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Re: I feel dumb, what's the difference? » LlurpsieNoodle

Posted by OzLand on August 4, 2007, at 23:24:28

In reply to I feel dumb, what's the difference? » OzLand, posted by LlurpsieNoodle on July 31, 2007, at 6:07:41

So, I said I would write something this weekend. See my memory is getting better. YAAAH. Anyway, I never know what someone means when they say they do psychodynamic therapy. My last pdoc said he did this, and I probably insulted him when I said, "Just what do you mean? What is your theoretical orientation? or do you just do some mish-mash approach, some generic thing?" He never answered me.

First, psychoanalytically informed psychotherapy can be from a number of theoretical perspectives. I not going to bore anyone with the varieties, but for example, in Chicago most people who are do a psychoanalytically informed approach, were trained in self-psychology ala Kohut who was from Chicago. I learned that in my advanced courses in grad school. It is sometimes referred to as an object relations approach which can be confusing as there are a number of object relations approaches as well. When a person goes through psychoanalysis, it might be Freudian analysis or another analysis. I was trained in traditional psychoanalysis first (as are most psychoanalytically trained persons), and then the major approach I learned was object relations ala drive theory plus ego psychology. This is because people at Menningers were trained to work with personality disorders as well as "neuroses" and "psychoses." One of the big name people who developed his theory of object relations ala drive theory was Otto Kernberg who was at Menninger's in the 60's and 70's. He is now at Cornell. The contribution of ego psychology is to consider how strong is one's ego, and part of therapy, then, is to work with the object relations approach (accounting for developmental factors and early childhood relationships and how this impacts on the present) while also working to help the person develop greater ego strength to deal with and manage impulses and anxiety. This probably sounds to stupid as I am just glossing over the surface

Anyway, yes all therapy (or most anyway) is trying to help someone "connect the dots." Some just work on the present and connecting the dots of what goes on in the present, and some give homework assignments (the behavioral component). Do psychoanalytically informed approachs only rely on insight, the aha experience? No, and this is where a lot of mental health professonals show their ignorance when they say that psychoananlytic approaches only go so far - to the insight, and they mean the intellectual understanding.

Insight for psychoanalytically trained people means changes in behavior too, not just the aha experience. If there is not change in behavior, then there is no real insight. It is not an approach for people who want quick fixes, though the approaches from a psychoanalytic perspective can be short term in the sense of doing a piece of the work, and usually the person returns to do another piece of the work when s/he is ready. That's me. I did not finish the work I started at Menninger's. But then it is also true that the work is never done. We all have to continue to work on ourselves to the day we die. To grow means one has to also change.

Homework, well it can be explicit or implicit, and it is usually implicit. If one is motivated to change (and yes there it is accepted there will be resistance), then one will or should take from therapy what one learns and apply it to everyday life. Since I learned of a link to the past, I am now aware of what I am up to when I start to react in certain ways, and I can now change and be different. This approach works very well for me.

In the beginning, though, at Menninger's, I had homework assignments as I hated myself so much. One asignment was to have to write two columns. On one side I was to write all those things that were "bad" about me. That was the easy side. On the other side I had to write what was "good" about me. I was to read three times a day what I wrote about myself that was good. Then I had to add to that side as time went on and continue to read what I wrote each day. I thought it was so stupid and did not really believe what I read as much of what I had put down was what other people had said about me like being intelligent, insightful, caring toward others, etc. I used to think, what a crock, but I have all the results of my psych testing too including how I did on the IQ test in spite of being profoundly depressed and wacked out with paychotic/dissociative episodes. Oh well.

So, homework, yes and no--not like CBT, for example. If someone tried to do CBT with me I would probably smack them. But that's me. I want what has worked for me and helped me develop long terms changes which sometimes I forget when I feel like sh*t. I think because what was--poor ego strengths, and what is now--good ego strengths is why my therapist sees me as able to handle some of his shared insigts. Again, this is not something I was used to. My therapist at Menninger's made subtle comments, but I was to make links and insights. I did. Now my therapist is doing this as he knows I am not going to stay in the area for forever, and he knows I can handle it--so he is indirectly stating some of the links. I am okay with this.

I guess I probably went off the deep end with all this, and if anyone finds this incomprehensible, I will try to explain as I did just sort of gloss over everything.

OzLand


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