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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Penny on October 1, 2003, at 13:21:55
Okay, y'all, I'm confused. I had this issue with therapy with my former therapist and now I'm coming up against the same thing with my current therapist - what exactly am I supposed to be *doing* in therapy?
When I was with my former therapist, I think I had a few goals in mind - I wanted to lose weight, so I wanted her to help me work on motivational issues surrounding that, I wanted to date more, so I wanted her to work with me on my issues with men, etc. But I stayed depressed so much of the time that I never really made much headway with any of my goals. I spent much of my time simply keeping my head above water.
At the same time, I had major transference issues with my therapist's pregnancy and maternity leave, so I had lots of fuel to draw upon in my sessions. In that respect, I feel like I did a good piece of work with my former therapist.
Now, however, I don't know what exactly I'm doing in therapy. I'm going twice a week right now, which I like except for the financial aspect, but I don't feel like I'm doing any work. I sense transference with my current therapist, but it's no where near as powerful so it doesn't spur as many issues. Often it seems I will just go into her office and we'll chat about my last visit to my pdoc and work and some about my former roommate or my parents or my grandmother or whatever, but we never get into any deep topics. Or I'll finally start to touch on something but by that time it will be the end of the session and I won't have time to really delve into it.
I guess what I'm saying is that I see the value of therapy for me right now just in giving me someone to touch base with a couple of times a week, to help me stay grounded, but other than that I'm wondering if it's becoming a waste of my time and money.
Or - worse yet - that my therapist and I aren't on the same page. I wish she would push me a little more, but instead I feel like she lets me completely take the reins and steer the session whichever way I want it to go, but that's not getting me anywhere. I need her to do some of the driving.
And I guess I should probably tell her that, right?
I really like her and when we've gotten into some heavier topics in the past (albeit briefly) she's been perceptive and insightful, but right now I'm just not sure that I'm doing any real work in therapy. Thoughts?
P
Posted by Tabitha on October 1, 2003, at 14:21:34
In reply to Clear goals in therapy, posted by Penny on October 1, 2003, at 13:21:55
you're right-- you have to talk to her about it. Sounds like what you are getting now is just supportive counseling. She may have a different take on it. She could see 'work' and progress you don't see, or she might think that a sounding board is all you want right now.
They all work differently. I hope yours will be flexible enough so that if you ask for more focused work and direction, you'll get it. At the least you deserve to understand where you're headed with the therapy.
Posted by fallsfall on October 1, 2003, at 14:44:31
In reply to Clear goals in therapy, posted by Penny on October 1, 2003, at 13:21:55
Hi Penny,
Yup, you need to talk to her about all of this. You can ask her if there are things that she has noticed that you should work on (i.e. for me, it would be splitting - black and white thinking). She will probably make you come up with some goals, like you did the last time - so you might want to have some in mind. Maybe a goal would be to figure out why you feel unstable, and what you can do about that.
Once you have goals, then it is easier to figure out what to talk about. I think most people do "The week in review", but that doesn't usually take very long.
I'm probably not the person to ask. I always had a list of things for my old therapist. It meant we had things to talk about (on the rare occasion that I ran out of things on my list, she would ask about things in my life). But I got the impression that she wanted me to be more spontaneous. I'm trying not to do the list thing with my new therapist (except for quickies on my week). He takes charge much more than my old one did. I'll be rattling on and he'll interrupt me and change the subject. I would have expected my CBT therapist to be more directive and my Psychodynamic one to be less directive, but it is the other way around. I spend less time talking about the mundane things in my life with my new one, and that gives us more time to work on issues.
So, now that I've proven that I have no idea what you should do... Since it bothers you, though, I think you should bring it up. I'm sure that she wants to be productive, too.
Let us know!
Posted by Dinah on October 1, 2003, at 19:19:30
In reply to Clear goals in therapy, posted by Penny on October 1, 2003, at 13:21:55
I've found I need to be clear sometimes with my therapist. When I'm feeling lousy, therapy fills itself and I just try to hang on for dear life. When I'm feeling better, I'm vaguely concerned about the time and expense of therapy. At those times I'd like to use the momentary lull in my emotions to move forward and do some real work. But he's not a mindreader, and I do have to tell him. Maybe even come up with things I'd like to work on. Then of course, when I'm feeling worse, I have to warn him that now is not the time to do whatever it is he might do if I were feeling better.
I'm sure talking to her will be productive.
Posted by Penny on October 2, 2003, at 8:49:51
In reply to Re: Clear goals in therapy, posted by Tabitha on October 1, 2003, at 14:21:34
> you're right-- you have to talk to her about it. Sounds like what you are getting now is just supportive counseling. She may have a different take on it. She could see 'work' and progress you don't see, or she might think that a sounding board is all you want right now.
