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Dr. Bob is Robert Hsiung, MD,
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Posted by Damos on July 19, 2005, at 17:17:58
In reply to good session about sessions, posted by alexandra_k on July 19, 2005, at 1:16:35
Wow!!!!!! I'm so very proud of you Alex and incredibly happy for you. With gg's permission I'll do happy dance on behalf of us both.
=0)
=0)
=0)
Posted by alexandra_k on July 19, 2005, at 18:08:56
In reply to Re: good session about sessions » alexandra_k, posted by cricket on July 19, 2005, at 6:55:02
> I cover my face a lot in therapy too. It is horrible. My therapist has started to point it out, which I hate even more.
> I want to scream "Don't you get it, you moron!"
> But the fact is he really doesn't, lots of times he really doesn't get it.Oh yes. They aren't supposed to SAY anything about it. It is like... If I close my eyes then you can't see me. Yeah, alright so it doesn't work precisely like that with closing ones eyes - but thats not the point and that is solved with the hands over the face anyways. The very least they could do is humour us!!! If there is anything that makes you want to sink through the floorboards even more than you already do it is pointing it out...
:-)
Thanks
Posted by alexandra_k on July 19, 2005, at 18:09:53
In reply to Re: good session about sessions » alexandra_k, posted by gardenergirl on July 19, 2005, at 12:42:16
:-)
Thanks. it really was a huge sigh of relief. i really did think she was trying to squeeze me out :-(
Posted by alexandra_k on July 19, 2005, at 18:10:28
In reply to Re: good session about sessions » alexandra_k, posted by Jen Star on July 19, 2005, at 13:10:33
Thanks. Its amazing how very hard some things can be.
Posted by alexandra_k on July 19, 2005, at 18:10:52
In reply to Alexandra you got Guts!!!!!!!!!!!!! (nm), posted by muffled on July 19, 2005, at 15:40:26
Posted by Dinah on July 19, 2005, at 18:10:57
In reply to good session about sessions, posted by alexandra_k on July 19, 2005, at 1:16:35
That's great Alexandra. She may not be the best trained for your problem, but empathy and compassion and a desire to learn (on both your parts) can probably overcome that more than education and training can overcome a lack of empathy, compassion, and a desire to learn.
Posted by alexandra_k on July 19, 2005, at 18:11:25
In reply to Re: good session about sessions » alexandra_k, posted by Damos on July 19, 2005, at 17:17:58
LOL! You watch out for those headphone cords Mr
:-)
Posted by alexandra_k on July 19, 2005, at 18:14:55
In reply to Re: good session about sessions » alexandra_k, posted by Dinah on July 19, 2005, at 18:10:57
> That's great Alexandra.
:-)
>She may not be the best trained for your problem, but empathy and compassion and a desire to learn (on both your parts) can probably overcome that more than education and training can overcome a lack of empathy, compassion, and a desire to learn.
Yeah. I think thats a really good way to look at it. Also... Given that I take issue with some of the standard treatment for DID I might actually be better off doing things this way... Well... Lets face it given that its next to impossible for me to find someone who has treated it before over here, its even less likely that I'd be able to find someone who was prepared to discuss what they were doing WITH me. And consider whether I had a point or whether I was missing something.
I think...
It really might be better this way.
I just have to look after myself so I don't get to crisis point and require intervention from community mental health...
Posted by Dinah on July 19, 2005, at 18:20:00
In reply to Re: good session about sessions » Dinah, posted by alexandra_k on July 19, 2005, at 18:14:55
I'm with you with traditional DID treatment. Both today and in the past. Two less than pleasant alternatives on opposite poles of the continuum of treatment where the ideal is probably somewhere around the middle.
If she treats you with respect, you probably know enough to work on the details with her.
Posted by alexandra_k on July 19, 2005, at 18:26:55
In reply to Re: good session about sessions » alexandra_k, posted by Dinah on July 19, 2005, at 18:20:00
> I'm with you with traditional DID treatment. Both today and in the past. Two less than pleasant alternatives on opposite poles of the continuum of treatment where the ideal is probably somewhere around the middle.
