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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by nickguy on July 30, 2007, at 21:22:26
I'm doing some therapy with somebody who is a therapist and trained in jungian analysis. It's mostly talk therapy. We do dream therapy sometimes as well. Just wondering if anybody else does different types of therapy? (btw, i'm some kind of mix of depression/social anxiety/ depersonalization)
Posted by OzLand on July 30, 2007, at 22:35:03
In reply to Anybody else do therapy thats not CBT/cognitive?, posted by nickguy on July 30, 2007, at 21:22:26
Sure; my therapist/pdoc is a psychiatrist trained in psychanalysis, and since he trained in Chicago, I think he is mostly out of the self-psychology tradition. I chided him about this, and though he did not respond except to say he guessed I would figure it out, I am pretty sure as when I was in grad school in Chicago, this is what I was taught in my advanced psychoanalytic class.
I was trained as a postdoc primarily in ego psychology/object relations (ala Kernberg) who used to be director of the hospital where I trained. My husband is an Adlerian, and I have colleagues who trained to be Jungian analysts. If it works for you, go with it. I personally for obvious reasons would not like for someone to do CBT with me. Throughing in a dash of it here and there with the analytic aPproach is okay.
Do you have a concern about this approach? There are others here as well who have analysts for therapists.
OzLand
Posted by Racer on July 31, 2007, at 1:59:15
In reply to Re: Anybody else do therapy thats not CBT/cognitive? » nickguy, posted by OzLand on July 30, 2007, at 22:35:03
Well, my T would probably say she's an eclectic feminist T, but she's mostly psychodynamic. There's a bit of cognitive, a bit behavioral -- although far less behavioral, really -- but it's mostly psychodynamic.
She's also very patient, which is helpful -- she has to deal with me, after all. That's not easy, as my mother is fond of pointing out to me...
Oh, yeah -- guess that's why I'm in therapy, huh?
Posted by LlurpsieNoodle on July 31, 2007, at 6:07:41
In reply to Re: Anybody else do therapy thats not CBT/cognitive? » nickguy, posted by OzLand on July 30, 2007, at 22:35:03
Okay, I'm fairly clear on what DBT and CBT entail. I've been with an "eclectic" T, and now 2 different psychodynamic Ts. one with a bend towards psychoanalytic work.
but what's the difference, practically? What can a client expect in a session? Don't we all just talk and then they say things to help us connect the dots?
I'm intellectually stimulated by using some kind of theory to connect the dots, but ultimately doesn't it come down to ME to make the insights? Or is insight not the name of the game?
And what happens after insight. This is when I typically approach a problem more pragmatically. get out my journal and reproach myself for not having taken better notes on the little CBT stuff that I have picked up.
I got hypnotized once too. That helped end a drought of depression-induced eating.
sorry so dumb. mind is porous. I *bet* I knew this stuff at one point. I picked up a couple of freebie books at the used bookstore a while back. and I have one book relating buddhist practice to psychoanalytic theory that has been useful.
Of course, what's the point? At the moment I can't even read a paragraph of Harry Potter without losing my train of thought between the beginning and end of a sentence.
off to make some oolong. Care to join me?
-ll
Posted by B2chica on July 31, 2007, at 9:03:37
In reply to Anybody else do therapy thats not CBT/cognitive?, posted by nickguy on July 30, 2007, at 21:22:26
my last T was TOTALLY jungian. he/it was perfect fit for what i needed.
my current T, i think, is eclectic, but focuses on what ind. needs are...i benefit more from psychodynamic so i think thats what she's mainly doing.
and for me personally, CBT is probably the farthest from what i need.
Posted by Maria01 on July 31, 2007, at 11:27:39
In reply to Re: Anybody else do therapy thats not CBT/cognitiv, posted by B2chica on July 31, 2007, at 9:03:37
My new T is mostly psychodynamic, and draws from both Jungian and Humanistic perspectives.
