![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by alexandra_k on February 4, 2004, at 19:05:28
Hello Gardner girl, I was wondering whether I could ask you a question? From your posts I am thinking you do clinical psychology of the CBT variety. Yet you see a T who is psycho-dynamically oriented. Can I ask why you don't see someone who does CBT? I am kind of curious..
I know that I have a tendency to run down CBT a bit.. This has more to do with the rigid and inflexable T's that I have encountered than anything intrinsic to CBT (I realise this in my better moments).. Though I think I might be more suited to something psychodynamic (or analytic or whatever, sorry but I don't know much about different varieties..) - I am not sure because I don't get to pick and choose. Would be interested to hear your thoughts on this issue.
Indeed, I would be interested to hear from anyone that has had experiences with both kinds of treatment and would like to know which was preferred and why.
Posted by gardenergirl on February 4, 2004, at 23:01:29
In reply to Question for gg., posted by alexandra_k on February 4, 2004, at 19:05:28
Thanks for asking. I am in training right now (4th year in grad school) to become a clinical psychologist. It's interesting that I appear to be CBT oriented in my posts. I'm actually more dynamically oriented. The model that appeals to me most is an emotion-focused one called process-experiential. It is an integration of CBT with humanistic/existential/gestalt, etc. What I really like about it is the focus on emotional re-experiencing that you then tie into the cognitive piece. The model views both as part of a cognitive-affective structure called schemes, which drive what we do, how we feel, and how we think. (I wish I had empirical evidence for you about the existence of these schemes. Wouldn't it be nice if we could see them in the brain?)
I had a very brief experience with CBT many years ago that was disatisfying. A high number of profs in my school, including my supervisor are all CBT therapists. My experience in classes focusing on CBT is that is feels *to me* to be rather empty and superficial. I think this is because I am a really feeling oriented person. I am pretty sensitive to my own emotions, even if I don't understand them. I also think that empathic attunement is one of my strengths in therapy versus listening for irrational beliefs.
My supervisor get into collegial debates all the time about whether feelings cause thoughts/behaviors or the other way around. Today he objected to the "accompanying" when talking about feelings and thoughts. As a CBT, he views feelings as the *result* of thoughts. I just don't agree with this on a gut level.
So, a long-winded, as usual, answer to your question, I see a psychodynamic T for a couple of reasons. First, he was the one assigned to me--luck of the draw. But more important, it really fits for me. I have really narcissistic parents and thus, had a really invalidating environment, especially for a sensitive child like I was (and am). This results in atypical depression, which has been chronic for decades. I'm not sure that CBT would really target the underlying hurt and needs which are driving my depression. I think I really needed my parental transference with my T. It's scary, and I leave sessions feeling really drained, whereas I would leave CBT sessions feeling like, "so now what? I know all that." (I hope that doesn't sound arrogant. It just was too cognitively based for me. I NEED to feel stuff to understand it.)
I certainly incorporate aspects of CBT into my treatment, including relaxation training, occasional homework, and pointing out irrational thinking at times. But I really care more about helping the client to articulate their feelings, and more importantly, to re-experience them with me in session, in order to better understand them and thus use the adaptive information that feelings can give us. Or to have a corrective emotional experience with me.
Does this make sense? Please ask questions if I have rambled too far off track.
It's tough when you do not get to choose your T. If I had a CBT T based on luck of the draw, I wonder if I would have stayed in therapy very long.
Good luck.
gg
Posted by Dinah on February 4, 2004, at 23:37:49
In reply to Re: Question for gg. » alexandra_k, posted by gardenergirl on February 4, 2004, at 23:01:29
> My supervisor get into collegial debates all the time about whether feelings cause thoughts/behaviors or the other way around. Today he objected to the "accompanying" when talking about feelings and thoughts. As a CBT, he views feelings as the *result* of thoughts. I just don't agree with this on a gut level.
>I'm currently trying to wade through "The EMOTIONAL BRAIN: THE MYSTERIOUS UNDERPINNINGS OF EMOTIONAL LIFE". The chapter I'm on discusses the research on that eternal debate in depth. I think I'll have to read it a few times before I really understand what I think about it, though my gut tells me that at least portions of emotions precede cognition, although they may be reinforced by the cognitions.
Posted by gardenergirl on February 4, 2004, at 23:43:18
In reply to Re: Question for gg. » gardenergirl, posted by Dinah on February 4, 2004, at 23:37:49
That sounds like a cool book. I just bought two books on emotion-focused therapy, by Greenburg and Elliott. (Dont'have titles handy, but got them through APA). I am so addicted to buying books! Let me know what you think, please.
