![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 23 to 47 of 47. Go back in thread:
Posted by pseudoname on April 10, 2006, at 10:32:54
In reply to Re: I disagree » gardenergirl, posted by special_k on April 9, 2006, at 23:08:56
> you okay pseudoname?
So sweet to ask. Yeah, I'm okay. I had to go away visiting on Sunday, so I didn't get enough time to post in this thread, which requires more thought for me than most of my posts.
> i think pseudoname sometimes takes things personally
Man, you got that right! LOL!! But it wasn't the case in this situation.
Actually, though, there was something about *my own* posts that was mildly frustrating to me and I couldn't figure it out what it was. But I now see, thanks to gg's observation, that I was sorta posting my conclusions without filling in what led me to think that way. Those posts were then less satisfying to write. (As well as less Babble-friendly.)
So I'll post more today here, in between errands. I really enjoy discussion about psychoanalytic subjects and therapy generally.
Posted by pseudoname on April 10, 2006, at 12:56:19
In reply to still here :-), posted by pseudoname on April 10, 2006, at 10:32:54
(Possibly book-length. <chuckle>)
A couple times K has suggested that transference theory can be over-applied or isn't appropriate in interpreting all emotional problems. That sounds reasonable, but as far as I know, there isn't any scale or test for telling what is an appropriate situation to consider transference and what isn't. Gardernergirl also points out that not all emotions are transference, but there again, as far as I know, there is no test for telling what response is or isn't transferential.
Two candidates come up, but neither seems very good to me: intuition and therapeutic outcome.
Intuition about transference simply can't be evaluated. It isn't a naturalistic sort of “intuitive” inference like those we make when deciding whether someone's angry or lying. Those “intuitive” judgments can be tested in the laboratory and turn out sometimes to be reliable (like with sussing others' emotions) and sometimes not (detecting liars).
I personally found my analyst's appeals to his “gut” authority to be maddening. Intuition is often wrong, especially when there's no absolute standard to train it against. Intuition can be extremely valuable to humans in detecting subtle environmental cues, but when it does work in those situations it can also be backed up (later) by breaking down and referring to the environmental details that really *are* involved. In this way we can scientifically point to mouth/eyebrow correlations to show what makes a smile intuitively convincing.
That sort of scientific back-up is something the intuitive assessment of “transference” (etc) doesn't have, as far as I know.
I feel that therapeutic intuition is highly unreliable, meaning that different therapists have different intuitions. Studies running therapists head-to-head against each other diagnosing films of patient interviews showed very poor agreement in their intuitive judgments of things like transference. I personally think that the same therapist will have different intuitions about the same patient's transference on different days of the week because there's never anything that she can check her intuitions against in order to learn to make them better.
That leaves therapeutic outcome. I haven't looked for a study that isolates transference as a factor in therapy, but studies looking at psychoanalysis (in which transference theory is typically a big part) famously show dramatically poorer outcomes even than doing nothing. That doesn't blame transference theory itself, of course, but it doesn't look good.
Still, transference theory could be therapeutically *valid* (i.e., “work”) if the person improves due to its use, even if we can never say that transference of stored-up childhood emotions is really what's going on. Even if the idea of transference helps calm someone emotionally, that does not say that it's an accurate description of what's going on. Let me illustrate.
Consider Kleinian transference, which prominently involves The Breast. The hungry child sees himself as filled with badness and his mother's breast as filled with goodness. In suckling, the goodness in The Breast goes into the child and things are great for a while, until he's hungry again and then both resents and demands the goodness in The Breast. The child both hates and loves, rejects and needs The Breast, setting up a conflict played out in transference all the rest of his life.
Nice story, eh? Powerfully explanatory.
Consider a financially strapped guy who needs to ask his boss for raise. The guy feels he is highly deserving and should've gotten the raise from his rich, lazy boss long ago without asking. In a Kleinian interpretation, he sees himself as filled with weakness and passivity and insecurity and dependence — in short, with badness, just like when he was a hungry baby. He both hates and needs his boss, who can give him the goodness (money, promotion, etc) he both resents and loves.
He's emotionally all tied up in knots over this situation. He's too upset and afraid to approach his boss, yet he must in order to live. His Kleinian therapist explains the transference issues involving The Breast and voilà! The guy can approach his boss with a reasonable assertive request for a raise. Why? Because he no longer sees the boss as a threatening, all-powerful figure. He knows that the boss is really The Breast, and, heck, he's managed that type of situation since he was a baby.
Transferential awareness, the working-through, and cure.
Is Kleinian transference really going on? I really, really doubt it, despite the apparent therapeutic success. The pattern of behavior alleged here seems too specific to me, when we know that learning and mental connections are enormously complex and cross-referenced. This transference doesn't “look like” the behavioral changes we see in developmental biology, where early-stage responses drop off quite cleanly and naturally as mature adaptations appear.
But anyway I doubt that this sort of transference story-inspired courage will last the employed guy very long. The next insecurity problem he faces may not be so easily mapped onto the story of his infantile conflicts with The Breast.
To the extent that such transference stories *do* help, I think there is something else going on. And I think that the “something else” is what therapy and research should focus on. I think the therapeutic key here is that the guy acknowledges his fears and bad feelings and stops fighting them. His (I think mythical) explanation of transference allows him to relegate those feelings to a sort of sideline where he tolerates feeling them because he thinks they're not really related to any current *real* threats. They're left over from childhood. He can't do anything about them, so he feels them but ignores them and goes and asks his boss for a raise. I think THAT'S the therapy and that's what we should deal with more deliberately & directly.
Posted by zazenduck on April 10, 2006, at 14:36:53
In reply to Testing transference, posted by pseudoname on April 10, 2006, at 12:56:19
Thanks. That was really well thought out.
