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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by Pfinstegg on January 6, 2005, at 20:42:45
In reply to Why is e-therapy supposed to be second rate?, posted by alexandra_k on January 6, 2005, at 17:43:43
There are people here, especially those with established relationships with their therapists, who seem to get a lot out of either e-mail or, perhaps more, phone sessions. Still,I do keep in mind that those of us with abuse and neglect issues do not have sufficient neuronal connections in our brains for proper emotional self-regulation. I've come to believe that an actual relationship with a therapist is vital- the opportunity to look at him/her, to hear his voice, feel what her presence is actually like- is crucial to developing those additional connections that we need to be able to soothe and calm ourselves, as well as to gain a fundamental sense that there is a loving, caring person for US.
Posted by alexandra_k on January 6, 2005, at 20:51:54
In reply to Re: Why is e-therapy supposed to be second rate? » alexandra_k, posted by Pfinstegg on January 6, 2005, at 20:42:45
>I've come to believe that an actual relationship with a therapist is vital- the opportunity to look at him/her, to hear his voice, feel what her presence is actually like- is crucial to developing those additional connections that we need to be able to soothe and calm ourselves, as well as to gain a fundamental sense that there is a loving, caring person for US.
Hmm. I guess that is what I am questioning. I mean, I grant you that an actual presence can be helpful but does it have to be necessary? Couldn't there be a virtual other way?
Posted by Pfinstegg on January 6, 2005, at 21:08:44
In reply to Re: Why is e-therapy supposed to be second rate? » Pfinstegg, posted by alexandra_k on January 6, 2005, at 20:51:54
I can't say that there couldn't be, because I don't know. I'm just falling back on the fact that we are smart mammals who are wired to develop healthy brains during childhood if we have safe. loving connections with important others. And, just in the last decade or so, it turns out that, even if we have had destructive childhood relationships, so that we develop PTSD, BPD, major depression or anxiety, we can still repair our brains all during our adult lives - if we have a really good, well-trained person to do it with. I think by far the biggest challenge is finding that person.
Posted by Joslynn on January 6, 2005, at 21:45:50
In reply to Why is e-therapy supposed to be second rate?, posted by alexandra_k on January 6, 2005, at 17:43:43
Maybe it is viewed as less helpful because it will not give us practice reading nonverbal cues and interacting with people face-to-face.
Posted by alexandra_k on January 6, 2005, at 22:07:11
In reply to Re: Why is e-therapy supposed to be second rate?, posted by Joslynn on January 6, 2005, at 21:45:50
Hmm, that is a good point. Maybe it would just help us develop healthy, well adjusted internet identities :-)
Posted by alexandra_k on January 6, 2005, at 22:15:46
In reply to Re: Why is e-therapy supposed to be second rate? » alexandra_k, posted by Pfinstegg on January 6, 2005, at 21:08:44
Yeah, I agree with you completely. I am just wondering whether where you have a lack of some things with internet therapy you may have a corresponding gain of other things. I agree that it would be different, but wonder whether it might actually be better for some, or well, for me. In my case. I guess that is why I am asking. But I haven't done much face to face therapy (outside CBT) and maybe there is a lot of important stuff (for other styles of therapy) that would be missed.
I mean perhaps it is important to know both reactions and responses. But then you could write about both. For me, when I am asked 'how are you feeling' in person I sometimes say 'I don't know'. Fact is it can take me 20 minutes before I am ready to answer. Not ok with face to face therapy, better for internet therapy.
I don't know.
(I guess I should say that there are different ways of doing internet therapy. I am mainly thinking of email therapy because what I like about that is the TIME DELAY).
Posted by alexandra_k on January 6, 2005, at 22:20:08
In reply to Re: Why is e-therapy supposed to be second rate?, posted by Joslynn on January 6, 2005, at 21:45:50
> Maybe it is viewed as less helpful because it will not give us practice reading nonverbal cues and interacting with people face-to-face.
Ok. So maybe it couldn't help people who have significant problems in those areas.
But not everyone does.
Posted by Pfinstegg on January 6, 2005, at 22:26:18
In reply to Re: Why is e-therapy supposed to be second rate? » Pfinstegg, posted by alexandra_k on January 6, 2005, at 22:15:46
I'd love to hear that you finally found a therapist who could help you feel comfortable and connected even though you might need 20 minutes (or even much more), to say what you were really feeling- especially, one who would not make you feel bad that you needed that time. They DO exist.
