodynamic. She's more Jungian (talking to the empty chair) and also does reiki (energy work.)
My feeling on therapy is if you're comfortable with the therapist and can make progress, even if it's slow, than it shouldn't matter what technique the therapist uses.
Poet
Posted by mattdds on December 29, 2003, at 13:42:28
In reply to Matt? before you disappear ..., posted by Medusa on December 29, 2003, at 6:44:12
> I have a therapist situation to post, and I'd really, really appreciate your take on it.
Hi,
I certainly didn't mean that I was storming out on the board. I'm not going anywhere, I just have problems relating sometimes, probably my own shortcomings.
I'd be happy to answer any questions you have. I'm no expert, but I can try to give some feedback on your therapist.
Best,
Matt
Posted by mattdds on December 29, 2003, at 14:29:35
In reply to Re: Therapist Orientation? CBT or psychodynamic? » mattdds, posted by Speaker on December 29, 2003, at 8:57:21
> Matt,
>
> I hope you hang on for a while for some of us that are new to this board. I too have CBT for several years and it has been a life saver and I have grown a great deal.That's great! So glad you were helped by it. It has been a lifesaver for me as well.
>I now have to change T and am trying to find out what would be best to try this time. However, I have felt CBT is a good fit for me and can't imagine another approach. I have PTSD and have worked through several trauma events...the easier ones - husbands death, killing a child that ran in front of my car and a few others.
Wow, it's hard for me to imagine all this happening to me. It's amazing that you got through it, and are doing better now.
>I am now approaching the most difficult that happened when I was quite young. This has been difficult to even approach and talking has come very slow for me.
I wish you luck as you face your most difficult issues. I'm confident that if you've come this far, you will be able to make even more progress.
>I guess I am being selfish but your input has been very good and maybe a few of us that are successful with CBT should hang around.
Thank you for that! I get just as much from posting as I do from the input I receive. The problem I have with the board is not the people who post, but with the direction the threads seem to take as they progress.
For example, I've noticed that with threads dealing with all things psychodynamic (or neo-Freudian), e.g. dreams, transference, therapist issues, and especially meds (on the other board), posters receive a flood of constructive input. Follow-up posts usually contain supportive advice about what meds work for a condition, how to navigate transference, what to do about a therapist issue, etc.
But for some reason, when it comes to cognitive therapy, we can't even seem to get past the question of whether it's effective! Meanwhile, nobody questions the validity or foundations of psychodynamic theory or the biological theories about mental illness. the threads seem to take the form of "here is what works" or "here is what the literature says". They're supportive. So far, I haven't found the CBT threads to be that. To put it bluntly, they tend to get quite heated at worst, and politely argumentative, at best.
I envisioned some type of forum where CBT issues will be the same. For example, someone might post if they are stuck working through a persistent negative thought or behavior, and the follow ups might suggest which CBT technique helped them. I thought it would be neat to have something practical like that.
>I have found everyone to be very supportive here but I have only been posting about six weeks.
There are some very smart, and caring people here. I find the board very supportive, in general. But for my very specific need (to discuss and relate CBT issues). I feel we get into, very subtle, yet definite "arguments" about CBT. My posting style may encourage this, and I usually wind up getting defensive, and then giving up. I wasn't really looking for a debate forum, I had enough of that in high school. I'm looking for an environment where people are already convinced about CBT, and want to *practice* it.
I know the whole board shouldn't change to accomodate my one need, and I jokingly suggested splitting it. But I was being sarcastic, because I knew there weren't enough that would post there.
So, I'm not "leaving". I'll probably just check the board every once in a while and jump in if I find something interesting to me. But I feel no animosity toward anyone. I lost my energy to debate.
If you have anything you'd like to discuss, a particular problem, just direct a thread to me. I'll look for it.
Best,
Matt
Posted by mattdds on December 29, 2003, at 14:33:48
In reply to Just one board, please!, posted by Poet on December 29, 2003, at 10:46:26
> I don't want to have separate boards for different therapy types. I wouldn't know where to post as my therapist isn't really CBT or psychodynamic. She's more Jungian (talking to the empty chair) and also does reiki (energy work.)