Posted by pseudoname on April 10, 2006, at 19:34:57
In reply to Re: Testing transference » pseudoname, posted by zazenduck on April 10, 2006, at 14:36:53
Posted by Dinah on April 10, 2006, at 20:19:05
In reply to that brand of therapy ;-) » special_k, posted by pseudoname on April 8, 2006, at 14:47:18
I rather think that transference isn't a useless or baseless theory.
If you look at Babble, you can see it in action every day. Dr. Bob is the same person, yet different people see him so wildly differently. He's a rather distant figure, so we don't have a lot of information to do reality checks on, and we tend to shove him into whatever template we have for people who exhibit the bits of information we know about him. And for many of us, those same templates might contain a lot of other people we meet in our life. And we might have other templates we shove other people into. And we might react to them with all the stored up perceptions we have to anyone stuffed in the same template. Perceptions that probably aren't all that accurate. If we can see past our own transference templates and into the real world, wouldn't that be helpful?
I don't think a therapist could do that by concentrating only on transference in the therapeutic relationship, but if they bring up distortions of reality in our views of various people, or if we learn to start considering that ourselves...
I'm not entirely convinced that therapy love is transference though. I tend to think it's the unintended consequence of the setup of therapy. The artificial intimacy of the therapy room, the undivided attention, all are things that our minds confuse with the situations that we're evolutionarily wired to associate with those conditions. Parent child (particularly mother child) and courtship and mating. It doesn't seem fair to mimic those situations then call the resulting feelings transference.
Posted by Dinah on April 10, 2006, at 20:23:38
In reply to Re: that brand of therapy ;-) » pseudoname, posted by Dinah on April 10, 2006, at 20:19:05
Posted by annierose on April 10, 2006, at 21:48:40
In reply to Re: that brand of therapy ;-) » pseudoname, posted by Dinah on April 10, 2006, at 20:19:05
You made loads of sense, and I thank you for that. It was well said and I feel that way too.
Posted by special_k on April 10, 2006, at 23:23:48
In reply to Re: that brand of therapy ;-) » Dinah, posted by annierose on April 10, 2006, at 21:48:40
interesting... i guess i have my own theory of transference (not sure how that sits with the standard lit lol).
imo...
- transference feelings can be qualitatively indistinguishable from non-transference feelings (which is just to say that they *can* be phenomenologically identical to non-transference feelings from the subjects point of view).
- transference feelings are differentiated from non-transference feelings by their aetiology. an analogy... someone presents with a burn. the burn is very real. you can see it. you can't tell whether it is a sunburn or not until you know more about what caused the burn. it is part of the identity condition for something being a sunburn that it was caused by the sun. analogously it is part of the identity condition for transference feelings that they are caused by the past rather than the present.
- an indicator of whether feelings are due to transference (as opposed to not being due to transference) is their intensity. if feelings are experienced as being particularly intense then that probably indicates that the feelings are a response to more than the present situation. or that the present situation has become a symbol for some greater situation.
i guess i was thinking of transference feelings as feelings originating in the past... but perhaps not... the 'greater context' line is probably important too. thinking here along the lines of what dinah was saying...
hrm.
i personally think a criterion of adequacy on a theory is that it should be consistent with the findings of evolutionary cognitive neuro psychology. because IMHO those fields are the fields in which our understanding is being advanced at a rapid rate of knotts. but that is just to say... if you want to be scientific (ie if it is truth rather than pragmatic value that interests you) then IMHO that is the way to go.
regarding pragmatism... i think the truth as traditionally conceived (ie of a relation to reality) is likely to pragmatically outperform theorists fictions in the long run. and theorists fictions tend to put an end to inquirey rather than advancing it...
i had significant issues with being told about 'rational mind' 'emotional mind' 'wise mind' in skills group because i thought those were fairly comperable examples of theorists fictions that prevent real understanding. i guess it might be a useful fiction for some. but i'm rather attached to the truth myself... my t was pretty good at differentating between fiction / metaphor and the rest so that was good for me. i remember one of my lecturers saying that he had trouble with meditation because they asked him to imagine that when he inhaled the air was reaching into his toes and he became disturbed at the view of anatomy that was presupposed... i guess there must be a middle way...
;-)
Posted by special_k on April 11, 2006, at 0:41:18
In reply to Re: that brand of therapy ;-), posted by special_k on April 10, 2006, at 23:23:48
> - transference feelings are differentiated from non-transference feelings by their aetiology. an analogy... someone presents with a burn. the burn is very real. you can see it. you can't tell whether it is a sunburn or not until you know more about what caused the burn. it is part of the identity condition for something being a sunburn that it was caused by the sun. analogously it is part of the identity condition for transference feelings that they are caused by the past rather than the present.
though of course that is a matter of degree (and so there wouldn't be a hard and fast line). i think it is about categorisation... and we are always classifying instances in the present according to categories we have had past experience with. and we are going around doing the symbol thing too with respect to interpreting the significance of things. so once again... a matter of degree.
> - an indicator of whether feelings are due to transference (as opposed to not being due to transference) is their intensity.though you can be mighty pissed for good reason either way.
i'm not so sure anymore...
i think that either 'transference' will be cashed out properly...
or the term will be replaced (eliminated) as the sciences progress.
i've often wondered whether psychoanalysis was entitled to invoke terms such as 'transference' etc because the explanadum was different (unique) from the rest of the sciences... but i'm not so sure... i'm not so sure... i was looking at whether i might be able to do analytic philosophy with psychoanalysis. and... i couldn't for the life of me see how that would go. it would involve translation... translating the psychoanalytic concepts into phenomena that have been observed / studied / or at least pheonomena that are observable / recordable within the cognitive neuro psychological framework... although... probably some relevant stuff in social psych too (though i don't know anything about that really)...one option (IMO by far the best option) is to consider that psychoanalysis doesn't aim to be a science... rather it is an art. the continental philosophers seem to be happy enough with it (and with doing continental philosophy on freud etc). but i can't see how do do it within my philosophical tradition where IMO philosophy is on a continuum with the natural sciences and ideally philosophy is just about the 'theory' level of developing theories that unite observed phenomena and predict what would seem to be suprising new phenomena (surprising phenomena in the sense that you wouldn't expect it without the theory).
but i dunno...
