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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by m3 on January 28, 2002, at 18:56:52
This is something I've always been curious about: can anyone offer concrete
examples of how therapy has helped them? I know it's hard
to sum up meaningfully, but I dunno, something like, before
therapy I would do x, and now I can recognize other options
and usually choose to do y.I know that clinical studies show therapy is pretty consistently
effective for many/most people with depression and
some other diagnoses. My scientific/knowledge-seeking/informed-patient
side is impatient with the subjective part of it and wants
to know how it works.I guess a related question is, how is a "newcomer"
(someone who's getting psych. symptoms for the first time)
supposed to pick a doctor? It seems odd to me that we're just
supposed to go by whether we feel a rapport with them, when
1) they (i.e. mental health professionals) presumably have strong and
differing views of what's the best way to treat people, and
2) most of us know nothing, at least up front, about the different
options.I guess what I'm getting at is, an educated mental health professional
who was getting symptoms would presumably make a choice of shrink
based on methodology, but your average patient can't. Seems strange
to me...anyone else feel the same?
Posted by robinibor on January 28, 2002, at 19:59:07
In reply to benefits of therapy? (longish), posted by m3 on January 28, 2002, at 18:56:52
HI. I'm sending the section called "Choosing a Therapist" from http://www.undoingdepression.com
I hope it helps with your second question. As for the first, I guess most people who have the "right" therapist believe they benefit from their therapy.> I guess a related question is, how is a "newcomer"
> (someone who's getting psych. symptoms for the first time)
> supposed to pick a doctor? It seems odd to me that we're just
> supposed to go by whether we feel a rapport with them, when
> 1) they (i.e. mental health professionals) presumably have strong and
> differing views of what's the best way to treat people, and
> 2) most of us know nothing, at least up front, about the different
> options.
>
> I guess what I'm getting at is, an educated mental health professional
> who was getting symptoms would presumably make a choice of shrink
> based on methodology, but your average patient can't. Seems strange
> to me...anyone else feel the same?Choosing a Therapist
If I were depressed and seeking a therapist I would consider the following factors:
1.My gut reactions-is this someone I feel that I can like and trust? Do I feel at ease? Do I have any reservations? Psychotherapy is the one chance we get in modern life to tell the absolute truth about ourselves. Is this person someone I feel can bear that responsibility?
2.References. Talk to friends, your minister, your doctor. A casual professional relationship isn't a good reference. You want to talk to someone who knows the therapist well-former patients are best.
3.The therapist's experience with depressed patients, including familiarity with cognitive and interpersonal techniques, which are recognized as especially effective with depression.
4.The therapist's openness to medication as part of treatment.
5.The therapist's willingness to be active and directive when it's called for, not to assume that listening by itself is enough, or that the patient's needs for advice or reassurance are childish and should be ignored.These last three factors are things you should definitely ask directly of the therapist. We are not gods, though some of us think so, and we will not be offended by direct questions. If you find a therapist who is offended, go find another therapist. As a matter of fact, it's best if you can to see two or three people for an initial consultation, and choose the one you feel can be most helpful.
Posted by sid on January 28, 2002, at 20:01:45
In reply to benefits of therapy? (longish), posted by m3 on January 28, 2002, at 18:56:52
Actually, some therapists openly annouce the type of therapy they're into. Some CBT clinics exist for example (cognitive-behavioral therapy). If that'S what you're looking for, then it's easy to find.
A concrete example (I did CBT and use it all the time now):
with chronic depression since I was 13, I used to feel bad about things as if there was a fault in me. I'd feel bad and guilty all the time. Now I can detach from things/situations and not hurt myself anymore than the actual situation. I stop the hurt. For example, my brother-in-law used to make me feel bad all the time, making nasty comments and sexually harrassing me. Now he still tries but he can't get to me. I ask myself if I did something to deserve this treatment. The answer is no because I want to avoid conflict with him, so I'm especially careful not to bother him. So if he treats me nadly it's his problem. If anything, I'm extra nice to him as long as he does not do anything unpleasant to me. Then, I avoid him when I see that he tries to put me down, I change room, I go talk to someone else. If need be, I tell him off. Bottom line is: I don't let it get to me anymore because I am fine, he has no reason to treat me badly, I don't deserve to be treated like this. I used to have low self-esteem and now, for the 1st time in my adult life (I'm 34), I do have self-esteem.The steps I can see in what I do (in this specific example):
1st: feeling bad because someone treats me badly
2nd: realization of actual situation (I don't deserve this)
3rd: action about it (I talk back, go somewhere else, etc...)
4th: beneficial feelings, or absence of bad feelings as there would otherwise be (I don't dwell on it, I move on to better things and people, trying to enjoy life as much as I can)Sometimes he still gets to me, which is normal, but I try very hard, ad usually succeed, to not stay there and wallow in the hurt. I am aware of my worth, my strength, and I use it.