I too, think that emotion can come before cognition. Think of all the pre-verbal stuff that infants experience. They have emotions, but cannot make any rational sense of them or even express them verbally (looking at crying and laughing as nonverbal).
And have you ever *felt* and even *known* something but had no words for it. Sometimes I react to art that way. Makes sense to me.
Besides, anytime I say, "my gut tells me" I know the value of emotions! :)
Thanks for telling me about that book. I should start making a list...
gg
Posted by alexandra_k on February 5, 2004, at 3:34:30
In reply to Re: Question for gg. » alexandra_k, posted by gardenergirl on February 4, 2004, at 23:01:29
Thanks for that gg. Nope, you didn't rave I was very interested in your answer. I feel your pain with respect to CBT's superficiality. It is easy for me to switch to rational / analytic mode when doing CBT - and on an intellectual level I too think that they are not telling me anything new .. Thats why I find Linehan's DBT varient of CBT more useful to me. It focuses more on emotions than cognitions - which I consider to be more problematic for me. Once you have done a year of skills training you are also supposed to (if you are ready of course) do some trauma work. I was terminated at that point which peeved me greatly as I think that I really need to do this. I have found the CBT approach brushes this off, considering it to be in the past and better left there (If only I could).
Your variety of CBT sounds very interesting to me. In NZ clinical psychologists are all trained in traditional CBT. (thats why I figured that was what you did). For alternative varieties I am afraid it is 'joe's well intentioned but hopeless back yard councelling service'. P-docs are trained in psychodynamic stuff but as CBT (just) outperforms psychodynamic stuff it is thought to be unscientific to practice anything other than CBT (spot the cognitive error!). P-docs are funded by the public system to do what only they can do - prescribe psycho-tropic meds. This annoys me as it is a substantial leap from something JUST outperforming another to maintaining that practicing one is unscientific because of this. (and that is the reason they cite). Also there is no evidence (to the best of my knowledge) as to whether one style of therapy may be better suited to particular kinds of people).
I don't have an issue with schemata being unscientific - cognitive psychology is scientific and would seem to provide empirical support for schemas for such things as 'going out for dinner' etc. Don't need to see them in the brain, can be like a computer program that is invisible from the hardware level of description - but gets implemented on it nonetheless (as is evident in the behaviour).
CBT is funny. They want to say that no thoughts don't cause behaviours (the problem of mental causation in philosophy requires this unfortunately). They also want to say yes your disfunctional thoughts cause your disfunctional behaviour so if ya have adaptive thoughts you will behave adaptively. Unfortunately this is a fatal contradiction for CBT (in my book anyway :( how sad...).
I think that there is evidence for emotions being primary in some cases, and thoughts being primary in others. It is a bit of an overgeneralisation to consider that one must preceed the other in every possible instance.
Consider the dog hanging its head in response to electric shocks eminating from the floor of the skinner box... Do you think CBT could teach him to buck up his act??? Is the dog in the grip of a cognitive error??? People who have been traumatised have reactive nervous systems that probably process stimuli on the unconscious level for threat potential.... Working out what you were thinking on many occasions is hard because you weren't aware of thinking anything at the time. But you have to come up with something (indeed a faulty something) in order to JUSTIFY your automatic response to the CBT therapist. Then you are promptly lectured on how maladaptive that thought was (talk about a lose lose situation, the ultimate in invalidation).
Now I am the one who is rambelling.....
Thanks for that.
Posted by dragonfly25 on February 5, 2004, at 6:31:09
In reply to Re: Question for gg., posted by alexandra_k on February 5, 2004, at 3:34:30
I thought I understood some of these therapies....but now I am totally confused. Sorry to barge in like this but I really don't understand all the different types of therapy and how they are different.
Can someone please explain why CBT is invalidating and how CBT would handle a trauma issue, how can CBT brush certain 'living' past issues aside if they are currently a problem? I am trying to deal with something and I am so confused as to who to go to for help.
I thought that therapy was talking to a doctor about what was bothering you, and obviously you go deeper into past stuff sometimes...I feel like i have never had therapy before, i feel therapy ignorant.
how can the treatment of abuse issues be treated differently? it sounds like they are but i don't see how it is possible to be soooo different that they need different names. I have experienced the psychodynamic/analitic type of therapy and found it was not useful at all(for me)
I hope I haven't lost anyone, I have sort of confused myself now. I guess what I am asking is, is CBT a form of repression and psychoanalysis not? Is this question to all over the place to be answered? sorry if i am confusing- but it is projecting my internal state. Can anyone explain further?
