![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by antigua3 on July 17, 2008, at 10:31:31
I've been doing a lot of reading on the therapuetic process from the T/pdoc point of view lately. People on this board have suggested some really valuable books, and I'm hooked on them at the moment.
The best book I read was about how psychotherapy can actually change the neural pathways in the brain, so that after a while of reinforcing the insights we learn in therapy, they become second nature (almost) and represent a new neural pathway has been developed. This can be viewed as the "corrective emotional experience" and now I understand better what my T means. This has helped explain to me why it is that when I get an "Aha!" moment, it still takes a long time for the insight to change my behavior.
In any case, every single book I've read said that the relationship between the T and patient is the absolutely most important thing in therapy. Working through tranference, etc. and having someone whom we can trust, bond with, etc. is the difference between what works and doesn't.
Part of my research has been to better understand my pdoc's therapuetic process. He says he uses "eclectic therapy," meaning he'll use whatever he deems appropriate--CBT or psychodynamic, mostly.
But here's the kick. He doesn't think the relationship between the two of us is "it." He thinks it's the relationship between me and my feelings, etc. Therefore, we don't pursue the relational aspects of our therapy. He always steers any conversation back to me. (This is even after he told me that in a recent placebo study, patients who established a "relationship" with the person dispensing the drug actually did better than those who received the placebo but didn't establish any type of relationship with the dispenser. Go figure!)
In any case, does anyone know what kind of therapy he is actually practicing? I just don't get it. Also, before anyone asks, he is tops in his field--but mostly with meds, maybe, but is involved with many studies on the effects of antidepressents in treating people with all sorts of disorders, etc. He is also affiliated with one of the top research centers in the country.
We have worked very hard in the past year or so and comng close to my core fears, etc., which to date have been unavailable to me except as absolute terror and then I disassociate or shut down. I'm numb at the same time, and can recite things disapssionately but I don't feel them.
I'm not planning on terminating with him anytime soon, but I still keep the option open. He has told me he "cares" but his boundaries are extremely strict. And yes, he does have experience and success in treating people with PTSD.
Any thoughts or ideas?
thanks,
antigua
Posted by Dinah on July 17, 2008, at 10:39:22
In reply to Question on Therapy Types (long/sorry), posted by antigua3 on July 17, 2008, at 10:31:31
My thought is a relatively cynical one.
I think he practices the sort of therapy that is comfortable for him. He could have simply gravitated to strict CBT, but instead incorporated facets of other types of therapy that he thinks are helpful. But since he is not comfortable talking about the therapeutic relationship, he doesn't incorporate those aspects into his practice. Even if he has read the studies.
I don't think it's necessarily a bad thing. I'm sure most therapists have to work with their own natures to some extent. If they tried to do something that was completely unnatural to them, they'd come across as stiff and formulaic. That's why there are so darn many therapists. So that we can choose one who matches our needs.
I'm not saying he doesn't match your needs. Clearly he matches some of them. And others you'll simply have to have attended to elsewhere. Because you can't get blood from a turnip. He can't offer what he doesn't have. But that's why there needs to be lots of people in our lives. Because all our needs can't be met in one person.
Posted by antigua3 on July 17, 2008, at 11:16:06
In reply to Re: Question on Therapy Types (long/sorry), posted by Dinah on July 17, 2008, at 10:39:22
That's a good answer, cynical or not. And you're right, one person can't meet all or needs. That's why I have my T--she's the warm, fuzzy, supportive, loving, etc. type, and the relationship is everything and she does help me sort this out.
I totally realize that I'm re-enacting my relationship with my parents by having both of these people treat me. The point is that I can't seem to get to the root of these issues with my female T, and that's why I've turned to a male. But it's a repetition with him too as the father figure (just as my T is the mother figure) and I know he must see it, but chooses to not address it, which further fuels the transference!
Complicated, I know. I always make things more difficult than they should be.
