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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by justyourlaugh on October 3, 2003, at 15:53:41
on tuesady i talked with my social worker about the past..
lots of childhood si...
now i cant stop thinking about si..i was real confident i was getting better..
could talking about it be triggering me?
i am picking at my head...noticing the knives i am putting away after meals...
i am so very hurt that this seems to have showed its horrible head ...again..
?
confused about going forward with weekly visits..
any help..
i am lost as to who to ask for advice??
jyl
Posted by Poet on October 3, 2003, at 17:16:13
In reply to confused about what is good...may trigger*****, posted by justyourlaugh on October 3, 2003, at 15:53:41
Hi Justyourlaugh,
Stay away from those knives, except for cutting food. Cutting yourself will only bring physical pain and deep down you know it won't release the emotional stuff. Anymore than when I stuff my face with food and then stick my fingers down my throat.
I didn't start therapy because I am an ex-bulimic. It didn't even come out until my sixth session. I pretty well keep myself under control by telling myself over and over that eating and purging won't get rid of what is really hurting me.
Talk can trigger my bulimia: if I get upset over something, I still reach for that comfort food. But I do it less often since I've been in therapy even if it isn't the issue I went in with.
I think that what you feel is similar to me. Your brain tricks you into thinking that the knives, like eating way too much food, will let the pain out.
They won't and keep telling yourself that. I'm going to stick with therapy, try to stick with it, too. You are brave to want to face those demons.
Poet
Posted by fallsfall on October 3, 2003, at 17:44:24
In reply to confused about what is good...may trigger*****, posted by justyourlaugh on October 3, 2003, at 15:53:41
I think that talking could be triggering.
I would talk about that with her, and your therapist and your pdoc and any other mental health person you come in contact with. In the meantime, try to acknowledge that you have that option, but are choosing not to use it - you have other (better) ways of dealing with the stresses.
Remember to love yourself.
Posted by Dinah on October 3, 2003, at 18:39:35
In reply to confused about what is good...may trigger*****, posted by justyourlaugh on October 3, 2003, at 15:53:41
I'd let your therapist know that talking about it stirs up the urges. It does for me as well sometimes, though other times it dissipates them. Then you could decide together what to do about it.
Take care of yourself. I've been trying to watch the urges pass by like leaves on a stream. It works better when I've had a tranquilizer.
Posted by HannahW on October 6, 2003, at 0:34:55
In reply to confused about what is good...may trigger*****, posted by justyourlaugh on October 3, 2003, at 15:53:41
I really don't have any good advice, but I wanted to tell you I'm sorry this is coming up again for you. It seems like just when I think an issue is dead, there it is again. I do, however, find that each time it comes up, it's easier to deal with, and I make more progress toward full recovery. I'm hoping for the same for you.
I posted for you on the Why Can't I Cry thread. I hope you'll read it. Basically, it's me apologizing for coming across badly. I honestly didn't mean to, and was glad that you responded to my post.
Hannah
Posted by jay on October 7, 2003, at 8:37:27
In reply to confused about what is good...may trigger*****, posted by justyourlaugh on October 3, 2003, at 15:53:41
> on tuesady i talked with my social worker about the past..
> lots of childhood si...
> now i cant stop thinking about si..i was real confident i was getting better..
> could talking about it be triggering me?
> i am picking at my head...noticing the knives i am putting away after meals...
> i am so very hurt that this seems to have showed its horrible head ...again..
> ?
> confused about going forward with weekly visits..
> any help..
> i am lost as to who to ask for advice??
> jyl
>JYL:
Sorry to hear...really! That sounds like unacceptable therapist behaviour. Catharsis (letting out emotions) is rarely productive in therapy. In fact, it can lead people to feeling "stuck".