I personally have no use for CBT, and am not a fan of it.My aunt is a retired psychologist, who worked from a Jungian/Adlerian framework. I worked for a time as the practice office manager, so I learned a lot about the different approaches =)
Posted by Phillipa on July 31, 2007, at 12:19:07
In reply to Re: Anybody else do therapy thats not CBT/cognitiv, posted by Maria01 on July 31, 2007, at 11:27:39
How come no one seems to like CBT? I thought it was supposed to be the most effective? Love Phillipa
Posted by Maria01 on July 31, 2007, at 13:01:38
In reply to Re: Anybody else do therapy thats not CBT/cognitiv, posted by Phillipa on July 31, 2007, at 12:19:07
CBT is most effective if someone wants to change a behaviour or just do short-term work: i.e. quitting smoking, weight loss, improving sport or work performance, communication, etc. It also focuses on changing thought patterns. Insurance companies love it because it is so short-term. Most CBT practitioners have no interest in the therapeutic relationship, and are not interested in helping the clients achieve any kind of insight. They are strictly interested in the here-and-now. Most CBT practitioners assign readings, checklists, and homework and call it therapy. My aunt used to call it "drive-thru" therapy.
There are lots of articles that state that CBT is effective in treating a lot of issues, but the changes are not long-lasting in most cases. Interesting to note that these studies are almost always sponsored by insurance companies or other parties with vested interest in short-term therapies.It's great for situational stuff, but not so much for achieving long-lasting change/insight.
Posted by B2chica on July 31, 2007, at 13:56:38
In reply to Re: Anybody else do therapy thats not CBT/cognitiv » Phillipa, posted by Maria01 on July 31, 2007, at 13:01:38
i've always thought of it as Therapy 'lite'...but didn't want to say that 1)didn't want to offend anyone and 2)couldn't really explain why i felt that way...thanks maria.
you described it perfectly.
Posted by Maria01 on July 31, 2007, at 14:10:09
In reply to Re: Anybody else do therapy thats not CBT/cognitiv, posted by B2chica on July 31, 2007, at 13:56:38
=) You're welcome...it's the most clear-headed I've been all day =)
Posted by nickguy on July 31, 2007, at 15:20:20
In reply to Re: Anybody else do therapy thats not CBT/cognitiv » B2chica, posted by Maria01 on July 31, 2007, at 14:10:09
I'm glad to hear all that. My "jungian" therapist is great and I like him a lot.
I did CBT twice, and it didn't have much effect. With the whole thought changing thing, anybody else feel like their head is so empty that they don't have thoughts to "change" in the first place?
The behavioral encouragement part of it was somewhat helpful, but you don't need to be trained in a certain therapeutic method to tell somebody whose socially anxious to try to go out sometimes.
Posted by OzLand on July 31, 2007, at 22:38:55
In reply to I feel dumb, what's the difference? » OzLand, posted by LlurpsieNoodle on July 31, 2007, at 6:07:41
Lurpsie
I will respond to you later on this topic if that is okay. Right now I am in a very bad way; see therapist tomorrow; and I am thinking of quiting my job. As you know don't want to explain here. Please understand; having a really bad time. It probably was not good to go off all my meds so fast. I am now feeling so anxious I can hardly breathe, and the depression, well I know that is not from going off the Parnate; it is too soon to be having depression as a result of no meds; it's just me right now. But I promise I will respod to you later. No you are not dumb.
OzLand
Posted by OzLand on July 31, 2007, at 22:41:04
In reply to Re: Anybody else do therapy thats not CBT/cognitiv, posted by Phillipa on July 31, 2007, at 12:19:07
Different strokes for different folks. I would never do well with CBT where as others might do quite well and do poorly with psychoanalysis.
Posted by Phillipa on July 31, 2007, at 22:57:32
In reply to Re: Anybody else do therapy thats not CBT/cognitiv » Phillipa, posted by OzLand on July 31, 2007, at 22:41:04
When I first started seeing a pdoc my docs did the theraphy and that was ideal. Love Phillipa
Posted by LlurpsieNoodle on August 1, 2007, at 10:55:39
In reply to Re: Anybody else do therapy thats not CBT/cognitiv » OzLand, posted by Phillipa on July 31, 2007, at 22:57:32
My T told me about his experiences in psychoanalysis said it was "interesting" but obviously not for him, as he is more psychodynamic. Also has a streak for giving me practical advice. go figure.