Posted by special_k on April 11, 2006, at 5:09:33
In reply to Re: that brand of therapy ;-), posted by special_k on April 11, 2006, at 0:41:18
i guess that the trouble is that CBT theorists often make a big deal of how they come up better than alternative theories for treating the main problems that people present with (anxiety, depression, and OCD i believe). they say that they are thus the *most scientific* variety of therapy available (the implication being that it is not ethically justifyable to offer less than the *most scientific* variety of therapy).
But... I have significant issues with CBT.
I have significant issues with their measures of 'improvement'. I have significant issues with the *brief* psychotherapy line that they advocate. I have significant issues with their eclecticism which means they practice from a theory that isn't even coherant (IMHO).
Sigh.
I have significant issues with the point that the CBT therapists are the ones who are running the experiments (they have managed to get the experimental psychologists on board) and so OF COURSE they are looking to justify their theory (in confirmation bias) rather than looking to do themselves out of a job!
(Okay so that is an ad homenim attack but sometimes they are justified. I think it is justified in this case as it is justified in the case of being sceptical of the findings that the drug companies report re the success of their newly developed medication)
Science is the best we have got...
But then when you consider the actual practice of science...
When you consider the ways in which statistics can be manipulated...
When you consider how *statistically significant* thresholds are arbitrary...
One is wise to remain sceptical.But I have significant issues with CBT... And so where does that leave me?
Maybe it is about... Training. And re: psychoanalysis... If you consider the majority have PhD's / are trained psychiatrists BEFORE undergoing how many years of training in psychoanalysis AND a course of analysis themselves...
Well that makes them the best trained.
Of course it might be a bit like a cult...
(And from a lot of accounts that is exactly what it is like)
But still... That is a significant amount of time to devote to studying something... And so you would expect that the average analyst... Would be *more interesting* to interact with at the very least.lol.
Posted by Dinah on April 11, 2006, at 7:44:17
In reply to Re: that brand of therapy ;-), posted by special_k on April 11, 2006, at 5:09:33
I think the problem with CBT is (well, ok it's not a problem really) is that some or all of it can be useful for almost everyone. So it comes out looking good in studies.
But apparently practitioners aren't always well trained on the exceptions.
Which probably could be said for all schools of therapy.
Besides, didn't they do studies (I remember seeing this on Dr. Bob's old grand rounds presentations) that showed that CBT was more effective for some personality structures than others?
For example, it's very effective for OCPD, which you might expect.
And although I don't recall this specifically, I'm guessing that it could be less helpful for people with borderline traits, which is why they invented DBT. The problem with DBT being that if you don't get someone of Marsha Linehan's skills, it can sometimes not come across as it was intended.
(Although to tell you the truth, I remember watching her videos, and being both charmed and realizing that I'd walk out on her early.)
Having a few borderline traits myself, I think it tends to make me worse. I tend to rebel and get angry and argue the CBT therapist into getting mad at me. (Yes, this has happened.) While my husband would think it was the therapy of therapies.
Posted by special_k on April 11, 2006, at 8:37:00
In reply to Re: that brand of therapy ;-) » special_k, posted by Dinah on April 11, 2006, at 7:44:17
> I think the problem with CBT is (well, ok it's not a problem really) is that some or all of it can be useful for almost everyone. So it comes out looking good in studies.
comes out good when compared to other *brief* forms of psychotherapy. i think they are talking 6-12 sessions... gg probably knows this stuff more than me... or someone else probably does... pseudoname? it only *just* outperforms brief psychodynamic. but it is considered to be statistically significant (which is an arbitrary threshold though to be fair i think it was arbitrarily decided on independent grounds)
;-)
i often wonder what science would look like had we set our arbitrary thresholds a bit differently... i wonder how different the 'facts' would look...
> But apparently practitioners aren't always well trained on the exceptions.think it comes out best (just) for depression, anxiety, and OCD (which are the most prevalent problems in psychotherapy). but sometimes the theory is silent on how to treat other disorders (they didn't know what to do with DID for instance. or dissociation more generally one can only suppose. i remember racer had problems trying to find someone to treat her dx. and so it goes on...)
> Which probably could be said for all schools of therapy.maybe... maybe they have slightly different target groups... maybe...
> Besides, didn't they do studies (I remember seeing this on Dr. Bob's old grand rounds presentations) that showed that CBT was more effective for some personality structures than others?really?
> For example, it's very effective for OCPD, which you might expect.oh. yeah, i guess. maybe because if you think of depression as a mood where people are likely to experience sadness (and therapy is about improving the feelings of sadness etc) then if you think of OCPD as a mood where people are likely to experience symptoms of OCD... i dunno. maybe i'm looking at them all wrong... but i guess... they are looking (typically) at behaviour change as the measure of improvement too... in the 'i sawed the legs off my bed and now i no longer lay awake fearing the monsters under the bed' kind of fashion... but then if your problem really is that not sleeping is majorly interfearing... well... isn't that a cure in a way?
> And although I don't recall this specifically, I'm guessing that it could be less helpful for people with borderline traits, which is why they invented DBT.heh heh. CBT theorists typically want to claim DBT as a 'varient' on CBT. but it is true it needed to be extended from 'brief' therapy (6-12 sessions or whatever) into an intensive program involving group therapy and individual therapy (so therapy 2X per week) + phone calls (or between session support) and so on... and phase one (the stage that has some empirical support for reducing inpatient days and objective measures of improvement such as ability to attend work etc) lasts one year. not so brief. and that is only supposed to be stage one - the stabilisation stage. after that there is supposed to be trauma work etc. apparantly Linehan envisaged it as fairly ongoing... I think after trauma work there is supposed to be a stage of constructing a life worth living etc etc... but in the country I was from only the first phase had empirical support so after the first year they diverted the resources into a new intake (unless peoples therapists got really very attached to them i think...).