What I would highly recommend (as a fellow Social Worker...even if I am f***ed up...heh) is focusing on the "here and now". This is much like Person-Centered counselling, Brief-Treatment, with some CBT thrown in. Think of it this way:
-Goal directed (i.e. short and long term)
-Try to develop a 'contract' (I will put up an example if anyone wants)
-Goal setting/implementation strategies (this is a bit tougher than it sounds...so focus on both short and long term *realistic* goals, which can be part of your contract. If they don't pan out, it's not your fault, it just means they may need to be adjusted.)The counsellor is likely/should be equipped with all of the excellent latest tools in empathy, interviewing skills, body language, etc.
So, maybe take some of this info to your counsellor, and explain in very concrete ways what you are looking for. The older psychotherapeutic/cathartic therapies have been proven not be very useful, and they are rarely even offered now in training in college/universities.
Please let me know what you think.
Best wishes,
Jay
Posted by Dinah on October 7, 2003, at 8:53:20
In reply to Re: confused about what is good...may trigger*****, posted by jay on October 7, 2003, at 8:37:27
The research shows that therapist theoretical orientation has little to do with therapy outcome. The biggest indicator of therapy success is the client's perception of the therapeutic relationship.
Catharsis may not be right for every patient. But it's not wrong for every patient either. We're all different and have different needs.
CBT may also not be right for every patient either, although it is certainly not wrong for every patient. The same thing for person centered and brief therapy.
And if my therapist was too goal directed and mentioned contracts, I'd dig in my heels and do the exact opposite of what he wanted. Different things work for different people.
I'll try to look up some of the latest outcome research if I get some time. It's really very interesting. But if you were to sum up a large body of research, the most simple description of the outcome is that old view (Rogers was it?) that the relationship is everything.
Posted by Dinah on October 7, 2003, at 9:07:08
In reply to Re: confused about what is good...may trigger*****, posted by Dinah on October 7, 2003, at 8:53:20
> The research shows that therapist theoretical orientation has little to do with therapy outcome. The biggest indicator of therapy success is the client's perception of the therapeutic relationship.
>
> I'll try to look up some of the latest outcome research if I get some time. It's really very interesting. But if you were to sum up a large body of research, the most simple description of the outcome is that old view (Rogers was it?) that the relationship is everything.You might look for:
Lambert, Shapiro & Bergin, 1986
Miller et al, 1997
And I was incorrect. Client factors account for the biggest variable in change.
Posted by justyourlaugh on October 7, 2003, at 9:16:05
In reply to Re: confused about what is good...may trigger*****, posted by Dinah on October 7, 2003, at 8:53:20
thankyou all for the input...
sometimes i feel so alone in this , but all of you have been a great "sunny spot" in this fork in the road.
i see my social worker in a hour,
jay,, he is an artist as well ,,and i am sure he is trying very hard to make me cry...
last week i got frustrated and said i refuse to talk about such things , i said " i am not crying today !"
he keeps insisting that i was molested or raped as a child and i am holding back,,
dinah,,i feel so tired,
there is so much researh out there,,many contradicting the other..
did you read the one about how medication is making the illnesses worse..
what do i believe, who do i trust?
i havent changed my clothes in days,,i need to "pretty up" for my appointment..mabe ill put something slutty on..
sorry for the run on..
jyl
thanks again for the support
Posted by Dinah on October 7, 2003, at 9:20:56
In reply to Re: confused about what is good...may trigger*****, posted by justyourlaugh on October 7, 2003, at 9:16:05
Ok, but Jyl. Be wary if you're therapist is trying to get you to remember things you don't think happened. My therapist expresses doubt frequently about my assertion that I was never molested. But the fact was that I wasn't, and he accepts it. Even if he doesn't understand how I got to be who I am if I weren't.
Posted by Dinah on October 7, 2003, at 9:22:18
In reply to Re: confused about what is good...may trigger*****, posted by justyourlaugh on October 7, 2003, at 9:16:05
P.S. Jyl
A friend and I think that therapists and pdocs should add to their standard questions "When was the last time you bathed before today." It's an excellent mood guage, but we always clean up before we go see them.
Posted by fallsfall on October 7, 2003, at 9:26:54
In reply to Re: confused about what is good...may trigger***** » justyourlaugh, posted by Dinah on October 7, 2003, at 9:22:18
Unless you want to be sure that they know you are having a hard time - then you show up as grungy as you can.
