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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 69 to 93 of 93. Go back in thread:
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
Posted by Lyrical13 on January 1, 2004, at 15:35:37
In reply to Re: I'm a little lost » naiad, posted by jane d on January 1, 2004, at 15:24:33
I agree. definitely ask about meds...ask about a good pdoc with experience with your type of problems. It was my endocrinologist who referred me to my first pdoc and it was a very good move. I started on meds in 1996 and have been on them with the exception of the summer of 1997 ever since. I've tried various things..I think it takes a while to figure out the right combo. I'm getting closer to it I think. They all helped some but after a while quit working and we'd have to try something else. But definitely ask. What have you got to lose?
Posted by DaisyM on January 1, 2004, at 21:54:45
In reply to Re: I'm a little lost » Lyrical13, posted by naiad on January 1, 2004, at 11:52:18
Psych meds are complicated and you need to be followed. Ask for a referral from your therapist or from your GP.
Very recently my GYN sat me down and told me she was worried that I was too stressed and depressed. (She's been my doc for over 16 yrs. so we are friends too) She offered antidepr. and wanted to refer me to "talk to someone." It was pretty sweet. I told her I was already taking care of it and I didn't want meds at this point. When I told my Therapist he had *alot* to say about MDs who are well-meaning but still shouldn't be prescribing out of their area. I think I hit a sore spot!
Posted by naiad on January 2, 2004, at 6:09:55
In reply to Meds » naiad, posted by DaisyM on January 1, 2004, at 21:54:45
Dinah, Lyrical, Daisy, Jane
Thanks for the encouragement. I'm seeing my T this evening and asking about a referral for meds is my first agenda item (someone here wrote a very funny *agenda* post...I think I'll keep that in my mind, but if I am giggling my T will think I am not depressed!)
Posted by ocdforyears on January 6, 2004, at 10:44:32
In reply to Therapist Orientation? CBT or psychodynamic?, posted by mattdds on December 26, 2003, at 1:52:24
Matt,
I'm new to this site, but as someone with ocd I can say that for me the best therapy is therapy which blends both cognitive tools and feeling based work. I think it's not realistic to separate the two as if they can't work together. And it's certainly not realistic to see the only alternative to CBT as Freudian psychoanalysis. I think Freud was completely wrong about libidinal theory, and I don't know anyone in therapy who is doing that kind of work.
I've seen many therapists in my life; from a single session to over four years. Maybe a dozen. And not one of them didn't believe that there wasn't a deep emotional component to my depression and ocd. But not one of them used Freudian terms or even what I would consider classical psychoanalysis. Object relations, yes. But I think the alternative to 'pure' CBT is feeling based therapy.
Sure, that invovles uncovering repressed emotion, lots of it, anger and rage and pain and terror. It involves examining all the feelings I've stuffed and all the people who hurt, abused, neglected me. It takes a lot of work. But I do think that is the final cure for me, as much as I can be cured. CBT helps me manage my obsessions, but then I still find anxiety, or even rage, beneath them if I really look.
I've made huge changes in my depression over the last ten years. Even over a about five years. But my ocd...that's very tough. Right now I'm trying ssri's for the first time. But I think this relates: are meds or therapy the cure? Why not use them together. Same with CBT and feeling based therapy.
As for classical Freudian psychoanlysis, or analysis which involves developing mental insight (learning how I work, as CBT therapists sometimes describe the goal of analysis therapies); that I don't have much faith in at all. Got to feel it to heal it.
Just my experience.
Posted by naiad on January 6, 2004, at 11:40:35
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by ocdforyears on January 6, 2004, at 10:44:32
I got a lot out of your post -- it just makes sense. However, your last paragraph: "As for classical Freudian psychoanlysis, or analysis which involves developing mental insight (learning how I work, as CBT therapists sometimes describe the goal of analysis therapies..." has me a bit confused. Are you saying that classical Freudian psychoanalysis is only about developing mental insight without addressing feelings? How could that be? I did take Psychology 101 in college but that was a long time ago and I don't remember, if I ever knew, the tenents of Freudian psychology. I just bought the book "Unauthorized Freud: Doubters Confront a Legend" by Frederick Crews, but have not yet read it.
I am still struggling with my analysis-leaning therapist who wants me to free-associate. I have a hard time with this process because I have been a thinker for so long. I carefully guard my feelings.