Posted by alexandra_k on January 6, 2005, at 22:36:20
In reply to Re: Why is e-therapy supposed to be second rate? » alexandra_k, posted by Pfinstegg on January 6, 2005, at 22:26:18
> I'd love to hear that you finally found a therapist who could help you feel comfortable and connected even though you might need 20 minutes (or even much more), to say what you were really feeling- especially, one who would not make you feel bad that you needed that time. They DO exist.
Yeah, I'm sure they do.
I just thought that I might be better with writing than speech. I am pretty incoherent with writing much of the time, but sheesh, you should hear me when I am in a state. Would save all that. I think I really would prefer it...Anyways. I got an email from my t. He said that they have agreed (in principle) to fund an assessment with a specialist up in Auckland. I hate assessments because I have had them where I had thought they had gone well only to find that after reading my file their opinion had changed considerably and then they go on to formally write all sorts of b*llshit.
I think this person treats DID. My t said there was someone in Auckland who he contacted but they see each client twice a week. Hard to do that. Would be a 2- 2 1/2 hour commute each way. Would need to have all of the above funded by CMH. Would need to have that sort of flexability in my timetable. Still, if it becomes an option then I am there I surely am.
Though scaired too. There is always that.
Posted by alexandra_k on January 6, 2005, at 22:41:43
In reply to Re: Why is e-therapy supposed to be second rate? » alexandra_k, posted by Pfinstegg on January 6, 2005, at 22:26:18
Posted by Pfinstegg on January 6, 2005, at 23:43:52
In reply to Re: Why is e-therapy supposed to be second rate? » Pfinstegg, posted by alexandra_k on January 6, 2005, at 22:36:20
Yeah, it IS scary- a lot is at stake. Still, it's the best news I've heard yet- that they are trying to find someone who knows how to treat dissociative disorders. Maybe they should just throw out that old file, which is probably all wrong. (BPD, etc.) They meet you, and recognize all your strengths and assets, and then they read old stuff in your file and probably get unduly concerned that they can't help you. People who have dissociative disorders (like me) can really get much better- the key is a therapist who knows how to treat it, and quite frequent therapy. It does sound like a huge commute, but maybe it's time you could put to good use, reading, writing, doing your work, etc. I just know you will feel so encouraged when you find the right therapist- it will give you real hope, which you've had to do without for so long.
I have never used babblemail, I don't see anything here which tells me how to start using it, although I know others do it.
Posted by alexandra_k on January 7, 2005, at 0:25:29
In reply to Re: Why is e-therapy supposed to be second rate? » alexandra_k, posted by Pfinstegg on January 6, 2005, at 23:43:52
Follow the 'Register' link near the top of the page just above the 'google' box. Then type your posting name and password into the 'update registration' bit. Then you should be able to turn your babblemail option from off to on. Babblemails will be sent to the email address you registered with. The recipient will not be able to tell your email address. If they want to reply then they need to send you a babblemail. You can babblemail by opening a post from the person you want to babblemail. If they have the babblemail option switched on then their name will appear in blue near the top of the box. That is a link, follow it to babblemail them :-)
(It isn't as hard as it sounds)Yeah. I have heard of people just grabbing their file out of their p-doc's hands and running off with it! Then it is gone for good! Unfortunately, unless they have all 7 on them there is still a record of me, sigh. But yeah, it is not worth the paper it is written on.
I would do the commute if it came to that. What I am most afraid of is that this person is not the specialist my p-doc has mentioned before. What if this person is supposed to see me and make a 'no treatment' reccomendation? Then CMH can say that they paid a lot of money for me to see a good specialist and he concurred with my last two psychology assessments that I am unsuitable for treatment? What if it is just a way to get rid of me?
I doubt that they would fund me to see a specialist psychiatrist twice a week. But as I keep saying to them: IT IS CHEAPER THAN FUNDING ME TO GO TO ASHBURN. And it is preferable to me also. I think the idea is that this assessment will determine the $$$ constraints. At the end of the day that is what determines whether I get adequate treatment or not. I am only too aware there are competent people out there - it is just that there is nobody competent to treat me in the CMH system in our region. And possibly in any other region either.