Posted by jay on October 7, 2003, at 9:33:05
In reply to Re: confused about what is good...may trigger*****, posted by Dinah on October 7, 2003, at 8:53:20
I know what you are saying, but as I said, psychoanalysis in it's original form is not being taught at schools of social work anymore. There are some off-shoots that work, obviously including what where once two different types of therapy...Cognitive and Behavioural. Brief-Treatment/Person Centered (which was practiced by Carl Rogers) counselling utilizes a bit from most fields, including Trait-Factor counselling, Gestalt, Adlerian, Humanistic, RET (Rational Emotive Therapy), Jungian, and Family Systems. I am hoping to but together a package for folks. CBT is of course now the most popular.
But, what I was trying to say, is a therapist uses bits and pieces of many types of counselling, and I would be hard-pressed to find a university in N. America that teaches the original, cathartic-focused Psychoanalysis. The term used is "Eclectic Therapy".
Also, I think you misunderstood, that goal setting and using a contract can take place at any point in the sessions. Until the client is comfortable, then those things may be introduced.
Posted by Penny on October 7, 2003, at 9:33:25
In reply to Re: confused about what is good...may trigger***** » justyourlaugh, posted by Dinah on October 7, 2003, at 9:22:18
> P.S. Jyl
>
> A friend and I think that therapists and pdocs should add to their standard questions "When was the last time you bathed before today." It's an excellent mood guage, but we always clean up before we go see them.Makes me think of when I was in the hospital - every evening we did vital signs in the day room, and they would ask: Did you have a shower today? A BM? As though that made all the difference.
Oh my...
P
Posted by Penny on October 7, 2003, at 9:36:38
In reply to Re: confused about what is good...may trigger*****, posted by justyourlaugh on October 7, 2003, at 9:16:05
I agree with Dinah, JYL. I've had several therapists say to me that they suspect I was molested as a child, but I have no memory of such and, other than my many issues with men, no reason to believe that I was. My current therapist doesn't bring it up.
But just being told that several times makes me question everything.
Trust in yourself. Go with what you know is true, and let therapy guide you toward the truth, but don't let it determine the truth for you.
Sorry if that makes no sense...
P
Posted by jay on October 7, 2003, at 9:51:46
In reply to Re: confused about what is good...may trigger*****, posted by Dinah on October 7, 2003, at 9:07:08
> > The research shows that therapist theoretical orientation has little to do with therapy outcome. The biggest indicator of therapy success is the client's perception of the therapeutic relationship.
> >
> > I'll try to look up some of the latest outcome research if I get some time. It's really very interesting. But if you were to sum up a large body of research, the most simple description of the outcome is that old view (Rogers was it?) that the relationship is everything.
>
> You might look for:
>
> Lambert, Shapiro & Bergin, 1986
>
> Miller et al, 1997
>
> And I was incorrect. Client factors account for the biggest variable in change.
Hey, no problem! This type of debate is very important. I don't want to come off as a know-it-all (sorry if I am), but am just posting things that I have found helped, and even let me help others as a (former) counsellor. I've got tons of books on therapeutic talking techniques, but I also worked in the field for a long time which took my head out of the text and into the real world. I *empathetically* state that I learn't mostly from my clients then a text book.It's slowly helped me, and I'd like to share with others, and I also do realize there are many who benefit from things that I haven't used with others or myself. I am a *very* open guy.
The main thing that bothers me is people seeing the same therapist for ten years, making that individual quite rich. Brief-Treatment/Person-Centered isn't just go through a few days then kick them out the door. It often focuses on crisis situations, and the same techniques can be used if the client returns. The goal planning again is in a state of flux..meaning things can change a fair bit over time.
I make it sound simple, but it is actually fairly complex. The reason it is used is not only because of it's proven efficacy, but because when dealing with everyone from homeless, detox, to mental health, the model is powerful bringing about fairly quick changes...small as they may be. If I counselled someone in a 28 day rehab program, there are many, many pressures to get their life back in order, and to prepare them for the 'real world'. Using classic psychoanalysis would be very irresponsible, kind of like fitting a car without brakes and tires.
