![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by antigua3 on July 30, 2008, at 10:59:11
Has anyone ever gone through long term CBT to treat severe csa? Or can suggest any books that deal with this? Most everything I find is about short term CBT.
My T experience has always been pyschodynamic, but I'm now entering this other type with my male pdoc. It sounds potentially helpful, given that I've been "stuck" with my female T, and as I've said before, I tend to protect her and can't deal with things that need to be dealt with.
FYI, the long term CBT is in conjunction with the psychodynamic--there's no way I'm giving up my T!
Any thoughts?
thanks,
antigua
Posted by cbtish on July 30, 2008, at 12:18:30
In reply to Long term CBT***csa trigger***, posted by antigua3 on July 30, 2008, at 10:59:11
You are right. There is no such thing as long term CBT. CBT just takes as long as it takes, which is rarely very long.
Certain things can make CBT take a long time--a long time in CBT is maybe a couple of years. For example, if you have a personality disorder that sabotages your ability to work with your therapist, then any therapy will take longer.
Having two therapists at the same time might make it difficult for you to get results. To avoid bad interactions, ensure the two always deal with separate issues. If the CBT is any good, you might start to find your psychodynamic starts to feel irrelevant. Or it might happen the other way around. Go with the flow.
Posted by Nadezda on July 30, 2008, at 13:18:52
In reply to Long term CBT***csa trigger***, posted by antigua3 on July 30, 2008, at 10:59:11
I did individual CBT along with psychodynamic therapy for a while. At the time, my emotions were too intense for me to use the CBT very well. Now, however, about two years later, I'm doing a DBT group, which is extremely helpful.
If you're stuck with your current T, though, that seems like a really big problem, which maybe you need to address more directly. Could you and she get a few consultations together, or perhaps could she get some supervision to help get through the block? She can't help you if you protect her-- and if she can't help you move past that, you'll be stymied in making progress.
I'm not sure doing therapy with someone else, even though it might help in the abstract, will make the psychodynamic therapy more useful. Unless what you're saying is that you aren't ready to deal with the csa issues, and really need a more supportive type of therapy-- which you have with your T.
I'd suggest, if possible, a DBT group, because from what I've experienced, they're really good.
Nadezda
Posted by cbtish on July 30, 2008, at 13:28:58
In reply to Re: Long term CBT***csa trigger***, posted by Nadezda on July 30, 2008, at 13:18:52
Yes, DBT often takes longer. For most people CBT is worth trying first, because if it works at all it will work quicker. A good CBT therapist will be able to tell you if you need DBT at the assessment/formulation stage after one or two sessions. A not so good one might take longer to work it out.
Posted by antigua3 on July 30, 2008, at 15:26:12
In reply to Re: Long term CBT***csa trigger***, posted by cbtish on July 30, 2008, at 13:28:58
Thank you everyone for your thoughtful responses. You offered some responses, which set off some alarms for me, but that's good.
To be clear, I'm not going to the pdoc to deal with issues w/my T. My T and I are working very well on this "block" of mine, of my always wanting to protect her, etc. It hits hardest when she goes away (as she is in the next week). It takes me right back to being either abandoned by my mother (sent away) or she going away. She is my mother so to speak, and she is encouraging me to let out all the feelings I had about these issues--how I couldn't tell my mother about what was going on because I had to protect, and how much worse everything was when she was away, etc.
So I feel confident in how my T & I are moving forward.The CBT is being done with my pdoc. I won't say that we are covering entirely different ground, but we are approaching it in a different way.
For example, I know understand when he says this isn't about the relationship between the two of us, as it is w/my T. I don't WANT it to be about the relationship--been there, done that with a male. All I need to know is that he cares, won't abandon me and is comitted to helping unravel the twisted way I constructed my psyche as a young child in order to survive.