Thanks
confused dragonfly
Posted by gardenergirl on February 5, 2004, at 8:21:31
In reply to Re: Another Question, posted by dragonfly25 on February 5, 2004, at 6:31:09
> Sorry to barge in like this but I really don't understand all the different types of therapy and how they are different.
You're not barging in. All are welcome! Sorry if our discussion was confusing. Let me see if I can help.
> Can someone please explain why CBT is invalidatingSee this post. It should help. http://www.dr-bob.org/babble/psycho/20040131/msgs/309104.html
>and how CBT would handle a trauma issue, how can CBT brush certain 'living' past issues aside if they are currently a problem? I am trying to deal with something and I am so confused as to who to go to for help.
I'm sorry you are struggling right now. CBT likely would work with a trauma issue by teaching you relaxation skills and then working with you to understand what was going on in your current life that may be affected by the trauma. That's what the poster meant by brushing aside the past. More than likely, the T would help you to identify irrational or maladaptive thoughts. These may or may not be associated with the trauma. For example, a person may believe that they are not worthy of love. This belief can affect a number of behaviors and feelings. CBT would help you to link your current behaviors with this belief, but would not necessarily spend much if any time processing the trauma.
> I thought that therapy was talking to a doctor about what was bothering you, and obviously you go deeper into past stuff sometimes...I feel like i have never had therapy before, i feel therapy ignorant.
I hope you are using ignorant as just not knowing yet versus criticizing yourself because you don't know. There's so many types of therapy, it is understandable that clients would not be familiar with many of them. It depends on the kind of counselor, therapist, or doctor you see, and also on their way of doing things. What has been your therapy experience? You can ask the person directly what their orientation is or what kind of therapy they practice. They should be able to give you an answer. Some may say "eclectic" which means they use a variety of models depending on the client and the issues.
> how can the treatment of abuse issues be treated differently? it sounds like they are but i don't see how it is possible to be soooo different that they need different names.
There really are a number of different types of treatment. Even within the main categories: CBT, psychodynamic, client-centered, etc. there are many, many subcategories, although I think when looking for a therapist, it is usually most helpful to look at the broad categories.
>I have experienced the psychodynamic/analitic type of therapy and found it was not useful at all(for me)
This may mean that this type is not helpful for your needs or that the therapist was not a good match for you. What was your experience like?
> I hope I haven't lost anyone, I have sort of confused myself now. I guess what I am asking is, is CBT a form of repression and psychoanalysis not?
CBT is not a form of repression. It just has a different focus than psychodynamic, which focuses on past history issues.
You might also look at these threads from the archives, where people discuss different orientations.
http://www.dr-bob.org/babble/psycho/20031213/msgs/291972.html
http://www.dr-bob.org/babble/psycho/20031221/msgs/293462.html
Feel free to post more questions. Answering you helps me to clarify it for myself, as well.Regards,
gg
Posted by Penny on February 5, 2004, at 8:27:08
In reply to Re: Question for gg. » alexandra_k, posted by gardenergirl on February 4, 2004, at 23:01:29
Very interesting...
my first T was much more CBT oriented - she was a clinical social worker, and she did focus on childhood issues as well, but she recommended Burns' "Feeling Good" to me right from the start. Now, don't get me wrong - I see the value of being able to recognize cognitive distortions - which I engage in frequently! - and fortunately my T didn't minimize the importance and power of my emotions, but I do think she essentially believed that cognition precedes emotion - whereas I, like you, am not so sure. Yes, of course, sometimes I can pinpoint how a particular thought can cause my mood to darken. But those are the times that it is fairly easy, for me, to apply the CBT skills to 'change the thought.' It's when the emotion at least seems to precede any negative thinking that I can't seem to do much about it.
Fortunately for me, my current T isn't big on CBT. She does do some of the cognitive distortion work with me, but she understands that it's not usually as simple as recognizing the skewed thought process.
P
Posted by fallsfall on February 5, 2004, at 9:22:14
In reply to Question for gg., posted by alexandra_k on February 4, 2004, at 19:05:28
My first therapist was CBT. She taught me lots of skills and coping mechanisms. She taught me how to look at what was happening and see what the different parts of it might be. She taught me how to tolerate distress. She taught me how to express what I felt. She taught me to identify thinking patterns that were simply not true ("because I missed one question on the test I will never be a good engineer"). She taught me how to survive through the emotional storms. She taught me that people can care, and that people can care even if I think that I'm not a very nice person.