:-(
> The problem with DBT being that if you don't get someone of Marsha Linehan's skills, it can sometimes not come across as it was intended.
yeah. or if a therapist doesn't quite get some of Linehan's skills...
;-)
> (Although to tell you the truth, I remember watching her videos, and being both charmed and realizing that I'd walk out on her early.)Lol. Haven't seen the video but I've read the book. I imagine her to be fairly stern... I think I'd resist that... But I think she also has a fairly good dynamic thing going on (though this is from the book so I don't know how she goes in real time) but a dynamic of off balancing and supporting etc. But yeah I imagine she might tend to do the off balancing thing... and have to backpeddle a fair bit. especially with clients who are getting used to her... she strikes me as fairly irreverant. heh heh. i'm not sure how i would go... okay i think though i'd probably go through a 'gee i'd really like to punch you in the face' kind of phase... and i'd probably walk out a couple times too (hmm... does her style maybe elicit borderline behaviours too????) i dunno... just how she struck me from the book.
i remember finding my t had a pretty good dynamic going on... i enjoyed it though sometimes i was fairly outraged at stuff she would say to me. but she could smile and backtrack and she could be really very soothing and softly spoken too (when she wanted to be) and so that helped things along considerably. i remember when i started dbt i had developed this unfortunate habit of curling up into a little ball (on my chair) and hiding my head in my knees when i really didn't want to talk about something. i think i used to dissociate if they continued... it was becoming a problem prior to dbt. sometimes they would just leave me there for a couple hours or something... anyways... i started to do that in maybe our second session and she said 'you know it makes it really hard to do therapy with you when you do that'. and i thought hmm. i suppose it does rather. and so i snapped out of it and we talked about something sort of related... but... a simple response... non judgemental... non confrontational... just simple... and there it was. lol. i felt that a lot 'of course how simple now that i see it that way...'.
ah memories ;-)
but ill timed irreverance... can be rather hard to take...
> Having a few borderline traits myself, I think it tends to make me worse. I tend to rebel and get angry and argue the CBT therapist into getting mad at me. (Yes, this has happened.) While my husband would think it was the therapy of therapies.
yes. i don't like hearing about my faulty logic or my cognitive distortions or about how if i would only change my thinking i could think myself into feeling different. i don't like the emphasis on thoughts -> feelings and i don't like them telling me i endorse these faulty thoughts either consciously or *unconsciously* if i deny it. i don't like how they say that those unconscious thoughts affect my behaviour when IMHO my degree of credance with which i endorse the cog distortions varies as a function of my mood rather than the other way around... i don't like it. i don't like it i say ;-) but apparantly it is because it isn't very validating of emotional responses
wah!!!!! validate me!!!!
:-)
something i did have trouble with in therapy... this isn't really related... but i remember the thing that caused us the most grief... was my lack of ability to think concretely.really.
we would talk about something abstractly and that would be okay. as soon as it came to fitting me into that picture... my mind would black out. really. just be vacant. empty. i couldn't comprehend or speak. felt so very stupid.
i do wonder how i'd do on cog. tests sometimes...
and i do wonder whether it is the ect or whether i've always been like this...
i dunno :-(
Posted by Dinah on April 11, 2006, at 8:54:59
In reply to Re: that brand of therapy ;-) » Dinah, posted by special_k on April 11, 2006, at 8:37:00
> > I think the problem with CBT is (well, ok it's not a problem really) is that some or all of it can be useful for almost everyone. So it comes out looking good in studies.
>
> comes out good when compared to other *brief* forms of psychotherapy. i think they are talking 6-12 sessions... gg probably knows this stuff more than me... or someone else probably does... pseudoname? it only *just* outperforms brief psychodynamic. but it is considered to be statistically significant (which is an arbitrary threshold though to be fair i think it was arbitrarily decided on independent grounds)
>
> ;-)
>
> i often wonder what science would look like had we set our arbitrary thresholds a bit differently... i wonder how different the 'facts' would look...
>
> > But apparently practitioners aren't always well trained on the exceptions.
>
> think it comes out best (just) for depression, anxiety, and OCD (which are the most prevalent problems in psychotherapy). but sometimes the theory is silent on how to treat other disorders (they didn't know what to do with DID for instance. or dissociation more generally one can only suppose. i remember racer had problems trying to find someone to treat her dx. and so it goes on...)
>
> > Which probably could be said for all schools of therapy.
>
> maybe... maybe they have slightly different target groups... maybe...***** Right. I would think that they have less success with some personality disorder traits. Leading insensitive therapists to write off personality disorders, when really they might just need something different.
> > Besides, didn't they do studies (I remember seeing this on Dr. Bob's old grand rounds presentations) that showed that CBT was more effective for some personality structures than others?
>
> really?***** Yeah. I know he no longer makes new ones, but I don't know if the old ones are still available.
>
> > For example, it's very effective for OCPD, which you might expect.
>
> oh. yeah, i guess. maybe because if you think of depression as a mood where people are likely to experience sadness (and therapy is about improving the feelings of sadness etc) then if you think of OCPD as a mood where people are likely to experience symptoms of OCD... i dunno. maybe i'm looking at them all wrong... but i guess... they are looking (typically) at behaviour change as the measure of improvement too... in the 'i sawed the legs off my bed and now i no longer lay awake fearing the monsters under the bed' kind of fashion... but then if your problem really is that not sleeping is majorly interfearing... well... isn't that a cure in a way?**** Not OCD, OCPD, obsessive compulsive personality disorder. They like rules and order, and they love something that they can use to order their unruly emotions. Plus, they'll make sure to scrupulously do their homework. No offense to OCPD types. My husband self diagnosed himself and is darn proud of it, and for good reason. He's a great employee and a responsible husband. I love the OCPD types of the world. I just feel sorry for the pain caused by their feeling that they need to take on the responsibilities of the world.