As you can probably tell, I am new at this therapy business. I'm trying to figure out if I 'm in the right place, with the right approach, and with the right person. My intuition tells me that medication (for depression) and an empathic, supportive therapist will help. I just wish that I was a better client and able to let my guard down more.
Posted by gardenergirl on January 6, 2004, at 18:24:27
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by naiad on January 6, 2004, at 11:40:35
> I am still struggling with my analysis-leaning therapist who wants me to free-associate. I have a hard time with this process because I have been a thinker for so long. I carefully guard my feelings.
>
> I just wish that I was a better client and able to let my guard down more.
Please don't get down on yourself for feeling guarded in therapy. I personally don't believe there are "good" or "bad" clients. We all have our own comfort level with opening up to others, and it takes time to feel safe in a therapy relationship. Perhaps talking with your therapist about how you are still uncomfortable may help.Take care,
g
Posted by Lyrical13 on January 6, 2004, at 20:15:34
In reply to Re: Meds, posted by naiad on January 2, 2004, at 6:09:55
I'm curious about this funny post on agendas. What did it say? I could use a laugh! I always have an agenda...things I want to talk about that day...sometimes I write it down..sometimes there are only 1 or 2 things that I really want to talk about that day so I don't need to. Most of the time I get to talk about all the things I want to..but sometimes there are so many things there just isn't enough time. And then there are times where we take up a lot of time talking about things that really weren't huge concerns.. I just mentioned them so the T had a picture of all the things that are weighing on me... I meant to mention them in passing but we get stuck on talking about them for a long time and then I don't get to spend as much time talking about the big things. Anyone have this experience?
Posted by Lyrical13 on January 6, 2004, at 20:36:48
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by ocdforyears on January 6, 2004, at 10:44:32
I agree with Matt...I've never had experience with Freudian type therapy or know anyone who has and I've been in counseling for 13 years off and on with many different counselors. I think there's both cognition and feelings involved. I also think that mood disorders are caused by a combination of things-genetics to be sure but also our experiences (that whole nature AND nurture thing) I also think that our brains/bodies have an emotional memory...something we're probably not even aware of. What I mean is, sometimes I find myself feeling sad or anxious and I'm not even aware of why..esp if it's at a time of year where I'm usually not going through that...it puzzles me for a bit because things seem to be going well at the time..but when I really stop and think, I realize that this time last year or the year before I was going through a very difficult situation and when I really examine it, I realize that I am still hurt or angry about that and approaching that anniversary affected my subconscious....I wasn't actively thinking about it but in the back of my mind, I was remembering "this was the time when this and such happened that really hurt me"
I don't think dwelling on past neg experiences is productive, but at the same time, I feel like the more I understand of my history and what happened to me or what choices I made that were detrimental, the more I understand my feelings and the more I'm able to heal.
Just recently...about a month ago...I figured out a puzzle that goes back 20 years...to when I was 13 or 14 years old. I couldn't figure out why I had such a strong attachment to my cats.. even though they started marking my carpet and were ruining our house...why couldn't I let go of them...find them a new home or take them to the shelter? I mean, I know they are part of our family and have helped me through a rough time, but why was this such an incredibly emotional thing for me..I was really worked up about it. NOw this is the time of year when I usually have trouble but I was worked up more than usual and not just about the cats. One morning it hit me... I was 13 or 14 when a very traumatic thing happened to me...something that caused me to dissociate...and my mom was there for me briefly but then got a phone call from my step-dad and abandoned me. They were separated at the time and he had just been drunk and at our house and I thought he was beating her up...that's when I suddenly found myself at the edge of the living room...not remembering how I got there and was up on the ceiling looking at this young girl in her nightshirt and hearing this shrill voice yelling "leave my mom alone!" realized after a little bit that the voice was coming from me... Anyway, after he left, my mom and I were crying and hugging and the phone rang. She answered it and talked to that &*^%$ for an hour and a half. The only one there for me was the cat. I went in on the bed and hugged my cat and cried and cried. the other part of that is that my little sister is now 14 and has started having problems with depression or bipolar...same age...AND I was upset one time and thought for a split second about calling and talking to her...we've shared a lot about our experiences...but then I thought "I can't do that. That's a lot to dump on a 14 yr old kid." Then I REALLY started to cry because that's exactly what happened to me....when I was 14 was when my mom started really dumping all her adult problems on me...I feel like I've been her romance counselor since I was 14 yrs old. I had already figured out parts of that years ago.. the mom counseling bit, the dissociation bit etc. but the 14 and the cat hit me all of a sudden just recently and it all fit.
