![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by alexandra_k on March 7, 2005, at 19:49:32
Still waiting on the assessment...
My p-doc decided to do something fairly novel with me today. He decided to actually try to do some therapy with me. Just a little bit...
I find it hard to think of stuff to say when left to my own devices. I don't say anything for a bit... And then I worry that I'll be told 'if you don't have anything to say then you may as well go home' like one of my therapists used to say. So I start rambelling about work and can get quite animated on the topic of my thesis which fills in those silences quite nicely, but is surely not what therapy is supposed to be about.
Need a little direction...
He asked me about why I don't look at him.
I don't look at therapists. Well, maybe briefly when I say 'hello' in the waiting room, but not after that. Certainly not once I am in their office.Trust, I guess.
I make a committment to get myself there on time.
I make a committment to answering questions as best I am able.
But that is all I can manage really.
He said 'trust doesn't come just like that, it has to be earned'.
I agreed. 'Not anymore'.
But he doesn't mind that I don't look at him.
He isn't going to try and flood it out of me, so that is nice.And that is all.
But that is nice.
To start on that.
Just a little bit.
Incase there really isn't anything / anyone else for me.
That is nice.:-)
Posted by Dinah on March 7, 2005, at 21:03:05
In reply to Eye contact..., posted by alexandra_k on March 7, 2005, at 19:49:32
Posted by alexandra_k on March 7, 2005, at 21:19:44
In reply to :-) (nm) » alexandra_k, posted by Dinah on March 7, 2005, at 21:03:05
I remember you talking about having your eyes closed once. Is that in general or just around certain topics?
Is it really very strange that I don't?
I don't shut my eyes (anymore) unless things get really bad and I feel like I just want to curl up and die or disappear or whatever. Just look at my hands or my knees or their shoes (occasionally) or something.
I was thinking about it and I never used to have that problem. But I developed it with my first t. Probably being stuck in the 'damned if I say anything at all, damned if I don't say anything at all' dilemma of too much CBT...
I dunno.
Posted by Dinah on March 7, 2005, at 21:48:46
In reply to Re: :-) » Dinah, posted by alexandra_k on March 7, 2005, at 21:19:44
Hmmm... I usually don't close my eyes as rational me. I don't necessarily look at him, but I only close my eyes sometimes. In fact, I remember in the years before emotional me emerged he once asked me to close my eyes, lean back and relax, and it made me feel sick and dizzy. I started panicking and needed to stop. I did look away from him. In fact I must have looked in the corners a lot, because he later said it looked as if I was watching fairies dancing that only I could see.
But as emotional me, I close my eyes and tip my head so far to the right that it sometimes aches afterwards. I have a natural head tilt, but it's often more extreme than that. And I almost can't open my eyes. I can maybe open them for a second, but if I try for sustained eye opening, my eyes flutter and twitch like some demented butterfly.
I hate to say it, but I think it's part of the self hypnosis I do. Maybe not, but that's my dark suspicion.
I know that in order to enter that state, I concentrate on the light and dark behind my eyes. And I turn it into a black & white image of my old dog's face (black with a white noseband), then alternate it with her body (white with a black face), which happens to be a near perfect negative of the face image. If I do that long enough I feel myself relax and, well, you know...
Actually I can usually do it pretty quickly now. Practice, practice, practice.
Which has nothing to do with your circumstances, except perhaps that my experience may not be replicable. But with my eyes closed, and in that state, I am immensely attuned to everything my therapist does and every change in his attitude and every nuance in the space between us.
Poor guy. He has to rely on his eyes and ears. :)
Posted by Dinah on March 7, 2005, at 21:50:33
In reply to Re: :-) » alexandra_k, posted by Dinah on March 7, 2005, at 21:48:46
I also lose my words and think in images and movement. If I've practiced what we were going to talk about, I'm fine. But if he steers me into areas I hadn't planned ahead, I often am frustrated in trying to interpret for him. He's been doing that more and more lately. I think because I told him about it.
