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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 g_g_g_unit on October 12, 2013, at 11:30:26
I've done a bunch of CBT over the years -- usually with recent graduates (due to more accommodating hourly rates), and one or two academics ..
regardless, I found working with a psychodynamic therapist/psychiatrist for about a year so much more intensely rewarding. I probably filled out hundreds of CBT worksheets and they barely made a dent in my psyche, but, even with my disintegrating memory/cognition, there are a handful of piercing insights from my psychiatrist that I don't think will leave me. I have a natural tendency to want to challenge and rebel authority figures, but he seemed to cut through that.
I don't know why that's the case .. if it's the nature of the process, or the fact that I respected him so much and was in awe of his intelligence.
I don't want to denigrate CBT, as I'm sure the practitioners are intelligent, but I just find it so bland and the 'advice' they offer me often just feels ripped-from-the-pages or something .. I have to continue with at some stage, since I have OCD, but I tried seeing a psychologist recently again (younger, maybe late 30s) and was bored. I wonder if I should look for someone older, but then I do worry about how up-to-date they might be, since the field seems to change so much
Posted by SLS on October 12, 2013, at 15:32:28
In reply to being challenged in therapy, posted by g_g_g_unit on October 12, 2013, at 11:30:26
I sometimes like to think of CBT as being more of a coping tool to be used while other therapies are administered and gain momentum.
I think CBT can reach surprisingly deep into one's psyche, but it takes a good therapist to help determine where to dig. It takes an understanding of the CBT paradigm and process for it to work best. If you don't focus on the dynamics between automatic thoughts > intermediate beliefs > core beliefs, you're not doing it right.
Some people say that CBT is worse than no therapy at all. I don't understand this.
- Scott
Posted by baseball55 on October 12, 2013, at 19:56:35
In reply to Re: being challenged in therapy, posted by SLS on October 12, 2013, at 15:32:28
I did dynamic therapy with a p-doc for eight years. It was an amazing, unforgettable experience. I still see him for meds now and still feel very close to him. I felt like I was never in my life so well understood.
I did a CBT group and found it useless. My depression and suicidality went back a long, long way into my childhood, which I had buried completely. IN CBT they kept wanting to attribute symptoms to some contemporary event and accompanying thought -- like my boss looked at me cross-eyed, so he must hate me and I'm a failure. But I never thought things like that. I liked my job, felt good about myself as I related to the world, for the most part.
But I would become disabled by hopelessness and thoughts of suicide. Dynamic therapy forced me to uncover a lot of defenses I had put up to avoid dealing with my childhood and adolescence and all the trauma I had experienced.
After working with my p-doc, I began working with a DBT therapist. This is so much more helpful than CBT. It's less about identifying negative thoughts and more about learning to accept and learn to regulate negative emotions. The emphasis is on learning to be mindful and practice self-compassion. Which isn't so different, actually, from what my p-doc always said about reparenting myself.
But even with DBT, I found that, when I was depressed I couldn't use it and when I was okay, I didn't feel the need for it. Now that I've been feeling more stable, I find the DBT more helpful in keeping me stable.
The one downside, for me, of dynamic therapy, was that I had intense and sometimes overwhelming transference issues which occasionally caused more problems than they solved. We did work through it. But it took a lot a time and a lot of tears.
Posted by alexandra_k on October 12, 2013, at 20:16:22
In reply to being challenged in therapy, posted by g_g_g_unit on October 12, 2013, at 11:30:26
CBT is very problem focused. Behavioral change focused. I think the idea is to try it in the first instance. If it works - great. I think often it tides people over while they right themselves / while the meds kick in. Perhaps I did gain something from doing it the first time... It was so long ago, I forget. It didn't take too long before my therapist said she'd run through all her toolkit of whatever that seemed applicable for my case. I think that took her... All of 3 months.
I think the relationship is the most important thing. And that that can transcend pretty much any actual training or qualification. They can't quantify much in the way of what features will make a good match.
I... I think I am starting to think more in stereotypes than I used to. I think maybe because where I'm living now... The population is much larger and more diverse. I guess... When that happens perhaps stereotypes are more likely to come online to help you deal... Not sure if that makes much sense...
If you want someone who is keeping up to date with research then see someone who is involved in research or who has colleagues who are (e.g., someone who has something to do with teaching / training newbies). If that is too expensive... Then someone who is in training themselves. Hopefully... They will have good supervision.