:-)
> If she treats you with respect, you probably know enough to work on the details with her.I hope so.
I don't want her to meet them. I don't want anybody to meet them. I'm happy to work on increasing communication but not happy to work on controlling switching. Nope. But I don't know how that would go down typically... I guess it would be all about my issues... But I do worry that that process isn't all that helpful. I'm not sure that my belief is solely the result of pathology.I don't know.
Posted by Dinah on July 19, 2005, at 18:29:19
In reply to Re: good session about sessions » Dinah, posted by alexandra_k on July 19, 2005, at 18:26:55
Your belief about being multiple?
There's a reasonable movement stating that if it doesn't cause you problems in your life, it's not pathology at all. And that therapy should focus on reducing the problems, not anything else.
But if I remember correctly, you don't think much of that approach.
So am I misunderstanding you?
Posted by alexandra_k on July 19, 2005, at 20:22:53
In reply to Re: good session about sessions » alexandra_k, posted by Dinah on July 19, 2005, at 18:29:19
> Your belief about being multiple?
??? I guess... I'm not 100% sure that I am... Well. I guess I fairly uncontroversially meet criteria, but I'm not at all sure that those aren't behaviours that my treatment within community mental health hasn't coaxed out of me over the years. I don't know. There was stuff there before I went into the system. But I don't know how much the system makes me worse by focusing in on certain things and inadvertantly coaxing certain behaviours out of me... Without that who knows. Maybe they will just lessen as I work on improving my life rather than trying to work on running away from some pathology or other. I don't know. I know some people think they DO know. They would say that I was just afraid and that is why I am trying to rationalise this. But I don't think ANYBODY knows what is going to happen or not happen for me. And I'd rather someone join me on the journey to find out rather than believe they do know when actually they don't. Might turn out they were right after all but I don't want it to become a matter of therapist fulfilling prophesy. And I don't want to be sucked into that way of thinking just because they are the supposed *experts*. I'm me, I am NOT a typical instance of some dx or other for them to be able to say what is going to happen with me to any degree of authority. Thats harsh, but I am coming round to this way of thinking a little more all the time...
> There's a reasonable movement stating that if it doesn't cause you problems in your life, it's not pathology at all. And that therapy should focus on reducing the problems, not anything else.
> But if I remember correctly, you don't think much of that approach.Ah. Thats a different description of 'the movement' than the description we were dealing with last time. Last time it was about the 'right to remain multiple'. In other words the right to continue to have missing time and periods of amnesia when you don't know what the body has been up to. Thats what I was a little wary of... You have the right I suppose... But it is one hell of a responsibility to have to take legal and moral responsibility for actions you can't even remember doing... Or I suppose if one doesn't think that one alter (or the host) is legally and / or morally responsible for the actions of another alter then it is a way of avoiding responsibility altogether. Does that sound healthy to you? It was that that I thought was dubious. They wanted to say that there was no reason other than a prejudice for a simple self to say that integration was the aim of therapy. That integration is violating these peoples right to remain multiple. Well thats fine... So long as they don't expect to avoid certain moral and legal responsibilities via exercising their 'rights'. IMO...
But this description is a bit different. Sounds fine to me.
In fact it reminds me of the DSM defintion of mental illness. Symptoms have to be severe enough to significantly impact on ones social / occupational functioning etc etc. Otherwise... Its not a mental illness. Its not a problem if its not a problem...
>I don't want her to meet them. I don't want anybody to meet them.
But I do want to be able to talk about them and about what they say to me etc when I need to. Supporters would take issue with my not wanting my t to meet them. Sceptics would take issue with my not being able to just stop with talking about them.
Posted by alexandra_k on July 19, 2005, at 20:26:50
In reply to Re: good session about sessions » alexandra_k, posted by Dinah on July 19, 2005, at 18:29:19
Sorry - I meant my belief about it not being helpful for my t to meet them / communicate with them directly.