Posted by gardenergirl on January 7, 2005, at 0:54:45
In reply to Re: Why is e-therapy supposed to be second rate? » Pfinstegg, posted by alexandra_k on January 7, 2005, at 0:25:29
Great timing with your question, alexandrak
I just got this in an email. Your uni library may have the access to this. I may also have via my library. Here is excerpt:
The *Harvard Mental Health Letter* has issued the following news release about an article in their new issue:
"Benefits Found in Long-Distance Psychotherapy"
It may seem like a basic necessity of any treatment that the patient and the doctor be in the same room -- especially in the case of the very personal process of psychotherapy. But as the January issue of the Harvard
Mental Health Letter reports, studies are showing that psychotherapy can be effective even when the doctor is ³seeing² the patient through phone calls or video.May not be that bad afterall?
gg
Posted by Pfinstegg on January 7, 2005, at 1:00:05
In reply to Re: Why is e-therapy supposed to be second rate? » Pfinstegg, posted by alexandra_k on January 7, 2005, at 0:25:29
Thanks! I'll do my best to make it work, but not until tomorrow evening (Eastern Standard Time- US), as i need to go to sleep, then analysis at 8 AM, then work. I'll try, though!
Posted by alexandra_k on January 7, 2005, at 1:49:11
In reply to Re: Why is e-therapy supposed to be second rate? » alexandra_k, posted by gardenergirl on January 7, 2005, at 0:54:45
> phone calls or video.
Those may be a bit different to emails though...
> May not be that bad afterall?I didn't think it was I just wondered why peoples seem to be so cautious in warning other peoples that it is not a replacement for face to face interaction which should be the preferred option wherever possible.
My question was just why?
And in response to most of what I have read about the reasons why my response is
But are you sure that that is necessary?
and / or But are you sure that that can't be done in alternative ways?
Posted by cubic_me on January 7, 2005, at 13:12:03
In reply to Re: Why is e-therapy supposed to be second rate? » gardenergirl, posted by alexandra_k on January 7, 2005, at 1:49:11
I think that if e-therapy was easily on hand I would go for it straight away. Not because I think it would be better for me, but because I could so easily avoid all those things I don't want to talk about and I would feel more protected. Sometimes I need to feel vulnerable to move forward, and that is what face to face therapy did for me that would be more difficult with e-therapy.
Posted by alexandra_k on January 7, 2005, at 17:50:57
In reply to Re: Why is e-therapy supposed to be second rate?, posted by cubic_me on January 7, 2005, at 13:12:03
> but because I could so easily avoid all those things I don't want to talk about and I would feel more protected. Sometimes I need to feel vulnerable to move forward, and that is what face to face therapy did for me that would be more difficult with e-therapy.
You don't think that you would feel more protected with e-therapy which may mean that you don't need to avoid all those things you don't want to talk about? I mean, I personally find it easier to write about stuff that is hard - but maybe that is just me. Stuff that is hard for me is stuff that is hard for me to express. Stuff that I kind of don't know how to express. If I try in a face to face interaction then things can go badly if I am misunderstood or if I can't get across what I am trying to say. I find that writing is helpful because I can really think about what I am saying and can go back and edit it and phrase it just right so it is fairly comprehensible. I do agree, though, that if you thought that you would avoid stuff that was hard then it would indeed be hard to progress and if you think e-therapy might bring that out in you then it might not be so right for you.
Do you think that face to face contact would be required in order for you to feel vulnerable?
For me how vulnerable I feel is a function of how much I express that is of real personal significance to me. I think I would find that easier with the 'illusion of anonymity' and with a time delay than in a face to face interaction.
Thats why I am thinking that e-therapy might be better for me.
Posted by alexandra_k on January 7, 2005, at 18:19:10
In reply to Why is e-therapy supposed to be second rate?, posted by alexandra_k on January 6, 2005, at 17:43:43
From http://www.metanoia.org/imhs/ p.8
>Is this “psychotherapy”?
No. But it definitely can be therapeutic.>Naturally, everyone wants to compare e-therapy to traditional psychotherapy. If you can talk to a therapist online, will traditional psychotherapy become obsolete? Absolutely not.