It was hard at the beginning, then became easier, now it's practically automatic: I treat myself better.
Other ex: all-or-nothing thinking. I use to think in black and white and felt I had no options ahead of me in general. Of course! Life is not in black and white. I've learned to think in more subtle ways and discriminate options as well as "convex combinations" of options (different tones of grey).
The idea is that over time and because of depression, your brain functions in a certain way which has become self-defeating to you. By conciensciously (sp?) changing your thining pattern and behavior, you can "remap" (for lack of a better word) how your brain functions. 1st you learn to catch yourself thinking or doing self-defeating things, then you move on to do something about it. I always felt "stuck" during my depression, and I was, because I had thought and behavior patterns that kept me at the same place (depression!). I undid some of those patterns and got out of depression. It took a long time mind you, I lost patience many times, thought about suicide a lot, thought that life was boring to death for the longest time, etc... Now I am upbeat and think that life is an adventure worth living... It took time and efforts, but I feel good now.
The benefits of therapy are long term too because I still use CBT all the time. I think it helps to avoid further episodes of major depression.
Voilà. That was a long answer, which I hope can help you. I did not use meds for my major depression, but I would recommend CBT and meds simultaneously, to speed up the recovery process.
Posted by finelinebob on January 28, 2002, at 23:52:49
In reply to benefits of therapy? (longish), posted by m3 on January 28, 2002, at 18:56:52
> This is something I've always been curious about: can anyone offer concrete
> examples of how therapy has helped them? I know it's hard
> to sum up meaningfully, but I dunno, something like, before
> therapy I would do x, and now I can recognize other options
> and usually choose to do y.Although I put off getting serious about therapy until I was 35 or so (been demonstrably depressed since the age of 8), I certainly knew things weren't right and spent a lot of time trying to figure out what was wrong. Over the years, I developed several metaphors to describe it since the core of my disorder is inaccessible -- for a long time, I've had this image of being out in the desert at night, sandstone rocks making some sort of wide circle with a bonfire in the middle and me dancing around that bonfire. I have never been able to look to the center. I know that's where my answers reside, but I can't look there. And even though in this imagery I can see shadows cast upon the ring of rocks, I still seem to think of the true center of that circle as more of a black hole than a fire.
Therapy is often compared to peeling back layers of an onion. For me, therapy has been more like moving closer to the center of that circle. And there was a time about a year ago when I finally realized that I'd made it -- I was standing at the center.
I've had a lot of sh*t happen in the year between that has completely side-tracked me from that.
All the same, I know I was there. It really is a black hole for me, tho ... I would leave a therapy session and not be able to remember a single thing that my T and I had discussed, but I'd still feel that something right happened. A lot of talk has helped to shed some light in that hole, and I can identify some of what's going on there now. But I still need just to stand there and study the lay of the land, to let my eyes grow accustomed to the light levels, if you will.
The other, much simpler way I know I've made progress? I've mentioned it elsewhere, but I'll say it again here: My T and I have dealt with all the issues I was willing to talk about or I **needed** to talk about, given events of the day. We've finally gotten me to the point where we can discuss the issues I **really** do NOT want to talk about one bit, with anyone!
Funny way to start a session..."I really don't want to say this, but ...". I know things are going well when, ten minutes into a session, I realize I'm pissed as hell at myself for opening my mouth.
flb
Posted by m3 on January 29, 2002, at 11:32:19
In reply to Re: benefits of therapy? (longish) » m3, posted by sid on January 28, 2002, at 20:01:45
Thanks for sharing your experience, sid...actually, I didn't make this clear,
but I've been in therapy for almost two years now (minus a few months' gap),
so these aren't new questions to me. In fact I really like my therapist
and I think that having a rapport with her is really important to
whatever it is that we're up to...I'm just a very analytical person,
and she doesn't follow the CBT model, which seems to me to be
the simplest/most behaviorist/easiest to understand. And yet CBT
also seems reductive to me at times, so I'm not concerned that she
doesn't use it as her sole method. She has tried explaining her
school of thought to me a few times (feminist/psychosocial/something-or-other),
and I sort of understand it, but I still don't quite grasp how it
relates to me feeling better. Probably something I'm fastening onto
to avoid thinking about the real point of why I'm there. :}
Posted by m3 on January 29, 2002, at 11:55:08
In reply to Re: benefits of therapy? » m3, posted by finelinebob on January 28, 2002, at 23:52:49
Wow, flb, your post sounded a lot like me/my issues. I hadn't come up
with the bonfire/black-hole image on my own, but perhaps I'll borrow
it now. :) I have the same experience of not being able to remember
what goes on in some sessions...sometimes it comes up within a session
that I can't remember details of something that was painful, or I feel
like I run out of things to say on whatever topic we're on. Probably very
common in therapy (my T doesn't seem surprised, anyway), but it's still a
weird feeling, like the train of thought I was on smashes full
tilt into a wall and splinters into a lot of unrecognizable pieces.Anyway, many thanks for your response. Do you know what school/methodology/model
your T subscribes to? (I can't help it, I am a persistently curious person. :) )
> Although I put off getting serious about therapy until I was 35 or so...
