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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Quintal on July 31, 2008, at 11:27:36
I don't feel so well after this one. I think it's because we're getting down the core of what I want out of therapy - 'Treatment Goals' as she wrote on the board. I couldn't think of anything particularly satisfying for her, and she was left wondering about that. "For someone who has a lot of anxiety you seem to be mangaing pretty well. There's nothing definite I can nail down here" [Narrowed her eyes suspiciously]. I think that's the problem. I don't want to be nailed down or forced or manipulated in any way. I've had enough of that in my life. This is what I dislike about CBT. I don't think it's very nice.
Then there's the ten session limit, so I feel very much under pressure to perform. What I liked about the humanist approach was the openness, and frankly the humanity. I think the core problem here is that I didn't ask for therapy, and CBT wouldn't have been my preference anyway. It was more or less foisted upon me and I suppose I don't really want it. It feels intrusive. I've managed to develop a healthy sense of independence, and I think this is what's helped me to cope with the trauma of last year. Even she acknowledges that I'm doing pretty well for myself. The idea of someone coming in and reprogamming me really undermines that. It feels a bit like enforced medication to me.
I suppose I have a lot of deeply rooted skepticism that people can change anything more than superficially in ten weeks. I'd prefer to be allowed to grow at a more natural pace anyway. This type of therapy is centered around making plans and setting goals for the future, and I'm not very interested in that. I've already said that what I really want most out of life at this point is some sort of spiritual guidance or teaching, more than concentrating on satisfying material desires and aspirations. That's the main conflict I'm having with this therapy - it's the underlying motive. I have no doubt it's good for doing what it sets out to do, but I don't think it's for me.
I don't want to terminate though because I think it would dissapoint my social worker who arranged it. There'd always be a sense of failure, so I think I will just see it through.
Q
Posted by Hermitian on July 31, 2008, at 11:51:42
In reply to Third session with T, posted by Quintal on July 31, 2008, at 11:27:36
I don't get it. CBT is focused on behavior, not goals or plans unless they related to changing behavior.
So that said, what behaviors do you have that you don't like? (rhetorical). If you don't have any, then maybe CBT is not what you need.
However, if you do have specific behaviors you want to change, and you resist plans to address those, then that is an avoidance strategy, because frankly, you just don't want to make the effort or sacrifice for whatever reason. Believe me, I know. In the back of your mind, you're thinking it will be too hard or you will be too uncomfortable, or you actually like the mal-adaptive behavior even though it will have a lousy long-term influence on your quality of life.
Think about something as prosaic as losing weight. A CBT plan that include life-style changes would indeed be an intrusion on somebody who loves to eat. A rejection of the plan based on an argument for autonomy is really a rejection of the plan because the person wants rationalize eating as he does.
So there you have it. You have to be honest with yourself about your motives. Change requires commitment, and if you aren't at least somewhat committed to change, then cease the therapy. You just have to ensure that your retreat is aligned with your values, not with your deficiencies.
I'm an ADD procrastinator. And when I resisted changing my behavior through timelines and challenges, I resisted too. And claimed my autonomy as an absolute. But then I looked myself in the mirror and said to myself, "I value autonomy so much, I would rather goof off and live this sub-optimal life till I die, than work to a future that is bright and hopeful." And when I said that, I knew I was not being consistent with my values. I could not buy into that value prop. It was only then that I committed to change.
Posted by Quintal on July 31, 2008, at 13:12:44
In reply to Re: Third session with T, posted by Hermitian on July 31, 2008, at 11:51:42
>So that said, what behaviors do you have that you don't like? (rhetorical). If you don't have any, then maybe CBT is not what you need.
I think DBT would be more what I would need if I had to choose a behavioural therapy, but I haven't asked her about that yet. There aren't many behaviours that I would want to change, it's more abut internal emotional turmoil, but I am comitted to working on my avoidance behviours. The thing is I've been doing a lot of this myself over the last few years and have come a long way. She feels that she doesn't have a lot to suggest on this front much more than I'm doing already. Just a bit of prompting here and there.