So, I hope that makes sense. I am putting together a 'portfolio' for Doc Bob on the counselling process, and I really could use your guys feedback and contributions. I've noted that reference you gave...thanx Dinah.
Please take care,
Sincerely,
Jay
Posted by Dinah on October 7, 2003, at 9:51:53
In reply to Re: confused about what is good...may trigger***** » Dinah, posted by jay on October 7, 2003, at 9:33:05
>
> Also, I think you misunderstood, that goal setting and using a contract can take place at any point in the sessions. Until the client is comfortable, then those things may be introduced.Chuckle. I've been in therapy over eight years, am relatively comfortable, and would still actively protest contracts and intrusive goal setting by doing the opposite. Unless of course, I recognized it as a paradoxical intervention, in which case I would bless my therapist out thoroughly because I despise being openly manipulated, then do exactly what he didn't want me to do. Gentle suggestions I accept just fine. :)
Posted by jay on October 7, 2003, at 9:55:56
In reply to Re: confused about what is good...may trigger***** » justyourlaugh, posted by Dinah on October 7, 2003, at 9:22:18
> P.S. Jyl
>
> A friend and I think that therapists and pdocs should add to their standard questions "When was the last time you bathed before today." It's an >excellent mood guage, but we always clean up >before we go see them.Hahahaaa..yes that is great! You know, I used to be such a good dresser..designer jeans, silk shirts...really nice expensive cologne. Oyyy..what has happened to me?!..heh. Another part of the 'lost', I guess. But..I am praying...I am *really* praying!..hah.
Posted by Dinah on October 7, 2003, at 10:09:35
In reply to Re: confused about what is good...may trigger*****, posted by jay on October 7, 2003, at 9:51:46
Well, since I've spent eight years with the same counselor, obviously I don't agree about the superior value of short term therapy. I put the poor guy through hell (ok Dr. Bob, you said I could say that) with minimal change for the first five years. Brief therapy would have been useless for me, because therapy for me *started* in year six. I tested him, I challenged him, I quit several times, I insulted him, I had him wondering if he shouldn't refer me out. And I am ever blessed that he didn't. Because his sticking with me for five years while I was a hellish client, and learning and growing as a therapist along the way. His letting me see how I affected him, in the most therapeutic and non-exploitive way possible. And most of all, almost all of all, his being there, session after session, getting mad, working things out, but overall treating me well even when he was angry and I was obnoxious, most of all JUST BEING THERE (I can't emphasize that enough) was what worked for me in therapy.
After five years he had earned my trust, and I started to work with him. If he had given in to his now admitted impulse to refer me out, it would have shattered my trust in future therapists forever. Instead, he tought me that trust doesn't always end in pain. Usually, but not always.
Social workers might not learn psychoanalysis, and they shouldn't. Psychoanalysts should. And today's psychoanalysts are unlikely to mention penis envy. But psychoanalysis still has it's place.
And my therapist isn't a psychoanalyst. But long term therapy was right for me. It wasn't harmful. It may have made him comfortable financially, but it wasn't a scam. I don't change quickly. I don't change easily. And short term therapies (by which I mean shorter than several years) wouldn't have made a dent.
But... everyone is different.
Posted by Adia on October 7, 2003, at 10:24:49
In reply to Re: confused about what is good...may trigger*****, posted by Dinah on October 7, 2003, at 10:09:35
Hi Dinah,
been reading the thread this morning and I just wanted to say that I too feel that we all have different needs and short-term therapy wouldn't have worked at all for me...I've seen my therapist for 3 years and it took me those 3 years to build trust and to be able to start talking...I wouldn't have accomplished anything in less than that, and I still have a long long way to go, but what truly helped me so far is to know she would be there no matter what, no matter what I told her, no matter what I did. That she would stick by me...Just as you shared.