Sometimes I find my free associating interupted by this male desire to fix my problems... lol
oz, if you're reading this- you take good care of yourself, and realize that if you need to take sick leave and go to the hospital that they won't automatically give you ECT treatment. Caring about you,
-Ll
Posted by OzLand on August 4, 2007, at 23:24:28
In reply to I feel dumb, what's the difference? » OzLand, posted by LlurpsieNoodle on July 31, 2007, at 6:07:41
So, I said I would write something this weekend. See my memory is getting better. YAAAH. Anyway, I never know what someone means when they say they do psychodynamic therapy. My last pdoc said he did this, and I probably insulted him when I said, "Just what do you mean? What is your theoretical orientation? or do you just do some mish-mash approach, some generic thing?" He never answered me.
First, psychoanalytically informed psychotherapy can be from a number of theoretical perspectives. I not going to bore anyone with the varieties, but for example, in Chicago most people who are do a psychoanalytically informed approach, were trained in self-psychology ala Kohut who was from Chicago. I learned that in my advanced courses in grad school. It is sometimes referred to as an object relations approach which can be confusing as there are a number of object relations approaches as well. When a person goes through psychoanalysis, it might be Freudian analysis or another analysis. I was trained in traditional psychoanalysis first (as are most psychoanalytically trained persons), and then the major approach I learned was object relations ala drive theory plus ego psychology. This is because people at Menningers were trained to work with personality disorders as well as "neuroses" and "psychoses." One of the big name people who developed his theory of object relations ala drive theory was Otto Kernberg who was at Menninger's in the 60's and 70's. He is now at Cornell. The contribution of ego psychology is to consider how strong is one's ego, and part of therapy, then, is to work with the object relations approach (accounting for developmental factors and early childhood relationships and how this impacts on the present) while also working to help the person develop greater ego strength to deal with and manage impulses and anxiety. This probably sounds to stupid as I am just glossing over the surface
Anyway, yes all therapy (or most anyway) is trying to help someone "connect the dots." Some just work on the present and connecting the dots of what goes on in the present, and some give homework assignments (the behavioral component). Do psychoanalytically informed approachs only rely on insight, the aha experience? No, and this is where a lot of mental health professonals show their ignorance when they say that psychoananlytic approaches only go so far - to the insight, and they mean the intellectual understanding.
Insight for psychoanalytically trained people means changes in behavior too, not just the aha experience. If there is not change in behavior, then there is no real insight. It is not an approach for people who want quick fixes, though the approaches from a psychoanalytic perspective can be short term in the sense of doing a piece of the work, and usually the person returns to do another piece of the work when s/he is ready. That's me. I did not finish the work I started at Menninger's. But then it is also true that the work is never done. We all have to continue to work on ourselves to the day we die. To grow means one has to also change.
Homework, well it can be explicit or implicit, and it is usually implicit. If one is motivated to change (and yes there it is accepted there will be resistance), then one will or should take from therapy what one learns and apply it to everyday life. Since I learned of a link to the past, I am now aware of what I am up to when I start to react in certain ways, and I can now change and be different. This approach works very well for me.
In the beginning, though, at Menninger's, I had homework assignments as I hated myself so much. One asignment was to have to write two columns. On one side I was to write all those things that were "bad" about me. That was the easy side. On the other side I had to write what was "good" about me. I was to read three times a day what I wrote about myself that was good. Then I had to add to that side as time went on and continue to read what I wrote each day. I thought it was so stupid and did not really believe what I read as much of what I had put down was what other people had said about me like being intelligent, insightful, caring toward others, etc. I used to think, what a crock, but I have all the results of my psych testing too including how I did on the IQ test in spite of being profoundly depressed and wacked out with paychotic/dissociative episodes. Oh well.
