Posted by Dinah on December 26, 2003, at 9:49:25
In reply to Therapist Orientation? CBT or psychodynamic?, posted by mattdds on December 26, 2003, at 1:52:24
Hi Matt. I don't think the attitude towards CBT is really all that hostile. I certainly don't think a new board is necessary. I wouldn't know where to post. :) Many of us have had CBT training and found that we got a lot from it.
It might all be a matter of timing. If you start a CBT thread those who are interested will join in, and how many will be interested may just depend on when you post. I tried to start a practical DBT thread, but no one was interested at the moment. Maybe one day they will be.
OK, as for your question. I happened to be talking to my therapist the other day. He said (admittedly with hesitation) that he supposes that the majority of his work is relatively short term (6-30 sessions) CBT work. He also incorporates other elements into his style, as needed by the client. When he first started with me, he was almost purely CBT with a lot of it straight from the "Anxiety and Phobia Workbook" complete with homework assignments.
I think he still does a fair amount of CBT with me, but he kind of eases it into the more interpersonal type of therapy he primarily practices with me. And he does that because of my own style. I think he thinks what I really need is to understand through experience that it is possible to build a trusting relationship with someone (which is an experiential method of telling me the same thing or correcting my thoughts about the trustworthiness of others). And to have my cognitive errors and behavioral patterns pointed out to me less didactically and more as they naturally crop up in a relationship. I stay with it because I'm much better off now than I was when I started.
I think maybe the personal characteristics of the pure CBT practitioners may be part of the problems I have with it. Perhaps the purists are the most logical and rational of the therapists, self selecting to the most logical and rational branch of therapy. And I'm not likely to get that far with someone appealing only to my intellect, because my feelings rebel.
But do you think the differences are really as great as they appear? For example, CBT therapists who do any long term work at all are likely to run into transference in certain clients. We've seen a fair amount of that on the board. So CBT therapists who do any but the briefest therapies should have some training in how to effectively and sensitively deal with the feelings that arise in the client. Otherwise they can do a fair amount of damage. They don't need to encourage transference, but they shouldn't be appalled or at a loss if it crops up. It's part of their business and they should be trained.
While the more interpersonal therapies contain many elements of CBT. An interpretation contains some element of cognitive awareness of faulty thinking. So does reality testing. Even the reason for working in the transference is to see what behavioral and cognitive errors a client makes and use the transference to point them out experientially. The style is different, and more emphasis is given to feelings and why you do what you do whether than just changing the thoughts and actions. I even recently remember reading an article on this very subject (how CBT therapists are incorporating more traditional therapies, and vice versa).
But both have the same goal, just different methodology. I'm not sure that there should be a built in antithesis between the two.
You might say that Cognitive Behavior Therapy gets you to the point a lot more quickly, and that may well be true - for those clients with the temperament to respond to it ideally.
I have always said that CBT or DBT should be required for everyone - maybe taught at school. They give you a very good set of coping skills and a way to do some reality testing.
poster:Dinah
thread:293462
URL: http://www.dr-bob.org/babble/psycho/20031221/msgs/293495.html