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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Daisym on July 12, 2011, at 15:33:24
We've probably had this discussion here before but the above thread has me thinking about techniques and what works and what doesn't. I'm wondering what other experiences people have had with this kind of thing.
For me, anytime I feel I'm being "manipulated" my guard goes way up. I think it is a deep, old response, learned in childhood but never-the-less, it gets in the way. The need to please, to do it "right," to make the other person happy - these are all fall back responses for me, even in therapy. I trust my therapist but that trust has a tentative edge to it when I think he is "doing" something to me.
It seems to me that many of these brain changing techniques fail to take into account the chemical response to fear and anxiety. These chemicals get in the way of laying down new neural pathways. Time and time again the research shows that it is the relationship between the client/patient and therapist that creates the conditions and security for change. I can't help but think that therapists, like all humans, sometimes need to be doing Something, while being in the relationship, especially if talking is hard. Techniques won't work if there is no underlying relationship of support, respect and trust.
My two cents, for what it is worth.
Posted by Anemone on July 12, 2011, at 16:09:24
In reply to Techniques, posted by Daisym on July 12, 2011, at 15:33:24
Hi Daisy,
Agree with what you said, about the need to please and respond right to techniques. I also feel my guard go up when manipulated. Without the relationship, techniques are not helpful. The relationship itself is helpful, to give support and hope when things are bad.
Posted by Dinah on July 12, 2011, at 16:54:08
In reply to Techniques, posted by Daisym on July 12, 2011, at 15:33:24
I think that's particularly true in some orientations. I think it's something my therapist has had to struggle with. He needs to *do*. It's hard for them to realize that building the relationship *is* useful work.
Maybe the blame is with the emphasis on short term solution focused therapy in today's therapy environment. The therapists themselves get a fair amount of pressure from their peers to get clients up and out. I'm surprised they don't play fast music in session, like they do in Burger King, to help us get healthier faster.
Those of us with therapists comfortable with long term therapy (and I only partially include myself here) are very lucky. Especially since most people don't go into therapy expecting it to be long term, and likely don't screen for therapists who are comfortable with it.
(I must confess that I have never felt any pressure to please my therapist. My therapist is more used to an immediate outright rejection, followed by gradual acceptance over time.)
Posted by Anemone on July 12, 2011, at 17:25:14
In reply to Re: Techniques » Daisym, posted by Dinah on July 12, 2011, at 16:54:08
Dinah, I laughed at your Burger King music technique.
(Actually, T made me wear headphones during talking session to listen to bilateral brain-stim. music while she talked yesterday.)
Posted by Dinah on July 12, 2011, at 19:54:14
In reply to Re: Techniques » Dinah, posted by Anemone on July 12, 2011, at 17:25:14
lol. Did it help any? Or did it just feel like pressure?
Posted by lucielu2 on July 12, 2011, at 19:54:44
In reply to Techniques, posted by Daisym on July 12, 2011, at 15:33:24
This is a big issue for me. I can't stand any "artifice" in therapy, e.g. using a "therapeutic" voice or saying something I imagine to be on p. 63 of the therapist's manual. I can be a real pain about it. When I started long-term therapy, I butted up again this at every session, which was bumpy and difficult for both of us. It took us literally years to negotiate a very human relationship in which I felt comfortable and secure in my belief that I was seeing the person he really is and that he was reacting to me in a very genuine way. I really learned to trust him through his letting me see who he is.
I have never tried some of these other approaches, but I'd have to guess it would be a problem there, too. I have to say that this is just me, it's no slur on any of these techniques.
Posted by Dinah on July 12, 2011, at 19:58:25
In reply to Re: Techniques, posted by lucielu2 on July 12, 2011, at 19:54:44
I'm the same way! My therapist doesn't dare use any of his standard phrases, and I'll call him on any therapeutic techniques I notice.
I tell him I think it's lazy of him to fall back on techniques. I want him fully present and engaged.
As you say, I'm just speaking of myself. Even my therapist doesn't agree it's lazy of him. :)
Posted by emmanuel98 on July 12, 2011, at 20:05:34
In reply to Techniques, posted by Daisym on July 12, 2011, at 15:33:24
Most studies of psychodynamic therapy (traditional talk therapy) find that the relationship is the most healing part of the process. I started seeing my p-doc thinking I would see him for a few months. Instead, I am still seeing him 6-1/2 years later, though we just cut back to every other week. I let myself feel vulnerable and dependent on him and I had never let myself feel vulnerable and dependent with anyone before. Also important was talking about the relationship. It was so intense for me, that I felt a need to express my feelings about him and the relationship, something I had never done before, even with my husband. His only "technique" is knowing how to be kind, empathic, compassionate and keep the sessions moving and useful by honestly raising issues that I would have found to shameful or embarassing to raise.