So, homework, yes and no--not like CBT, for example. If someone tried to do CBT with me I would probably smack them. But that's me. I want what has worked for me and helped me develop long terms changes which sometimes I forget when I feel like sh*t. I think because what was--poor ego strengths, and what is now--good ego strengths is why my therapist sees me as able to handle some of his shared insigts. Again, this is not something I was used to. My therapist at Menninger's made subtle comments, but I was to make links and insights. I did. Now my therapist is doing this as he knows I am not going to stay in the area for forever, and he knows I can handle it--so he is indirectly stating some of the links. I am okay with this.
I guess I probably went off the deep end with all this, and if anyone finds this incomprehensible, I will try to explain as I did just sort of gloss over everything.
OzLand
Posted by Phillipa on August 4, 2007, at 23:46:07
In reply to Re: I feel dumb, what's the difference? » LlurpsieNoodle, posted by OzLand on August 4, 2007, at 23:24:28
Melanie Klein was big in object relations . I bought her book as a Christmas present for my pdoc. As he said as per her when my mother disapppeared I thought she was gone forever. Just like the baby in the high chair who drops a toy and thinks it is gone forever. Hence my abandonment issues. We went over and over her theories. Also had a good therapist what did good CBT one column for the worst that could happen, one for but really , and the third but this what the actuality is. Love Phillipa
Posted by Phillipa on August 4, 2007, at 23:55:13
In reply to Re: I feel dumb, what's the difference? » LlurpsieNoodle, posted by OzLand on August 4, 2007, at 23:24:28
A little history on Klein. Love Phillipa
ABOUT KLEINObject Relations Theory emerges wholly from the profound impact of the work of Melanie Klein (1882-1960). Klein sought to elaborate on and extend Freud's original theory through her observations and clinical work with children. Indeed, Klein's work as a whole is an extension of Freud's work, but also a transformation of Freud's original insights through her unique interpretive perspectives. Klein was also profoundly influenced by Sandor Ferenczi, her own psychoanalyst. Klein's insights were so transformative of Freud's work, in fact, that her theoretical work was rejected by many orthodox Freudians -- a clash best represented in the split between Klein's "London school" and the "Viennese school," most closely associated with the figure of Anna Freud. The initial class between Klein and Anna Freud, leading to this profound and lasting 'split,' involved differences in opinion regarding the treatment of children. Klein used play therapy and used interpretive techniques which were very similar to the techniques used with adults. Anna Freud, on the other hand, held that children's egos were not yet developed enough for classical analysis, and, instead, she advocated a more educative role for the analyst who works with children. The heated debates in WWII Britain -- within the British psychoanalytic society -- led to a profound schism in the psychoanalytic community which is still evident to this day. In fact, until recently, most American psychoanalysts, who were more closely aligned with Freudian ego psychology, held Klein and subsequent Object Relations Theory in contempt for this reason, and, vice versa, the Kleinian tradition generally demonized the ego psychology movement. Thankfully, today this schism is beginning to heal.
Working with children, Klein felt she had observed processes in pre-Oedipal children that were very similar to Oedipal conflicts in older children. Throughout her career, she attempted to theoretically justify these observations. In turn, Klein and her followers applied her practice and theory to work with psychotic adult patients. Klein generally saw similarities between young children's coping strategies in play and psychotic symptoms. In general, however, Klein imagined that all adults retain, at some level, such psychotic processes, involving a constant struggle to cope with paranoid anxiety and depressive anxiety. Klein was led, therefore, to apply her approach to adult neurotics, as well as psychotics and children. Klein's technique, in all cases, involved a method of using "deep" interpretations which she felt communicated directly to the unconscious of the client, thus by-passing ego defenses. In conclusion, Klein's theories, such as the paranoid-schizoid and depressive positions, her conception of sexuality and envy, and her discovery of projective identification as a defense have all been highly influential contributions to the field which, regardless of Klein's intentions, opened up new possibilities for psychoanalysis which were quite different than Freud's classical psychoanalytic practice and theory. The term "object relations" ultimately derived from Klein, since she felt that the infant introjects the 'whole' other with the onset of the depressive position during the ontogenesis of the self.