Anyway, this post is much longer than I intended. Sorry for getting off on such a tangent...again....
Oh, but one more thing I wanted to mention that is really relevant to the whole type of tx discussion is this...how many of you focus on analyzing family systems...dysfunction and your role in that..ie in addiction rehab they talk about different roles people play in the family. The hero, scapegoat, lost child, etc. Also about birth order and roles we take in our family and characteristics we have based on birth order. Anyone look at that when analyzing stuff in tx?
L13
Posted by ocdforyears on January 7, 2004, at 1:28:21
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by naiad on January 6, 2004, at 11:40:35
Naiad,
wow. I'm actually amazed someone read the post, and even responded. Sounds silly, but this is my first experience with this kind of board.
And I was in a hurry and wrapping up... sorry for the confusion.
I'm not a therapist, just a long-term client. But I do want to know what I need to do to get well. I think the cognitive model is hot right now, largely because it's marketed well and because you can measure its results quickly in a quasi-scientific manner. Eighty percent of people with ocd feel somewhat better one year after CBT therapy according to a survey; like that.
It's harder to evaluate other forms of therapy, maybe, and those groups doing other kinds of work aren't taking surveys, I guess. But I'm suspicious of any therapy which tells me I don't have to go and feel my old pain/anger whatever; that all I have to do is change my thinking. Why not both?
And I guess what I was trying to say is that pure behaviorists (and I've only seen one as a client, and only one session) seem to misunderstand what happens in other forms of therapy. I know that's a big generalization, but I don't think other, non-cognitive models of therapy are just about understanding behavior, they're about processing emotion. I would be very curious, though, to hear from someone who's done long term CBT, and only that, for depression or anxiety or obsessions. I have to admit, I could be wrong. Maybe there is a shorter path.
And this is all sounding so cerebreal to me now, like a class discussion. And like cross talk, but I hope this helps a little. What I can say is that emotions, expressed in any way but especially in a safe environment, play a large role in healing my depression/anxiety. It is scary to release them. Sometimes I process in more 'safe,' solo ways: I write, or I exercise while thinking about what's bothering me; I even have this friend I leave honest voice messages with (sometimes an answering machine feels less frightening than a live person, though we share that way on the phone once a week.
Sure there is tremendous healing in sharing with a therapist, in a meeting, but when I can't get that I am able to let pain out solo, and there's no risk of being hurt. It may be one place to start anyway.
And the last thing I'll say (and I know I write a lot) is that the whole CBT/meds/feelings therapy thing confuses me also. If I had acid reflux disease or something, there would be a single agreed upon cure. Here, go take the purple pill. In this area, some docs tell me it's all biological, some say it's all trauma based, and some all due to lousy thinking (or at least that's the only way I can control my problem, through cognitive changes). I like the therapist who uses all these things, or is open to them. To get physically healthy, I eat right, and exercise, and take vitamins. Why not try the multiple approach in therapy?
The great triangle of healing: receiving love from others and self, releasing feeling, thinking correctly.
But I have to stop now, I sound like Dr. Phil. Really I'm just a hurting person trying to make it like all the rest.
Best of luck naiad. And cool boardname.
Posted by naiad on January 7, 2004, at 5:49:37
In reply to Re: Therapist Orientation? CBT or psychodynamic? » naiad, posted by gardenergirl on January 6, 2004, at 18:24:27
Gardengirl,
Thanks for the encouragement. I know (on a cognitive level) that I should not be thinking about myself as a "bad client." And I also know that the word "should" is outlawed! My therapist has NEVER said or hinted at that judgement, so it is clearly an example of faulty thinking. There I go again, blaming myself. What a vicious cycle!
I am a gardener, too. Can't wait for spring!
Posted by naiad on January 7, 2004, at 5:53:59
In reply to agenda post, posted by Lyrical13 on January 6, 2004, at 20:15:34
I think it was Karen_Kay with responses by Dinah. I'll look for it in the archives later today and let you know. You'll get a laugh.
Take care...