>
> My feeling on therapy is if you're comfortable with the therapist and can make progress, even if it's slow, than it shouldn't matter what technique the therapist uses.
>
> PoetDon't worry, nobody is splitting the board. I jokingly suggested making a separate CBT board. Don't worry, there is not enough demand to make that happen. And you're right, there are just too many therapy types to make special boards for everyone.
Matt
Posted by Dinah on December 29, 2003, at 15:43:11
In reply to Re: Therapist Orientation? CBT or psychodynamic? » Speaker, posted by mattdds on December 29, 2003, at 14:29:35
I'm sorry, Matt. I misunderstood the purpose of this thread. I'm glad Gardenergirl was more on the ball.
I think you'll be most likely to get what you want if you just phrase a question that you would like a CBT outlook on, and see if you get any responses. If you phrase it as a direct question, it may be less likely to go off track. I tried that once or twice with DBT and got limited response. I think maybe we aren't sure of our knowledge base? I know I might be reluctant to answer something that requires specific knowledge. That may be the reason.
Posted by mattdds on December 29, 2003, at 19:56:16
In reply to Re: Therapist Orientation? CBT or psychodynamic? » mattdds, posted by Dinah on December 29, 2003, at 15:43:11
> I'm sorry, Matt. I misunderstood the purpose of this thread. I'm glad Gardenergirl was more on the ball.
>I didn't articulate myself very well in the beginning as to what I was looking for. No need to apologize.
> I think you'll be most likely to get what you want if you just phrase a question that you would like a CBT outlook on, and see if you get any responses. If you phrase it as a direct question, it may be less likely to go off track. I tried that once or twice with DBT and got limited response. I think maybe we aren't sure of our knowledge base? I know I might be reluctant to answer something that requires specific knowledge. That may be the reason.
Yeah, you're probably right. I remember your DBT thread, and I remember posting similar threads that got little or no response. Let me be clear, I don't think people are *responsible* for answering my questions or following up on my threads. I'm just trying to find some people who are looking for the same thing I am.
Knowledge base *is* likely the problem. I would even go further and say *jargon* is the problem. Even if we decided on CBT, for example, there are different names that different CB therapists use for the same techniques.
I think I may have an idea to try to solve this problem. Here is my idea, please tell me what you think:
I'd like try to assemble a self-help group using a standardized manual. You mentioned Bourne's books before. I might suggest "Mind Over Mood" or "Ten Days To Self Esteem" by Burns. Those interested in participating could vote on the book.
Whoever decided to participate would have to obtain a copy of the book, and adhere to the concepts and language of the book. I know there have been many self-help groups assembled based on the Burns manual.
I wonder if it could be done at psycho-babble book club? With reading assignments and everything.
It sounds robotic, but I think it would give everyone a standardized, methodical way of communicating and working toward solving problems.
I even had in mind taking initial statistics from everyone, provided they are willing to provide them. I thought of assessing mood, anxiety, procrastincation by means of scales, and monitoring the progress of the group. Also, whether the person is receiving meds of therapy. I also thought of showing the outcome (e.g. reduction in measurable anxiety, and mood in the participants) of the "therapy" at completion.When I get a bit more time, maybe I'll give this a try, and post more about it. Maybe tomorrow I'll start a new thread to see if anyone is interested.
Take care,
Matt
Posted by gardenergirl on December 29, 2003, at 21:28:08
In reply to Self-Help Group with Manual (maybe on p-book club) » Dinah, posted by mattdds on December 29, 2003, at 19:56:16
mattdds,
That sounds like a really cool idea! Although I likely would not participate as it does not match my preference, I would be interested in following its development...that is if I could "lurk."I think I can relate to your desire to chat with others who have similar experiences in therapy. I have a friend who has a T with a similar approach to my T, and we sometimes process our reactions and experiences together. It's very normalizing to hear about others issues and how they are targeted because it reinforces that we are not alone in our difficulties and experiences.
g
Posted by Speaker on December 29, 2003, at 21:43:44
In reply to Re: Self-Help Group with Manual (maybe on p-book club), posted by gardenergirl on December 29, 2003, at 21:28:08
Matt,
I think this would be great! I will probably get one of the books just because I haven't done a lot of reading and have been wanting to. Let me know if you are really serious or if it was just tongue in cheek :).
