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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by CareBear04 on March 15, 2006, at 9:03:49
I've been looking for a new T, and I have an appointment with a psychologist who says she does mostly CBT and a little DBT. What exactly does that mean? I vaguely remember doing some CBT and DBT about three years ago and not liking it, but I was in a really bad place and was just starting out down the psychiatry path. Plus, I didn't like my therapists. Can someone explain to me what a CBT appointment is like and what the relationship between T and patient is like? Since my initial experience with CBT/DBT, I've done only psychodynamic therapy and liked that a lot.
THanks-- any input would be greatly appreciated!
CB
Posted by B2chica on March 15, 2006, at 9:42:34
In reply to What does it mean when a T does mostly CBT?, posted by CareBear04 on March 15, 2006, at 9:03:49
CBT is cognitive behavioral therapy. it's like it says, it deals with behavior and the thoughts that control it. like recognizing you are filled with anxity, ask self why, tell self there's no real reason to feel it, that it won't hurt you, that you are ok, anxiety goes down.
stuff like that. basically they reshape the way you view your depression, anxiety whatever, and the cooresponding actions.DBT is dialectical behavior therapy (talk about it all), is typically group (and one on one). this is supposed to be more intense. describe things that happened that week, how you acted/reacted, any consequences, and how you can react differently next time. typically for those that are suicidal, or self-injurers, BPD, etc.
you look at Emotional mind, Reason mind combine together is 'wise mind'.
so example, emotional mind-i was scared, intimidated, unsure of self, anxiety; Reason mind-he couldn't really hurt me, he has no power over me, i'm a good person; Wise mind-tell him how i feel, find supportive person to be with you, work on good self-esteem.-try googling them also.
HTH
b2c.
Posted by fairywings on March 15, 2006, at 9:47:55
In reply to What does it mean when a T does mostly CBT?, posted by CareBear04 on March 15, 2006, at 9:03:49
My experience with CBT wasn't that great. I don't really like CBT, but I guess it does have it's value. My daughter recently went to a CBT therapist and she was the worst. She wasn't at all warm, she just told my daughter to just "think differently" about anxiety, and gave her homework to think about when she had anxiety, why, and what she was thinking. She went to maybe 6 appts. and quit.
My most recent experience a CBT therapist was so-so, but I told him I didn't want to do CBT as soon as I found out that was his bent. He was fine with that, and although he did challenge my faulty thinking, he was good with insight too. He asked me a LOT of questions, seemingly unrelated a lot of times, and then he'd give me his "take". He was usually right on the money, and VERY smart! He was incredibly motivating, I loved that, dissipated my guilt - I loved that, but he could also say things that were hurtful, which is one reason why I quit. He wasn't much for exploring past hurts, and when there are a lot, sometimes I think we need to go there. I don't think CBT is much for that. Unfortunately ins. cos. are really pushing for faster relief, and fewer sessions, I guess CBT does that more often than psychodynamic, but I think a lot of times it's just putting a band aid on a gaping wound. I don't know, maybe it all depends on the therapist.
I think if you already have a good idea you don't want to do CBT, you might want to look for a psychodymic therapist you can check out too. Good luck with this!
fw
Posted by Dinah on March 15, 2006, at 10:34:08
In reply to What does it mean when a T does mostly CBT?, posted by CareBear04 on March 15, 2006, at 9:03:49
Naturally there are as many different CBT therapies as there are practitioners, unless they're straight by the book. My therapist mainly does CBT, because that's mainstream therapy right now. But he's only strictly by the book if that seems to be what's called for.
In general, you can expect that the therapist will focus more on the here and now, as opposed to the past. The therapist probably won't get into the therapeutic relationship unless you bring it up. And then they have varying degree of skill working with it.
They're really a lot like teachers. They teach you to recognize patterns of thinking that aren't useful to you. They'll also teach you behavioral techniques to control the physical symptoms of your illness. DBT is also skills training, with a bit more emphasis on eastern philosophy. Distress tolerance and radical acceptance are two of the skills I remember. It's considered, when practiced by a skilled practitioner, to be more validating of the client's present experience while also encouraging change.
Neither are particularly introspective, but more change oriented.
For those that it works well for, it works very well.
For those who aren't suited to it, it can be not quite enough.
But I think that the skills they teach can be useful to anyone. I still use my relaxation skills and my OCD thought challenging skills.
But what it didn't do was teach me what was behind my OCD thoughts. It didn't go deep.
