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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by SLS on May 10, 2009, at 7:01:16
I get the feeling that CBT is not very popular here on Psycho-Babble Psychology. Why is this?
I have used CBT successfully for quite awhile. I don't think it is meant to be a universal panacea. However, I think it has its place to help change thoughts, feelings, and behaviors at the surface. If you get real good at it, you can even help change core beliefs (I am inadequate; I am unlovable). I have seen it help quite a few people to improve their self-esteem. CBT can work quickly, and can often jump-start the therapeutic process.
I do like IPT, and it has helped me more than CBT at uncovering and working with some core issues from my past. I think CBT is actually meant to be a technique taught by the therapist or by using informational resources like books or seminars for use outside the therapeutic milieu. It is something you can practice all day long as negative messages (automatic thoughts) pop-up. IPT and CBT can work well together. They are not either/or therapeutic modalities. They are complementary.
- Scott
Posted by TherapyGirl on May 10, 2009, at 8:08:42
In reply to CBT is not very popular around here. Why?, posted by SLS on May 10, 2009, at 7:01:16
Because we'd all prefer to have our hearts broken by therapists we are overly connected to who eventually leave us? Nope, that would be just me. (That is mostly a joke.)
I don't really know the answer to your question, Scott. For me, early on when I was starting out in therapy, I don't think the CBT approach would have worked. There was so much damage from the abuse and it was so hard for me to feel safe. I needed someone to be in that space with me. Of course right now, I've been thinking CBT would be a better approach to losing my T. It would be less abstract and more concrete.
I'll be interested to hear what others think, Scott.
Posted by SLS on May 10, 2009, at 8:18:19
In reply to Re: CBT is not very popular around here. Why? » SLS, posted by TherapyGirl on May 10, 2009, at 8:08:42
> Because we'd all prefer to have our hearts broken by therapists we are overly connected to who eventually leave us?
LOL
:-)
You have a wonderful sense of humor.
- Scott
Posted by Dinah on May 10, 2009, at 9:51:29
In reply to CBT is not very popular around here. Why?, posted by SLS on May 10, 2009, at 7:01:16
I'm not sure it's CBT that is unpopular exactly. My therapist is (or was) primarily CBT. He just sandwiches it into a more palatable relationship based package. In the early days he did send me home with homework, study sheets, and a manual. But he found it wasn't the best approach with me. Now he's more subtle.
I think most of us could analyze the CBT aspects of our behavior, though we might not put it in the terms of core beliefs, dysfunctional automatic thoughts, etc.
My own personal opinion of CBT was that it didn't give enough credit to the amygdala. The model that first you think the thoughts then you had the reaction never seemed right to me. But my therapist modified what he said to take that into account and once he did that, and once he was more conversational in style, I was more receptive.
I *do* think there may be a greater number of interpersonally based therapies represented on Babble. Part of that is that some people find Babble by googling "I hate my therapist" or "I love my therapist". And that CBT therapy is often fairly short term in this insurance environment, so people may not have as much time to think about therapy.
But partly it's because I think many people who come here with a results oriented short term therapy model in mind may be disapproving or lack understanding of what they see here and might say so directly or indirectly. And people already here might find it difficult to relate to a teacher/student unattached relationship, so there is no large quantity of replies that are on spot for the poster who does not have a therapy based on relationship.
So my thought is that the split isn't CBT/non CBT but more relationship based/not relationship based. If both types of posters managed to adopt a "to each his own" attitude and if enough nonrelationship based clients started to post here, I think the self selection bias could be reversed. But those are pretty big obstacles to overcome.
I mention to Dr. Bob sometimes that it might be a good idea to start a sort of Psychology Board Lab (probably not in those words) for a more concrete results oriented practice or discussion. So that even those of us who post there could post on a second board about the practical stuff like those CBT or DBT steps. And posters who aren't believers in relationship based therapies can feel more comfortable.
But Dr. Bob is interested in fewer boards, not more, so it seems unlikely. Plus, it might take some nurturing to get off the ground and develop momentum.
Just my ramblings and observations. I could be wrong.
(You know, a lot of the angst in my therapy relationship came from the fact that my therapist at one time seemed mildly disapproving of very long term therapy and very intense therapy relationships. He isn't anymore, and I think his whole therapy style has changed from what he's told me. He says he's matured as a therapist. I suppose that means he's more flexible now.)