Posted by Dinah on July 19, 2005, at 20:34:08
In reply to Re: good session about sessions » Dinah, posted by alexandra_k on July 19, 2005, at 20:22:53
That's what I meant about the under-represented middle ground. I think you have the perfect right to do whatever you wish in therapy. If it helps you, and improves your life, what difference does theory make? Actually, I think the middle ground is more represented in the real world than the literature would have one believe.
No, I didn't mean that I thought people should continue to have pathology that would make them a danger to themselves or others without treatment. I don't believe that about any disorder. I was talking about people who had reached co-consciousness and were no longer experiencing lost time or seriously life-disturbing symptoms. If they can work out a way to live with their condition, and wish to remain that way, I've got no problem with it. I even understand the reasoning behind the campaign against integration as a blanket goal. But I wouldn't agree that a life without serious pathology shouldn't be a blanket goal. :)
But certainly no one has a monopoly on how to achieve that. Clearly. Absolutely. The literature on the topic is testament to that, no matter what the beliefs of the writer may be.
Posted by alexandra_k on July 19, 2005, at 21:01:15
In reply to Re: good session about sessions » alexandra_k, posted by Dinah on July 19, 2005, at 20:34:08
> That's what I meant about the under-represented middle ground. I think you have the perfect right to do whatever you wish in therapy. If it helps you, and improves your life, what difference does theory make?
Yeah. I guess the debate is about what has been shown to be helpful. So you get a group of people with similar dx / symptoms. You try some strategy or other and then find some measure. Maybe you ask them how much better they feel (subjective measures). Maybe you have an objective measure of functioning. Studies like this are taken to be authorative with respect to informing us WHAT WORKS. So lets say treatment x helps 9/10 people. Lets say treatment y helps 2/10 people. Treatment x is heralded as the best available treatment for dx / symptom whatever. But there is nothing to say whether I am the one person that treatment x doesn't help, there is nothing to say whether I am one of the two people who treatment y helped.
There is nothing to say who is more likely to get better with which kind of treatment. There is nothing to say HOW MUCH better people got. There is no adequate way to operationalise (measure) improvement.
So IMO 'treatment success' and measures of it are slightly silly... Meaningless... But it is relied upon to make psychology a real science 'just like physics'. Sigh.
And all that is begging the question with respect to whether the subject really does have condition / symptom whatever in the first place... And when one of the measures of whether they really have that or not is when they get better or don't get better with the typical treatment for that dx / symptom then what we have is a theory which errs towards internal consistency at the expense of falsifyability / making meaningful claims about the world.
One of my rants... Sorry.
>Actually, I think the middle ground is more represented in the real world than the literature would have one believe.
Yeah. I agree. People who jump on bandwagons tend to be extremists. I know a few people who used to seriously research DID but gave up in disgust. They said it was too 'politically loaded'. They would receive hate mail from supporters and sceptics, clients, and therapists. After a while... You just give up in disgust and throw up your hands.
And thats a shame.
Lots of grand pronouncements are still bandied about
But oh well... Leave them to it.
Its a shame.I agree with you about co-consciousness.
> But certainly no one has a monopoly on how to achieve that.
Well... You get certain people treating the disorder... Writing treatment manuals on the disorder... Working in specialist clinics... The *experts* the *authorities*.
Then you get the people who write about that all being just so much sh*t...
Then you get the people who throw their hands up and just don't want to know
(e.g., community mental health)
And at times...
I can understand why.
Posted by alexandra_k on July 19, 2005, at 21:09:16
In reply to Re: good session about sessions » Dinah, posted by alexandra_k on July 19, 2005, at 21:01:15
just like their is a danger in seeing clients as a typical instance of dx y
there is a comperable danger in seeing therapists as a typical instance of therapy x.i get that
i do
Posted by Dinah on July 19, 2005, at 21:13:48
In reply to Re: good session about sessions, posted by alexandra_k on July 19, 2005, at 21:09:16
I dunno. Are we trying not to critique the therapist or the therapy? Because some therapists do their best to be seen as a typical instance of therapy x. They pride themselves on it. :)
There may be a handful of patients who do the same, but not nearly as many I'm sure. There aren't manuals written for *us*.