Just because something is new doesn't mean it is an improvement, though. I mean... There are advances... But there is an awful lot of 'apparent advances' which are of course required for funding etc etc etc. There is a lot of smoke and mirrors... I guess the idea is that people who are trying their best to make advances... Well... At least those people are trying their best. People away from taht setup... Who knows. More likely to be 'just a job'.
Only that isn't quite fair / right either. Where are you more likely to find someoen who actually helps *You* (rather than them). Or... Who is a good fit such that what is good for them is also good for you... The fit is the most important thing.
I'm sorry I'm not making much sense today.
Transference is hard for me to. I think it is helpful. But it is hurtful. It feels like it is... The right kind of hurt.. A good hurt... LIke finding a knot with the foam roller..
Posted by g_g_g_unit on October 13, 2013, at 3:34:39
In reply to Re: being challenged in therapy, posted by SLS on October 12, 2013, at 15:32:28
> I think CBT can reach surprisingly deep into one's psyche, but it takes a good therapist to help determine where to dig. It takes an understanding of the CBT paradigm and process for it to work best. If you don't focus on the dynamics between automatic thoughts > intermediate beliefs > core beliefs, you're not doing it right.
>Yes, I wouldn't want to undermine CBT because I believe it can work for certain issues like anxiety/OCD.
I suppose one difference is that CBT placed a lot of weight on my own interpretations of issues, whereas psychodynamic therapy often involved my therapist interpreting/analyzing my streams-of-consciousness; in other words, the stuff he offered was highly personalized and there was something jarring about having it come from him. Maybe it's because other therapists I've worked with haven't elicited that degree of respect, and I certainly don't respect myself very much. I also felt the experience more intellectually enjoyable, which I can understand might not necessarily correlate with its real-world utility.
> Some people say that CBT is worse than no therapy at all. I don't understand this.
>I think I can partially understand that insofar as CBT seems to place a heavy weight on issues stemming from your own faulty interpretation of things, and if you aren't in a position to enact much behavioural change, it can just become frustrating. If I complain about not being able to read or achieve a certain standard it's because I'm a "perfectionist", which just paints a desire for a certain quality-of-life as a pathology.
At this point, I feel like there's enough rational reason for me to be depressed, and I don't think there's much difference in my quality-of-life between living in chronic escapism and when I was undergoing CBT.
Posted by g_g_g_unit on October 13, 2013, at 3:40:40
In reply to Re: being challenged in therapy, posted by baseball55 on October 12, 2013, at 19:56:35
Thanks for sharing your experience, baseball55. It's cool you had such a life-changing experience .. I never quite attained that degree of comfort with my psychiatrist, I do have rather stubborn father issues and could never quite get past his masculine authority, though I also partially blame that on my treatment-resistant anxiety.
DBT sounds interesting. I think like I alluded to in the post before, there's the fact that a lot of my negativity and despair feels rational and environmentally-enforced and attempts to change my thinking often feel fruitless, which result me just blaming myself even more for not being able to change.
I've never been disposed towards analytic interpretations of OCD, but one interesting thing is that my (now severe) OCD emerged precisely at a time when I could no longer live in denial of my ADHD, and emerged as another excuse to divert me from it. No CBT practitioner seems particularly enthused about this idea -- that the OCD itself became a kind of defense mechanism -- but my old psychiatrist said it seemed perfectly logical to him.
Posted by Dinah on October 13, 2013, at 8:25:59
In reply to Re: being challenged in therapy » baseball55, posted by g_g_g_unit on October 13, 2013, at 3:40:40
> I've never been disposed towards analytic interpretations of OCD, but one interesting thing is that my (now severe) OCD emerged precisely at a time when I could no longer live in denial of my ADHD, and emerged as another excuse to divert me from it. No CBT practitioner seems particularly enthused about this idea -- that the OCD itself became a kind of defense mechanism -- but my old psychiatrist said it seemed perfectly logical to him.
I've discovered this about myself. Or at least strongly theorized it. I suspect my brain prefers the stress of irrational concerns to the stress of entirely rational concerns. OCD can be one of the most powerful distractors.
Posted by Dinah on October 13, 2013, at 8:34:17
In reply to Re: being challenged in therapy, posted by baseball55 on October 12, 2013, at 19:56:35
> After working with my p-doc, I began working with a DBT therapist. This is so much more helpful than CBT. It's less about identifying negative thoughts and more about learning to accept and learn to regulate negative emotions. The emphasis is on learning to be mindful and practice self-compassion. Which isn't so different, actually, from what my p-doc always said about reparenting myself.