Posted by pinkeye on March 7, 2005, at 21:53:58
In reply to Re: :-) » Dinah, posted by alexandra_k on March 7, 2005, at 21:19:44
Does it matter if you open or close your eyes or you look straight or away?
I think whatever you feel comfortable should be just fine.
With my previous T, I used to look straight I think. I felt comfortable doing that. With my new T, I do all sorts of things - look aside, look in her eyes, look at her dress etc etc. I really don't care one way or the other.
But usually after the session is over, I can't even remember what she was wearing..Somehow I don't register her face too much. With my previous T, I used to remember everything in detail.
CBT is actually not all that bad as you think it is. Once you realize that you are in control, it is pretty empowering, if you take it in that sense. Of course, therapists are also limited by what they have control over.. If they could, they could rewrite our past and then change things around us, but it is not possible. Taht is why they are asking the only thing they have control over - us - to change to atleast make it bearable for us.
Posted by alexandra_k on March 7, 2005, at 22:01:13
In reply to Re: :-) » alexandra_k, posted by Dinah on March 7, 2005, at 21:48:46
Eye contact came up in the assessment too. She asked me to look at her and I recoiled and started shaking my head almost violently. She said 'its okay I was just trying to help bring you back'. Then it was okay. I could do that myself and she wasn't going to try to make me look at her so that was okay.
I am not sure why that is so very very hard for me.
I used to have my eyes closed but then I did also have problems dissociating in session. I know I need to try to keep them open to stop that.
So I do.
I do try.
But if people try to force the eye contact thing then it is too much. Then I have to close them.
Posted by Dinah on March 7, 2005, at 22:07:37
In reply to Re: :-) » Dinah, posted by alexandra_k on March 7, 2005, at 22:01:13
I guess I try to dissociate, in a way, in session. I could use other words to describe it. I could say that I focus to access a deeper level of consciousness, so that the external constraints that guide our ever day behavior are lowered, and I am able to talk freely without inhibition.
But I'd just be saying that.
Posted by alexandra_k on March 7, 2005, at 22:11:50
In reply to Re: :-) » alexandra_k, posted by pinkeye on March 7, 2005, at 21:53:58
> Does it matter if you open or close your eyes or you look straight or away?
I don't think it should. But some therapists get very wound up about it. That was why I am happy that he doesn't seem to mind. But who knows? I think my last t thought I'd come right in time so she didn't pressure me to start with. After seeing her for three months she started putting pressure on me about it. Seems to be a 'mark of progress' or something. A mark that they insist on...
> I think whatever you feel comfortable should be just fine.I hope so :-)
> CBT is actually not all that bad as you think it is.
Other people get a lot from it, I understand that.
>Once you realize that you are in control, it is pretty empowering, if you take it in that sense.
If you are able to derive that from it it must be very empowering, yes.
> Of course, therapists are also limited by what they have control over.. If they could, they could rewrite our past and then change things around us, but it is not possible.
I know that. No therapist of any orientation can do that... Except possibly narrative therapy ;-)
>That is why they are asking the only thing they have control over - us - to change to atleast make it bearable for us.
Sure.
But there are lots of different ways of doing that. CBT is one of them, but there are others too. CBT works well (very well indeed) for some people and I don't want to take that away from them. All I can say is that it is not suited to me.
Posted by alexandra_k on March 7, 2005, at 22:12:20
In reply to Re: :-), posted by alexandra_k on March 7, 2005, at 22:11:50
Posted by pinkeye on March 7, 2005, at 22:14:42
In reply to Re: :-), posted by alexandra_k on March 7, 2005, at 22:11:50
Out of curiosity - so what else do you think would be suited to you?
If you don't want to change the way you perceive things and the way you feel, what are you hoping to accomplish by going to therapy? IT is just a genuine question, don't know how to word it differently - so don't take offense.