Thanks again,
antigua
Posted by meme3842 on July 17, 2008, at 11:24:12
In reply to Question on Therapy Types (long/sorry), posted by antigua3 on July 17, 2008, at 10:31:31
Your post made me think of my relationship with my previous therapist. Definitely, our connection--the transference--was an important part of the process. We always talked about how certain things she said or did made me feel cared for, rejected, abandoned, etc. But I think that over time, the therapy evolved in way so that I was not only connected to her, but so that I could connect to myself. Does that make sense? I had a difficult time connecting to anyone, especially myself. So maybe this doesn't really answer your question, but it seems that ultimately one goal in therapy is to connect with your own feelings and own them for whatever they are. Maybe that's what your pdoc is trying to do without putting the focus on your relationship with him. Personally, I don't see how that would work. Anyway, I might have just contradicted myself.
Posted by Dinah on July 17, 2008, at 11:46:33
In reply to Re: Question on Therapy Types (long/sorry) » Dinah, posted by antigua3 on July 17, 2008, at 11:16:06
Do you think it's possible to work it out without his cooperation? Is it possible to work it out when the outcome isn't the same as the first time?
My understanding that working through the transference involved discovering that not all similar circumstances are repeats of the first. That not all relationships that remind you of your father will have the same course as your relationship with your father.
But that that requires that it actually *be* different.
But maybe I'm wrong in what goes on.
Posted by raisinb on July 17, 2008, at 12:57:15
In reply to Question on Therapy Types (long/sorry), posted by antigua3 on July 17, 2008, at 10:31:31
It's a very difficult balance. The therapist has to attend to all the nuances of the therapeutic relationship, while still keeping the focus on the client's conflicts and feelings. I think the secret is to discuss the transference ad nauseam, but not to leave it there.
I think meme summed up what happened for me pretty well. Eventually, I did realize that much of my intense transference *was* about core beliefs I have about myself. And accepting myself for who I am will coincide with accepting my therapist and our relationship. But she, too, had to accept and work with all my intense feelings about her (which she did well often, not so well other times) before these insights could grow.
But that's me and my conflict. Transference, though it has similar effects on all of us, stems from very individual sources. So maybe your pdoc is doing what's best for you, as he sees it. Or maybe as Dinah says, he's just doing what he wants to do.
I'd ask for a rationale as to why this particular boundary is helpful for *you.* Listen to his answer, and figure out if he's trying to help you or to protect himself.
Posted by antigua3 on July 17, 2008, at 12:59:11
In reply to Re: Question on Therapy Types (long/sorry), posted by Dinah on July 17, 2008, at 11:46:33
But I don't want the outcome to be the same; I think that's the main issue I deal with. Can the outcome ever be different with him?
In part, I think that's why he keeps throwing it back to me, to show me that it's not the same. I do worry about him hurting me, though, but in a much different way than my father did. But where do I draw the line?
It's hard to pinpoint what the problem is. He has changed a lot since we first started, as he has gotten to know me (or as I've let him get to know me) but he is still a "Doctor" with a capital "D" if that makes any sense.
He has helped me come to some remarkable insights, but can we go where I've been afraid to go if he remains the "conduit" as he calls it. I waffle on this all the time. It's the same old thing. Can I trust him?
antigua
Posted by antigua3 on July 17, 2008, at 13:04:16
In reply to Re: Question on Therapy Types (long/sorry), posted by meme3842 on July 17, 2008, at 11:24:12
Actually, that made a tremendous amount of sense to me. He is trying to help me connect to my feelings and to own them.
Can it work? That's the question. I'm pretty strong and a big part of me appreciates his approach because I don't want to become totally dependent on him (dependence is absolutely verboten). I don't want to go through all those things. I've been through them! But do I have to in order for this to work? Especially since I get support from my T?
antigua
Posted by antigua3 on July 17, 2008, at 13:09:51
In reply to Re: Question on Therapy Types (long/sorry) » antigua3, posted by raisinb on July 17, 2008, at 12:57:15
My defensive child would say he's just doing it to hurt me. But rationally I know that's not true.