SEE ALSO: Winnicott, Bion
QUOTATIONS FROM KLEIN
"It is an essential part of the interpretive work that it should keep in step with fluctuations between love and hatred, between happiness and satisfaction on the one hand and persecutory anxiety and depression on the other." (from "The Psychoanalytic Play Technique: Its History and Significance," 1955)
"It was always part of my technique not to use educative or moral influence, but to keep to the psychoanalytic procedure only, which, to put it in a nutshell, consists in understanding the patient's mind and in conveying to him what goes on in it...." (from "The Psychoanalytic Play Technique: Its History and Signficance," 1955)
"One of the many interesting and surprising experiences of the beginner in child analysis is to find in even very young children a capacity for insight which is often far greater than that of adults." (from "The Psychoanalytic Play Technique: Its History and Significance," 1955)
"Reparation...is a wider concept than Freud's concepts of undoing in the obsessional neurosis and of reaction formation, for it includes the variety of processes by which the ego feels it undoes harm done in phantasy, restores, preserves, and revives objects. The importance of this tendency, bound up as it is with feelings of guilt, also lies in the major contribution it makes to all sublimations, and in this way to mental health." (From "The Psychoanalytic Play Technique: Its History and Significance," 1955)
"Mourning...involves the repetition of the emotional situation the infant experienced during the depressive position. For under the stress of fear of loss of the loved mother, the infant struggles with the task of establishing and integrating his inner world, of building up securely the good objects within himself." (from "Some Theoretical Conclusions Regarding the Emotional Life of the Infant," 1952)
"I believe that the ego is incapable of splitting the object--internal and external--without a corresponding splitting taking place within the ego." (from "Notes on Some Schizoid Mechanisms," 1946)
"The main processes which come into play in idealization are also operative in hallucinatory gratification, namely, splitting of the object and denial of both frustration and of persecution. The frustrating and persecuting object is kept widely apart from the idealized object. However, the bad object is denied, as is the whole situation of frustration and the bad feelings (pain) to which frustration gives rise. This is bound up with denial of psychic reality. The denial of psychic reality becomes possible only through strong feelings of omnipotence--an essential characteristic of early mentality. Omnipotent denial of the existence of the bad object and of the painful situation is in the unconscious equal to annihilation by the destructive impulse. it is, however, not only a situation and an object that are denied and annihilated--it is an object relation which suffers this fate, and therefore a part of the ego, from which the feelings towards the object emanate, is denied and annihilated as well." (from "Notes on Some Schizoid Mechanisms," 1946)
"The various ways of splitting the ego and internal objects result in the feeling that the ego is in bits. This feeling amounts to a state of disintegration." (from "Notes on Some Schizoid Mechanisms," 1946)
"With the introjection of the complete object in about the second quarter of the first year marked steps in integration are made. This implies important changes in the relation to objects. The loved and hated aspects of the mother are no longer felt to be so widely separated, and the result is an increased fear of loss, states akin to mourning and a strong feeling of guilt, because the aggressive impulses are felt to be directed against the loved object. The depressive position has come to the fore." (from "Notes on Some Schizoid Mechanisms,
Posted by OzLand on August 5, 2007, at 0:01:27
In reply to Re: I feel dumb, what's the difference? » OzLand, posted by Phillipa on August 4, 2007, at 23:46:07
Yes I have read Melanie Klein, one of the early precursors to object relations theory.
OZ
Posted by OzLand on August 5, 2007, at 0:15:54
In reply to Re: I feel dumb, what's the difference? » Phillipa, posted by OzLand on August 5, 2007, at 0:01:27
Lost my other response; hit the wrong button and went off the Internet; it's gone; doesn't matter; yes read them all and others. I thought Melanie Klein was okay with most things, but she started to get rather off the wall with some stuff I felt. Liked Margaret Mahler's developmental stages, etc. much better.