The things I learned from her are invaluable. But, I do a lot of reading, and I knew that I wanted to get deeper into WHY I end up with all these self-defeating patterns. I asked her, and she did try, but it just isn't in the theory of therapy that she subscribes to to do what I needed done.
I now see a Psychodynamic (self oriented) psychologist. He is very good at going into the why. We do a bunch of transference work (whereas my CBT therapist once said "Why are we always talking about our relationship???"). I feel like this approach will help me to FIX what is wrong, rather than just learn to COPE with what is wrong. So, for me, at this time, Psychodynamic is better.
I do wonder, and worry, what would have happened if I started with Psychodynamic. I use the skills I learned in CBT every day to tolerate what comes out of my Psychodynamic therapy.
I think that each client, at each moment in their therapy, has innate preferences for one type of therapy or another. Usually, I don't think that they know what those preferences are. Eclectic therapists, in theory, would switch to whichever mode was more helpful at the moment.
There is no right answer. It depends on who you are, what your issues are, how you think, how you solve problems, who your therapist is, how you relate to your therapist, and what your goals are. At least, that's how I see it.
Posted by dragonfly25 on February 5, 2004, at 9:46:36
In reply to Re: Another Question » dragonfly25, posted by gardenergirl on February 5, 2004, at 8:21:31
Thanks gg :)
>CBT likely would work with a trauma issue by teaching you relaxation skills and then working with you to understand what was going on in your current life that may be affected by the trauma.
So if I have, for years been avoiding or blocking a traumatic event and was actually successful at it (well i thought i was) and now it is being triggered by something, i am wondering how I go about dealing with it. In CBT do I have to go through the ghory details or do I jsut talk about ways to relax and cope with it? But in doing that doesn't it basically require you to talk about what happened? (sorry if i sound vague) If I can't talk about it....does that mean I can't overcome it?
>hope you are using ignorant as just not knowing yet versus criticizing yourself because you don't know.
Well i have to admit i feel pretty stupid not understanding therapy, having been in it for years. but i guess i meant ignorant for not knowing. I don't even know what kind my psychoanalitc therapy was. He did alot of talking...
>This may mean that this type is not helpful for your needs or that the therapist was not a good match for you. What was your experience like?
It was really awful, he was trying to keep me screwed up i think. (i am serious) I was trying to forget and he was forcing me to think about stuff. that may not sound mean, but the approach and personality to match was an absolute NIGHTMARE.
I guess I am really srtuggling right now b/c i thought i new how to take care of a certain issue, it was dormant i supose and now it is unavoidable. I do have a therapist but I am unable to talk about details- would that be more along the lines of CBT?
thank you for the links it helped clear things up alot.
dragonfly
Posted by 64Bowtie on February 5, 2004, at 13:29:30
In reply to Re: Question for gg. » gardenergirl, posted by Dinah on February 4, 2004, at 23:37:49
[alexandra_k]
>>>As a CBT, he views feelings as the *result* of thoughts. I just don't agree with this on a gut level.
[Rod]
<<<Simple. Until someone suggests that memories are assembled, stored, and recalled differently in childhood than they are in adulthood, the ”gut" isn't seen as the menace that it truly can be for adults.
<
The visceral cortex (gut manager in the brain) is a sensory organ that provides us with bodily function management and safety as adults. What no one told me before I started causing myself trouble was that how ever I used my "gut" as a child, would be different as an adult. Children rely on reactions in the gut for decision making.
<
Please accept my apology if what I am saying feels wrong. I am not implying badness (or goodness for that matter). Children remember things as bad for them if they make bad feelings in the "gut". The opposite applies for good feelings. Candy and cheesecake seem to give me mixed (up) messages, still.
<
More detail: visceral management involves core organs. Heart, stomach, intestines, and diaphragm. The lungs are expanded and contracted by the diaphragm, especially when troubles brew and lives are threatened.
<
The "gut" becomes a menace when we are sitting comfortably on a couch in a friend’s living room and we start hyperventilating at the "thought" of falling. I wouldn't believe it possible if I hadn't seen that and many other similar phobic reactions. When the person is brought back to the here-and-now, the hyperventilating is extinguished.[Dinah]
>>>...my gut tells me that at least portions of emotions precede cognition, although they may be reinforced by the cognitions.