Posted by antigua3 on May 10, 2009, at 9:52:13
In reply to CBT is not very popular around here. Why?, posted by SLS on May 10, 2009, at 7:01:16
I've been around the block and tried psychodynamic, CBT, EMDR, you name it. My pdoc practices CBT primarily and I must say it has helped me tremendously, once I got to a place where I felt safe enough to challenge myself. Before that, it wasn't helpful as I needed pyschodynamic, but doing the two therapies in conjunction has helped me see how my automatic thoughts (negative ones naturally) have driven me into an emotional tailspin, which I can now recognize SOME of the time.
I have to terminate with my pdoc so let's see if I can use the CBT to help me through this agonizing phase.
So, as it's usually pointed out, your mileage may vary. The thing is, though, at least for me, is that CBT can be invalidating at times and that can be devastating for someone who isn't suited to it.
I, too, am interested to see what others say, so thanks for bringing it up.
antigua
Posted by Phillipa on May 10, 2009, at 11:08:46
In reply to Re: CBT is not very popular around here. Why? » SLS, posted by antigua3 on May 10, 2009, at 9:52:13
I've done CBT years ago and it was fine then in a group. The ones here have said CBT but don't give assignments or help change negative thoughts. I always think the worst despite trying hard not too. Phillipa
Posted by seldomseen on May 10, 2009, at 11:17:02
In reply to CBT is not very popular around here. Why?, posted by SLS on May 10, 2009, at 7:01:16
My therapy is largely relationship based, and my therapist is purely psychodynamic. In fact, I don't think he has a CBT bone in his body.
It used to make me quite angry that he seemed to be perfectly fine with the fact that I felt like crap, felt horrible about myself and was filled with self-negating thoughts. I felt as though I would leave his office with no real way of helping myself. However, his emphasis remained on understanding where those thoughts come from, interpretation and building the relationship betwen us.
I think, as my inner core strengthened through the relationship with him, that *I* began to implement CBT on my own. I began to directly challenge some of my own thoughts. While I never gave myself homework, I would check to see if I was overgeneralizing or just in general being toxic to myself. I began to change those "tapes".
So, in a very long way, I guess I'm saying that I agree with you about the two forms of therapy being complementary.
Seldom
Posted by fleeting flutterby on May 10, 2009, at 12:14:48
In reply to CBT is not very popular around here. Why?, posted by SLS on May 10, 2009, at 7:01:16
> I get the feeling that CBT is not very popular here on Psycho-Babble Psychology. Why is this?<<
---flutterby: Yes, I have concluded the very same thing.
>
> I have used CBT successfully for quite awhile. I don't think it is meant to be a universal panacea. However, I think it has its place to help change thoughts, feelings, and behaviors at the surface. If you get real good at it, you can even help change core beliefs (I am inadequate; I am unlovable). I have seen it help quite a few people to improve their self-esteem. CBT can work quickly, and can often jump-start the therapeutic process.<<---flutterby: yes, I have been helped so much by it. Though, I do have an aversion to relationships so that could be why I feel better about CBT than with psychodynamic therapy or IPT or whatever label is preferred. I'm not sure I want to "connect" emotionally with the therapist and have an emotional dependence --on anyone. was taught(through childhood) that dependence is a weakness and that's how you get devastatingly hurt.
>
> I do like IPT, and it has helped me more than CBT at uncovering and working with some core issues from my past.<<---flutterby: Yes, I can understand this, though my old thoughts say this is dangerous ground I'm treading on.(uncovering past)
>> I think CBT is actually meant to be a technique taught by the therapist or by using informational resources like books or seminars for use outside the therapeutic milieu. It is something you can practice all day long as negative messages (automatic thoughts) pop-up. IPT and CBT can work well together. They are not either/or therapeutic modalities. They are complementary.<<
---flutterby: yes, though I think it seems more people reach unhealthy dependence and being "stuck" in IPT than in CBT. i think that's partly why I am apprehensive of IPT-- I've spent my whole life being mentally unhealthy and stuck-- I sure don't want to "pay" someone for that same outcome that I could very well achieve on my own.
It really scares the heck out of me to read how some people day dream that their therapist was their parent or their lover or some other connection......
I wish, like Dinah said-- there was a section just about CBT and the like- that way I could stay away from posts that make my stomach turn in knots.I tried psychodynamic therapy and it gradually increased my anxiety, nightmares and did nothing for my self esteem.(I feel it's damaged me further-- having just it without CBT)
I'm doing better with CBT. I just have a little over a year behind me with it, but I feel I've far surpassed those three years in IPT.maybe like you said-- both would be the best though....... i s'pose i might be ready for a little IPT with this CBT therapist I see..... maybe....