> > And although I don't recall this specifically, I'm guessing that it could be less helpful for people with borderline traits, which is why they invented DBT.
>
> heh heh. CBT theorists typically want to claim DBT as a 'varient' on CBT. but it is true it needed to be extended from 'brief' therapy (6-12 sessions or whatever) into an intensive program involving group therapy and individual therapy (so therapy 2X per week) + phone calls (or between session support) and so on... and phase one (the stage that has some empirical support for reducing inpatient days and objective measures of improvement such as ability to attend work etc) lasts one year. not so brief. and that is only supposed to be stage one - the stabilisation stage. after that there is supposed to be trauma work etc. apparantly Linehan envisaged it as fairly ongoing... I think after trauma work there is supposed to be a stage of constructing a life worth living etc etc... but in the country I was from only the first phase had empirical support so after the first year they diverted the resources into a new intake (unless peoples therapists got really very attached to them i think...).
>
> :-(
>
> > The problem with DBT being that if you don't get someone of Marsha Linehan's skills, it can sometimes not come across as it was intended.
>
> yeah. or if a therapist doesn't quite get some of Linehan's skills...
> ;-)
>
> > (Although to tell you the truth, I remember watching her videos, and being both charmed and realizing that I'd walk out on her early.)
>
> Lol. Haven't seen the video but I've read the book. I imagine her to be fairly stern... I think I'd resist that... But I think she also has a fairly good dynamic thing going on (though this is from the book so I don't know how she goes in real time) but a dynamic of off balancing and supporting etc. But yeah I imagine she might tend to do the off balancing thing... and have to backpeddle a fair bit. especially with clients who are getting used to her... she strikes me as fairly irreverant. heh heh. i'm not sure how i would go... okay i think though i'd probably go through a 'gee i'd really like to punch you in the face' kind of phase... and i'd probably walk out a couple times too (hmm... does her style maybe elicit borderline behaviours too????) i dunno... just how she struck me from the book.***** They were expensive. I sold a lot of belongings on eBay thinking that surely I'd be cured if I just studied them (grin), but I watched them once and put them away. I wish I could mail the videos to people. Although I'm not sure where they're compatible, and I don't want to break copyright laws, and I'd be worried that people would forget to return them.
>
> i remember finding my t had a pretty good dynamic going on... i enjoyed it though sometimes i was fairly outraged at stuff she would say to me. but she could smile and backtrack and she could be really very soothing and softly spoken too (when she wanted to be) and so that helped things along considerably. i remember when i started dbt i had developed this unfortunate habit of curling up into a little ball (on my chair) and hiding my head in my knees when i really didn't want to talk about something. i think i used to dissociate if they continued... it was becoming a problem prior to dbt. sometimes they would just leave me there for a couple hours or something... anyways... i started to do that in maybe our second session and she said 'you know it makes it really hard to do therapy with you when you do that'. and i thought hmm. i suppose it does rather. and so i snapped out of it and we talked about something sort of related... but... a simple response... non judgemental... non confrontational... just simple... and there it was. lol. i felt that a lot 'of course how simple now that i see it that way...'.
>
> ah memories ;-)
>
> but ill timed irreverance... can be rather hard to take...
>
> > Having a few borderline traits myself, I think it tends to make me worse. I tend to rebel and get angry and argue the CBT therapist into getting mad at me. (Yes, this has happened.) While my husband would think it was the therapy of therapies.
>
> yes. i don't like hearing about my faulty logic or my cognitive distortions or about how if i would only change my thinking i could think myself into feeling different. i don't like the emphasis on thoughts -> feelings and i don't like them telling me i endorse these faulty thoughts either consciously or *unconsciously* if i deny it. i don't like how they say that those unconscious thoughts affect my behaviour when IMHO my degree of credance with which i endorse the cog distortions varies as a function of my mood rather than the other way around... i don't like it. i don't like it i say ;-) but apparantly it is because it isn't very validating of emotional responses
>
> wah!!!!! validate me!!!!
>
> :-)**** Biofeedback guy really hated me. So much so that I asked him if he felt his feelings for me would interfere with the therapy. Which made him hate me more. I think that was our last session. While if I try to argue with my therapist, he just smiles and admits that I may be correct. And I fall flat on my face because there's nothing pushing back.
>
>
> something i did have trouble with in therapy... this isn't really related... but i remember the thing that caused us the most grief... was my lack of ability to think concretely.
>
> really.
>
> we would talk about something abstractly and that would be okay. as soon as it came to fitting me into that picture... my mind would black out. really. just be vacant. empty. i couldn't comprehend or speak. felt so very stupid.
>
> i do wonder how i'd do on cog. tests sometimes...
> and i do wonder whether it is the ect or whether i've always been like this...
> i dunno :-(
>**** While I'm perhaps overly literal. That causes me trouble in CBT sometimes. Because if you literarlly pick apart what they say, they get mad.
***** But I really hate the "choice" thing that underlies all of it. Everything's a choice. Bah.
Posted by Dinah on April 11, 2006, at 8:56:40
In reply to Re: that brand of therapy ;-) » Dinah, posted by annierose on April 10, 2006, at 21:48:40
Thanks annierose. I think moderately well first thing some mornings, but by evening I'm invariably cognitively a mess.
Posted by zazenduck on April 11, 2006, at 9:15:25
In reply to Re: that brand of therapy ;-), posted by special_k on April 11, 2006, at 5:09:33
>
> Maybe it is about... Training. And re: psychoanalysis... If you consider the majority have PhD's / are trained psychiatrists BEFORE undergoing how many years of training in psychoanalysis AND a course of analysis themselves...