I needed those years to build trust. And the relationship I build with her and that safety and trust makes all the difference in my life.
I can't see how short-therapy would help me..I may be wrong but to be helped mostly in crisis or to be able to function doesn't feel I would be solving the real underlying issues and the crisis would always come back and inside I would be just as hopeless and isolated as I feel sometimes.
I feel that for me the way to change or to live a better life, is throught developing a trusting relationship (for the first time in my life) and being accepted and heard. I would panic with all that goal-oriented thing and fix-it thing as soon as possible. I prefer to go at my pace and know that my therapist will be there...
as far as money goes, I don't feel it is that I am making her rich. I feel she cares about me (and her patients) as human beings and that she just has to make a living but that she loves her profession.
i can't think how short-term therapy would work..maybe it does work when you want to have some insight on some very specific issue, but I can't think how that can help you change or feel more whole, or enrich your whole life.But as you said we all have different needs..
just my feelings...
Adia.> Well, since I've spent eight years with the same counselor, obviously I don't agree about the superior value of short term therapy. I put the poor guy through hell (ok Dr. Bob, you said I could say that) with minimal change for the first five years. Brief therapy would have been useless for me, because therapy for me *started* in year six. I tested him, I challenged him, I quit several times, I insulted him, I had him wondering if he shouldn't refer me out. And I am ever blessed that he didn't. Because his sticking with me for five years while I was a hellish client, and learning and growing as a therapist along the way. His letting me see how I affected him, in the most therapeutic and non-exploitive way possible. And most of all, almost all of all, his being there, session after session, getting mad, working things out, but overall treating me well even when he was angry and I was obnoxious, most of all JUST BEING THERE (I can't emphasize that enough) was what worked for me in therapy.
>
> After five years he had earned my trust, and I started to work with him. If he had given in to his now admitted impulse to refer me out, it would have shattered my trust in future therapists forever. Instead, he tought me that trust doesn't always end in pain. Usually, but not always.
>
> Social workers might not learn psychoanalysis, and they shouldn't. Psychoanalysts should. And today's psychoanalysts are unlikely to mention penis envy. But psychoanalysis still has it's place.
>
> And my therapist isn't a psychoanalyst. But long term therapy was right for me. It wasn't harmful. It may have made him comfortable financially, but it wasn't a scam. I don't change quickly. I don't change easily. And short term therapies (by which I mean shorter than several years) wouldn't have made a dent.
>
> But... everyone is different.
Posted by Adia on October 7, 2003, at 10:32:33
In reply to Re: confused about what is good...may trigger*****, posted by jay on October 7, 2003, at 8:37:27
Hi..
just wanted to say that I don't think letting out emotions and catharsis is wrong...maybe at some time it doesn't work with a particular patient, but I don't understand how denying or holding your emotions inside could help. If I don't let them out, they stay inside of me and I am isolated and alone with them..
I find it so relieving when I am able to show emotions and cry or talk about things which I've kept secret all my life.
I understand we are all different and have different needs and different things work for us...
But i don't think it is wrong to let out emotions...I even want to be able to do that and let go, instead of holding it all inside, it doesn't disappear and it doesn't go away just because I don't address it. Everything is there and it affects the way I live.
Maybe in some cases it can be triggering..but I have found that it was better to go through the pain, instead of keeping it inside and living in denial...just my feelings...sorry if I am wrong...
Adia.
> > on tuesady i talked with my social worker about the past..
> > lots of childhood si...
> > now i cant stop thinking about si..i was real confident i was getting better..
> > could talking about it be triggering me?
> > i am picking at my head...noticing the knives i am putting away after meals...
> > i am so very hurt that this seems to have showed its horrible head ...again..
> > ?
> > confused about going forward with weekly visits..
> > any help..
> > i am lost as to who to ask for advice??
> > jyl
> >
>
> JYL:
>
> Sorry to hear...really! That sounds like unacceptable therapist behaviour. Catharsis (letting out emotions) is rarely productive in therapy. In fact, it can lead people to feeling "stuck".