It's a different way to unravel the onion, for those of you who have had to hear that analogy about what therapy is like. Yikes, I hate that. Wish I had a dime for everytime I've heard it.
question always welcome,
antigua
Posted by antigua3 on July 30, 2008, at 17:01:59
In reply to Re: Long term CBT***csa trigger***, posted by antigua3 on July 30, 2008, at 15:26:12
I forgot the most important part, why I'm doing this.
I want to unravel the irrational beliefs that I developed as a coping mechanism to deal with the csa, so that I can minimize/deal with, etc. the overwhelming and disproprotionate amount of love I have for my father that does not reflect the reality of our relationship.
This is not just black and white thinking; it's a distorted belief that affects my life and gets me into situations that I have to deal with that trigger this.
i'll shut up now. maybe not, i think I'm starting another thread below..
sorry to be so needy,
antigua
Posted by Daisym on July 31, 2008, at 2:25:28
In reply to Long term CBT***csa trigger***--Whay am I going?, posted by antigua3 on July 30, 2008, at 17:01:59
Let me premise this with "I'm taking pain meds" just in case it isn't coherent. (Surgery a week ago.)
My first question is what are you looking for, connected to long-term CBT? Do you want to make sure you are doing it right...or that your pdoc is doing it right? When I begin to research I typically figure out much later that I'm looking for 1) a short cut or 2) to understand the rules of whatever "tricks" my therapist might try to use on me. Asking yourself what you are trying to understand is a really good question. Fallsfall told me a long time ago that therapy really started to work for her when she stopped doing her own therapy and began to trust her therapist to do it (paraphrased).
As far as the research on csa goes, "straight" CBT is not the therapy of choice, but a type of CBT called "exposure therapy" has lots of clinical evidence that it works. That doesn't mean it won't work for you. It just means that for most people, changing their thoughts doesn't help them integrate their trauma or learn how to live with it. If you haven't read Babette Rothschild,'s "The Body Remembers" I'd recommend it.
I think I know what you mean about the distorted beliefs left behind. But I think the challenge is not to necessarily figure out what is "true" or "real" or "correct" - but instead to be able to hold two truths at the same time. Yes, you loved him. There were likely good reasons for that. My dad was my primary caretaker for the first 5 years of my life. So he hurt me but he also made a deep connection to me. And to this day, he says the most outrageous things but that doesn't negate the fact that he did call, that he loves me and he worries -- all very dad things to do.
And yet, I know, very deeply, that he also destroyed me - or a potential me. So I imagine you love your dad and hate him. It is really hard to let the hate part out. We want to say, "I hate what he did but not him" etc. And maybe you don't. Only very recently can I say those words - but boy do they echo "this is a large sin" when I do. That's not to say that you might not be distorted - there might be more to hate than love when you look at all the facts dispassionately. Maybe your dad was a really bad guy. But that doesn't change how you feel.
Timing - as they say. It might be equally helpful to acknowledge why you loved him and what you hoped for, as much as it would to try and force reality into your brain and heart. I just don't think that will work - the conflict is too deep.
For me - the conflict remains in the realm of "why?" Why did he do this? What drove him? As I've started to let go (some) of the "it was my fault, I turned him into a monster" beliefs, I've noticed another question looming large - "could I have saved him? Could I have turned the monster back into the dad I loved?" These are questions that are painful to grapple with and come from the youngest, most scared parts of me. The adult can think about them rationally and answer all the questions and explain all the feelings and draw all the connections. But the child is frightened and confused - and has a lot of plain old grieving to do.
Keeping writing, Antigua. This is such important work you are doing.
Posted by antigua3 on July 31, 2008, at 8:29:30
In reply to Re: Long term CBT***csa trigger » antigua3, posted by Daisym on July 31, 2008, at 2:25:28
Oh Daisy, you always ask the really hard questions. It's so easy for me to think and believe that I'm right in what I'm doing that I often can't see the forest for the trees.