The plain fact of the matter is that although he knows I think this is important, he doesn't appear to agree. But I could be totally wrong.
Believe me, we've discussed this, and despite what he says, he does know the relationship is important within the boundaries, otherwise we wouldn't be working well together.
I just wish I could put my finger on this. It's really bothering me. And as I've said, it affects trust of course.
antigua
Posted by Dinah on July 17, 2008, at 18:54:22
In reply to Re: Question on Therapy Types (long/sorry) » Dinah, posted by antigua3 on July 17, 2008, at 12:59:11
My gut feeling is that yes, you can trust him.
You can trust him to be himself, with all the strengths and limitations that implies. You can trust him to not want to hurt you and to have your best interests in mind.
At least that's my opinion. And I could be completely and totally wrong here. But he's been pretty consistent in being himself. Insistent on it even.
Can you trust that what he thinks is best for you is really what's best for you? I don't know that you can ever trust anyone, including yourself, to know something so hard to predict.
I don't know that he can ever prove that. You might decide to take that leap of faith. But there is no time table on that. You'll make it if and when you're ready.
In the meantime, enjoy those insights! I wish my therapist had more of them. And better ones...
Posted by Lemonaide on July 17, 2008, at 22:23:24
In reply to Re: Question on Therapy Types (long/sorry) » antigua3, posted by Dinah on July 17, 2008, at 18:54:22
I am not sure what I think. I first had a T who said our relationship was a practice one for real life, but when it came to us communicating about the relationship, he was wasn't comfortable
With my current T of almost a year now, we talk about our relationship on how each other in the room affects each other. But I wouldn't say our therapy is based on our relationship. It is more about my feelings, past, and future.
But maybe I don't struggle because it is such a good one and things are open and honest. He calls the ace an ace of spades he says (don't know where he got the terminology from. But what he means is he calls it like it is.
I am sure you can do therapy either using the relationship directly or not. What it comes down to is that it is an easy way for T's to use as an example, to teach. I think I need to get to bed, not sure if this helped at all. lol
Posted by Looney Tunes on July 18, 2008, at 0:50:43
In reply to Question on Therapy Types (long/sorry), posted by antigua3 on July 17, 2008, at 10:31:31
This is interesting.
From my understanding of things, working through the transferance issues is where you (1) learn to understand yourself and (2) learn to understand your relations with other people.
So, the ideal situation would be for the therapist to accept the transferance, control their reactions to the transferance, and let the client have a different experience so that the client feels differently than in the past. And then the client can figure out that this is what should happen in the relationship and what the client should expect.So for example: If I have a transferance reaction to my T so that I get upset and feel that he is lying to me. Ideally, he would respond that he is not lying to me and that he is always honest with me. Go through this over and over until I go AHA! You are not like my mother who lied to me and I should not have been lied to. And I should not expect people to lie to me. I've worked through it!!!
So, the relationship with my T was the vehicle for me figuring myself out. The AHA moment....
The problem I have with the statement about the relationship between you and your feelings being the most important....What if you don't trust your own feelings yet? How do you get there? How do you put the two together if you are used to your feelings as they already exist? What is the vehicle to help the change? Your thoughts? ICK...that's too CBT for me.
Hmm...hope I did not babble too long. I am tired.
Posted by Daisym on July 18, 2008, at 1:53:02
In reply to Question on Therapy Types (long/sorry), posted by antigua3 on July 17, 2008, at 10:31:31
I have an instructor who often says, "we must break our attachment with attachment." And this from an infant researcher!
Babette Rothschild writes a lot about Trauma treatment (big Ts and little ts) and about somatic memories. She often says that the theraputic relationship is important but it can be background to the trauma work. She emphasizes the trust factor but talks a lot about Alan Shore's work of attunement, misattunement and reattunement. Essentially the therapist gains trust when there is a rupture that is repaired.