>
> What I would highly recommend (as a fellow Social Worker...even if I am f***ed up...heh) is focusing on the "here and now". This is much like Person-Centered counselling, Brief-Treatment, with some CBT thrown in. Think of it this way:
>
> -Goal directed (i.e. short and long term)
> -Try to develop a 'contract' (I will put up an example if anyone wants)
> -Goal setting/implementation strategies (this is a bit tougher than it sounds...so focus on both short and long term *realistic* goals, which can be part of your contract. If they don't pan out, it's not your fault, it just means they may need to be adjusted.)
>
> The counsellor is likely/should be equipped with all of the excellent latest tools in empathy, interviewing skills, body language, etc.
>
> So, maybe take some of this info to your counsellor, and explain in very concrete ways what you are looking for. The older psychotherapeutic/cathartic therapies have been proven not be very useful, and they are rarely even offered now in training in college/universities.
>
> Please let me know what you think.
>
> Best wishes,
> Jay
>
>
Posted by Penny on October 7, 2003, at 10:43:07
In reply to Re: confused about what is good...may trigger***** » jay, posted by Adia on October 7, 2003, at 10:32:33
Adia,
I don't think you are wrong at all. In fact, isn't that one of the purposes of therapy - to have a 'safe place' where we can be honest and express our emotions?
I don't think the matter here is how long therapy lasts, or which is more effective (long-term or short-term), but just to make sure that there are certain goals and methods of reaching those goals. I, personally, think that therapy is a combination of art and science, and it takes a skilled practitioner to weave the two together effectively. In fact, in my last session, my therapist talked to me about ways we can use CBT and DBT techniques, but combine those with some work on my past and the pain I experienced growing up, etc.
I can see how raw emotion expressed but not processed in therapy could be harmful, but if you are expressing that emotion and processing it with the help of the therapist, isn't that the point?
I guess it depends on what your goals are.
P
Posted by Adia on October 7, 2003, at 11:25:34
In reply to Re: confused about what is good...may trigger***** » Adia, posted by Penny on October 7, 2003, at 10:43:07
Penny,
Thank you for your message, I guess I was in panic after reading the other messages and I guess I was or I am not in the best place to read that kind of thing..sorry :o)
And yes you are right...We all have goals in therapy and it is important to know what they are...My therapist is sometimes hard or pushy when she feels I'm stuck or I am not progressing the way she thinks I could..and I find it relieving too to know where we are going.I just feel scared to be told feelings are not okay...but I feel better now after reading your post and Dinah's :o)
I am glad you have a good therapist. :o) Thank you for sharing your views with me.
> Adia,
>
> I don't think you are wrong at all. In fact, isn't that one of the purposes of therapy - to have a 'safe place' where we can be honest and express our emotions?
>
> I don't think the matter here is how long therapy lasts, or which is more effective (long-term or short-term), but just to make sure that there are certain goals and methods of reaching those goals. I, personally, think that therapy is a combination of art and science, and it takes a skilled practitioner to weave the two together effectively. In fact, in my last session, my therapist talked to me about ways we can use CBT and DBT techniques, but combine those with some work on my past and the pain I experienced growing up, etc.
>
> I can see how raw emotion expressed but not processed in therapy could be harmful, but if you are expressing that emotion and processing it with the help of the therapist, isn't that the point?
>
> I guess it depends on what your goals are.
>
> P
Posted by judy1 on October 8, 2003, at 9:39:37
In reply to Re: confused about what is good...may trigger***** » Penny, posted by Adia on October 7, 2003, at 11:25:34
this has probably been the most damaging aspect of any of the therapies I have been through- asking to recount childhood memories is easily the most triggering act for me. acknowledging that it occurred is one thing, but some therapists have insisted on the 'facts' and that is a guarantee to put me in a dissociative state and subsequently si. while my therapist most definitely gets it, my shrink does not- although I think he sees the relationship of bringing it up and me disappearing for 3 months. I guess for me 'here and now' therapy has been the most helpful, but I think we all can agree that our unique problems all carry unique solutions. take care, judy
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