Posted by Lyrical13 on January 7, 2004, at 20:32:58
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by naiad on January 7, 2004, at 5:49:37
Me too! Love gardening. I'm just starting out but learning. I've found it to be very therapeutic, calming and relaxing even though it can be hard work. But that helps too with moods. And it gives me such joy to see the things I toiled at spring to life and grow into beautiful plants and flowers and food. I feel a lot of pride looking at pictures of how my yard used to look and how much progress I've made..very tangible reward. I found that I the depression started to creep in this fall, and we were still having some nice days, escaping to the garden for a little bit to pull some weeds or dead-head some flowers improved my mood considerably.
Looking forward to spring and already starting to look at garden books and plan my next steps! The front yard is a big challenge. I've made some changes but it is still not where I'd like it to be, so I'm doing some brainstorming and looking at different books for ideas. I just got a note in the mail from the library that some of the garden books I requested are in. I can't wait to look at them!
L13
Posted by naiad on January 8, 2004, at 10:09:38
In reply to gardening as therapy, posted by Lyrical13 on January 7, 2004, at 20:32:58
L,
Sorry that I can't find the thread about having an agenda when meeting with your therapist. I'm sure it was sometime in late November or December because that is when I found this site.
Yea to gardening! I also find it therapeutic (hard work, sometimes frustrating but when it goes well, oh so rewarding!). Take care and be well.
Posted by gardenergirl on January 8, 2004, at 10:42:14
In reply to Re: gardening as therapy, posted by naiad on January 8, 2004, at 10:09:38
>
> Yea to gardening! I also find it therapeutic (hard work, sometimes frustrating but when it goes well, oh so rewarding!).I agree, it's very therapeutic. Even just a few minutes a day of deadheading or just enjoying being around living, beautiful things immensely helps my mood.
Now, if only I could master houseplants!
Posted by Emmylou on January 8, 2004, at 11:52:35
In reply to Re: Therapist Orientation? CBT or psychodynamic? » gardenergirl, posted by mattdds on December 26, 2003, at 17:59:34
This thread contains some very interesting discussions. Thought I'd talk briefly about my experiences. I agree with those who have written that it's a matter of preference concerning the *approach* one wants and/or needs to take to address their own issues.
I had been seeing a CBT therapist now for over 2 years. When I started seeing him, I thought I'd be done in a matter of months. I'm eternally grateful to my therapist b/c he's helped get me through so many downs in my life. What I've noticed is that while I've gained some really practical and invaluable skills at combatting and addressing thoughts and situations -- so much so that at times my responses are automatic -- I'm beginning to feel that the changes occurring are not as "deep" as I'd like them to be. What I mean is that I've conditioned myself to respond to situations in ways I've learned are effective, but I'm not truly convinced that I am an all-around ok person that is worthy of love.
I've started seeing a therapist ("analyst") to help me understand the "whys." I know what situations trigger my negative thoughts and I'm vigilant, but I don't truly understand why I have these negative thoughts to begin with. I do have ideas, and I want to explore them, and I believe that "analysis" is the way for me personally. I believe it's an avenue for self-exploration, and that the more one understands himself, the better the prospects for lasting change.
Posted by Lyrical13 on January 8, 2004, at 22:58:55
In reply to Re: gardening as therapy, posted by gardenergirl on January 8, 2004, at 10:42:14
So far I've only killed one of the four houseplants I have! I brought them all in from the outside this fall. All hanging plants. I always look for the ones that say they're easy to grow! :)
Posted by ocdforyears on January 9, 2004, at 10:27:42
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by Emmylou on January 8, 2004, at 11:52:35
Emmylou,
thanks for responding from the cbt side. The one truly cbt therapist I saw believed my ocd was a result of trauma in my childhood, but that the only way to control it was cognitive tools. I still think both approaches count, but the deep work, feeling and healing the pain and rage...that seems where I want to head, hard as it is.
Posted by Medusa on January 10, 2004, at 7:25:29
In reply to Re: Therapist Orientation? CBT or psychodynamic?, posted by Emmylou on January 8, 2004, at 11:52:35
> I don't truly understand why I have these negative thoughts to begin with. I do have ideas, and I want to explore them, and I believe that "analysis" is the way for me personally. I believe it's an avenue for self-exploration, and that the more one understands himself, the better the prospects for lasting change.
>
Emmylou, if you happen to get to the point where you feel that analysis has gotten you as far as it can, think about a short-term 'family systems' theory -based therapy. I know I sound like a broken record, practically evangelizing for this approach, but I've had really good results with it so far. It's hard as h@ll though ...
This is the end of the thread.
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