Now, with his blessing, I see a DBT therapist every week who is to be my primary therapist, with him just continuing to see me for support and because I feel unable to give him up. Her focus is more technique based -- learning particular exercises to regulate emotions and suicidal ideation. But she really believes in what she does and is very skilled at doing it. It has actually helped me a lot.
Posted by emmanuel98 on July 12, 2011, at 20:25:32
In reply to Re: Techniques, posted by emmanuel98 on July 12, 2011, at 20:05:34
When I was in the hospital two years ago, I had a p-doc who was so transparent in his use of "technique" that I couldn't stand talking to him. He was young, probably only a couple of years out of residency. Everything he said sounded like something he read in a textbook, woodenly delivered. My p-doc came to the hospital to meet with him and me because he wasn't happy with their treatment plan. I talked with him later about this hospital doc and he said, he was very nervous, even with him and didn't really seem to know what he was doing. I pity the poor patient who ends up with him in private practice.
Posted by Daisym on July 12, 2011, at 22:28:16
In reply to Re: Techniques, posted by emmanuel98 on July 12, 2011, at 20:25:32
I'm sure I've raised an eye brow or two when I've commented on the "therapy manual" - I know my own therapist has bristled at those comments. Once he told me, "I'm sure there are phrases in your work that you frequently use too." This is very true and it helped me stop watching for his "mistakes" and relax more. I find when I'm relaxed he uses less of those pat phrases, which tells me it is easier to be real with someone less defensive.
I've been thinking about this a lot today and I've decided the technique I probably hate the most is "reality testing." We learned it in school - it is a way of questioning a stated belief to see how entrenched it is and what the evidence for the belief is. It is effective but in my own head I want to scream, "I know I'm being irrational, or using black/white thinking. But leave it alone, it is working for me!" Ug.
I guess what I was trying to say was that I have no problem with "techniques" when they are honestly talked about and presented as tools. But overall, it is the relationship and the genuine caring of the therapist that creates lasting change and benefit.
Posted by Dinah on July 12, 2011, at 22:57:23
In reply to Re: Techniques, posted by emmanuel98 on July 12, 2011, at 20:05:34
I never minded my therapist teaching me coping skills. Well, maybe I'd mind if he presented them as a magic answer to all my problems.
But maybe that's due to my own bias. I think teaching coping skills is a very sensible thing to do.
Posted by antigua3 on July 16, 2011, at 18:06:07
In reply to Techniques, posted by Daisym on July 12, 2011, at 15:33:24
This is probably off track, but it has to do with different techniques, but has anyone run into a situation where their p-doc makes it clear that you (me) are being treated differently than he treats other patients, that in fact, he has his own therpeutic approach for me that doesn't mirror what he does with other patients?
This has come up because I am aware that he does treat me differently, and in my mind, in a "lesser than" way. Even when I hear him speak to other patients in the waiting room or after I leave, his tone is very different.
Am I just being naive? (how do you spell that word, anyway?). Do Ts and psychiatrists treat patients differently based on their need? I guess I always thought my T (who I don't see anymore) was the same way with everyone, providing the same loving guidance.
antigua
Posted by Dinah on July 16, 2011, at 19:41:39
In reply to Re: Techniques, posted by antigua3 on July 16, 2011, at 18:06:07
My therapist treats me different than I've seen him treat other clients. Mostly because he's known me longer, but also because I'm a different person with different needs.
He's actually told me that with the population he often treats, he's seen more as a guide than a traditional therapist and that there isn't the same dynamic as there is with me, where he's a parental figure. Mind you, I strongly suspect he underestimates the power imbalance in even therapeutic relationships that seem peer to peer. But what do I know. I do suppose it would be badly received if he treated some clients with the somewhat distant avuncular affection he adopts with me. While I'd be quite put out with him if he adopted a more peer to peer stance with me. I think he puts more importance in speaking in a way the client can hear than he does on technical purity.
Besides, each relationship really is different. If he was the same person with every client, would he actually be in relationship or just practicing a technique? I'm sure you have some friends you are sillier with than others, and some friends you are more serious and thoughtful with?
In what way does it seem "lesser than"?
If I remember, didn't he set out to be a counterpoint to the warmth of your therapist? Maybe it is an intentional stance based on what he believes you need. Would you actually appreciate being treated the way you see him treat others? I'd have the hide of mine, in the very nicest way possible, if he greeted me with a hail fellow, well met attitude.
Do you have the sort of relationship with him that you can ask? One of the very best parts of a long term therapy relationship is the ability to ask a question and receive a thoughtful reply. Eventually. Since at times he seems to require a fair amount of time to apply thought. It might be interesting, should he admit the truth of your observations, to discover how he came to decide what you need from him. Or what quality in you he's responding to.
