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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by rockymtnhi on May 25, 2004, at 13:14:14
I went to see my pdoc yesterday hoping that she would release me from care. (I can get the same meds from my family care doctor). Anyway, she asked me if I still have suicidal thoughts. I told her that I still do but they are not any different than they have always been. {This means that sometimes I think that it is easier to just end it than it is to work through all this stuff}. Needlessly to say, she did not release me.
My concern is that I have not told my T that I still have these thoughts. I am worried that he will be angry with me for not controlling them (he is a CBT T) or that he will be angry with me for not telling him in the first place. Should I call him and tell him that I went to see the pdoc and told her this information?
Thanks.
Posted by Racer on May 25, 2004, at 14:29:49
In reply to I need some feedback please..., posted by rockymtnhi on May 25, 2004, at 13:14:14
Disclaimer: I'm not a huge fan of CBT as a whole answer to anything, so that colors my response.
Seems to me you *are* controlling these thoughts, if you think, "It would be easier just to end it than to keep slogging through all this hard work in therapy" and then DO keep slogging through the hard work. Maybe thinking the thought is your release valve, without any real need to DO anything about it? Just a thought... (Maybe I'm saying you're not controlling having the thought, but you are controlling the behavior, which is a good step in the right direction, doncha think?)
Anyway, that's my feedback. Should you call him? Well, if the worry about it will build up between now and your next visit with him, then yeah, I'd call. Otherwise, just bring it up next time you see him. Hope that helps.
Posted by DaisyM on May 25, 2004, at 17:59:45
In reply to I need some feedback please..., posted by rockymtnhi on May 25, 2004, at 13:14:14
I agree with Racer. I think you should bring it up in your next session. Your PD doc ought to be working with your therapy, not around it. I don't think your Therapist will be angry with you. It is a hard discussion to have but very beneficial. If we have to worry about upsetting our Therapist, we would never get through what we have to do.
It might be hard but you could bring it up around a report about your med visit.
Good luck! Let us know how it goes.
Posted by rockymtnhi on May 25, 2004, at 23:07:28
In reply to Re: I need some feedback please..., posted by Racer on May 25, 2004, at 14:29:49
Racer,
You bring up some good points. A thought is just that. I have not acted on it.
Just curious, what do you dislike about CBT? You seem to have some real insight into all this stuff.
RMH
Posted by rockymtnhi on May 25, 2004, at 23:10:44
In reply to Re: I need some feedback please..., posted by DaisyM on May 25, 2004, at 17:59:45
Thanks, Daisy.
I think that I am going to call my T tomorrow and let him know what I said to the pdoc.
I know that I should not be concerned about what he thinks, but I am concerned about him booting my out of therapy. He is a good therapist and he has helped me. He frowns though, when I don't keep my thinking in check.
Take care.
rmh
Posted by Poet on May 26, 2004, at 0:40:37
In reply to I need some feedback please..., posted by rockymtnhi on May 25, 2004, at 13:14:14
Hi,
Your T shouldn't be angry with you for not controlling your suicidal thoughts. He should be proud of you for not acting on them and for telling your pdoc the truth.
I'm in the opposite situation that you are. I told my T about my suicidal thoughts and now I'm seeing a pdoc for meds, instead of the family doc that I used to.
Poet
Posted by Racer on May 27, 2004, at 13:22:17
In reply to Re: I need some feedback please..., posted by rockymtnhi on May 25, 2004, at 23:07:28
You know, I think there's a lot of good to CBT, in that it addresses behaviors that contribute to mood disorders. I think my strong reservations about it are twofold: first, it's addressing behaviors without really allowing for processing of the causes of those behaviors; second, the people who practice CBT therapy many times in my experience (<<notice a lot of qualifiers? This is only my opinion, and only based on my own limited experience) seem to approach it with an almost religious zeal, and without a lot of flexibility. Again, that's based solely on what I've seen, and I don't think it's the model itself, so much as the practitioners I've encountered.