>
[Rod]
<<<First question: Do you see in the literature somewhere that cognition is distinct from thought? Isn't cognition from the root word "cognos", which is Greek for knowing, thinking, and assuming? I like to "cogitate" a lot, and its legal to doit in public, even...lol
<
Them "neuro-folks" I continually invoke show us what they see our wiring doing during the information perception process. A perception progresses to a thought if it passes our beliefs (filter). If they fail to pass, perceptions are held in suspension until enough information supports it as a thought.
<
Perceptions become memories when they pass the beliefs, and an EMOTION is then attached to establish value. Value aids in the placement and recall of memories in the adult mind by impparting value and meaning to the memories we store.
<
To back up the tape one notch. http//www.dictionary.com reports a belief as opinions and/or facts supported only by testimony (this is the reason I see no belief worth killing or dying for). I surmize that your dilemma of which comes first, emotion or "cognition" (thought) can be clarified by a study of "whys and whens" of beliefs.
<
Beliefs are a very efficient tool for intuiting what the next best thing to do is. From a time/value study, beliefs are most useful to our casual, day-to-day lives. They allow us to take action without having to process the existing knowledge all over again.
<
Even though there is 100 years separating Jean Piaget and Roger Penrose, anyone can read both and notice the overlapping in technology available to tolerance and discovery. Piaget observed empirically the cause and effect of developmental behaviors. Penrose has been studying "brain-juices", along the way finding how brilliant Piaget really was.
<
If you think you've "seen a ghost" while reading this post, czek the archives.
<
Rod
Posted by alexandra_k on February 5, 2004, at 16:57:55
In reply to Re: Question for gg., posted by alexandra_k on February 5, 2004, at 3:34:30
Hi. I think that it is a shame that there aren't any studies (to the best of my knowledge) that have been done on whether different kinds of people may be better suited to different kinds of treatment.
I did find that I learned invaluable skills from DBT training - but I think that I would like to use those skills to enable me to make sense of my life and I find that I am not getting that meaning from CBT. That is not to say that other people may indeed be better suited to the CBT style of things..
A scheme is different from a schemata isn't it (??? Not sure - haven't heard the term before and read it wrong..).
Beliefs are interesting. There is much current research being done on how we form beliefs. It is hoped that we may be able to come up with a model of belief formation that may be implemented on a computer simulation... maybe we can explain delusional beliefs by there being a breakdown in one or more componants in the model.
Interesting idea.... relies on delusional beliefs resulting from 'cognitive biases and / or deficiencies' however. An alternative approach would be to consdier that delusional subjects are not so much trying to make false and implausible claims about external reality, but are rather attempting to express their anomalous experience with a public language that is inadequate to the task. Some people develop delusions after head trauma - does the head trauma result in cognitive deficiencies or an anomalous experience? or both -how could we decide? Is the delusion an abnormal experience or an abnormal belief?? The jury is still out. (I pump for the latter - the former seems to imply that we should engage in pointing out the delusional subjects cognitive errors and trying to argue them out of their beliefs by cognitive restructuring and logic. The second seems to imply that we need to engage in radical empathy and attempt to draw the delusional subject away from giving expression to their anomalous experience and back to reporting on the world - as the rest of us (at least try) to do...)
While theory is fairly logically independent of treatment sometimes a theory does seem to flow quite naturally into a course of treatment. I think that sometimes emotions are just primary (as the behaviourists have shown us emotions can be conditioned regardless of cognitive awareness). The difference between a belief and an emotion is supposed to be that an emotion has a motivational force (an urge) that tends to result in action, whereas a belief is 'informational'. In theory people act to satisfy their desires on the assumption that their beliefs are true and they use their beliefs to inform them what the best way to achieve their desires may be. The difference between a belief and a desire is like the difference between a thought and a feeling. Hard to explain, maybe only grasped by introspection...
Posted by Dinah on February 5, 2004, at 17:24:52
In reply to Re: Question for gg., posted by alexandra_k on February 5, 2004, at 16:57:55
I think they are doing outcome studies. For example, CBT works better for Axis I disorders with no personality disorders, next best for a single personality disorder accompanied by an Axis I disorder, next for a single personality disorder, and not so very well at all for comorbid personality disorders.
Actually, it works ok for those who stick with it, but the dropout rate is high. Of course, I think combining the personality disorders as if they were a homogeneous group is ridiculous. I'm guessing that a bit of obsessive compulsive personality disorder helps a bit with CBT, in fact I think I saw it in one of the Grand Rounds presentations linked on this site. While borderline personality disorder probably isn't as good a fit with CBT, and I think there's a pretty high dropout rate.
