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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by capricorn on June 30, 2010, at 20:16:21
On what grounds would a person be deemed unsuitable for psychotherapy?
Posted by Dinah on July 1, 2010, at 9:39:37
In reply to Suitability for therapy, posted by capricorn on June 30, 2010, at 20:16:21
I'd think it would depend on the type of therapy.
Cognitive behavior therapists might deem anyone who isn't ready and willing to change unsuitable for therapy.
Psychoanalysts might deem someone with poor ego strength unsuitable for analysis.
I suppose severe cognitive impairment would be an issue for many types of therapy. But behavior therapists might not see it as an overwhelming problem.
Some therapists might consider someone in the depths of depression to the point that they were unable to care for themselves or someone in severe mania unsuitable for anything but the most basic supportive therapy until medications stabilized them somewhat. But other therapists might not agree.
Posted by deerock on July 1, 2010, at 10:05:34
In reply to Re: Suitability for therapy, posted by Dinah on July 1, 2010, at 9:39:37
ive read that some sociopathic personalities are made worse by certain types of therapies. i think its very individual. other therapists wont work with people who are borderline and may feel they are too difficult and refer them to someone else.
overall it depends on the problem and the therapist.
id say that if someone is actively suicidal or homicidal they should not be in therapy and most therapists will tell u go to go a hospital.
Posted by capricorn on July 1, 2010, at 11:59:28
In reply to Re: Suitability for therapy, posted by Dinah on July 1, 2010, at 9:39:37
Thank you for your reply,Dinah.
I am guessing any therapy would have been CBT, or variant of CBT, based as this is the therapy my mental health trust prefers to use.
I am deemed highly intelligent by a number of pdocs i have been under though i do have some areas of cognitive difficulty, ie much better verbally then non verbally/performance IQ wise .
I would not say i am severely cognitively impaired though.I was not in the depths of depression or mania when told i wasn't suitable.
My pdoc has said i am prone to 'psychotic symptoms' which i can accept sometimes(especially when stressed) and other times i think 'what psychotic symptoms?!'I am not sure what you mean by 'poor ego strength' so can not answer on that point.
Posted by capricorn on July 1, 2010, at 12:08:52
In reply to Re: Suitability for therapy » Dinah, posted by deerock on July 1, 2010, at 10:05:34
Thanks for your reply.
As far as i am aware i am not a 'sociopathic personality'.I do have some borderline traits but seeing as how i am dxed with PD NOS rather than borderline PD obviously don't meet the necessary diagnostic threshold.I am not currently homicidal or suicidal neither was i when i was told i was unsuitable.
Posted by deerock on July 1, 2010, at 12:54:57
In reply to Re: Suitability for therapy » deerock, posted by capricorn on July 1, 2010, at 12:08:52
PD= psychotic disorder?
NOS means they dont know what the hell is going on.
how old are you?
i was Dx'd as PD NOS about 14 years ago adn I did not have a single psychotic symptom at the time. i never understood why i had that Dx.
do you know what your psychotic symptoms are?
people who are psychotic are suitable for therapy. thats may be a preference on the T's part vs. a global belief in the community.
i hope you feel better soon. how are you feeling today?
Posted by Dinah on July 1, 2010, at 13:09:46
In reply to Re: Suitability for therapy » Dinah, posted by capricorn on July 1, 2010, at 11:59:28
Perhaps you should understand it to mean that that particular therapist is not suitably trained to be *your* therapist. Since different therapists have different ideas, I don't think one therapist can declare you unsuitable for any therapy.
I'd write that therapist off and try again.
Posted by capricorn on July 1, 2010, at 13:35:03
In reply to Re: Suitability for therapy » capricorn, posted by deerock on July 1, 2010, at 12:54:57
> PD= psychotic disorder?
PD= personality disorder.
>
> NOS means they dont know what the hell is going on.Means i fit general criteria for a PD but not any specific PD.
>
> how old are you?53. I have been receiving psychiatric treatment since i was nearly 17. Prior to personality disorder dx had 30 years of being dxed with schizophrenia then schizoaffective.
>
> i was Dx'd as PD NOS about 14 years ago adn I did not have a single psychotic symptom at the time. i never understood why i had that Dx.