Posted by naiad on December 30, 2003, at 9:11:28
In reply to Re: Self-Help Group with Manual / I'm In :), posted by Speaker on December 29, 2003, at 21:43:44
Matt,
I have been following this thread and it is fascinating. I would be very interested in participating in your book club (Burns book, espcially...he has an interesting website). Hope you can find the time to initiate it. Thanks.
Posted by mattdds on December 30, 2003, at 11:03:06
In reply to Me, too., posted by naiad on December 30, 2003, at 9:11:28
Hey all,
Thanks so much for the comments!
It's great to know there are more out there that are interested in this type of therapy...it has been outstanding for me!
I was serious about initiating that. I've been trying to do something like this for a long time. I think it has tons of potential to be very productive and interactive.
Time is an issue for me right now. I'm taking step II of the National Dental Boards very soon, and I'm up all day and night studying for it. Can you say caffeinism?
I really plan on following through on this, but I might need a couple weeks to take and recover from the stress of the boards.
Perhaps in the meantime, we can get an initial headcount, figure out which framework (i.e. book or manual, like Burns'), and get Dr. Bob to give us some help possibly (I'll try to figure out how).
I do plan on doing some number gathering (e.g. baseline anxiety, depression, etc. scores, and then track them perhaps weekly or every other week).
I think this will be a blast!
I'll let you all know shortly.
Thanks again!
Matt
Posted by Lyrical13 on January 1, 2004, at 10:59:18
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by DaisyM on December 26, 2003, at 13:43:22
OK...I have been to tons of different therapists over the years but don't know how I would label their different techniques. I was a psych major for quite a while (this was 10 years ago) and am familiar with the terms but I'm getting confused (and I have no clue what DBT is). I've also read a lot of self-help stuff looking at family systems, birth order, growing up in a dysfunctional family...with divorced parents, ACOA kinds of stuff. I'm very analytical and with most of my therapists we've looked at why I do and feel what I do, where that came from (past experience, family dynamics etc) and also look at my thought processes and do some reality checks. I think this falls mostly in the CBT camp. But it seems to me in my experience that my therapists have used a mix of techniques. The therapist I'm working with now mostly listens and we talk about my feelings, concerns, worries, etc. and she offers suggestions, asks questions to make me think, suggests things to read, suggests strategies...sometimes the questions she asks aren't always easy or what I want to hear, but they are usually quite helpful. But I am at a point in my life where I have been through a lot of different tx and have worked through the denial and I feel like I have a more objective picture of myself and my behavior...that I feel OK enough about myself to acknowledge that I have dysfunctional patterns of interaction that I need to work on without that affecting my self-worth. I am in a place where I realize that no one is perfect and everyone makes mistakes and all I can do is try my best. I look back over my history and can see how I've grown. I can see steady improvement over the years. I couldn't have ever done it with tx alone though. I definitely need the meds. That was the problem with earlier tx. I worked with a therapist (and this was a clinical psych student) who was a warm, caring wonderful man who had me working through David Burns' book and handbook (New Mood Therapy? Feel Good Handbook? something like that) It was helpful but I felt like I wasn't "doing good enough...wasn't trying hard enough..." etc. Basically I was failing at tx because if I was good at it then I would be feeling better. I now see that in my case (chronic major depression for 13 years...very cyclical...worse time is Aug thru Jan...) all the tx in the world can't help if there's messed up brain chemistry. I didn't start really feeling better until I did meds AND tx.