Posted by pedr on January 29, 2002, at 12:16:42
In reply to benefits of therapy? (longish), posted by m3 on January 28, 2002, at 18:56:52
> This is something I've always been curious about: can anyone offer concrete
> examples of how therapy has helped them? I know it's hard
> to sum up meaningfully, but I dunno, something like, before
> therapy I would do x, and now I can recognize other options
> and usually choose to do y.
>
> I know that clinical studies show therapy is pretty consistently
> effective for many/most people with depression and
> some other diagnoses. My scientific/knowledge-seeking/informed-patient
> side is impatient with the subjective part of it and wants
> to know how it works.
>
> I guess a related question is, how is a "newcomer"
> (someone who's getting psych. symptoms for the first time)
> supposed to pick a doctor? It seems odd to me that we're just
> supposed to go by whether we feel a rapport with them, when
> 1) they (i.e. mental health professionals) presumably have strong and
> differing views of what's the best way to treat people, and
> 2) most of us know nothing, at least up front, about the different
> options.
>
> I guess what I'm getting at is, an educated mental health professional
> who was getting symptoms would presumably make a choice of shrink
> based on methodology, but your average patient can't. Seems strange
> to me...anyone else feel the same?m3,
I was referred to a CBT therapist through my GP so that is where I started. As the waiting list was 1.5 years [bloody NHS] so I went private. It helped a tiny bit - about 3%. I then took Cognitive Analytical Therapy [CAT] for a good 25 sessions or so. This also helped a tiny bit. I was gutted as my expectations had been so much higher and I was still in so much pain and distress.I then saw a psychiatrist privately at the Priory [famous expensive clinic] and he recommended I do Rational Emotive Behaviour Therapy [REBT - used be called RT or RET]. I'm getting to grips with it now and it the most powerful model I've tried. Don't get me wrong - most days I'd rather not be around due to depression and anxiety, it is not a panacea. But, I am [touch wood] noticeably more resilient than before I started REBT. And it gives me hope which is important.
You might want to check it out at http://www.rebt.org/
HTH and best wishes,
pete.
Posted by finelinebob on January 29, 2002, at 18:53:49
In reply to Re: benefits of therapy? » finelinebob, posted by m3 on January 29, 2002, at 11:55:08
> Wow, flb, your post sounded a lot like me/my issues. I hadn't come up
> with the bonfire/black-hole image on my own, but perhaps I'll borrow
> it now. :)Be my guest! =^)
> Anyway, many thanks for your response. Do you know what school/methodology/model
> your T subscribes to? (I can't help it, I am a persistently curious person. :) )She's quite eclectic in her approach. She was trained at Michigan which, when she was there, was a lot more psychodynamic than it is even today. She's more Buddhist than Jewish, but both are important to her. She does a lot of yoga and has hooked me up with some alternative med practitioners from wholistic nutritionists to a kinesiologist to therapeutic massage. She's quite a talented painter. Not at all interested in technology for its own sake, but (1) once she got a portable cd player she could hook up to her ancient all-in-one tape/radio/record (yes, as in vinyl, LP, analog audio) player she accumulated the most amazing and extensive world music collection I have ever seen (better than what you can find at Tower Records, I'd say), and (2) once she saw the Mac Cube and flat-panel display, she replaced her 386 with one of those (which is good for me, since I've been bartering therapy for computer lessons ... she wants to explore creating digital art). She has a bright, open mind and an experience-rich life, and she remains open to just about any approach that lends insight into one's life. She places the emphasis on the insight and not the theoretical path to it.
That said...I hope it gives you some sense.
Thinking about other ways I've known that therapy has made some contribution or, rather, I've made some progress through therapy ... ever have a dream about flying? I've had several, though none in years as far as I can remember, but as a lucid dreamer I could never tell if I was really flying or having an out-of-body experience. The reason I bring it up is that on several occasions, 3 or 4, where I've felt my T and I have really been able to pierce the veil through to something that been hidden inside me for a long, long time, I've had that out-of-body experience feeling right there on the couch. Too hard to describe -- kind of like my "spirit" was floating several inches above where my body was. Still, it was an intense, wonderful feeling ... as if my brain had cooked up the best reward it could give me for finally figuring out something crucial, finally fitting some critical part of the puzzle together.
(whoa!)
flb
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