>
> Well that makes them the best trained.
>
> Of course it might be a bit like a cult...
> (And from a lot of accounts that is exactly what it is like)
> But still... That is a significant amount of time to devote to studying something... And so you would expect that the average analyst... Would be *more interesting* to interact with at the very least.
>
> lol.:) :) that's just what I used to say! plus poetry they always quote poetry. I always thought they never really wanted to be mds in the first place. their undergrad degrees were always liberal arts no bio or chemistry boys at all! I think tho the standards for getting into training institutes are falling as there is a smaller pool of applicants
Posted by pseudoname on April 11, 2006, at 12:29:48
In reply to Re: that brand of therapy ;-) » pseudoname, posted by Dinah on April 10, 2006, at 20:19:05
Hey, Dinah. I'm glad you came back from your “pause”. :-)
> I have a feeling i made no sense. (nm)
I think you gave a good account of why most people on the psych board like the idea of transference.
> I rather think that transference isn't a useless or baseless theory.
I wish now I hadn't put it so harshly. I forgot that I was posting on a public board, not having a tete-a-tete. I should've been more respectful of others' investment in very serious therapy issues, and I apologize to anyone offended. I'm grateful anybody wants to talk about these things with me, and I don't want to come off as a troll.
I like my last post better (“Testing transference”).
> you can see it in action every day
> Dr. Bob is the same person, yet different people see him so wildly differently.Actually, I can't see it. I see different people having starkly different responses, but I do NOT know what causes those differences. On the basis of published research and some speculation, I assume that many things are involved…
•other current social resources,
•current sex/romance relationships
•myriad other current cortisol-releasing stresses,
•other current endorphin- & testosterone-releasing successes,
•recently acquired habits of response *to* emotions,
•social skills & habits acquired with peers in the teen years,
•religious & political beliefs,
•individual tolerance levels for emotional distress from any cause,
•current social pressures about behavior (manners, etc)
•assumptions and mistaken information,
•permanent minor differences in brain structure,
•brain chemistry changes (from meds, etc),as well as
•consistent long-term features of childhood relationships with caregivers and others.
In all that mess, virtually none of which is actually scientifically traceable as an individual lives in real life, I don't know how someone can assert that a given difference is due to transference and not to five or six of the other influences.
Even (mostly) pre-transferential babies start out having wildly different attitudes and interests.
The fact that a response is troublesome or uncommon or disproportionally intense is not evidence that it's transference instead of some other combination of influences.
I think the allure of transference theory is that it gives a compelling, reassuring explanation for our scary, unpredictable, uncontrollable emotions.
I read "Bangkok 8", a detective novel set in Thailand. The characters kept referring to previous lives to explain their own and others' odd, intense emotional reactions. It's an exact parallel with transference. There is *real* (perfectly authentic) therapeutic benefit of believing in past lives, but no scientific basis for that belief, and (I think) the therapeutic effect can be obtained more directly with an approach deliberately targeting it.
That benefit, I think, is accepting troublesome emotions with a shrug, diminishing their importance, ignoring them, and doing what you want to do despite their occurrence. But I think that transference theory, besides being (oh here I go again) very dubiously “veridical” wastes time and effort that could be spent deliberately zeroing in on its good effect.
By rejecting transference or other psychdynamic ideas, I'm NOT arguing for CBT. It's got some truly helpful techniques but as you say, it's far from a cure-all. I think it's far more limited than Beck & Burns & those folks say.
I keep bringing up the *acceptance* portion of Acceptance and Commitment Therapy, which has some overlap with DBT, but no one seems interested. Probably because it looks like stiff-upper-lip on first glance. But I think the benefit of mindful acceptance of uncontrollable, unexplainable emotions is EXACTLY the real therapeutic benefit than *can* come from transference therapy, but deliberately targeted, not hit-or-miss, and without the (IMO) pseudoscience, obsession with childhood, and other unproductive baggage of psychoanalytic theory.
Thanks for hearing me out.
Posted by pseudoname on April 11, 2006, at 14:10:30
In reply to Re: that brand of therapy ;-) » pseudoname, posted by special_k on April 9, 2006, at 4:46:23
I appreciated your concern for me.
You've said a lot in this thread I've not addressed directly. There's so much going on here. I want you to now I am reading it all anyway. ;-)
> I have been struggling a little with different theorietical orientations myself. Sometimes I think I'd like to do analysis... Othertimes I think the whole thing is a crock.
You do seem ambivalent about the ideas. Ambivalence itself is a psychoanalytic theme. ;-)
I too have been *struggling* with theories of therapy. I found a very real allure in psychoanalytic ideas. It didn't make any difference to me at the time that there was an utter lack of any evidential basis for believing them. I knew that. But I saw it as an act of faith, and I expected to be liberated from my bad feelings somehow through examining things like my transference.
I knew that studies show people get worse in analysis than if they do nothing.
I knew that transference had a horoscope-like ability to stretch to cover ANY situation. Love your teacher? Transference! Hate your teacher? Transference! Indifferent toward your teacher? Transference! Keep switching between loving & hating your teacher? Transference!
But it was so reassuring to think that the problems I had would eventually be understable in terms of things I already have access to, namely my own feelings and history. Things I'm intimately familiar with and that are really important to me and that have been dismissed by other people all too often – namely my feelings & fears & ideas & so on.
You said having the CBT person point out your irrational errors or whatever was not “validating.” (I agree!) But the idea of transference is extremely validating. It says, among other things, that your personal history is important, your feelings are important, and you are feeling right now exactly what you should be feeling, given your history.
I think that is a kind of relief.
But I think that the exact same sense of validation can be obtained without resorting to the assumption of transference. Consider:
“We do not know what is causing your emotional reaction because there are too many complex influences and we have no way of sorting it all out. However, we know that your feelings are important and that this feeling is exactly what you should be feeling in this situation.”