>I don't get it. CBT is focused on behavior, not goals or plans unless they related to changing behavior.
Actually the CBT that I've encountered has been very much goal orinetated - this is one of the things my therapist made clear from the first session. I have Bipolar I disorder and was hospitalized for psychosis last December, and this why I was referred to the psychologist. I'll come back to this later. Going back to:
>So that said, what behaviors do you have that you don't like? (rhetorical). If you don't have any, then maybe CBT is not what you need.
Yes, I think you're right about that. My problem doesn't seem to be primarily behavioural, but I do have some. I'm not opposed to the method as such, but I don't think it's well suited to my needs. I already use what could be called CBT techniques to cope with psychotic experiences, although I think of it more as a sort of mediation technique. T has been very impressed and supportive of these methods I already have in place. I don't take any antipsychotic medication because I'm mostly controlling it using these methods. This is another example of why I feel so strongly about my autonomy. It isn't limited to therapy, and on the whole I think it's a good thing.
I won't copy and paste all of your post, but one of things that bothered me most was the part on autonomy. What I do want to say is that after having a childhood where I had very little control of choice over what I did, or what was done to me, independence/autonomy is one of my prime acheivements, and maybe as a result I don't give myself over to the control of another person easily.
I'm very honest about my motives, and I know what they are. There are some issues, one in particular, that I don't want to share with her at this stage, and yes, I see it is a defence mechanism. I don't trust her enough yet, and probably won't if I'm only going to be seeing her for ten sessions. This issue doesn't involve real-life goals or behaviours though, it's about some trauma that I suffered as a child. I would feel much... safer, I suppose raising this with a humanist counsellor, and I did once raise it when I saw one at college.
My T thinks I'm doing pretty well in tackling my avoidance behaviours, which is my main behavioural problem. I've commited to change on this front. Earlier this year I enrolled at college, and I'm working on other diffuclt areas like rebuilding my real-life social circle. That said, my main problem now is psychosis and internal instability. We discussed this in our first session and had pretty much the same view on the origins of bipolar disorder - that it might be partly a hereditary biological condition, and also due to childhood trauma and instability. From what I've read, when CBT is used in bipolar disorder and Schizophrenia it isn't aimed at curing the unerlying illness with the hope of it going away as such, it's more focussed on on learning ways to cope with it.
The 'problem' is that the coping skills I've learned are as good as anything the mental health team seem to be able to teach me, and all they've had is praise for me. As a result of this I've been invited to give some talks on my experiences and what I've learned to a group of mental health professionals in the hope that they might be able to pick up something usesful to help their other clients. T and all the others involved in my case think this is a great idea, and it is pretty exciting, but I'm more the person who would rather write a book than give a talk, so I'm very nervous about it. I'll have to get used to public speaking for my college course, but it is one of my worst fears - something I'd do almost anything to avoid, so this was supposed to be one of our treatment goals, but we seem to have forgotten about it today. So that is probably the main thing she can help me with, otherwise there isn't an awful lot she can help me with, and I think that's one of the frustrations for her.
I'm pleased that CBT helped you overcome your difficulties. It sounds like a good techinque for ADD. As a different CBT therapist once said to me though, although CBT is one of the most researched methods it isn't the be all and end all, and for some people another approach is more appropriate. That therapist actually talked with my pdoc and made a referral to psychodynamic therapist, so it all depends on what works best for you, and I think sometimes our instincts about what's best for us are right.
Q
Posted by Hermitian on July 31, 2008, at 13:32:33
In reply to Re: Third session with T » Hermitian, posted by Quintal on July 31, 2008, at 13:12:44
That's a great write-up. Thanks. Now I understand more. Bipolar is a pretty complex condition. Frankly I have a tough time seeing how CBT would fit with that. Psychosis in psychosis and not driven by learned behavior that can be unlearned by CBT. Maybe it would allow you to react better to cycling. But I'm no shrink.
I hope whatever you try works for you.
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