Anyway, when I looked for a therapist this last time, I didn't really go into it looking for a particular style because I didn't know what I wanted. I just asked a couple of trusted friends with medical knowledge of docs in my county who they thought was good for my particular problem. I really like my current therapist and pdoc and think this will be a team that will work. My last therapist was someone that I worked with since 1996. The last time I saw her was fall 2002. OUr system was that when i was in crisis I would be in tx for a while...every wk or every other wk with appts further apart as I got feeling better. After a few months she would say "I think you're doing pretty well. you know what to do. Call me if you need me" and we would d/c tx. Next time I had a rough time I'd call and we'd resume tx. It was helpful but I felt like there was something missing. My current pdoc says with my type of problem I should always be in tx. Just less often when I'm doing better. Now it looks like I don't have depression with GAD but rather BP2. This is a whole new thing to me. I'm a little skeptical about tx forever but for now I do think I need to stay in even when I'm "feeling good" cause there are problems on the other extreme that I haven't even addressed yet (spending sprees, multiple projects, sleep issues, etc)
Well, I rambled on and on about this. I guess the bottom line is: 1) I have no clue what kind of tx I'm getting and 2) it seems like my tx has almost always been a combo of different techniques.
L13
PS my current therapist and my previous therapist are both MSWs vs psychologists. I don't know if this makes a difference.
Posted by naiad on January 1, 2004, at 11:52:18
In reply to Re: Therapist Orientation? I'm a little lost, posted by Lyrical13 on January 1, 2004, at 10:59:18
Thanks for your story. I think I would benefit from meds but don't know how to ask. I keep hoping one of my doctors (gynochologist, for instance) will recognize my depression and offer to proscribe an anti-depressant. Any advice? Should I just ask? My therapist is a MSW
Posted by Dinah on January 1, 2004, at 14:53:31
In reply to Re: I'm a little lost » Lyrical13, posted by naiad on January 1, 2004, at 11:52:18
If you think you would benefit from medications you should ask. My therapist suggested sending me to a psychiatrist and I resisted at first. But if your therapist can't recomment a psychiatrist, ask your regular doctor. I'm not sure that it's a good idea to rely on your gynecologist to prescribe for the first time. Psych drugs have too many unintended side effects that unfortunately not even psychiatrists always recognize. My current psychiatrist was the only one that noticed that I really shouldn't be on an antidepressant without a mood stabilizer!
Posted by Dinah on January 1, 2004, at 14:59:28
In reply to Re: Therapist Orientation? I'm a little lost, posted by Lyrical13 on January 1, 2004, at 10:59:18
DBT is dialectical Behavior Therapy, developed by Marsha Linehan for suicidal and parasuicidal patients, but that would probably benefit almost everyone. :) It combines CBT with eastern mindfulness and acceptance philosophy.
I assume I'll always be in therapy at least occasionally unless they improve medications. It is part of my mental health maintenance, like my glucphage for my diabetes. It might not make me all "better" but it keeps me functioning at my highest possible level without resorting to less healthy coping mechanisms. It would be nice if I woiuld just quit getting overstimulated or melting down under stress. But not likely. And in the meantime it's better that I use therapy as ego glue rather than self injury or some of the other alternatives.
I don't know about your particular circumstances, but if once a week or once a month therapy keeps you functioning at your best, is it really so bad?
Posted by jane d on January 1, 2004, at 15:24:33
In reply to Re: I'm a little lost » Lyrical13, posted by naiad on January 1, 2004, at 11:52:18
> Thanks for your story. I think I would benefit from meds but don't know how to ask. I keep hoping one of my doctors (gynochologist, for instance) will recognize my depression and offer to proscribe an anti-depressant. Any advice? Should I just ask? My therapist is a MSW
>
Naiad,Ask! And if your therapist disagrees, ask who she/he thinks would benefit from meds. If your therapist is one of those that believes almost no one should take meds then go ask someone else. If the answer is that meds are OK but not for you, see if the reasons make sense to you. If not, ask someone else. You can wait an awful long time for someone else to raise the issue. I'm the opposite. I delayed a long time on asking about therapy. I'd have been much better off if I'd done it sooner.
Jane
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