That said, lemme tell you about me as an illustration of the problem I have with it. My response to most stressors is to go rational, examine all the things I'm thinking and place each thought into a neat pile of "fits available evidence" and "does not fit available evidence" and then I try very hard to force myself to act on the "FAE" pile. The problem is that that's not always consistent with what my gut says, nor with what my emotions say, and that conflict, that internal incongruence, builds until I implode. I just had a nightmare experience with a CBT zealot who kept trying to get me to stop trying to express my emotions. I was feeling more and more like an overblown balloon, and it made me a lot sicker than I was to begin with. And every time I tried to say that it wasn't working for me, she'd cut me off. CBT has really good points, but it is not a one-size-fits-all solution to every problem experienced by every client at every time.
Also, I make a real distinction between thinking a thought and acting on it. "Acting on it" is open to interpretation, too: for the sort of self-critical thoughts I think frequently, "acting on them" means continuing on the well-established path they lead me down. It doesn't necessarily mean that I attempt suicide every time I think a negative thought, if I did, I'd never have time for anything else! It just means that once I think one negative thought about myself or my situation, I often start ruminating on how hopeless my life is, how little there is that I can do about it, etc. For me, successfully countering those critical thoughts doesn't mean holding them off and refusing to recognize that I'm thinking them. When I try to do that, the agitation and anxiety I feel is too overwhelming. What does help, though, is more of an acceptance that I think [x], followed by a thought like, "...but it doesn't really matter, in the bigger picture."
A specific example, for me, is my body. When I look in the mirror and see a life-sized model of the Venus of Willendorf looking back at me, that critical voice starts in with a lot of self-accusation, including the idea that I'm so hideously deformed that I really shouldn't keep struggling to live, since no one could ever see me and not be nauseated. (OK, slightly exaggerated, but since I'm not looking in the mirror right now, I can't remember what I really do think. I know I go through the things like the bad teeth and how difficult it is to deal with them; the very bad vision and the problems that causes; the arthritis and how much pain that causes; etc.) Anyway, when I'm calm enough to respond to that, I can look at that hideous creature and say to her, "Yeah, well, but it doesn't matter what we look like, because we can write coherent sentences, we have friends we respect and admire, we know a lot of useful things, we can analyse and understand current events, we can do so many other things, that our appearance isn't our defining characteristic." To me, that isn't an unhealthy response. It doesn't mean that I reject what I'm really and truly and genuinely experiencing, while it also doesn't get lost in that experience. Does that make sense? Sure, I probably don't literally look like that Venus -- for one thing, I have a face ;-D -- but that's not really the issue when I'm doing that to myself. The real issue is my value, my self-worth, and my solution does address that issue, even if I still walk away slightly sick at my body. When I tried to express some of that body stuff to the CBT T, she just said, "But you're not fat." and moved on to something she thought was important. Telling me what she considered to be objective reality doesn't help strengthen my ability to hold the damage of the thoughts at bay.
There! I think that's what I mean about distrusting CBT. It's not the thoughts themselves that are the problem, it's the damage we allow them to do to us. So, it's not so much never thinking those thoughts again, as learning to combat those critical thoughts when we do think them. Does that make sense to anyone? LOL. I know, I did say I could write a coherent sentence, but I guess only when I think a coherent thought... Today I'm just typing stream of consciousness, so you're reading my thought process to get to that conclusion.
My conclusion: any good therapy involves both recognizing the thought processes and learning ways to protect ourselves from the damage those critical thoughts cause. (Personally, I think really good therapy also involves processing past pain, so that we don't fall back into the same space again later.) Therefore, any therapy that says it is a failure to HAVE a negative thought is not adequately addressing the realistic needs of most patients. How's that?
Thanks for asking me that. I'm glad I figured out why I'm leary of CBT.
Posted by rockymtnhi on May 27, 2004, at 21:55:06
In reply to Re: I need some feedback please..., posted by Racer on May 27, 2004, at 13:22:17
Thanks, Racer.
CBT has helped me with my internal dialogue. It has not helped with healing any of the wounds of the past. I am "doing" better, but not "feeling" better.
I fortunately, have not had CBT at the hands of zealots. Perhaps those zealots should practice there own medicine.
Thanks for sharing your experience with me.
This is the end of the thread.
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