I suspect that the issue of the relationship *is* one of the major transference issues for you to resolve - because you had such a complicated relationship with your father - love/hate, and you were unseen by your mom - essentially abandoned - so that it must have felt like you weren't important to her. The relationship wasn't important.
If we step back and look at what a client needs the therapist (the relationship with the therapist) for, it might help make sense out of his approach. Clients need a therapist to help them name their feelings, to trust their perceptions and their feelings and perhaps even to scaffold a client as they feel their feelings. They provide a safety net "I'm not going to let you go off the deep end" - so we can explore our experiences and how they effect us now. But they also are often needed as projection screens - what can we throw up there so we can see what we are feeling.
I think your pdoc has looked at what you need from him - after all, you are clear that you have your therapist for the relationship, comfort piece. But you are also clear that you need to work with him to work through another set of experiences and feelings. I have to wonder if you can't reach your core fears with your therapist because she doesn't activate them in you. Your pdoc does but he also offers strict boundaries - and therefore a strict containment field. You won't be able to seduce him, or hurt him and you don't need to hold back with him. He sends the message that he isn't overly invested - but it maybe you need him to be this way so you can be free of impact to remember. The impact on him, that is. He isn't allowing you to derail the exploration of your feelings and experiences by talking about the relationship - or his feelings.
And trust -- well, I think you trust him about the important things. Because other wise you wouldn't be working this hard on it. I don't think you trust yourself, at least not enough yet. I have the same issues, btw.
My final thought is that this he is a "showing" not a "telling" therapist. He shows you that he cares but doesn't want to talk about his caring. I think there is a lot of CBT here - in which the relationship is not a primary factor.
I don't know if any of this makes sense. The question you ask is a huge one. The Boston change group grapples with the question, "what is the change agent of therapy" all the time. And they can't agree. I think if you are making progress and getting what you need, stay with it.
Posted by Lemonaide on July 18, 2008, at 8:34:15
In reply to Re: Question on Therapy Types (long/sorry), posted by Looney Tunes on July 18, 2008, at 0:50:43
Hi LT,
Not all kinds of therapy uses transference as a vehicle, in fact I believe it is mostly seen in psycho analysis therapy, which is a less favored and less used type of therapy right now. Most therapy now use other methods other than transference.
Posted by antigua3 on July 18, 2008, at 10:40:33
In reply to Re: Question on Therapy Types (long/sorry) » antigua3, posted by Dinah on July 17, 2008, at 18:54:22
I think I'm going to break the three post rule here because everyone has such interesting and different things to say.
Dinah, my pdoc instilled some trust in me when he was there for me (as a "Doctor") and looked out for my best interests when I had surgery. He said the drug they were going to give me for pain wouldn't work for me because it's blocked by the antidepressant I was taking. My surgeon had never heard of such a thing, but he was right. At first they gave me the right drug, I was fine, but when they switched drugs, I could prove to them I was wrong because I had a lot of pain.
So that inspired a lot of trust in him as a Doctor, which has carried over.
You make a good point. And he & I have argued over this at times. I can trust him to be himself, but if I demand something different, he won't give.
Let me make it clear too, that he said he "cares." He didn't say I care about YOU, but just that he cares about our treatment. I had to work hard to get that out of him. Once when I was very angry and said "I could walk right out of here and you could care less." His response? "Yes, you could, and we'd both know how much better you have become since you've started comng here." He was right, I couldn't argue with that.
I trust my instincts, and I can speak up if I think he's wrong, or headed in the wrong direction.
I take that leap of faith, and then back off, which he says is common.
So thanks, I appreciate your insights.
antigua
Posted by antigua3 on July 18, 2008, at 10:43:28
In reply to Re: Question on Therapy Types (long/sorry) » Dinah, posted by Lemonaide on July 17, 2008, at 22:23:24
That was very helpful.