For myself, I like CBT for teaching useful tools. But sometimes when I see CBT therapists write or talk among themselves I get so angry, and understand why I don't *do* CBT very well with pure CBT therapists. I saw a consensus the other day that if a client is "venting" during a CBT session, then they're showing disrespect for the therapist and the therapy by deviating from the agreed upon goals and procedures. Geez. What are these people doing in the helping profession?
CBT therapists seem to see themselves primarily as educators, which is great unless you need a therapist.
Posted by Dinah on February 5, 2004, at 17:33:03
In reply to Re: Re: Question for gg. (w/trepidation) » Dinah, posted by 64Bowtie on February 5, 2004, at 13:29:30
Might I suggest the book "The Emotional Brain" by Joseph LeDoux?
The book answers your specific points with far more detail than I possibly could.
Posted by dragonfly25 on February 5, 2004, at 18:16:13
In reply to Re: Question for gg. » alexandra_k, posted by Dinah on February 5, 2004, at 17:24:52
hi Dinah,
I found that vERY intersting, but I am once again confused :), what are you suposed to do exactly, with CBT. I appoligize if I sound liek a broken record in this post but as old as I thought therapy was to me it is so NEW. So am I understanding correctly that you don't talk about what is troubling you? So What do you say to them? I feel so silly that I am not getting this? I should go read more old posts. Dinah I found that so interesting about the venting...that is probably what I do, not sure though.
thanks
dragonfly
Posted by Dinah on February 5, 2004, at 18:44:01
In reply to Re: Question for gg. » Dinah, posted by dragonfly25 on February 5, 2004, at 18:16:13
Well, remember that not all CBT therapists practice "pure" CBT. My own therapist does a lot of CBT work.
In CBT there is a fair amount of homework. You do talk about your current life situations in the light of applying CBT principles to current difficulties.
Which my therapist does on occasion too, he just does it conversationally and without homework.
I apologize for my earlier rant. I had just read some material that I interpreted as rather disrespectful to clients. Certainly not all CBT therapists are like that.
Can you ask your therapist what his/her orientation is? And if it's CBT, for a description of your therapist's way of applying it.
Posted by dragonfly25 on February 5, 2004, at 18:51:56
In reply to Re: Question for gg. » dragonfly25, posted by Dinah on February 5, 2004, at 18:44:01
Thanks Dinah
I am 95% sure it is pure CBT, but I could be wrong. I will ask. I don't feel like I'm getting anywhere with therapy. But I think asking about it would be a good start:)
I don't mind if you rant.
Posted by alexandra_k on February 5, 2004, at 20:55:47
In reply to Re: Question for gg. » alexandra_k, posted by Dinah on February 5, 2004, at 17:24:52
Hi people.. Made a mistake in my last post. I meant to say that I think that experience is more important, or prior to, or fundamental to belief in most cases (though not all). Talked about endorsing the latter - I meant the former. I haven't read the emotional brain - but will sometime this year. One of my friends does work on memory and thinks that he is just god.
What I kind of meant by outcome studies is hard to explain. I know that DBT outperforms psychodynamic stuff (just) for BPD for example. But then Borderlines are hardly a homogenous group are they??? Wonder if some borderlines may do better with psychodynamic stuff than DBT - maybe the ones that DBT isn't too effective with. I wonder what factors would be relevant to which kind of treatment works best??? (Other than diagnosis and / or particular symptoms). I, for example, have a very strong defence of intellectualisation. I do not cope well with people telling me that I am illogical as I am sure I can do 2 dimensional modal semantics better than they - it doesn't work to try to argue me out of my 'maladaptive beliefs' . What I personally need is to see someone who is prepared to engage with me. Then I can be more emotionally responsive (reactive??) and there is a genuineness in my emotional responses that comes through once my intellectual guard comes down. And then I am in a place to be able to see and evaluate my current responses etc...
My current T is CBT trained. She hasn't done DBT - but said she will try to be 'informed' by it best she can. I said I didn't really care - just so long as she was prepared to help me figure out what is going on for me and why and how I might be able to change it and how I can make sense of it all. She has agreed. She has put away her little boxes and 6-12 wk timeframe and is trying to just see what works with me and stick to that and see how we go. I am grateful for her willingness to be flexable (she acknowledges that CBT hasn't worked too well for me in the past) but I am concerned that aside from CBT I am not sure that she really knows what she is doing...