Posted by alexandra_k on March 7, 2005, at 23:19:21
In reply to Re: :-) » alexandra_k, posted by pinkeye on March 7, 2005, at 22:14:42
> If you don't want to change the way you perceive things and the way you feel, what are you hoping to accomplish by going to therapy?
Firstly - acceptance is just as important as change IMO. Sometimes I just need to hear that I am okay. My perceptions and feelings are acceptable, understandable, justified, allowed. We are allowed to feel that way and that is fine. That is okay. That we don't have to change to be acceptable either to ourself or to others.
Secondly - CBT isn't the only therapy that looks at altering the clients perceptions and feelings. I dare say all therapies look at that. But different theories have different strategies for effecting those changes. Cognitive restructuring is not well suited to me. I find it to be invalidating of my experience (because of 1) and I have philosophical objections to the theory too.
If it works for you, if you can find some use in it then that is terrific! Really. It is like how some people do well on a certain kind of med and others have an allergic reaction.
> Out of curiosity - so what else do you think would be suited to you?Don't know. I am tempted to say anything but behaviourist and cognitive therapies. I'd like to try something psychodynamic... Or maybe humanistic... I don't know. I don't know enough about them. I am not picky to tell you the truth, at this point I just want someone anyone who is not a CBT therapist.
Good therapists can quite often transcend their theorietical orientation anyway..
Posted by alexandra_k on March 7, 2005, at 23:33:24
In reply to Re: :-) » alexandra_k, posted by Dinah on March 7, 2005, at 22:07:37
I guess I have numbness and then I have disappearing. Numb is good. To kind of filter out their responses so that I feel able to answer the questions properly. But I guess a cost of that filtering is that I miss all the good responses too. I miss that they aren't responding with disgust or rejection or smirks or whatever. I guess numbness is something I would have to work on as part of trust too. To trust their responses to me.
Though I would much prefer to not know.
At this stage anyways.But the disappearing is something I fight with all my strength - unless people push me too hard. Then I just want to curl up and die. And I do curl up and I disappear. My first t found that out when she started insisting on eye contact. Apparantly I would curl up and stay that way for a couple of hours and then kind of snap out of it. That happened quite a lot...
But my next t (in DBT) would say 'it is hard to do therapy with you when you do that' at the start of the curling up. And she learned to back off sometimes. Eye contact never became an issue. She would insist on talking about it (which is uncomfortable but ok) but never trying to make me do it (which is not ok).
But I fight it with all my strength because sometimes they come out then. And I don't want that to happen. Not in therapy. Not ever. The point is to make them go away. I don't want them to come out any more. They have to stop it. I just want to figure out how to stop that from happening.
Posted by thewrite1 on March 7, 2005, at 23:39:18
In reply to Eye contact..., posted by alexandra_k on March 7, 2005, at 19:49:32
I almost never look at my T. She has asked me to a few times. I usually comply, but then immediately look away.
Posted by alexandra_k on March 7, 2005, at 23:42:52
In reply to Re: Eye contact... » alexandra_k, posted by thewrite1 on March 7, 2005, at 23:39:18
> I almost never look at my T. She has asked me to a few times. I usually comply, but then immediately look away.
How come?
Posted by Shortelise on March 8, 2005, at 12:15:31
In reply to Re: :-) » Dinah, posted by Dinah on March 7, 2005, at 21:50:33
What is it like to be a therapist and sit there looking into eyes all day?
Sometimes it feels like my T's eyes aren't focussed.
I search his eyes, need to look there, to see what's there, what he may be thinking, feeling about what I'm saying.
Alexandra, your pdoc sounds gentle. I think you deserve the most gentle care.
ShortE
Posted by thewrite1 on March 8, 2005, at 13:35:12
In reply to Re: Eye contact... » thewrite1, posted by alexandra_k on March 7, 2005, at 23:42:52
I think most of the time I'd too ashamed of what I'm talking about to be able to make eye contact. I think she asks me to look at her because she thinks I'm getting lost in some memory, and sometimes I am.