Posted by Dinah on July 19, 2005, at 21:18:47
In reply to Re: good session about sessions » Dinah, posted by alexandra_k on July 19, 2005, at 21:01:15
I understand your rant completely.
I'm lucky to have a therapist who doesn't believe that much in diagnosis and treatment by the books. Or rather, I think he starts out that way with each client. Straight by the books CBT. But he doesn't stick with it against evidence that something different is needed.
Maybe someday there will actually be more uniformity in psychiatry/psychology. To make it more like physics. And then all these tribulations will be seen as part of the development.
But I sort of hope not. I like to have the illusion that individuals are individuals. A lot more idiosyncratic than the subjects of some of the other sciences. :)
Posted by alexandra_k on July 19, 2005, at 21:52:07
In reply to Re: good session about sessions » alexandra_k, posted by Dinah on July 19, 2005, at 21:18:47
Therapists were making claims about how they could help people. Charging them lots of money and they said they helped people. It was hard to tell whether they were trying to make a quick buck or whether there was some truth to their helping people. It was hard to tell whether the therapists were masters at getting their clients dependent on them, or whether there really was some benefit to the process.
There was a call for therapist accountability. If you think therapy helps then PROVE IT.
I think the idea of being 'more like physics' is that physics was seen as the most scientific of the sciences, if that makes any sense. It is thought to be science at its best. You run experiments in tightly controlled conditions to learn about what things cause other things to happen.
With respect to therapy if therapy is about improving peoples lives then you need to be able to measure improvement. You need to be able to say how much someone has improved and whether one person has improved more than another.
You need to be able to scientifically test the claim that therapy is helpful.
You need to be able to deliver one KIND or type of intervention. Take lots of people with dx whatever. Give some treatment x give others treatment y let the next group get by by themselves. It is assumed that the people with the dx are the same in relevant respects. It is assumed that every therapist delivering treatment x is delivering the SAME KIND of treatment. So they have to do it by the book.
Then the trouble comes that there are certain kinds of therapy which have been shown to be relatively effective for some people with dx y when that type of therapy is practiced by the book. There is no evidence to show that some other idiosyncratic type of therapy helps. There is no evidence to show that a modified version of that type of therapy helps.
If therapists have an obligation to do their best to deliver on their promise to help people improve their lives then maybe they have an obligation to go with what has been shown to be effective. They may have an obligation to go by the book.
This is the line of community mental health.
CBT was found to out-perform other varieties of therapy with respect to the problems that the majority of clients present to community mental health with.
That is to say by the book CBT where therapists to this, followed by the next thing, followed by the next thing.So I go along to community mental health. They take a list of my problematic symptoms. Then they proceed by doing this, followed by the next thing, followed by the next thing.
They considered it unethical to deviate from that.
And there it was.And that...
IMO that...
Is an example of the worst kind of pseudoscience.
Something that has an understanding of science just enough to cause some serious damage.
Like one of my friends knew enough about computers to cause some serious damage - to install a faulty hard drive.Science is kind of about getting to kinds of types of phenomena. Things are the same in relevant respects. Science thus abstracts away from individual differences. Individual differences aren't so important. Individual differences are irrelevant, a side issue, an annoyance that we disregard by abstracting out what is the same. The relevant similarities.
That is why psychology can seem so impersonal sometimes. Impersonal. AKA (relatively) objective. Abstract away from individual differences in order to focus on similarities. Then you have predictions as to what will likely happen in other situations where things are relevantly similar.
If you focus too much on individual differences then you don't gain predictive leverage. And it is predictive power that is fairly much the best mark of a good scientific theory.
Some people do focus on individual differences. They like case studies. But how much you can generalise from one case study to other people... Well... I was reading something on personality psychology the other day about the conflict between theorists who focus on relevant similarities vs theorists who are focused on individual differences. It was an interesting read. I don't know all that much about it.