Yep, my pdoc calls a spade a spade and that's part of what I appreciate about him. My T is very soft and comforting and doesn't believe in that type of direct approach, which is good, because that's not what I need from here. But she respects it, and helps me understand his point of view--although I will admit, she often shakes her head not understanding, and sometimes it's my interpretation of what he has said that might be off and she helps me to reevaluate it.
thanks so much,
antigua
Posted by antigua3 on July 18, 2008, at 10:49:56
In reply to Re: Question on Therapy Types (long/sorry), posted by Looney Tunes on July 18, 2008, at 0:50:43
You're right, it's very CBT.
All I can say is that I've been locked in transference with certain types of men my whole life and the experiences I had as a child w/my father have never been worked out. I recognize that now when I meet certain men because my warning signals go off. But I've never worked it through to completion. I have to in order to get to the core of my love/hate feelings for my father--I've never let the anger out and I have a disproportionate amount of love for him that doesn't fit the situation.
By being the "Doctor," my pdoc models the "corrective" behavior, but the question remains that as we get in deeper (which we are just starting to do), will he be able to handle it and act appropriately? Mostly I know he won't be as available as my T and he will keep his boundaries.Will I flip over that? I don't know. But I have my T.
I hate CBT, although I admit some of it has definitely worked on me.
thanks for your thoughtful response. I really appreciate it.
antigua
Posted by antigua3 on July 18, 2008, at 11:13:56
In reply to Re: Question on Therapy Types (long/sorry) » antigua3, posted by Daisym on July 18, 2008, at 1:53:02
Daisy,
All good points. You're right. I "protect" my T from my most difficult feelings, but with her I can discuss the transference. She is my mother; we're both very clear on that, and I'm still at the point that I can't express anger toward her. Ultimately, I may not ever be able to because I don't want to step out of my "good girl" role. that's probably why I've been in therapy w/her so long.I do hate her when she goes away on trips (like she is now) because it brings up abandonment issues. We talk about it now, but we're still not there yet. And I recognize I may never get there with her.
I hope my pdoc does provide the "safe containment" you describe. You know, I went into this with him w/the whole idea of not getting attached to him and not going through this whole transference thing, and that's what I wanted. But the mind is trickier than that, and doesn't always cooperate. I don't long for him, want to sexualize the relationship (that seems like a really "icky" thought with him, which should be explored with my T) or live under his desk. I want him to do his job and FIX me. Yes, that's not how this works.
I will admit that I think about him often, about things I want to say to him, but I can't just call and tell him. I tried writing, but he once called a part of my writing bull*, which had a profound effect on me and I haven't been able to write since (except for work, and here sometimes, although I'm very often inhibited, which is too bad because I'd like to be more help to others). I don't know why I give him this power over me--the most important thing in my life (besides my kids) is my writing, and here I've let a stupid, angry comment from him affect me this way. I know I have to break the chord from what he said, but I haven't been able to do that yet.
Basically, I trust my feelings very strongly, but in the area of my father, my biggest fear is that I won't be able to contain the feelings and something terrible will happen when I tell. He says it's his job to take care of himself, and we will be covering things that we've already touched on, but he didn't assure me that he wouldn't be disgusted or think less of me (I need to remind him of that!)Opening up this part is crucial, or I will just have to learn to accept it and live with it being hidden. I'm serious about that.
I think you've pegged him right. I do know that I make him step out of his comfort zone sometimes, but that's just too bad. That's his problem. If it was too much, he wouldn't treat me.
Your comment about somatic memories is so right on. I feel this physically and I want to get rid of it.
thanks again,
antigua
Posted by Dinah on July 18, 2008, at 11:37:36
In reply to Re: Question on Therapy Types (long/sorry) » Dinah, posted by antigua3 on July 18, 2008, at 10:40:33
Just an administrative clarification. Responses to different posters are an exception to the three post rule. So you wouldn't be breaking it at all.