>
> do you know what your psychotic symptoms are?I do experience paranoia and weird thoughts also lack of motivation and difficulty when it comes to future goals but not sure those last two are psychosis symtoms.
I have difficulty experiencing positive emotions and experience negative emotions far more intensely.
When pressurised/stressed i can become highly anxious/frightened/irrational/paranoid/and vocally very expressive ie prone to heated ranting and raving.
>
> people who are psychotic are suitable for therapy. thats may be a preference on the T's part vs. a global belief in the community.
>
> i hope you feel better soon. how are you feeling today?Today has been a goodish day ie low levels of anxiety and paranoia.
Things can and do change on a day to day basis though.
Posted by Dinah on July 1, 2010, at 13:37:39
In reply to Re: Suitability for therapy » Dinah, posted by capricorn on July 1, 2010, at 11:59:28
I've never totally understood the ego strength concept, but I have inferred that it has something to do with tolerating stress and anxiety without falling to pieces.
Which doesn't mean that those with poor ego strength aren't suited to any sort of therapy. They just aren't suited to certain types of therapy.
My ego strength is poor, according to my therapist. I'd have to ask him if it's improved any with therapy.
Posted by capricorn on July 1, 2010, at 13:44:57
In reply to Re: Suitability for therapy » capricorn, posted by Dinah on July 1, 2010, at 13:37:39
I tend to experience a noticeable decline in functioning when stressed.
Posted by Dinah on July 1, 2010, at 13:57:27
In reply to Re: Suitability for therapy » Dinah, posted by capricorn on July 1, 2010, at 13:44:57
Then perhaps supportive therapy is what you need? It's not that supportive therapy can't bring about change. I think that's how my therapy has been and in time it did bring about change.
But the therapist is careful not to demolish current defenses. And not to stress the client beyond what they can tolerate.
Posted by deerock on July 1, 2010, at 14:02:31
In reply to Re: Suitability for therapy » deerock, posted by capricorn on July 1, 2010, at 13:35:03
boy oh boy can i relate to this one cap. hang in there.
<<<
I have difficulty experiencing positive emotions and experience negative emotions far more intensely.
Posted by violette on July 1, 2010, at 18:40:10
In reply to Suitability for therapy, posted by capricorn on June 30, 2010, at 20:16:21
Hi Capricorn,
Dinah said it best-consider it the therapist's issue and seek another. Some Ts only want to accept the 'easy' patients, for example, if working with patients with more complex issues makes them feel bad about themselves (which could lead them to question their own abilities, affect their self esteem, etc.).
Others might not have the training or appropriate emotional regulation themselves to treat those with more complex/longstanding traits. Some Ts have unresolved issues, too, and triggers, and take antidepressants, etc.
Try not to be too hard on yourself. I think stressors affect or add to everyone's mental health, including all those who do not seek mental health treatment. And my guess is there are 1 million + people out there who could qualify for "PD NOS" or any other PD. Conventional psychiatrists, from my experience, don't look into it but instead, prescribe meds rather than provide the whole range of treatment options. PDs can change too, I've read time and time again that Borderline traits often subside as a person ages.
Some more conventional type of psychoanalytic/ psychodynamic therapists define 'suitability for therapy' differently than other types of therapists. That can include being psychologically minded (being able to objectively look at yourself), ego strength (as Dinah mentioned), motivation for change, current environmental stressors (such as having steady employment), etc.
So being designated as 'unsuitable' could have been that particular Ts view-not the view of all Ts. Just a thought. Sometimes I get that sort-of-psychosis, and although my T is psychodynamic, we see those experiences as therapeutic-not a negative thing at all. Though some psychoanalysts, as they get more experienced, want the patients who are easier to treat. But I got lucky, I suppose. On the other hand, some from that school of thought might enjoy the challenges and are more interested with patients who may have traits similar to yours.
I'd agree with Dinah that it might be wise for you to check into 'supportive' psychotherapy, though that doesn't mean other options aren't available. You might just find supportive therapy to be just what you need. Either way, please don't feel that you are not suitable for therapy because a T told you so. Everyone has underying biases and preferences, including Ts. Seeking therapy itself is a very positive trait, imo.
Take care,
Violette
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