But I have no treatment options left. She is willing to try to help me and I am so imensely grateful for that, but scaired that she may well not know any different.
Posted by Dinah on February 5, 2004, at 21:57:44
In reply to Re: Question for gg., posted by alexandra_k on February 5, 2004, at 20:55:47
That's very encouraging. Flexibility is my number one therapist requirement. My therapist's main work right now is shorter term CBT, since that's mainly what insurance companies like to cover. But he's modified his approach for me. I think it's more attachment theory, with some self psychology thrown in. Although he also quotes Jung from time to time, and has tried to do some Gestalt techniques (I refused of course). I really ought to ask him... I think he used to treat patients that were similar to me years ago, when he first started. And he's darned good at it most of the time. And getting better and better.
So hopefully she'll have had enough exposure to other models of therapy to at the very least soften the CBT educational approach. Maybe she'll even enjoy the challenge and the change from the same old same old.
Posted by alexandra_k on February 5, 2004, at 23:06:54
In reply to Re: Question for gg. » alexandra_k, posted by Dinah on February 5, 2004, at 21:57:44
>...has tried to do some Gestalt techniques (I refused of course).
How come?? sorry but I am excedingly ignorant of anything other than CBT, DBT, behaviourism, cognitivism, and experimental psychology. I have certaintly heard of the 'psychodynamic tradition' but don't know anything else about it really. I mean psychoanalysis is the 7-10 year stuff doing associations on the couch right??? but thats not publicly or health insurance funded right??? but then there are infinately many varieties and i really know nothing about them though am very interested to learn more. Any info and opinions would be gratefully received - online resources and / or serials / journals preferred :-)
Posted by Dinah on February 6, 2004, at 0:05:33
In reply to Re: Question for gg. » Dinah, posted by alexandra_k on February 5, 2004, at 23:06:54
http://mentalhelp.net/psyhelp/chap15/chap15d.htm
An excerpt:
"Beyond attending to body language, feelings, and wants, Gestaltists prescribe learning experiences or homework, such as having a group hold, comfort and feed an inhibited, aloof, unemotional man (to get him in touch with childish dependency again), having a dependent woman with a weak, whiny voice to talk like a little girl (to recognize how her helplessness is used), having a shy, self-depreciating person walk around the room like he/she had just gotten an A in a tough course (to recognize and accept feeling proud), having group members imagine being an animal (to see if the choice reflects personal traits or wishes), having a shy person gradually explore being more sociable, and so on (Gilliland, et al., 1989). Gestaltists also make use of dreams (see method #6), imagination (next step), guided fantasy (method #5c), looking for the opposites (next step), the empty chair (see step 3), and many other techniques for finding parts of ourselves. Most of these things you can do yourself."
I refused because I'm not too good at theatrical productions, and am too self conscious to try. I won't even punch his pillows or lay down on the floor.
Posted by 64Bowtie on February 6, 2004, at 2:13:53
In reply to Re: Re: Question for gg. (w/trepidation) » 64Bowtie, posted by Dinah on February 5, 2004, at 17:33:03
Dinah,
He is a great resource for left-brain brain studies. In fact I quote his research sometimes, for certain audiences.
We seem to be more interested in the mind/brain nexus and the messy stuff at Babble. When I jibber-jabber with abstractions, I miss y'alls as an audience. I wish you could see me pointing at the wall like it was a blackboard full of diagrams everytime I post.
I still don't have it right. Sometimes its timing. Sometimes its reader attention span (and yawning at my boring delivery).
I assure you I have seen this stuff work over and over again. We are equipped with the goodies to make it all ok and right.
Eric Berne of "Transactional Analysis" fame, had at least one thing right as I see it. "We were all born princes and princesses. Along the way our families turned us all into FROGS. Its our job to find a way to turn ourselves back into royalty. We have the tools so we need to learn how to use them."
Its sad that what I am proposing sounds toooo darned simple to be right:
1. That we were all born with enough tools to restore ourselves to balance and harmony.
2. That if I have a tooth ache, you can't feel it.
3. That if I look at myself out-of-body across the room, I know I have a tooth ache but I can't feel it from my vantage point across the room.
4. That if I resign my reactions to "problems" to my "gut", as an adult, my life will remain messy. Feeling a solution lacks a plan.
5. That when I see what I want clearly in my mind's eye, I can only then make goals, and plans to achieve them. I can't feel a goal.