Posted by littleone on March 8, 2005, at 14:24:22
In reply to Eye contact..., posted by alexandra_k on March 7, 2005, at 19:49:32
Depending on the person, I either have terrible eye contact or none at all.
Some people I can look at, but usually only because I make myself do it because it is expected of you. But this only happens with people I stay removed from. Kind of like they just get my social face, they don't get me. But even then, I can't look at them when I talk. I'll be looking looking and they'll ask a question and my eyes will slide away while I answer. Then they'll flick back afterwards.
Some people I can't look at at all. If I don't like them/disapprove of them/etc. And I think this type of no eye contact is because I don't want them to see what I really think of them.
And then there are some people I can't look at at all because I do like them. I think this one is all tied up in shame.
I never ever make eye contact with my T. When I was first seeing him, he tried different things to try to overcome this problem. One of his attempts involved drawing a smilie face and sticking it up in front of me. I was supposed to make eye contact with the picture.
I couldn't even do that :(
Posted by pinkeye on March 8, 2005, at 14:27:41
In reply to Re: :-) » pinkeye, posted by alexandra_k on March 7, 2005, at 23:19:21
I think whichever CBT therapist that you went to, didn't do the job right.
My CBT therapist both ex and the current one, completely accepted me. Accepted my feelings, but at the same time acknowledging that changing for the better would be a good thing.
Acceptance does not mean you are perfect the way you are. It just means you see a person for what he or she really is, and you don't reject the person as invalid or unworthy. It means, that recognizing that the person has lived several years of life, and has gone through lots of things in life, and has evolved into a person in the way which he/she knew how best to be - with the limited knowledge and tools available.
Cognitive restrcuting does not mean it is invalidating of your thoughts and thought patterns. It just means, you need to learn a little bit more. Like, you might be a basically a very smart person, but when you get hired for a particular job, then you need specialized training for that job right? Like that, we might be basically smart and intelligent, but there might be some techniques which we didn't learn for effectively coping up with life's difficulties. CBT only attempts to teach you that. It does not say what you are is invalid or you are crippled. When I went to my first therapist, I was pretty smart and intelligent and I thoguht I had it all figured out in life. In fact, the first session, I asked him why I should tell him everything about my life.. I thought I knew everything I needed to know. But then I slowly changed - because he pointed out, that I was suffering so much and that brought me to his office. He asked me what other option do you have? And why are you here? And that struck me.
And I did start out being quite defensive... I had an explanation for everything I did - for all the difficulties in my emotions.. but then he gradually removed all the defenses. Mostly he pointed out that I was being very defensive and that he couldn't help me if I was defensive, and I realized it almost immediately and changed.
This is not a pro CBT message. I am just thinking you are pretty smart girl, and I think you are young - and you don't have to suffer unnecessarily. Especially since CBT is the only therapy that you can go to now with your public system.
> > If you don't want to change the way you perceive things and the way you feel, what are you hoping to accomplish by going to therapy?
>
> Firstly - acceptance is just as important as change IMO. Sometimes I just need to hear that I am okay. My perceptions and feelings are acceptable, understandable, justified, allowed. We are allowed to feel that way and that is fine. That is okay. That we don't have to change to be acceptable either to ourself or to others.
>
> Secondly - CBT isn't the only therapy that looks at altering the clients perceptions and feelings. I dare say all therapies look at that. But different theories have different strategies for effecting those changes. Cognitive restructuring is not well suited to me. I find it to be invalidating of my experience (because of 1) and I have philosophical objections to the theory too.
>
> If it works for you, if you can find some use in it then that is terrific! Really. It is like how some people do well on a certain kind of med and others have an allergic reaction.
>
> > Out of curiosity - so what else do you think would be suited to you?
>
> Don't know. I am tempted to say anything but behaviourist and cognitive therapies. I'd like to try something psychodynamic... Or maybe humanistic... I don't know. I don't know enough about them. I am not picky to tell you the truth, at this point I just want someone anyone who is not a CBT therapist.