>
> My first question is what are you looking for, connected to long-term CBT? Do you want to make sure you are doing it right...or that your pdoc is doing it right? When I begin to research I typically figure out much later that I'm looking for 1) a short cut or 2) to understand the rules of whatever "tricks" my therapist might try to use on me.>>I researched it because I wanted to understand what he was trying to do and why we were having a problem connecting--not to influence the outcome by being some know-it-all, trying to trip him up on not doing it "right," but I wanted a genuine understanding of how the process works. Since I've done this, we've had two powerful sessions.
From what I've read, and discussed with my pdoc, through this process, you first look at the feeling (anxiety), what lies beneath it (fear) and then figure out why I feel the fear--what am I afraid of? There's terror underlying the fear that I'm never able to access. It just cycles from anxiety, to fear, to terror, and then I change my circumstances (move around, do some work, etc.), which distracts me for a bit until the anxiety returns and the cycle starts all over again. I want to break that cycle; I have to break that cycle if I'm to truly get over this. Nothing to date has come close to letting the terror out, and that includes psychodynamic, hypnosis and EMDR therapies. I may never get there, but this is worth a shot.
I see the CBT as a methodical way to approach this. I am a very methodical/literal person and having an explicit process may be helpful.
> As far as the research on csa goes, "straight" CBT is not the therapy of choice, but a type of CBT called "exposure therapy" has lots of clinical evidence that it works.
>>Yes, I know exposure therapy is a therapy of choice for PTSD in this day and age of managed care, and I've discussed it w/my pdoc, but we aren't going to keep exposing me to the trauma to alleviate my symptoms. That would be retraumatizing me too much, he says; instead, think of it as concentric circles. We all live in different circles that start from our inner core to our outside life. We will work on each one of those circles, and I will tell him as much as I remember about living within each one--my inner circle, my family, extended family, school life, etc. At each circle, we will discuss my thoughts, feelings and actions, and see where that gets us.
In many ways, it feels similar to psychodynamic, but he asks different types of questions. It's upsetting, don't get me wrong, but it helps me to think in a different way.
>....for most people, changing their thoughts doesn't help them integrate their trauma or learn how to live with it. If you haven't read Babette Rothschild,'s "The Body Remembers" I'd recommend it.
>
>>I will read the book, thank you. There is some research that suggests that through therapy we can actually change neural pathways in the brain, to form a "corrective" experience. I do know that once I'm aware of a connection between my past and current life, the new way of thinking will finally take over after I've learned to practice that way of thinking. Whether or not it can work in this instance is still an unknown.> I think I know what you mean about the distorted beliefs left behind. But I think the challenge is not to necessarily figure out what is "true" or "real" or "correct" - but instead to be able to hold two truths at the same time. Yes, you loved him. There were likely good reasons for that. My dad was my primary caretaker for the first 5 years of my life. So he hurt me but he also made a deep connection to me. And to this day, he says the most outrageous things but that doesn't negate the fact that he did call, that he loves me and he worries -- all very dad things to do.
>
> And yet, I know, very deeply, that he also destroyed me - or a potential me. So I imagine you love your dad and hate him. It is really hard to let the hate part out. We want to say, "I hate what he did but not him" etc. And maybe you don't. Only very recently can I say those words - but boy do they echo "this is a large sin" when I do. That's not to say that you might not be distorted - there might be more to hate than love when you look at all the facts dispassionately. Maybe your dad was a really bad guy. But that doesn't change how you feel.
>
>>Yes, my father was a really bad guy. Honestly and truly, no one in this world loved him except for his mother and me, and his third wife, who knew a different man. And faced with the evidence, there is no reason I should have this disproportionate amount of love. I can hold the good feelings about him--on a rational level I had good reason to love him--but I let the love overwhelm the situation, which is pathological, not just a matter of holding both feelings at the same time. But I will admit that hating him is very difficult, and in this case I don't believe in "hate the sin, love the sinner." It doesn't fit.I'm pretty sure this is about letting the hate out and acknowledging what he did to me, the severity of it, and how it determined the course of my life. There is grieving going on for what I lost, and some of the sadness is seeping out, and I'm grateful for both of this.