That seems more honest to me than invoking transference.
It is a part of Acceptance and Commitment Therapy, which endorses the idea that you are feeling exactly what you should be feeling, given your history — and physiology and current situation and 100 other influences.
I don't want to sound like a shill for ACT. I have serious problems with it or at least with its founder and the zeitgeist of its core adherents. But the *mindful acceptance* component solves for me a lot problems about therapy.
The ACT people would probably have no problems with an transference claim as long as it were used to let go of the struggle over the unwelcome emotion. As in…
“I'm in love with Dr Bob because he reminds me of my father only better.”
ACT might say, Whatever, as long as you see you have no control over this emotion and allow it to occur. Maybe call it love-prime, and realize that even while you're feeling it, other emotions can also occur, like “real” love for someone else, or real boredom, and it's all beyond conscious control and it it's all a part of being uniquely you.
That's validating, AND it doesn't make untestable assuptions or prematurely narrow the discussion or cut off inquiry into possible causes and influences.
I'll post this, but I dunno if it makes sense. :)
Posted by Dinah on April 11, 2006, at 15:41:40
In reply to alternatives to transference » Dinah, posted by pseudoname on April 11, 2006, at 12:29:48
Well, I'm not going to try to convince you or anything. We can just agree to differ on the topic.
I've found it helpful, and it makes sense to me.
If you don't find it helpful, or it doesn't make sense to you, that's cool.
Posted by Dinah on April 11, 2006, at 16:22:45
In reply to Re: alternatives to transference » pseudoname, posted by Dinah on April 11, 2006, at 15:41:40
I'm sorry if that seemed a bit curt. I didn't mean it to be.
It's just a bit of self talk that I've found useful.
Posted by pseudoname on April 11, 2006, at 16:47:57
In reply to Re: alternatives to transference, posted by Dinah on April 11, 2006, at 16:22:45
> I'm sorry if that seemed a bit curt.
You are kind. Any curtness in the original was more than made up for by this extra post.
> Well, I'm not going to try to convince you or anything.
I wouldn't mind. *I'm* trying to convince people. ;-) But I need to make sure my technique is as respectful as yours. Thanks.
Posted by pseudoname on April 11, 2006, at 16:53:20
In reply to Re: alternatives to transference » Dinah, posted by pseudoname on April 11, 2006, at 16:47:57
> *I'm* trying to convince people. ;-)
Not really “convince.” Just ... trying to show other possibilities. A few other things to think about.
Posted by special_k on April 11, 2006, at 18:57:51
In reply to not really “convince” people, posted by pseudoname on April 11, 2006, at 16:53:20
I don't have much time...
(have to go do some work or i'll be beating myself up today)but i think...
i'm coming to see what you are talking about.
yup.
thank you.(((((((pseudoname)))))))
write more later.
thank you.PS thats a good response... i always say 'i'm not trying to convince you that i'm right' (although of course i am because everybody thinks their beliefs are true and when beliefs conflict someone must be wrong and nobody thinks their beleifs are false or they wouldn't believe them... although sometimes people can be rationally motivated to retain contradiction AK! i'm going now)
:-)
Posted by special_k on April 12, 2006, at 23:26:44
In reply to alternatives to transference » Dinah, posted by pseudoname on April 11, 2006, at 12:29:48
> Actually, I can't see it. I see different people having starkly different responses, but I do NOT know what causes those differences. On the basis of published research and some speculation, I assume that many things are involved…
> •other current social resources,
> •current sex/romance relationships
> •myriad other current cortisol-releasing stresses,
> •other current endorphin- & testosterone-releasing successes,
> •recently acquired habits of response *to* emotions,
> •social skills & habits acquired with peers in the teen years,
> •religious & political beliefs,
> •individual tolerance levels for emotional distress from any cause,
> •current social pressures about behavior (manners, etc)
> •assumptions and mistaken information,
> •permanent minor differences in brain structure,
> •brain chemistry changes (from meds, etc),
>
> as well as
>
> •consistent long-term features of childhood relationships with caregivers and others.
>
> In all that mess, virtually none of which is actually scientifically traceable as an individual lives in real life, I don't know how someone can assert that a given difference is due to transference and not to five or six of the other influences.yeah. i hear what you are saying. so you think that 'transference' will eventually be eliminated as people come to a greater understanding of these other factors. as the science of behaviour progresses... we will explain behaviour by recourse to some of those factors instead of the catch all 'transference'. i guess... i agree...
> The fact that a response is troublesome or uncommon or disproportionally intense is not evidence that it's transference instead of some other combination of influences.
yeah.
> I think the allure of transference theory is that it gives a compelling, reassuring explanation for our scary, unpredictable, uncontrollable emotions.yeah... though... pseudoexplanation...
Kaplan and Saddock "synopsis of psychiatry" say:'Transference is the patient's displacement onto the analyst of early wishes and feelings towards persons from the past. Some resistences may emerge because patients experience the psychiatrist as a parental figure from the past, and they seek to defy the perceived parental control. A contemporary view of transference would acknowledge that the analyst or physician's real characteristics always influence the transference. In other words, one could describe transference as an admixture of figures from the patient's past and the *real relationship* with the clinician in the present'.
hmm... that is very different from what i was thinking... or maybe related... but still quite a bit different. i thought transference was a defence... but no it doesn't seem to be...
> I read "Bangkok 8", a detective novel set in Thailand. The characters kept referring to previous lives to explain their own and others' odd, intense emotional reactions. It's an exact parallel with transference. There is *real* (perfectly authentic) therapeutic benefit of believing in past lives, but no scientific basis for that belief, and (I think) the therapeutic effect can be obtained more directly with an approach deliberately targeting it.
yeah, okay.