>
> Good therapists can quite often transcend their theorietical orientation anyway..
>
>
>
Posted by alexandra_k on March 8, 2005, at 15:42:57
In reply to I wonder, posted by Shortelise on March 8, 2005, at 12:15:31
> Alexandra, your pdoc sounds gentle. I think you deserve the most gentle care.
He can be :-)
Thank you.
Posted by alexandra_k on March 8, 2005, at 16:01:24
In reply to Re: Eye contact... » alexandra_k, posted by thewrite1 on March 8, 2005, at 13:35:12
> I think most of the time I'd too ashamed of what I'm talking about to be able to make eye contact.
Yeah. I think there is a bit of that in there for me too. He asked me if I knew that psychotherapists used to sit behind their clients. I said that I did and IMO that was preferable. Because then you don't have to worry about or be distracted by the therapists responses / reactions to you.
But maybe that comes down to trust too...
>I think she asks me to look at her because she thinks I'm getting lost in some memory, and sometimes I am.
Yeah. I think some people find eye contact helpful to refocus on the present.I am not one of them though :-(
Posted by alexandra_k on March 8, 2005, at 16:03:10
In reply to Re: Eye contact... » alexandra_k, posted by littleone on March 8, 2005, at 14:24:22
No. I wouldn't look at a picture either.
IMO that is turning the situation into a farce.
Yuk.Shame does seem to be a big one.
Fear that they will be disgusted or whatever.
Fear that they may be justified in responding like that.I don't trust them.
But I don't trust myself either :-(
Posted by alexandra_k on March 8, 2005, at 16:32:52
In reply to Re: :-) » alexandra_k, posted by pinkeye on March 8, 2005, at 14:27:41
> I think whichever CBT therapist that you went to, didn't do the job right.
I think they did it fairly much by the book...
> My CBT therapist both ex and the current one, completely accepted me. Accepted my feelings, but at the same time acknowledging that changing for the better would be a good thing.Then they transcended their theory.
There isn't really anything on acceptance in CBT.
Not until Linehan emphasised it.
There is a little more stuff on it now.> Acceptance does not mean you are perfect the way you are.
I think you are perfect just the way you are. Yes YOU dear reader. All of us are.
>It just means you see a person for what he or she really is, and you don't reject the person as invalid or unworthy.
What does it mean to see someone the way they 'really are'? I think that we are all perfect just the way that we are. Right now, in this very instant YOU ARE PERFECT. PERFECTLY ACCEPTABLE PERFECTLY LOVABLE PERFECTLY WORTHY.
>It means, that recognizing that the person has lived several years of life, and has gone through lots of things in life, and has evolved into a person in the way which he/she knew how best to be
Absolutely. Given your genes and experiences you could not be otherwise than what you are now.
>with the limited knowledge and tools available.
Yes. We will never know everything nor will we ever have everything. But we can have more experiences and learn more skills. Always.
> Cognitive restrcuting does not mean it is invalidating of your thoughts and thought patterns. It just means, you need to learn a little bit more. Like, you might be a basically a very smart person, but when you get hired for a particular job, then you need specialized training for that job right? Like that, we might be basically smart and intelligent, but there might be some techniques which we didn't learn for effectively coping up with life's difficulties. CBT only attempts to teach you that. It does not say what you are is invalid or you are crippled. When I went to my first therapist, I was pretty smart and intelligent and I thoguht I had it all figured out in life. In fact, the first session, I asked him why I should tell him everything about my life.. I thought I knew everything I needed to know. But then I slowly changed - because he pointed out, that I was suffering so much and that brought me to his office. He asked me what other option do you have? And why are you here? And that struck me.
> And I did start out being quite defensive... I had an explanation for everything I did - for all the difficulties in my emotions.. but then he gradually removed all the defenses. Mostly he pointed out that I was being very defensive and that he couldn't help me if I was defensive, and I realized it almost immediately and changed.If you managed to get all that from it then that is terrific! Really. Well done. But some people are unable to take that from CBT. One persons cure brings out an allergic reaction in another...