OZ
Posted by LlurpsieNoodle on August 5, 2007, at 13:15:49
In reply to Re: I feel dumb, what's the difference? » LlurpsieNoodle, posted by OzLand on August 4, 2007, at 23:24:28
Thanks for the overview and for your personal experiences.
please correct me if I'm wrong
-object relations considers people etc as "objects" and focuses on our early formative relationships with important people in our lives. For example my relationship with my mother affects the way that I react to/with my academic advisor and my therapist-insights are one step, but the path to change is to take the insight and work with it to find more practical ways to implement this added knowledge and adjust the way we react to/interact with our world?
-I noticed that my T in Chicago (the one I saw for 8 mos) was much more explicit when I was in crisis, and also used the termination process to neatly sum up the things that we worked on during therapy together. Is this what you mean when you're talking about how your current T is pursuing a more active and intense course of therapy right now?
thanks for all that, you make a lot of sense, and continued finger-crossings that your memory improves.
-Ll
Posted by OzLand on August 5, 2007, at 15:35:42
In reply to Re: I feel dumb, what's the difference? » OzLand, posted by LlurpsieNoodle on August 5, 2007, at 13:15:49
Yes; for the most part when speaking of objects, one is speaking about persons. Also is the case with "part objects" and "splitting." Persons may only see part of who someone is or only part of who s/he is, and "react" to that as if it is the whole person. Splitting is different, but I won't get into that. We "see" ourselves through our own lenses, and the same is true for how we see other. So, yes, it is true that how we view our selves and others is related to past experiences during the formative years.
Insight is understanding and making changes in how one views the self and other and how one puts these views into practice. When one sees the connections, distortions, etc, then it is typically difficult to maintain the same type of interactions. For example, the whole issue of abanonment and feeling the therapist is abandoning when s/he goes on vacation. The head says of course this is not true, but I FEEL like it is true. Once one knows from the heart as well as the head that this is not abandonment, it is not an issue anymore. The heart is saying, this has been my experience.
When persons are in crisis, yes even a psychoanalytically informed therapist is going to be more active, more directive, etc.
With my therapist now, he is more active in a different way. He is not directive and does not give advice or suggestions. He is not waiting for me to make the links with the past. Part of this in my opinion is because of my resistance and ambivalence re getting into csa. Part of it is too that he knows I don't want to be in therapy or analysis for the next 8 years. And, I think part of it is that psychoanalytically informed psychotherapy has evolved in this direction for some therapists. We talked about this when I was at Menninger's doing my postdoc. Some of the old time analysts bemoaned that insurance was only paying for short term treatment and therapy. Others like one of my favorite professors there said that he did not think it destroyed to process to be more active and facilitate making the lings for patients. This is what my therapist does now. As I show my self to be in crisis, he is more directive like saying, if xxxx, then I want you to call me immediately. And he will tell me to do A, B, and C after I leave. There have been only a couple of times he has viewed me as going off the side of the cliff. He sees me in acute distress but believes I have the ego strenghts at this point to figure out what I need to do. He's right. Sometimes he trusts me to figure out what to do more so than I trust myself. In crisis I might be more prone to want to do A vs. B, and he will speak his opinion and tell me not to do A just yet. Wait and see. That's the whole issue of not seeing the forest for the trees in the moment, and it is something I struggle with at this time.
Oz
Posted by Phillipa on August 5, 2007, at 19:58:43
In reply to Re: I feel dumb, what's the difference? » LlurpsieNoodle, posted by OzLand on August 5, 2007, at 15:35:42
In my case its a matter of when a person leaves a room they are gone forever and I'm abandoned hence my fear of being alone. Can't be alone now but working on that in baby steps with this therapist. My mother was a believer in Spock who said not to pick a crying baby up and to let them cry alone. So I have multiple abandoment issues. Always have. I can leave alone to go somewhere but there must be someone home when I get there. Love Phillipa
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