Posted by Dinah on April 11, 2006, at 8:54:59
In reply to Re: that brand of therapy ;-) » Dinah, posted by special_k on April 11, 2006, at 8:37:00
> > I think the problem with CBT is (well, ok it's not a problem really) is that some or all of it can be useful for almost everyone. So it comes out looking good in studies.
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> comes out good when compared to other *brief* forms of psychotherapy. i think they are talking 6-12 sessions... gg probably knows this stuff more than me... or someone else probably does... pseudoname? it only *just* outperforms brief psychodynamic. but it is considered to be statistically significant (which is an arbitrary threshold though to be fair i think it was arbitrarily decided on independent grounds)
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> ;-)
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> i often wonder what science would look like had we set our arbitrary thresholds a bit differently... i wonder how different the 'facts' would look...
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> > But apparently practitioners aren't always well trained on the exceptions.
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> think it comes out best (just) for depression, anxiety, and OCD (which are the most prevalent problems in psychotherapy). but sometimes the theory is silent on how to treat other disorders (they didn't know what to do with DID for instance. or dissociation more generally one can only suppose. i remember racer had problems trying to find someone to treat her dx. and so it goes on...)
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> > Which probably could be said for all schools of therapy.
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> maybe... maybe they have slightly different target groups... maybe...***** Right. I would think that they have less success with some personality disorder traits. Leading insensitive therapists to write off personality disorders, when really they might just need something different.
> > Besides, didn't they do studies (I remember seeing this on Dr. Bob's old grand rounds presentations) that showed that CBT was more effective for some personality structures than others?
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> really?***** Yeah. I know he no longer makes new ones, but I don't know if the old ones are still available.
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> > For example, it's very effective for OCPD, which you might expect.
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> oh. yeah, i guess. maybe because if you think of depression as a mood where people are likely to experience sadness (and therapy is about improving the feelings of sadness etc) then if you think of OCPD as a mood where people are likely to experience symptoms of OCD... i dunno. maybe i'm looking at them all wrong... but i guess... they are looking (typically) at behaviour change as the measure of improvement too... in the 'i sawed the legs off my bed and now i no longer lay awake fearing the monsters under the bed' kind of fashion... but then if your problem really is that not sleeping is majorly interfearing... well... isn't that a cure in a way?**** Not OCD, OCPD, obsessive compulsive personality disorder. They like rules and order, and they love something that they can use to order their unruly emotions. Plus, they'll make sure to scrupulously do their homework. No offense to OCPD types. My husband self diagnosed himself and is darn proud of it, and for good reason. He's a great employee and a responsible husband. I love the OCPD types of the world. I just feel sorry for the pain caused by their feeling that they need to take on the responsibilities of the world.
> > And although I don't recall this specifically, I'm guessing that it could be less helpful for people with borderline traits, which is why they invented DBT.
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> heh heh. CBT theorists typically want to claim DBT as a 'varient' on CBT. but it is true it needed to be extended from 'brief' therapy (6-12 sessions or whatever) into an intensive program involving group therapy and individual therapy (so therapy 2X per week) + phone calls (or between session support) and so on... and phase one (the stage that has some empirical support for reducing inpatient days and objective measures of improvement such as ability to attend work etc) lasts one year. not so brief. and that is only supposed to be stage one - the stabilisation stage. after that there is supposed to be trauma work etc. apparantly Linehan envisaged it as fairly ongoing... I think after trauma work there is supposed to be a stage of constructing a life worth living etc etc... but in the country I was from only the first phase had empirical support so after the first year they diverted the resources into a new intake (unless peoples therapists got really very attached to them i think...).
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> :-(
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> > The problem with DBT being that if you don't get someone of Marsha Linehan's skills, it can sometimes not come across as it was intended.
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> yeah. or if a therapist doesn't quite get some of Linehan's skills...