6. That my level of dysfunction can be measured by the numbers and severity of my bad habits that result in my unresolved-internal-conflicts.
7. That the fear of danger, which worked fine in my childhood, was wisely replaced by respect-for-the-same-danger, in my adulthood, providing me with optional results, at my choice.
8. That I successfully replaced avoidance-of-the-new, with curiosity and discovery of the new.
9. That I have found my personal power to be my ability to make a difference, and my strength to be my ability to withstand.
10. That my life was governed by my level of the near-slavery nature of obligation, which I updated and replaced with love, respect, acceptance, and responsibility, all working in concert.
11. That beliefs are only a tool, and not ever an end or a goal.
12. That I recognize when someone else is indentured to an opinion as if it were reality instead of only the "story" that it is.
13. When I speak to the only guy in my mirror, there is only one voice, mine.
14. When I seek beautiful outcomes, that's all that will happen for me. What "Happens to me" is beyond my control, so wisdom says don't worry if it hasn't happened.
15. that if I see past events in black and white, the represent onresolved childhood issues.
16. That my misplaced arrogance about folks not liking our family because we were so poor, kept people from liking me.
17. Indecision blocks curiosity locking me into continuation of multigenerational multilayer dysfunction.
18. That "who I am" is never measured by "what I do(did)". If "what I did" was a bad thing, I am still me, and I can make amends and promise never to transgress again. My bad behavior is simply that, bad behavior. I remain "me", no matter what....
19. Violence and coercion used as conflict resolution strategies in adulthood, are leftovers of inappropriate parenting from childhood. The residue of poor conflict management strategies is a messy adulthood.
20. Holding onto the illusion that we can't change "what we do(did)" without changing "Who we are" and thus must be avoided, locks folks into continuous conflict with reality. Continuous strife and struggle is not a "life".
Rod
Posted by alexandra_k on February 6, 2004, at 5:45:31
In reply to Re: Gestalt techniques » alexandra_k, posted by Dinah on February 6, 2004, at 0:05:33
sheesh I am not suprised you didn't want to do that stuff!!! I would only lie on the floor for one reason, and I can asure you it wouldn't be too theraputic for me.
Heh heh, the things peoples do eh :-)
Posted by Dinah on February 6, 2004, at 8:02:27
In reply to Yep. I'm familiar with La Doux » Dinah, posted by 64Bowtie on February 6, 2004, at 2:13:53
Hi. I'm on my way to therapy and haven't much time, but I'll get back to you later on it.
Have you read this particular book. In it he gives the right brain, although I think deep brain might be more accurate, its full due and credit.
He appears to say that the cognitive model is insufficient to explain emotion. That emotions shouldn't be made cold and lifeless by trying to cram them into the cognitive model. That the emotional brain works parallel to the cognitive brain, and that reactions are not necessarily mediated by cognition in order to result in an emotion. And that this is a product of evolution, and not a bad thing.
He does seem to believe that behavior therapy has a better chance at changing the emotional pathways, which I'm not altogether sure I agree with unless you see experiential therapy as a form of behavior therapy, in which case I totally agree.
But I'm still wading through it so my conclusions may be incorrect. I'll get back to you when I've finished.
If you don't mind me saying so, I'm not sure you're giving enough credit to individual biological differences. Not just mental illnesses, though it's probably a good idea to keep in mind that our ability to will things like bipolar illnesses away is minimal.
But also individual biological differences in how our brains work. These also have evolutionary and even current value, although they may also cause us grief. Childhood experience is one factor among many for your resulting brain chemistry now. Our biological predispositions also interact with our childhood experiences to produce our now cascading amygdalas.
Perhaps I'm biased in favor of this because of my experience with animals. No "childhood experiences" or training will make my Lucky into a Harry. They just start out with different equipment. They are shaped by their environments in different ways. And they respond to interventions in different ways.
Will and positive thinking will only take you so far and no more. I happen to be very familiar with this in my own life, because for a very long while I relied on Will.
But you wish to be a coach, not a therapist, no? And as such you would be dealing with a different subset of the population? So don't let your difficulties in getting people like me to respond to your approach deter you. There are many many people who are nothing like me. :)
Posted by 64Bowtie on February 6, 2004, at 22:26:03
In reply to Re: Yep. I'm familiar with La Doux, posted by Dinah on February 6, 2004, at 8:02:27
There are many many people who are nothing like me. :)
...and that's the main reason I'm enjoying getting to know you, dearheart. Intuition says you are quite a find....
Rod
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