> That benefit, I think, is accepting troublesome emotions with a shrug, diminishing their importance, ignoring them, and doing what you want to do despite their occurrence. But I think that transference theory, besides being (oh here I go again) very dubiously “veridical” wastes time and effort that could be spent deliberately zeroing in on its good effect.okay. but... couldn't transference still happen (authority issues etc).???
> I keep bringing up the *acceptance* portion of Acceptance and Commitment Therapy, which has some overlap with DBT, but no one seems interested.ahem. i think i've shown an interest ;-) i'm interested because of Linehan and her focus on acceptance. she wrote something with hayes (the ACT guy) and i started reading it online but didn't get the whole thing (what i read was very interesting indeed... about the third wave... behaviourism... cognitive behaviour therapy... then the third wave of balancing acceptance with cognitive behavioural change)
> You do seem ambivalent about the ideas. Ambivalence itself is a psychoanalytic theme. ;-)
yeah. i should look up 'ambivalence' lol.
> I too have been *struggling* with theories of therapy. I found a very real allure in psychoanalytic ideas. It didn't make any difference to me at the time that there was an utter lack of any evidential basis for believing them.
yeah... hurting people etc etc... and lack of alternatives.. sigh. i still don't know...
> But it was so reassuring to think that the problems I had would eventually be understable in terms of things I already have access to, namely my own feelings and history. Things I'm intimately familiar with and that are really important to me and that have been dismissed by other people all too often – namely my feelings & fears & ideas & so on.
yeah. maybe that is the appeal really.
> But I think that the exact same sense of validation can be obtained without resorting to the assumption of transference.
yeah.
“We do not know what is causing your emotional reaction because there are too many complex influences and we have no way of sorting it all out....
aw. but that's no good... not only do we like validation... we like some kind of approximation of an answer too...
> I don't want to sound like a shill for ACT. I have serious problems with it or at least with its founder and the zeitgeist of its core adherents. But the *mindful acceptance* component solves for me a lot problems about therapy.
yeah. i understand.
Posted by pseudoname on April 13, 2006, at 19:39:28
In reply to Re: alternatives to transference » pseudoname, posted by special_k on April 12, 2006, at 23:26:44
[This was a lot longer, but I'm trying to focus. LOL]
> > I keep bringing up the *acceptance* portion of Acceptance and Commitment Therapy, which has some overlap with DBT, but no one seems interested.
>
> ahem. i think i've shown an interest ;-);-) Yes, you have. And I knew that. (I'm sending you a Babblemail about it.)
A nice guy named Pedrito in the UK was interested, too. He even told someone else a month or two later, “I'm just concentrating on ACT right now...” I wonder if he found it useful. I don't think he's posted since.
> so you think that 'transference' will eventually be eliminated as people come to a greater understanding of these other factors. as the science of behaviour progresses...
As far as “transference being eliminated”, I think as far as academic psychology is concermed, that's already happened. Freudian ideas are entirely absent from modern psychological research. But I doubt that transference will ever disappear from those clinical programs that currently teach it. Why would they get rid of it? Any possible reason (research failure, e.g.) has already happened, and it's still taught.
> but... couldn't transference still happen (authority issues etc).???
It could. But you could never know that that's what was going on. Maybe the patient would have authority issues no matter what had happened in her childhood. The Saddocks' definition of transference you cite could be going on, but they don't tell me how I could find that out.
I guess my main trouble with it, and why I'm speaking against it so persistently, is that as soon as transference is considered in a therapy, it takes over! It can be applied to any situation; there's really no way to disprove it; and other ideas are shut out. If I start with a theory that expects to find transference, then I WILL find it, guaranteed. Since it's an emotionally evocative, creatively appealing idea, and probably does feel quite validating, it's also very hard to get rid of or even hypothetically set aside in order to consider other possibilities.
Hmm. I never realized ’til just now that that's why I find transference so pernicious. It's like flypaper.
Why transference can't be eliminated:
Analysis attracts bright, “deep” people: quite verbally intelligent, emotionally and interpersonally aware, sensitive (in the best sense of the term), and literate, and who are able to focus tremendously on introspection (which is not as easy as snide detractors suggest). As you say, psychoanalysis is more like art, and I think that its narrative, creative, aesthetic sides are really appealing to the right people.
But when it succeeds, I would suggest that it's the analysands themselves, with their creativity & sensitivity, that are much more responsible, perhaps inadvertently or without being aware of it, for the therapeutic gains they experience than are the Freudian ideas they're trying to apply. I think their abilities & sensitivites could be put to better use if the Freudian ideas were set aside and the actual therapeutic variables were targeted more directly.
(And I've said already what I think those are.)
But as long as these really bright people are having emotionally rewarding experiences on the couch, there will be clinical schools teaching psychodynamic techniques, and the theory of transference will never be eliminated.
> i can't see how to do it [psychoanalysis] within my philosophical tradition where IMO philosophy is on a continuum with the natural sciences […]
Yeah; that's me as well. The one thing I did get out of my years of analysis is greater emotional self-awareness. (People who think I'm a stone cold annoyance are probably shocked.) ;-P
I started getting unexpectedly strong reactions to artwork while I was in analysis, and I feel a lot more warmth & connection with children now.But I think that sort of emotional encouragement can also be targeted more directly and safely and without all the pseudoscience, religiosity, and other baggage of psychoanalysis.
Posted by Dinah on April 15, 2006, at 16:59:39
In reply to transference not eliminated » special_k, posted by pseudoname on April 13, 2006, at 19:39:28
I've been thinking about it, and I think it's a lot a matter of definition of "transference". I define it rather more loosely than you do, I think. More as anything in one's perceptions or reactions beyond what is called for in the reality of the situation or the person. The part that comes from our layering of reality.
I just think it's useful to learn to strip that layering, and see what's really there. Or at least as close to it as possible.
It doesn't need any Freudian concepts beyond the recognition that sometimes we layer reality with our own stuff.
This is the end of the thread.
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