> Especially since CBT is the only therapy that you can go to now with your public system.CBT is not an option for me either. None of the CBT therapists will work with me. All are in agreement that CBT is not helpful for me. I need something different.
First you need to understand that acceptance is intrinsically valuable (it is good in itself - it is its own end).
Then you can think about the balance of acceptance and change. About how acceptance facilitates change in a way that trying to make people change does not.
Someone is upset.
There are two options:
1) They can accept the situation.
2) They can try to change the situation.If the therapist pushes for change then the client may resist. The client may take the message that 'it is all my fault' or that 'I am unacceptable unless I change' or whatever. (Not that all do but that some do).
The therapist can continue to bash their head up against a wall. Get frustrated. Maybe take that out on the client. Cajole, manipulate, try to coax them into changing...
Or the therapist can switch strategies and work on getting the client to accept the situation as it is.
Sometimes that is what the client needs.
Other times the client realises that they do not want to accept it and then they want to change it. THEY want to change it, THEY see that they would prefer it to be different.
But no.
Some will insist on bashing.Change
Change
It is all about change.
That is why CBT is considered 'superior' to alternative therapies.
Because it slightly outperforms others with respect to change.
Change is the motto
Some people have a natural drive to change
They are probably well suited.
Other people need to be accepted
Well tough,
That is just not cost effective.I remember doing a mindfulness exercise with the DBT group. The skills trainers were recently converted CBT therapists. The exercise was to 'balance an egg on the table'.
People spent 5 minutes trying to stand it up on its end.
I put it on the table and looked at it.
My therapist asked me in the next session why I had refused to participate in the mindfulness exercise.
I said I didn't know what she meant.
She said I wasn't trying to balance my egg.
I told her I didn't need to try to balance my egg.
It was balanced already.They don't teach you that in CBT
And they weren't even willing to try to understand.
They would rather jump to conclusions about me.
And that is my experience with CBT
Over and over again
Good luck to them.
I have had enough.
But to be fair,
So have they.
Posted by annierose on March 8, 2005, at 17:20:50
In reply to Re: Eye contact... » thewrite1, posted by alexandra_k on March 8, 2005, at 16:01:24
Late to join this thread ...
I lie down, therefore do not make eye contact. I can sit if I want, and I do from time to time to reconnect. For me, and I don't understand fully why this is so, I feel closer to my T when I don't make eye contact with her. It's so different. It took a long time for me to trust her enough to consider lieing down as an option. And a long time to relax, but now, I like it. I can pretty much "see" her smile and chuckle or give a look of concern. And it is freeing ... I'm able to discuss more intimate issues without the worry of her reaction.However ... every so often, I'll sit up to soak up her smile and other expressions ... just to make sure she's there. I'll make random eye contact, but she looks away as often, although not when speaking, when thinking.
Annie
Posted by pinkeye on March 8, 2005, at 17:42:22
In reply to Re: :-) » pinkeye, posted by alexandra_k on March 8, 2005, at 16:32:52
Well, I do think you are really really smart and clear. If not now, you will find a way to cure yourself. I am sure of that.
Maybe your therapist was a go - by - book therapist and he overdid the part of trying to change you all the time. Maybe all of them did.
I can fully understand how just accpeting you and not trying to change you all the time will end up giving more empowerment to the client. Then the client can choose when he/she wants to change and what he wants to change. Ultimately we are the ones who can really know what is good for us, and what we would like ourselves to be. If a client wants to be more accepted as she is, rather than change into something better, I think the therapist's job then become more of a validating the lcient and accpeting the client instead of trying to change the client. I am sorry to see that your therapist didn't have the common sense to give that to you.
My ex T had lot of common sense to supplement what he learnt in therapy, so that was probably what helped.
Next time you try a therapist, mabye you should judge them by whether they have common sense - irrespective of whether they are CBT or psychodynamic or anything.
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