Posted by antigua3 on July 17, 2011, at 13:01:24
In reply to Re: Techniques » antigua3, posted by Dinah on July 16, 2011, at 19:41:39
Hi Dinah,
It seems "lesser than" because I have heard him express true warmth and caring to others, but i don't hear it for me. I don't believe he cares for me or even likes me, but this could be my warped vision. When pushed, he has said that he cares for me, but it's not a spontaneous thing at all. It is a very deliberate move on his part when he makes that statement and only does so when pushed.We have discussed this until there is no more to discuss. He says I am making assumptions about him and I reply that I am only commenting on how I see the person in front of me treats me and the actions he takes toward me.
We talk about how he believes he is using the therapeutic approach with me that he thinks I need, but I don't necessarily agree. Never have really, but I've hung in there because we have done some incredible work together. I can never deny that.
But, it has been tough as nails. Yes, he provides one very important element that was lacking in my life--consistency. I can count on him being there and not abandoning me, and I know how important that is to a person who grew up like I did.
I recently finished a book on using attachment theory in psychotherapy and I found so much to relate to, and I don't think my p-doc is the attachment figure that would work best for me. If there's warmth and caring, I don't see it, I don't feel it. When I talk about terrible things, the expression in his eyes is always the same, whether I'm talking about the weather or something brutal that happened. His expression never changes, I can't read his eyes. the mirror reflecting back reflects nothing to me.
do I make any difference to him? No, I don't think so. Why should that even be important? I feel like an appt, not a person.
It's not time to walk away. I'm not finished. The attachment is so strong, but in a way, it reflects the negative attachment I had with my father. It's all so complicated; I can't figure it out anymore.
My T is gone and I will not start over with another T or p-doc. I feel really stuck.
And yes, yes, we talk about this, but he doesn't seem to hear me, and mostly, he doesn't agree with me. He won't tell me that I am wrong about my perceptions and maybe that's what I want--to hear that I'm cared about, thought of, liked, etc.--he sticks by not seeming to understand what I am saying, as if he is providing what I am asking for--and balances that against the argument that he thinks he's doing what is best for me, given my history with male authority figures.
It can be so confusing,
thanks for listening,
antigua
Posted by Dinah on July 17, 2011, at 16:39:12
In reply to Re: Techniques, posted by antigua3 on July 17, 2011, at 13:01:24
I don't ever think you'll get him to be a warm attachment figure. You may see glimpses of it with others, and perhaps they would see glimpses of it with you, but I really don't think that's who he is.
Can you take the good in the relationship, and recognize that he is who he is, and it's no reflection on you? Just as your father's role in your relationship reflected who he was, not who you were. And in some ways he does show his caring to you. By being a consistent presence in your life. By not rejecting you. By doing his best for you as a client, so far as he understands it. A stereotypical undemonstrative father who shows care by doing?
That being said, I will acknowledge that no matter the ideal, the therapeutic relationship really isn't entirely different from other relationships. Sometimes therapeutic partners get into a pattern just as married couples or parents and children do. Where needs and expectations on one side can cause an emotional withdrawal on the other side. I will rather shamefacedly admit that I occasionally mind the therapeutic relationship as I might mind my marital or even parental relationship. I say shamefacedly because I know that theoretically a client shouldn't have to do that. That a therapist is responsible for his reactions in the therapeutic relationship.
Still, there are times when I step back and look at the pattern going on and do something on my side to try to change it. I acknowledge that while he does this sometimes, I'm better at recognizing when it needs to be done. This last breach between us had a number of causes. He wasn't being professional, the boundaries had gotten a bit lax, and he admits now that he really wasn't himself. He does have depression from time to time, though I'm not sure if that played a role this time. But part of it was that I had gotten into the role of criticizing him for his lack of attentiveness in session. And being very watchful for sleepiness on his part, at which time I'd pounce on it as proof that he didn't care, that he wasn't being a good therapist, etc. And while that was true, it wasn't doing the situation much good. He got sleepier, I got angrier. I had to take a step back (with the aid of a month of quitting) and choose to change the dance. Instead of looking for signs that he didn't care, I made the decision to tell him how much I appreciated this or that quality of his. Or how much he had helped me with such and such. When I changed my moves, he seemed to change his. I find the same thing happens with my husband.
While I don't for one second believe that your therapist cares more for other clients or would be warm and fuzzy for anyone at all, I do wonder if maybe you've developed a well practiced dance between the two of you. And if you think that may be true, whether there's any way to refuse to dance that dance for a while, and seek out a new pattern.
Which may or may not be helpful to you. I'm not up to date on your story.
(And I'm dreadfully sorry to have forgotten, but did your motherly therapist retire?)
Posted by ron1953 on August 11, 2011, at 13:28:08
In reply to Techniques, posted by Daisym on July 12, 2011, at 15:33:24
You mentioned, "chemical response to fear and anxiety."
I learned a great deal of very useful information on that subject from an excellent book, "Emotional Intelligence". Highly recommended reading.
This is the end of the thread.
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