>
> They all work differently. I hope yours will be flexible enough so that if you ask for more focused work and direction, you'll get it. At the least you deserve to understand where you're headed with the therapy.I think she will be. She's very easy to open up to and level with - but I do hope she has some ideas for ways I can see more concrete evidence of progress. Like homework assignments, etc. Even my former therapist wasn't big on that, but she did do a little of it.
And then I wonder if it even matters b/c I just don't know if I have the energy!!!!
P
Posted by Penny on October 2, 2003, at 8:59:27
In reply to Re: Clear goals in therapy » Penny, posted by fallsfall on October 1, 2003, at 14:44:31
> Hi Penny,
>
> Yup, you need to talk to her about all of this. You can ask her if there are things that she has noticed that you should work on (i.e. for me, it would be splitting - black and white thinking).I have a problem with all or nothing thinking: I said something the other day - I had purchased a little 1 gallon acrylic aquarium for my froggie - and I got it home and it was cracked. So I was telling her how I had to take it back to the store b/c when I got it home I discovered that "naturally" it was cracked. She stopped me and pointed out that I was referring to the aquarium being cracked as though it was evidence of the universe's plot against me - naturally the aquarium was cracked b/c naturally everything goes wrong for me, etc. She does pull things out like that when I'm just talking about stuff, but I guess I want more direction.
My biggest problem, though, I think, is negative self-talk. And she reminds me to work on my thought-changing exercises, but it seems at times like she's trying to not push me too much - but I'm not sure why...
>She will probably make you come up with some goals, like you did the last time - so you might want to have some in mind. Maybe a goal would be to figure out why you feel unstable, and what you can do about that.
I have a problem with goals - one of my main goals is what it has always been, which is to deal with my fear of men/issues with men, and we were starting to get into that, but, just like with my former therapist, I started sliding downhill so she said we'd put that on the back burner until I'm feeling better.
Perhaps the stability thing would be a good one - for me to work on why I feel so unstable and how I create more stability for myself.
P
Posted by Penny on October 2, 2003, at 9:08:58
In reply to Re: Clear goals in therapy » Penny, posted by Dinah on October 1, 2003, at 19:19:30
> I've found I need to be clear sometimes with my therapist. When I'm feeling lousy, therapy fills itself and I just try to hang on for dear life. When I'm feeling better, I'm vaguely concerned about the time and expense of therapy. At those times I'd like to use the momentary lull in my emotions to move forward and do some real work. But he's not a mindreader, and I do have to tell him. Maybe even come up with things I'd like to work on. Then of course, when I'm feeling worse, I have to warn him that now is not the time to do whatever it is he might do if I were feeling better.
>
> I'm sure talking to her will be productive.I think so - I just wonder if she's not pushing me b/c of what she might perceive as my fragile state of being right now. And perhaps I don't need to be pushed right now. My emotions are all over the place, and I'm just not feeling really together, and I can't find the right meds to help with the problem.
When I was with my former therapist, I would get to her office with enough time to sit for 10-15 minutes prior to our session and journal, so I could sort of collect my thoughts about what I wanted to talk about. But the timing of my sessions right now, combined with the fact that I have to take a bus home from work to get my car to get to therapy, limits the amount of free time I have before the session. If I could get there earlier and try to focus, perhaps that would help as well. Instead, I feel right now like I'm spending half of the session trying to figure out what to talk about.
With my former therapist, it was almost always about family (my parents in particular, then the other stuff around the time of my grandfather's suicide), and with my current therapist it has been more about my former roommate. And I guess some of what I have been talking about lately has been my pdoc and how very available he has been for me, especially lately, and how it makes me kind of uncomfortable. But it's almost as if I'm afraid to delve too far into those waters, and she's not really pushing, so, as I said, I'm pretty much getting nowhere.
Anyway - I see her at 6 p.m. today, so I'm going to try to have my thoughts collected before going. I've refrained from journaling much lately because it's usually not a good idea for me when my mood is low, but maybe I need to journal with limits.
I don't know. I'm sure she'll have some ideas.
P
Posted by Penny on October 3, 2003, at 8:40:06
In reply to Clear goals in therapy, posted by Penny on October 1, 2003, at 13:21:55
And she smiled and looked as though she's been waiting for me to say something.
I also told her about acting out on my birthday - getting so angry with myself and reminding myself of my dad and the rage he used to express fairly often when I was a kid. She seemed as though that concerned her, but also like it was something that she could help 'fix' in a way, so she was interested in discussing it.