I like the way you put this. I hadn't quite thought of it in those terms.
I think it puts the finger on why CBT annoyed me so much. First, it assumed that feelings were a product of thoughts in the moments, while I knew instinctively what scientists say about the amygdala. Second, it annoys me no end to tell myself things I don't believe. Or even to tell myself things I do believe but don't seem to make any difference.
So I don't respond overly well to CBT even for emetophobia. Yes of course I know it won't hurt me, aside from the pain of the panic. I know the panic won't kill me. That it will just be unpleasant for a period of time. If knowing that would cure me, I wouldn't *have* emetophobia.
It lifted a lot of my resentment when my therapist thought it not unlikely that even after exposure therapy, my phobia won't miraculously go away - especially in situations where I feel trapped. Shifting the focus to how I could deal with how I might very likely feel was far more helpful.
Posted by SLS on October 13, 2013, at 14:41:17
In reply to Re: being challenged in therapy, posted by baseball55 on October 12, 2013, at 19:56:35
I learned a lot here.
Thank you.
- Scott
Posted by sigismund on October 13, 2013, at 14:57:41
In reply to Re: being challenged in therapy, posted by baseball55 on October 12, 2013, at 19:56:35
>Which isn't so different, actually, from what my p-doc always said about reparenting myself.
Dynamic therapy (at least in part) seems to be based on the parenting model.
>The one downside, for me, of dynamic therapy, was that I had intense and sometimes overwhelming transference issues which occasionally caused more problems than they solved. We did work through it. But it took a lot a time and a lot of tears.
This makes me think and takes me back. There were some things and some times. For the life of me I could not figure out what was going on, apart from a lot of dreadfully strong feelings that I felt took me over. I'd think 'Oh God, it's happening again' and it would take a week to dissipate. Where was it coming from? Evidently me. ??
Posted by Phillipa on October 17, 2013, at 22:23:11
In reply to Re: being challenged in therapy, posted by sigismund on October 13, 2013, at 14:57:41
Did you find it was worse afterward when it finally was over with? PJ
Posted by sigismund on October 19, 2013, at 0:15:00
In reply to Re: being challenged in therapy » sigismund, posted by Phillipa on October 17, 2013, at 22:23:11
No, not worse. It passed in something like weeks when it came. And I can't say I have ever felt that kind of thing much since. Maybe *sometimes* I get that feeling 'Oh my God, it's started again' and I know it will take a couple of weeks to go.
It is something to do with therapy, and I was thinking of the post I responded to, about transference. Pretty bloody awful, I can say that with confidence, but not much else. It reminds me of my T saying she was glad she had forgotten most of her training analysis.
Posted by g_g_g_unit on October 27, 2013, at 1:10:28
In reply to Re: being challenged in therapy » Phillipa, posted by sigismund on October 19, 2013, at 0:15:00
have people here generally found psychiatrists who practice psychotherapy to be the most user-friendly?
I'm starting to think it isn't a coincidence that the only one (after nearly a decade spent seeing them) who treated me like a human being was also a therapist, though he had previously worked with children, which might have helped things.
it would help narrow down the criteria in future searches
Posted by alexandra_k on October 27, 2013, at 1:58:54
In reply to psychotherapy + psychiatrists, posted by g_g_g_unit on October 27, 2013, at 1:10:28
in my experience, yes. but cost tends to be prohibitive.
Posted by baseball55 on October 27, 2013, at 18:59:01
In reply to psychotherapy + psychiatrists, posted by g_g_g_unit on October 27, 2013, at 1:10:28
I saw my p-doc for therapy and meds. I saw another p-doc for help with addiction and met with him an hour a week for eight weeks. He was great. The only other p-docs I've seen have been in hospitals. Generally, they spent a lot of time with me during the first few days and all but one were very experienced and compassionate. I've never been to a p-doc who just does twenty minute med visits. I think I would be very uncomfortable with that.
Posted by Phillipa on October 27, 2013, at 19:41:31
In reply to psychotherapy + psychiatrists, posted by g_g_g_unit on October 27, 2013, at 1:10:28
Most certainly as they listen to you and then decide what your real needs are they know the whole person. I started when psychiatrists were both therapists and also then prescribed meds. The time for appointments the 50 minute one that then people complained about as not a full hour. Phillipa
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