(*she said with a fearful look of apprehension*)an interesting post- thank you for it.
flutterby-mandy
Posted by obsidian on May 10, 2009, at 19:44:30
In reply to Re: CBT is not very popular around here. Why? » SLS, posted by TherapyGirl on May 10, 2009, at 8:08:42
> Because we'd all prefer to have our hearts broken by therapists we are overly connected to who eventually leave us? Nope, that would be just me. (That is mostly a joke.)
no, I think that might be me too (mostly? a joke..I can't tell right now)
CBT? I don't know, I evaluate and re-evaluate all my thoughts already, I just don't think it's for me
I say quit therapy! any kind of therapy (and all medication too)
uh oh, a little bit of black and white thinking??
I know it's irrational, but I don't care
Posted by emmanuel98 on May 10, 2009, at 21:00:31
In reply to Re: CBT is not very popular around here. Why? » TherapyGirl, posted by obsidian on May 10, 2009, at 19:44:30
I have been seeing a p-doc for psychodynamic therapy every week for a few years. He wanted me to also do CBT/DBT. I was in a DBT group for a while, until the schedule began to conflict with my job. Now, for the past year, I have met every two weeks with a social worker who does DBT/CBT. The combination of behavioural therapy and psychodynamnic therapy has been wonderful for me. The behavioural part helps me with practical skills -- mindfulness, meditation, identifying dysfunctional thoughts and reactions. I also still find my weekly therapy sessions worthwhile to deal with meds and to learn how to accept love and deal with feelings of dependency. I consider myself lucky that my insurance will pay for both.
Posted by FindingMyDesire on May 11, 2009, at 23:54:25
In reply to CBT is not very popular around here. Why?, posted by SLS on May 10, 2009, at 7:01:16
I don't know much about all of the kinds of therapy. But what Dinah said made sense to me about a possible reasoning for the collection of folks here.
Although I think I searched for something along the lines of "I'm in love with my therapist". I may have used the words, "Sexual attraction" or "romantic feelings" as well.
No, wait. Maybe it was "Am I the only one this attached to my therapist?!?!?!"
LOL
Posted by Sigismund on May 12, 2009, at 16:51:13
In reply to Re: CBT is not very popular around here. Why? » SLS, posted by antigua3 on May 10, 2009, at 9:52:13
I'm not sure with my current psych what it is we do.
We sit across from each other and he surprises me by being way more sceptical and cynical about the whole human experience than I am.
Then I might say that it is so frightful and embarrassing I feel like killing myself.
And he will say 'O no, I think it's fascinating'.
Posted by Sigismund on May 12, 2009, at 16:56:27
In reply to Re: CBT is not very popular around here. Why?, posted by Sigismund on May 12, 2009, at 16:51:13
So we were talking about the perhaps dubious gift of existence and I mentioned some sympathy card for cancer that went
'Congratulations. Great news, I wish I could join you.'
and he said
'Why is that considered insane? No doctor ever says that to his patients, and why not?'
and then proceeded to tell me about his 100 yo mother.
Nice to have someone I can get on with.
Posted by Amelia_in_StPaul on May 15, 2009, at 18:24:31
In reply to CBT is not very popular around here. Why?, posted by SLS on May 10, 2009, at 7:01:16
I'm not sure if CBT is indeed not very popular here (and I haven't read other posts) but I think CBT (and DBT) are the only therapies worth their salt. I think that only therapy that helps a person restructure their experiences and learn to cope and tolerate with distress is going to effect change in the long run. I like some of psychodynamic theory/ego psychology for its illumination of problems (attachment theory) but its bunk for actual help. Same w/others.
Posted by Dinah on May 15, 2009, at 19:28:39
In reply to Re: CBT is not very popular around here. Why?, posted by Amelia_in_StPaul on May 15, 2009, at 18:24:31
> I think that only therapy that helps a person restructure their experiences and learn to cope and tolerate with distress is going to effect change in the long run.
I think a lot of people here have had the experience of psychodynamic therapy helping them with those things.
Posted by Kath on May 15, 2009, at 22:09:08
In reply to CBT is not very popular around here. Why?, posted by SLS on May 10, 2009, at 7:01:16
Hi Scott,
I love CBT. Son & I are both 'doing' the book "Mind Over Mood"
Yesterday I did a "Thought Record" about my reaction to seeing a photo of how AWFUL my son looked when he came back from BC 2 1/2 years ago with psychosis. When I started it my 'sadness' was at 100% & despondency was really high also. By the end, the 'sadness' was down to 30% & the despondency at ZERO.