I was telling her that I got so angry with myself Wed. night - I was throwing things in my house and yelling at myself - and I don't get that way very often but I do have episodes - and it makes me want to hurt myself. I don't - but I want to - and she brought up the possibility of a DBT group, or, if one is not available right now, said that perhaps we could work through some of it in our sessions. But she also said that she doesn't want to be in a position where she has to push me to work on things I don't feel like working on. I think she would like it better if I was in a group rather than actually doing the DBT with her.
And I told her about my frustration with meds and how nothing seems to work and so on, and she talked a little bit about 'willing suspension of disbelief' and said she wasn't saying that I should 'pretend to be happy' or act as though everything was okay, but that maybe I could try to just not write off every new medication before I've given it a chance, and maybe I could try to look at it as "something will work, someday" even if this particular med isn't working right now.
She said my pdoc and I are working on one part of it, and that she feels we can get at the other side of it - she said she gives some credit to CBT, but thinks that it oversimplifies things quite often - that, no, your emotions aren't always a result of your thoughts - but that the thoughts can feed off of the emotions and the emotions can feed into the negative thinking, hence the downward spiral, so we need to figure out a way to stop some of that if we can.
Anyway, it was a productive session I think, though I'm not sure how I feel about the whole DBT thing. I don't really like the idea right now of seeing her once a week and then group once a week, and I don't know how I feel about us doing DBT in our sessions. I just don't know...
P
Posted by fallsfall on October 3, 2003, at 16:53:16
In reply to Re: Well, I brought up the topic of goals..., posted by Penny on October 3, 2003, at 8:40:06
Sounds like a great session. Good for you for bringing all of those things up.
I did the DBT Skills Training Group. I think that it was helpful for me. I have a friend who is trying to do Skills Training with her therapist. I would strongly recommend finding a group. The biggest reason that Dr. Linehan suggests that Skills Training be done in a group is that each of us have enough weekly crisies to fill out therapy time. Skills Training seems to be the lowest priority, so it gets dropped when things are crazy. But things won't stop being crazy until you have learned the skills. So if you separate them, then the Skills Training time will actually be used for Skills Training. It is also more fun to do Skills Training with other people.
So your goals are:
1. DBT
2. Optimism on meds
3. Stop downward spiralIs that right?
Good job!
Posted by Medusa on October 8, 2003, at 15:43:25
In reply to Re: Clear goals in therapy » fallsfall, posted by Penny on October 2, 2003, at 8:59:27
> I have a problem with goals - one of my main goals is what it has always been, which is to deal with my fear of men/issues with men, and we were starting to get into that, but, just like with my former therapist, I started sliding downhill so she said we'd put that on the back burner until I'm feeling better.
>Hey Penny - is there any chance that there's a causal relationship with your feeling worse about the same time you started working on your men issues, and not just a correlation?
I was really, really helped with "men issues" in a short-term therapy I did, that ironically focused a lot on my mother (and her relationship to her father). I think there's a place for talk therapy, but I also feel like I wasted soooooo much time and lots of money on vague sessions. If you could find a systemic therapist, it might be worth adding that to your cocktail. It's usually just a few sessions - the systemic approach goes for hard, fast, painful fixes. I disagree with their idea that things are "fixed", but ... I got results, and my depression etc etc changed in quality as a result of that therapy. I know I sound really evangelical about this ... like I'm selling you some weird herbs I swear will make you look like a movie star. Maybe I should post separately about systemic short-term therapy.
I'm glad you were able to hash this out a bit with your therapist ... as for DBT stuff, would you be interested in doing some of that on-line? I think Dinah is interested, and I certainly am ... I just don't know how we could structure posting about that. Again, vagueness conquers many good intentions ...
Posted by Dinah on October 8, 2003, at 18:01:59
In reply to is it possible that ... » Penny, posted by Medusa on October 8, 2003, at 15:43:25
Let's definitely firm that up.
Would you rather do it skill by skill? Or use real life situations and brainstorm skills to use.
Fallsfall, any ideas?
Posted by fallsfall on October 10, 2003, at 23:51:44
In reply to Re: DBT » Medusa, posted by Dinah on October 8, 2003, at 18:01:59
I think that we should contact Marsha Linehan and ask her if she wants to run an experimental DBT class on the net - with us as her group. She could use it for her research, and we would participate for free. I sent her a letter once, asking for advice. Her assistant sent me a bunch of articles, some of which were interesting. The drawback to this would be that it might take them a little time to figure out how to do it online, and we would like to do it now.
Following the curriculum can be tedious, but I think we'd miss a lot by trying to apply the skills to a real life situation. As far as I can tell, I'm the only one who has actually gone to Skills Training - is that right?
Maybe we should take a count of who would like to be involved in whatever we do. We should definately do something. I wonder if Dr. Bob has appropriate training to run such a group, and whether he would be interested???