Posted by antigua3 on July 18, 2008, at 12:06:52
In reply to Re: Question on Therapy Types (long/sorry) » Looney Tunes, posted by Lemonaide on July 18, 2008, at 8:34:15
You're absolutely correct. I guess I'm just so used to expecting transference, that I don't understand what's going on if it isn't present. Too much reading, I suspect.
thanks for your comments, I appreciate your kindness in answering,
antigua
Posted by Phillipa on July 18, 2008, at 12:48:25
In reply to Re: Question on Therapy Types (long/sorry) » antigua3, posted by Dinah on July 18, 2008, at 11:37:36
Wrong board but thanks. Phillipa
Posted by DAisym on July 18, 2008, at 14:33:00
In reply to Re: Question on Therapy Types (long/sorry) » Looney Tunes, posted by Lemonaide on July 18, 2008, at 8:34:15
I think we need to separate out transference from the relationship. I agree that there are many therapies that don't work with the transference...or even believe in the concept of transference per say. Psychoanalysis is on one end of the spectrum that says everything the client feels about their therapist is from a past relationship but in psychodynamic work, there is more of a belief in a cocreated relationship. The feelings are "real" but might be created out of the client's organizing principles - expectations. Relationship "habits" my therapist calls them.
As far as being "out of favor" I think we need to be really careful about research around psychological techniques or philosophies. CBT is more easily replicated and is a lot shorter, therefore cheaper, and insurance companies love that. How can you study, much less replicate, something that has so many variables? Someone else might have suffered the same trauma I have, but did they have the same family mix, the same kind of school experience, etc? So much of this comes from client report - "I feel better."
I've been studying Journal therapy recently. The studies here show that writing about your deepest, darkest feelings for 20 minutes, four days straight, improve function, feelings and health. The major question still to be answered is "why?" But the science is good - so do we just accept that it works? And there is no relationship factor here.
I went to a recent lecture about Freud. I loved two statements: Freud did not do as he said - he got very involved with his patients. He lamanted when they didn't fall in love with him. And Freud wasn't all wrong. He discovered that telling a secret was like draining a wound and that secrets have a way of telling on themselves - they slip out here and there.
I have been asking myself two questions lately: If it feels good, does that mean the therapy is working? And if it doesn't feel at least a little good, will anyone stay with it long enough to let it work?
Posted by Looney Tunes on July 18, 2008, at 22:50:36
In reply to Re: Question on Therapy Types (long/sorry), posted by DAisym on July 18, 2008, at 14:33:00
Freud did not do as he said - he got very involved with his patients.
>
> I have been asking myself two questions lately: If it feels good, does that mean the therapy is working? And if it doesn't feel at least a little good, will anyone stay with it long enough to let it work?
====================
Good points. Yes, Freud broke many boundaries and did not practice what he preached. He went to dinner with patients, he loaned patients money, he went for walks with patients....all altering the therapeutic framework that he seemed to be so "strict" about. (Ah, but Freud was using cocaine, so maybe he did not remember these events LOL)Therapy rarely feels good for me. Once and awhile I feel like T is being the good parent I never had and that feels good. But the reality of recognizing that T is not my good parent, does not feel good. And eventually I get back to that reality....so yes, there is a moment of feeling good surrounded by mostly feeling bad.
Usually when I leave T, I am wiped. I am exhausted, I need silence and sleep. I don't feel good.So your point about needing it to feel a little good, so people stay is accurate. For that few moments or maybe session that T is being my good parent, it keeps me going. That little feel-good keeps me hooked through the hard times when it feels so bad.
Posted by antigua3 on July 19, 2008, at 11:39:44
In reply to Re: Question on Therapy Types (long/sorry), posted by Looney Tunes on July 18, 2008, at 22:50:36
Thank you so much everyone. You've really helped a lot to help me sort out my pdoc.
I'm off to the library today to learn more about CBT. I think that will be helpful.
thanks again,
antigua
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