Posted by fallsfall on March 15, 2006, at 11:24:04
In reply to What does it mean when a T does mostly CBT?, posted by CareBear04 on March 15, 2006, at 9:03:49
I did 8 1/2 years of CBT and am working towards my third year of psychodynamic. They are quite different.
CBT is great for those who it is suited. But it isn't suited to everyone. Psychodynamic isn't suited to everyone either. Since you've tried both and didn't like CBT and did like Psychodynamic, I would urge you to find a psychodynamic therapist. It has made a big difference for me.
Posted by Racer on March 15, 2006, at 11:56:15
In reply to Re: What does it mean when a T does mostly CBT? » CareBear04, posted by fallsfall on March 15, 2006, at 11:24:04
Some people just don't do well with CBT -- I'm one of them, so I'll tell you a bit about why, so you can see if you think it fits you.
Part of the whole anorexic thing, for me, is "controlling" my feelings, and it includes feelings of hunger: if I can control my reaction to hunger, I can control my reactions to other feelings. That's obviously simplified, but that's a big part of it. It's holding everything tightly inside me. And CBT tends to trigger that for me. There's such emphasis on 'when you start to feel [x], redirect yourself to thinking [y].' That's not a bad way of going about it, but for someone who has to run down a checklist of symptoms to figure out she's feeling hunger, let alone something like anger or hurt or loneliness, well, not necessarily helpful.
For me, I think it's important that I learn to *feel* emotions, before I start working on stopping them. And, the more a therapist tells me it's all up to me, all I have to do is control my thinking and I will never feel bad -- the worse I feel, and the more I work on *not* feeling, and starve myself. According to my current therapist, who does specialize in eating disorders, that's actually a pretty common reaction to CBT in someone with anorexia. (Although CBT, while not her favorite orientation, does have more benefit for bulimia, proving again that we are all different. Your mileage will vary.)
Overall, though, I'd say I'm with others who've replied: if you haven't responded well to CBT in the past, you're probably better off looknig around for a psychodynamic T now.
Good luck, whatever you do, and best luck in finding a good fit in a therapist.
Posted by CareBear04 on March 15, 2006, at 12:06:57
In reply to Re: What does it mean when a T does mostly CBT?, posted by Racer on March 15, 2006, at 11:56:15
Thanks for all your replies, everyone. I have an appointment with this new T on Friday, and I'm really nervous. Part of the reason I was more willing to give CBT a try is that I just had a T who specialized in psychodynamic. He's in training for psychoanalysis. It didn't go well at all. He would always wait for me to talk first, and that would just lead to these loooong silences. He made me feel like anything I said would be wrong. In part, I think it was because our personalities didn't match at all. I'm hoping that at least I'll like this new T as a person and find it easier to talk to her.
I've read the _Feeling Good Handbook_ and I agree that CBT often seems oversimplified, like, "just change your thinking..." duh... if only it were that easy. I don't think my thinking is really that faulty the way it used to be when I would blow everything out of proportion. I think I'm just at an age where I need someone to talk to about a lot of overwhelming decisions and things going on in my life. Can a CBT T help with that?
THanks again,
CB
Posted by fairywings on March 15, 2006, at 17:13:44
In reply to Thanks everyone!, posted by CareBear04 on March 15, 2006, at 12:06:57
Oooo, I wouldn't like that either! bleh! No wonder you want to try something diff.
Like you said, it all depends on the T - if you like their personality and style. Sometimes then, no matter what their theoretical background, things just fall into place.
(my ex T and current T talk a LOT, and I like that)good luck,
fw
Posted by Veracity on March 22, 2006, at 11:46:38
In reply to Re: Thanks everyone! » CareBear04, posted by fairywings on March 15, 2006, at 17:13:44
I found CBT quite helpful in addressing the out-of-control spiral that my depression and anxiety could often become but like others have said, it is certainly more of a band-aid than a cure.
One of the biggest downsides of CBT (for me) is that it places 100% of my success in dealing with troubling emotions on my shoulders. Ultimately, it is up to me to process and change my reactions to my experiences. And this leaves me feeling quite, well, very alone. Even when my therapist participated in going over my CBT "homework" (mood logs, etc.) with me, I felt very isolated. I yearned for the connection that just talking provides.
Also - and I'd be interested in hearing if others feel the same way - I cannot reconcile the idea that if certain bad emotions like hopelessness and worthlessness are based on distorted/wrong thinking, then wouldn't positive emotions such as hopefulness and worthiness also be based on such distortions? To my mind, I don't think you can just pick-and-choose which emotions you're going to be real about. It seems as though for CBT to really work, you've got to be honest about how all emotions are affected by how we think about and experience our respective realities.
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