IMO psychology isn't a unified discipline. It needs to be subdivided. I think it probably will be in the future. There are too many different paradigms in operation at the mo. And its not just a matter of translating the findings on one paradigm into the findings of another. Quite often the findings contradict the findings of another paradigm. It is hard to find rules of translation.
> But I sort of hope not. I like to have the illusion that individuals are individuals. A lot more idiosyncratic than the subjects of some of the other sciences. :)Mmm. A matter of degree... But, as Quine was so fond of saying 'a big enough difference in degree can lead to a difference in kind'.
Interchangability vs individual uniqueness / irreplacability.
That seems to be a theme that a lot of people worry about.
me too.
i worry.
Posted by alexandra_k on July 20, 2005, at 0:20:24
In reply to Re: good session about sessions » Dinah, posted by alexandra_k on July 19, 2005, at 21:52:07
Sorry... Lost it a little for a bit there. Just got my period so maybe that explains it ;-)
Posted by Dinah on July 20, 2005, at 5:44:38
In reply to Re: good session about sessions, posted by alexandra_k on July 20, 2005, at 0:20:24
No need to apologize. I agree with you for the most part.
I just got sidetracked. :(
Posted by cricket on July 20, 2005, at 10:59:30
In reply to Re: good session about sessions » Dinah, posted by alexandra_k on July 19, 2005, at 18:26:55
> I don't want her to meet them. I don't want anybody to meet them. I'm happy to work on increasing communication but not happy to work on controlling switching. Nope. But I don't know how that would go down typically... I guess it would be all about my issues... But I do worry that that process isn't all that helpful. I'm not sure that my belief is solely the result of pathology.
>
Yeah, I know about not wanting anybody to talk to them directly.It took years for me to get to the point of letting them talk to my T.
But after working with him for so long and building up an alliance, I think it just seemed like the fair (both to them and to my therapist) thing to do. I got tired of being the omniscient narrator all the time. Also, I have to say it has helped a lot with switching, at least in therapy.
Why do you say you don't want to work on controlling switching? I'm not sure I understand.
Posted by alexandra_k on July 20, 2005, at 16:22:41
In reply to Re: good session about sessions » alexandra_k, posted by cricket on July 20, 2005, at 10:59:30
> But after working with him for so long and building up an alliance, I think it just seemed like the fair (both to them and to my therapist) thing to do. I got tired of being the omniscient narrator all the time. Also, I have to say it has helped a lot with switching, at least in therapy.
Yeah. I really want to try and see whether I can get by without doing that. See... I first became aware of them as voices. I think it took a bit of time before they started taking on a life of their own... I already have fairly good communication with them. I'd rather therapy be about me improving communication with them. I need to be the way-station. Not my therapist. I don't want it to be about the therapist being the way-station telling me what they have said, what they have done. I need to know. Then I can tell my t.
Thats just the way I want to do it.
I don't know if it will work like that.
But I do want to give it an honest try that way first.
> Why do you say you don't want to work on controlling switching? I'm not sure I understand.Being able to switch on demand. Thats what I mean. I don't want to switch anymore. If they talk to me more, if we sort out whatever sh*t is going on then maybe it won't happen anymore.
Posted by alexandra_k on July 20, 2005, at 17:40:13
In reply to Re: good session about sessions » alexandra_k, posted by Dinah on July 20, 2005, at 5:44:38
> I just got sidetracked. :(Right.
Sorry about that.
I didn't think.
Posted by kerria on July 22, 2005, at 0:15:37
In reply to good session about sessions, posted by alexandra_k on July 19, 2005, at 1:16:35
(((Alexandra))),
i can definately believe how hard it was to ask your new T for the weekly sessions and the same time- i would have been a wreck. i almost always cover my face with T after five years, only a few parts aren't shy irl.
It's so so good that it worked out so well. you're so brave to not say supportive- i would have said supportive for a while and work up to the hard stuff later (if we still think so then). You're right though, life is short and you might as well get what you pay for-. We'll try to be supportive here at pb -- and i hope that your T is supportive too, with the work.
Anyways, i'm so glad that it worked out so well. You deserve the best T.Take care,
kerria
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