What's IBT??:-)) Kath
PS - sometimes I forget to do them. I'll do one tomorrow about his ex GF coming back!!
Posted by SLS on May 16, 2009, at 5:51:06
In reply to Re: CBT is not very popular around here. Why? » SLS, posted by Kath on May 15, 2009, at 22:09:08
Hi Kath.
> What's IBT??
IPT = InterPersonal Therapy
It is a type of talk therapy that focuses on interpersonal relationships as they are sometimes the source of psychological discomfort. If one learns to improve their interpersonal skills, much of their anxiety and depression are mitigated. I am not sure that IPT alone addresses sufficiently the Gestalt of the phenomenon we call the mind. Psychodynamics represents the antithesis of IPT in some ways. It focuses more on intrapsychic dynamics rather than social dynamics.
I think other posters in this forum could do a better job at explaining these things. I might have gotten some things wrong.
- Scott
Posted by Kath on May 16, 2009, at 19:28:35
In reply to Re: CBT is not very popular around here. Why? » Kath, posted by SLS on May 16, 2009, at 5:51:06
Posted by Cecilia on May 17, 2009, at 2:53:37
In reply to Re: CBT is not very popular around here. Why? » Kath, posted by SLS on May 16, 2009, at 5:51:06
I think a lot of people don't like CBT because as one poster wrote it's invalidating. The T gets to decide what's rational and the patient is supposed to believe it. Personally, I not only don't believe what some "expert" who's no expert on my life believes to be the truth, I don't even believe the shrink believes it either. (Though I may be wondering inside whether he thinks I'm stupid enough to believe it, and is laughing at me for being that stupid...)
Of course, I failed psychodynamic therapy too. Seven years worth of extremely expensive paid friendship. Constantly feared that she would abandon me and of course in the end she did.
Actually I don't think different types of therapy are really that different from each other. The CBT guys think CBT is so scientific, no transference. What planet are they from? Of course there's just as much transference. If you like your CBT T you'll try to believe what he believes, or pretend to, so he won't dump you. If you don't, you'll won't believe any of his so-called "rational" thoughts.
Cecilia
Posted by Dinah on May 17, 2009, at 8:42:24
In reply to Re: CBT is not very popular around here. Why?, posted by Cecilia on May 17, 2009, at 2:53:37
> If you like your CBT T you'll try to believe what he believes, or pretend to, so he won't dump you. If you don't, you'll won't believe any of his so-called "rational" thoughts.
:)
My therapist says this. Well, he says positive transference in the initial stage of therapy helps a client accept what a therapist is saying. Or something like that.
The funny thing was that I didn't believe my therapist's so-called rational thoughts at first. But over time, in part because I liked and respected him enough to listen to him, I grew to see that he was at least partially right.
I don't think CBT or any other type of therapy is inherently wrong. I got a lot from my CBT training eventually. I think the problem comes from therapist rigidity and lack of skills. Even CBT therapists ought to be trained in the dynamics of the therapy relationship and its permutations. And I think the best of therapists assess each client and tailor their practices to best suit their needs.
Hmmm... I do think of the CBT part as training, and the interpersonal part of it as therapy.
Posted by Phillipa on May 17, 2009, at 19:06:12
In reply to Re: CBT is not very popular around here. Why? » Cecilia, posted by Dinah on May 17, 2009, at 8:42:24
You mean when I was told not to stay home even one day a week that was wrong as if I did was told I'd never go out again. Consequently have to leave the house daily. Phillipa
Posted by Amelia_in_StPaul on May 17, 2009, at 21:26:22
In reply to Re: CBT is not very popular around here. Why? » Amelia_in_StPaul, posted by Dinah on May 15, 2009, at 19:28:39
My opinion is that it doesn't do much for helping a person cope day to day.
> > I think that only therapy that helps a person restructure their experiences and learn to cope and tolerate with distress is going to effect change in the long run.
>
> I think a lot of people here have had the experience of psychodynamic therapy helping them with those things.
Posted by Amelia_in_StPaul on May 17, 2009, at 21:37:05
In reply to Re: CBT is not very popular around here. Why?, posted by Cecilia on May 17, 2009, at 2:53:37
I think the therapists who have been invalidating are that way because of their own ineffectual ways of being, not because CBT is inherently invalidating. Perhaps my view is influenced by my background: I used to teach rhetorical theory, and part of that was teaching about logical fallacies. Plus, my philosophy degree was heavy into logic. I guess that I see the value in logic (balanced with emotion and tempered by an understanding of situational factors).