> ;-)
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> > (Although to tell you the truth, I remember watching her videos, and being both charmed and realizing that I'd walk out on her early.)
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> Lol. Haven't seen the video but I've read the book. I imagine her to be fairly stern... I think I'd resist that... But I think she also has a fairly good dynamic thing going on (though this is from the book so I don't know how she goes in real time) but a dynamic of off balancing and supporting etc. But yeah I imagine she might tend to do the off balancing thing... and have to backpeddle a fair bit. especially with clients who are getting used to her... she strikes me as fairly irreverant. heh heh. i'm not sure how i would go... okay i think though i'd probably go through a 'gee i'd really like to punch you in the face' kind of phase... and i'd probably walk out a couple times too (hmm... does her style maybe elicit borderline behaviours too????) i dunno... just how she struck me from the book.***** They were expensive. I sold a lot of belongings on eBay thinking that surely I'd be cured if I just studied them (grin), but I watched them once and put them away. I wish I could mail the videos to people. Although I'm not sure where they're compatible, and I don't want to break copyright laws, and I'd be worried that people would forget to return them.
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> i remember finding my t had a pretty good dynamic going on... i enjoyed it though sometimes i was fairly outraged at stuff she would say to me. but she could smile and backtrack and she could be really very soothing and softly spoken too (when she wanted to be) and so that helped things along considerably. i remember when i started dbt i had developed this unfortunate habit of curling up into a little ball (on my chair) and hiding my head in my knees when i really didn't want to talk about something. i think i used to dissociate if they continued... it was becoming a problem prior to dbt. sometimes they would just leave me there for a couple hours or something... anyways... i started to do that in maybe our second session and she said 'you know it makes it really hard to do therapy with you when you do that'. and i thought hmm. i suppose it does rather. and so i snapped out of it and we talked about something sort of related... but... a simple response... non judgemental... non confrontational... just simple... and there it was. lol. i felt that a lot 'of course how simple now that i see it that way...'.
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> ah memories ;-)
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> but ill timed irreverance... can be rather hard to take...
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> > Having a few borderline traits myself, I think it tends to make me worse. I tend to rebel and get angry and argue the CBT therapist into getting mad at me. (Yes, this has happened.) While my husband would think it was the therapy of therapies.
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> yes. i don't like hearing about my faulty logic or my cognitive distortions or about how if i would only change my thinking i could think myself into feeling different. i don't like the emphasis on thoughts -> feelings and i don't like them telling me i endorse these faulty thoughts either consciously or *unconsciously* if i deny it. i don't like how they say that those unconscious thoughts affect my behaviour when IMHO my degree of credance with which i endorse the cog distortions varies as a function of my mood rather than the other way around... i don't like it. i don't like it i say ;-) but apparantly it is because it isn't very validating of emotional responses
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> wah!!!!! validate me!!!!
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> :-)**** Biofeedback guy really hated me. So much so that I asked him if he felt his feelings for me would interfere with the therapy. Which made him hate me more. I think that was our last session. While if I try to argue with my therapist, he just smiles and admits that I may be correct. And I fall flat on my face because there's nothing pushing back.
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> something i did have trouble with in therapy... this isn't really related... but i remember the thing that caused us the most grief... was my lack of ability to think concretely.
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> really.
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> we would talk about something abstractly and that would be okay. as soon as it came to fitting me into that picture... my mind would black out. really. just be vacant. empty. i couldn't comprehend or speak. felt so very stupid.
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> i do wonder how i'd do on cog. tests sometimes...
> and i do wonder whether it is the ect or whether i've always been like this...
> i dunno :-(
>**** While I'm perhaps overly literal. That causes me trouble in CBT sometimes. Because if you literarlly pick apart what they say, they get mad.
***** But I really hate the "choice" thing that underlies all of it. Everything's a choice. Bah.
poster:Dinah
thread:628935
URL: http://www.dr-bob.org/babble/psycho/20060406/msgs/631714.html