Posted by Dinah on October 11, 2003, at 7:11:08
In reply to Re: DBT, posted by fallsfall on October 10, 2003, at 23:51:44
I can answer the last one. Dr. Bob is careful to keep to his moderator duties and not establish a therapeutic relationship with any of us.
And I would like to be involved.
I know of a DBT yahoo group where the topic is definitely DBT only. People basically bring observations about DBT and examples and observations about applying DBT IRL. It's called "DBT support" in the Yahoo groups section.
But I thought it would be nice to do something here. I may not be quite sure how it would work, but you can count me in.
Posted by Medusa on October 11, 2003, at 11:43:39
In reply to Re: DBT » fallsfall, posted by Dinah on October 11, 2003, at 7:11:08
Dinah, is there a way I can contact you via e-mail?
Posted by Dinah on October 11, 2003, at 14:35:50
In reply to Re: DBT » Dinah, posted by Medusa on October 11, 2003, at 11:43:39
My email is in the FAQ. :)
Posted by michmich on October 11, 2003, at 22:17:31
In reply to Re: Well, I brought up the topic of goals... » Penny, posted by fallsfall on October 3, 2003, at 16:53:16
Hey everyone. I am starting a one a week hour and half DBT group at my school. I wonder how it will go. I can post about my thoughts on it if anyone would like.
Posted by Dinah on October 11, 2003, at 22:20:22
In reply to I go to DBT, posted by michmich on October 11, 2003, at 22:17:31
We would definitely like. Good luck with it, and congratulations on making the commitment. :)
Posted by NikkiT2 on October 12, 2003, at 7:05:10
In reply to Re: I go to DBT » michmich, posted by Dinah on October 11, 2003, at 22:20:22
A very close friend of mine starts training as a DBT leader next week.. she is the first service user to be involved in DBT in the UK, so I am very proud of her.
One she's got going, I can ask her about her opinions on running an online DBT group.
Oh, and rumour has it that Marsha Lineham is going to be at a conference I'm going to!!! That will be an interesting one!
Nikki
Posted by Dinah on October 12, 2003, at 9:29:21
In reply to Re: I go to DBT » Dinah, posted by NikkiT2 on October 12, 2003, at 7:05:10
Cogratulations to her!
And let us know what you think of Linehan. I really like the respect she gives for the people diagnosed with BPD. Her books don't have the dismissive tone so many do, but a lot of compassion and understanding of the dynamics.
Also, I think she's coming to Grand Rounds, as Dr. Bob reminded us. So we need to watch the Grand Rounds schedule.
Posted by NikkiT2 on October 12, 2003, at 11:14:04
In reply to Re: I go to DBT » NikkiT2, posted by Dinah on October 12, 2003, at 9:29:21
Oooh, a grand Rounds by her would be great!!
yeah, its great to see someone talk about BPD sensibly with out all the "its untreatable", and "they're all just parasites" (yes, I heard that said by a PD specialist at a conference last year!). Most of the sites / books out there dealing with BPD take their ideas from "Walking on eggshells" which is a book I detest!!
It would be pretty cool to actually meet her!!!
Nikki
Posted by Dinah on October 12, 2003, at 12:07:19
In reply to Re: I go to DBT » Dinah, posted by NikkiT2 on October 12, 2003, at 11:14:04
Ugh. I can't believe a doctor would be so insensitive. People act the way they do because they're in pain. Sigh. While I realize that's hard to remember sometimes when you're in the middle of a situation, a doctor should have the sense to keep it in mind when opening his mouth.
Looks like it's December 15, and an update on DBT research.
http://psychiatry.uchicago.edu/grounds/
I also sold enough stuff to buy her videos, although it's just like me. I haven't watched most of them yet. :)
Posted by Medusa on October 12, 2003, at 18:31:48
In reply to Re: DBT, posted by fallsfall on October 10, 2003, at 23:51:44
> I think that we should contact Marsha Linehan
I *really* like this idea.
>The drawback to this would be that it might take them a little time
>I think it would be worth the wait. It's not like we can't do anything on our own in the meantime, and will get all of our problems fixed by the time her group got set up.
> I wonder if Dr. Bob has appropriate training to run such a group, and whether he would be interested???
>I would not be interested in such an arrangement.
Posted by Medusa on October 12, 2003, at 18:43:28
In reply to Re: DBT » Medusa, posted by Dinah on October 11, 2003, at 14:35:50
> My email is in the FAQ. :)
Please be civil. (Smirk. Ya know, what if I felt like your smiley was sardonkeytic?)
Thanks Dinah. I'll e you when I get back into town. I'm thinking of packing my workbook to show an acquaintance ... but I don't think it would be appropriate plane reading.
This is the end of the thread.
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