Truth with a capital T does not exist, in my opinion. But unquestionably, there are ways that humans structure their experience, and some of those ways are healthy and some of them are not.
These schema are culturally mediated (influenced) but that doesn't mean that they don't objectively exist. When a person has been sufficiently traumatized, s/he will see the world as a scary place, and be unable to function as well as s/he could because of that fear (and because of fearful thoughts). That doesn't mean s/eh is wrong or doesn't have a good reason to think as s/he does. But it does cause a great deal of distress (speak as a recently re-traumatized person).Therapists who are any good are humble to the experience. They offer alternative ways of looking at the world because the client is in distress, looking for different ways to be in the world. CBT isn't a rigid book of rules; nor does it imply judgment. The best therapists know that they themselves aren't perfect, and perfection is nothing to try to attain. It's all about limiting distress, not about seeing things in the "right" way.
> I think a lot of people don't like CBT because as one poster wrote it's invalidating. The T gets to decide what's rational and the patient is supposed to believe it. Personally, I not only don't believe what some "expert" who's no expert on my life believes to be the truth, I don't even believe the shrink believes it either. (Though I may be wondering inside whether he thinks I'm stupid enough to believe it, and is laughing at me for being that stupid...)
>
> Of course, I failed psychodynamic therapy too. Seven years worth of extremely expensive paid friendship. Constantly feared that she would abandon me and of course in the end she did.
>
> Actually I don't think different types of therapy are really that different from each other. The CBT guys think CBT is so scientific, no transference. What planet are they from? Of course there's just as much transference. If you like your CBT T you'll try to believe what he believes, or pretend to, so he won't dump you. If you don't, you'll won't believe any of his so-called "rational" thoughts.
>
> Cecilia
>
>
>
Posted by Amelia_in_StPaul on May 17, 2009, at 21:39:58
In reply to Re: CBT is not very popular around here. Why? » SLS, posted by Kath on May 15, 2009, at 22:09:08
Wow, Kath, that's excellent!!!! I'll have to get that book. I'm keeping a thought spreadsheet (I asked my therapist to help me with my PTSD fearful thoughts and he suggested typing up thoughts that "scare me" so we can go over them); I'll have to look up this book.
How is your son doing? How are you??
> Hi Scott,
>
> I love CBT. Son & I are both 'doing' the book "Mind Over Mood"
> Yesterday I did a "Thought Record" about my reaction to seeing a photo of how AWFUL my son looked when he came back from BC 2 1/2 years ago with psychosis. When I started it my 'sadness' was at 100% & despondency was really high also. By the end, the 'sadness' was down to 30% & the despondency at ZERO.
>
>
> What's IBT??
>
> :-)) Kath
>
> PS - sometimes I forget to do them. I'll do one tomorrow about his ex GF coming back!!
Posted by Dinah on May 24, 2009, at 12:46:25
In reply to Re: CBT is not very popular around here. Why? » Dinah, posted by Amelia_in_StPaul on May 17, 2009, at 21:26:22
There is a religious concept, Hindu I think, that has always struck me as being unbelievably wise.
The idea is that there is more than one path to God. In this case, four. Action, devotion or love, knowledge, and meditation or transcendence. If you think of your journey to God as being a way to get to the top of the mountain, there are four ways to get there. All are perfectly valid. But since we all start at different spots on the bottom of the mountain, and since we all have different gifts, God gives us more than one way to reach him.
I've found the idea applicable to many other things in life besides religion. If you consider "wellness" to be the top of the mountain, therapy provides us more than one path to get there. Since all of us start with different temperaments, different life experiences, and different ideas of what well might look like, there is more than one type of therapy to help us along our path. With a bit of stretching, one might even be able to define the different types of therapy as belonging to one of the same groups as the original religious concept. Or you might add a few others.
Some of them might take a bit longer than others, and not fit in the sixteen week study models. But that doesn't mean that for a given individual the path isn't the best one for them to true and lasting wellness, and improved everyday functioning.
If I had to pigeonhole my therapy, I'd say it was based more on the path of love and devotion. Knowledge wasn't the right path to get to wellness through the obstacles of my personal challenges. I needed something far more visceral and experiential. And perhaps even more transcendent.
What has been best for me at any given point has changed. And my therapist's greatest strength (along with his phlegmatic disposition) is an ability to sense those needs and help me guide myself where I need to go.
I wouldn't at all disrespect or invalidate your opinion or experience. But there are other opinions and other experiences that I also validate.
Dialectics?
This is the end of the thread.
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