> Timing - as they say. It might be equally helpful to acknowledge why you loved him and what you hoped for, as much as it would to try and force reality into your brain and heart. I just don't think that will work - the conflict is too deep.
>
>>I don't know about that. I'll have to think about this.> For me - the conflict remains in the realm of "why?" Why did he do this? What drove him? As I've started to let go (some) of the "it was my fault, I turned him into a monster" beliefs, I've noticed another question looming large - "could I have saved him? Could I have turned the monster back into the dad I loved?" These are questions that are painful to grapple with and come from the youngest, most scared parts of me. The adult can think about them rationally and answer all the questions and explain all the feelings and draw all the connections. But the child is frightened and confused - and has a lot of plain old grieving to do.
>>yes, that may be a big part of it. But for me, the child has to grow up, and helping her to grow up in a much healthier way is my primary task.
Also, I'm not concerned with the "why" part. I think I've figured that out. There are facets of his own life that made him the way he was and I accept that. But that in no way lets him off the hook. I'm sorry you're struggling w/this, I know how hard it can be. It has been suggested to me on more than one occasion that I jumped over the anger and went straight to forgiveness, which may explain part of my problem.
I think there are two root issues:
1)There is a "reality" to this situation (of what type of person he was, what happened, etc.) and my interpretation of that reality.2)While I argue that I don't blame myself for what he did, that may be entirely untrue below the surface. I don't believe I caused him to do the things he did, or wanted him to do them. They happened for whatever reasons that had to w/him and not me. I just happened to be there. I accept now that it wasn't because I was special or that he loved me more, etc.
Enough; sorry to be so long.
[antigua]
Posted by Daisym on August 1, 2008, at 0:08:54
In reply to Re: Long term CBT***csa trigger » Daisym, posted by antigua3 on July 31, 2008, at 8:29:30
Late night thoughts:
the anxiety - fear - terror cycle sounds a lot like a neurobiological response - the anxiety starts and your amygdala just takes over. It goes from 0-60 even though it isn't necessary now - the item that starts the anxiety may just be worth anxiety, not terror. But your body has learned to gear up immediately.
And I was talking to my therapist about this thread today. He pointed out that I research now almost as much as I ever did and yet I profess to trust him. I do trust him! But in thinking about why I research, I think, for me, it is about wanting to be psychologically competent. Introspection and psychological concepts were not encouraged at all when I was growing up. We didn't have family meetings, or talk about our feelings or problem solve together. (I actually heard my 16 year old say to his old brother, "wait until I bring this up at the family meeting!" I had to laugh.) So I think I've educated myself to be able to trust myself. And the more I've read, the more I'm curious. I think brain research is fascinating.
My therapist agreed that this feeds my intellect. He said he thinks I'm curious and really interested in understanding myself. And he didn't think this was about pathology. (thank goodness) But then he asked me, "are you ever unhappy with the way we work together - with the kind of therapy we do?" He didn't mean ruptures, he meant theory/approach. I hope I wasn't making him worry - it is so hard to tell when doing phone-sessions. It doesn't sound like your pdoc minds you researching - I'm glad he'll discuss it with you.
This thread has given me a lot to think about. Thanks.
Posted by antigua3 on August 1, 2008, at 8:38:56
In reply to Re: Long term CBT***csa trigger, posted by Daisym on August 1, 2008, at 0:08:54
Interestingly enough, my pdoc encourages the research, but my T doesn't. I think she's afraid that I'll we triggered.
As a matter of fact, when my pdoc knew that I had an understanding of his approach to therapy, it opened things up a lot, maybe because he knew he could speak to me at a level that he knew I could understand. That said, I have tons to learn!
antigua
This is the end of the thread.
Psycho-Babble Psychology | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.