>Therapists can provide only a small amount of help via the Internet — an amount so small that everyone, without exception, agrees that these online interactions are not “therapy”.
But why? Why only a 'small amount of help'? Is that because nobody has tried therapy properly over the internet or because the methods have still to be worked out?
I see no a-priori reason why internet therapy couldn't be a viable alternative (and not just a second rate one) to traditional psychotherapy.
Not for everyone, sure, but why not a better option for some? (And not just in virtue of inaccessibility or physical impairment)
>Many people find it very helpful to talk with a therapist online. But it will never replace the unique experience of forming a continuing face-to-face relationship with a psychotherapist.
Why not?
>Full-fledged therapy requires physical presence for the therapist to be able to do his/her job.
Why?
Posted by alexandra_k on January 7, 2005, at 19:35:47
In reply to Re: Why is e-therapy supposed to be second rate?, posted by alexandra_k on January 7, 2005, at 18:19:10
And on a bit of a different (though related) theme:
http://dr-bob.org/babble/studs/20040420/msgs/439131.html
But maybe this is a lot different from therapy?
Posted by Dinah on January 7, 2005, at 20:07:32
In reply to Re: Why is e-therapy supposed to be second rate?, posted by alexandra_k on January 7, 2005, at 18:19:10
I had thought it was just considered to be different, not inferior. It's probably better in some ways, just like I express myself better on Babble than in person, and often use the words I use in posts to talk to my therapist. But then in other ways it would be not as good. Like I can't imagine therapy without *feeling* my therapist constantly.
Any time things are different, there are bound to be ways in which one is better and ways in which another is better. There's no saying which is better for any one person.
(I did an email consultation once and found the lack of real time interaction a drawback since I couldn't correct misconceptions and each e-mail was a "session" so misconceptions were hard to correct. But I've read files or reports from face-to-face consultants that left me scratching my head and saying "What the ....? as well, so that can happen in person. So can lying on the part of the client, etc.)
Posted by alexandra_k on January 7, 2005, at 21:24:18
In reply to Re: Why is e-therapy supposed to be second rate? » alexandra_k, posted by Dinah on January 7, 2005, at 20:07:32
>I did an email consultation once and found the lack of real time interaction a drawback since I couldn't correct misconceptions and each e-mail was a "session" so misconceptions were hard to correct.
Well yeah. I would have thought a couple of back and forths should count as a session.
Maybe the notion of 'session' is kind of not very fitting because it would be hard to figure how much information is comperable to a session. There is also the point that you can have two pieces of writing the same length but one can be a fairly easy rambly read and the other can be harder going and require more time to think about.
It would be hard to correct misconceptions if one substantial email counted as a session. I don't think I'd like that very much.
Posted by cubic_me on January 8, 2005, at 8:34:22
In reply to Re: Why is e-therapy supposed to be second rate?, posted by alexandra_k on January 7, 2005, at 21:24:18
Dr Bob has written a book on e-therapy. I was going to do something on this for a uni project, but changed my mind, so I still have the book sitting on my shelf and haven't read it.
Posted by meg7 on January 8, 2005, at 11:25:41
In reply to Why is e-therapy supposed to be second rate?, posted by alexandra_k on January 6, 2005, at 17:43:43
I tried e-therapy for a while after not being able to discuss anything during regular sessions. It really is easier to think about things first and to organize them, especially when concentration is also a problem. After sending two e-mails and receiving a short answer after a long time, I found that nothing has changed and that the fear of my T's reaction to sensitive issues was still there, so I stopped. Maybe if I had been completely anonymous it would have been easier...
Posted by alexandra_k on January 8, 2005, at 15:43:44
In reply to Re: Why is e-therapy supposed to be second rate? » alexandra_k, posted by meg7 on January 8, 2005, at 11:25:41
>After sending two e-mails and receiving a short answer after a long time, I found that nothing has changed and that the fear of my T's reaction to sensitive issues was still there, so I stopped.
Well sure, that would have been like them falling asleep in session or something! I think this may show that one can still be vulnerable in an email relationship...
Posted by alexandra_k on January 8, 2005, at 15:44:15
In reply to Re: Why is e-therapy supposed to be second rate? » alexandra_k, posted by cubic_me on January 8, 2005, at 8:34:22
mmm. I shall read it one day :-)
This is the end of the thread.
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