![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by Emme on January 29, 2002, at 11:46:21
In reply to CBT and other experiences, let's talk, posted by sid on January 29, 2002, at 11:10:33
Hi there. I'm back after a few days of not reading posts. I agree with the idea of a multi-pronged approach to managing mood disorders. My therapist uses the word "manage" as it is a chronic illness for me. Her job, together with my psychopharmacologist's job, is to help me keep symptoms in remission as best as possible and to help me find the way to recover as rich a life as possible. She quakes in fear at the very thought of me being without medication because she sees the profound change - when I'm off or between meds - it's not pretty.
So...the components of the multi-pronged approach? When the chips are really down, minimize stress and responsibility as much as possible. Don't feel bad about not making it to things I just can't get to. If I can't manage to wash dishes, uses paper plates for a short while, splurge and pay for laundry drop-off service once in a while if I can't handle doing laundry, etc.
Then, when I perk up a bit...get back to exercising as soon as possible ( which I willingly do), do yoga, play my violin, get out of the house as much as possible, initiate contact with friends as best I can, etc. Yeah, all this is totally obvious. But for a while I wasn't really doing the most helpful things for myself at the right times, feeling stress over not keeping up at times when I just couldn't. I don't find all of this easy. But the encouragement helps.
And in active therapy, she uses her own style of CBT (she's certainly familiar with Burns' book, and with Beck's work). She doesn't get into breaking it down into which of the 10 categories a though falls into. But she'll say "that's a cognitive distortion", explain why, and we work on it from there. Many of my fears and worries have some elements of cognitive distortion, and can be tackled with *concrete examples* of how things can be different from the way I perceive them. We've found that I'm helped a lot by being given specific examples of how things have worked for other people to offset the negative examples I've seen and internalized. And we've gradually evolved a set of what we humorously call "mantras" for me to keep in mind.
So...taking my medicine is crucial, and I'm not aruing against an organic source of brain illness by any stretch. I feel the most dramatic help from the medication when we find something that works. Right now I don't think about whether I'll ever go off meds. That's to think about sometime in the future and if the answer is ultimately no, then so be it. The multi-pronged approach gives me some other tools to help things along the way.
Emme
> Anyone up to talk about this?
>
> Jane d mentioned that my redirect protests might have made people shy away from continuing the CBT thread, so let's talk here, if anyone is up to it.
>
> I have talked some about my experience with CBT, that it helped me get rid of major depression, along with acupunture. And I use it everyday now without realizing it most of the time at this point.
>
> I am convinced it can be a good complement to meds for many people, although, like meds, it does not work for everybody. Acupuncture works in about the same proportions as meds, but it works for some people for whom meds do nothing. So my contention is that people dealing with depression ought to consider many approaches to heal their illness since if one approach does not help, another might. Also, many approaches might help, and together they might help faster. I did not take meds for my major depresion (I now take them for dysthymia and anxiety), but if I had to do it all again, I would take meds too in order to get all the benefits faster. I took a very long way home, I finally got there, but I got discouraged many times along the way. Also, I started yoga recently and I find that it helps a lot with the anxiety.
>
> That's my story, in a nutshell. So please, if you feel like sharing your stories, do. About CBT and about other things that may help.
>
> The forum is open.
>
> - Sid
Posted by sid on January 29, 2002, at 13:08:27
In reply to Re: CBT and other experiences, let's talk, posted by Emme on January 29, 2002, at 11:46:21
Thanks Emme for sharing your experience. I'm glad you are finding ways to cope with your illness.
I have a question for you, and anyone else who might have an answer. I have decreased stress to help deal with my depression, as you suggest. I am an introvert, that is people take energy away from me instead of giving it to me, as would happen with a more extraverted person. Hence, people are a major factor of stress for me. So over time I have become relatively isolated, and I am well enough now to want to be around people more. But I do need some time alone each day, to "regenerate my batteries." So at this point I kind of want to expand my social activities, but I am tentative about it... not sure how, not sure if, not sure that it won't be detrimental either.
Have you felt that? It is one thing to push people away to get better, but then when you're ready to see them again, they may not be too open to it anymore. That's still a sore area of my life. And I am ambivalent about what to do about it.
Depression takes a toll on relationships. I am much better now, but I'm not back on the relationship train (family, friendships as well as romantic relationships) and I feel like I should probably give it more of a try, but it seems like a lot of work for the introverted that I am.
Rings a bell, anyone? And Emme, keep posting and letting us know how you are doing.
- Sid
> Hi there. I'm back after a few days of not reading posts. I agree with the idea of a multi-pronged approach to managing mood disorders. My therapist uses the word "manage" as it is a chronic illness for me. Her job, together with my psychopharmacologist's job, is to help me keep symptoms in remission as best as possible and to help me find the way to recover as rich a life as possible. She quakes in fear at the very thought of me being without medication because she sees the profound change - when I'm off or between meds - it's not pretty.
>
> So...the components of the multi-pronged approach? When the chips are really down, minimize stress and responsibility as much as possible. Don't feel bad about not making it to things I just can't get to. If I can't manage to wash dishes, uses paper plates for a short while, splurge and pay for laundry drop-off service once in a while if I can't handle doing laundry, etc.
>
> Then, when I perk up a bit...get back to exercising as soon as possible ( which I willingly do), do yoga, play my violin, get out of the house as much as possible, initiate contact with friends as best I can, etc. Yeah, all this is totally obvious. But for a while I wasn't really doing the most helpful things for myself at the right times, feeling stress over not keeping up at times when I just couldn't. I don't find all of this easy. But the encouragement helps.
>
> And in active therapy, she uses her own style of CBT (she's certainly familiar with Burns' book, and with Beck's work). She doesn't get into breaking it down into which of the 10 categories a though falls into. But she'll say "that's a cognitive distortion", explain why, and we work on it from there. Many of my fears and worries have some elements of cognitive distortion, and can be tackled with *concrete examples* of how things can be different from the way I perceive them. We've found that I'm helped a lot by being given specific examples of how things have worked for other people to offset the negative examples I've seen and internalized. And we've gradually evolved a set of what we humorously call "mantras" for me to keep in mind.
>
> So...taking my medicine is crucial, and I'm not aruing against an organic source of brain illness by any stretch. I feel the most dramatic help from the medication when we find something that works. Right now I don't think about whether I'll ever go off meds. That's to think about sometime in the future and if the answer is ultimately no, then so be it. The multi-pronged approach gives me some other tools to help things along the way.
>
>
>
> Emme
Posted by jane d on January 29, 2002, at 13:34:06
In reply to CBT and other experiences, let's talk, posted by sid on January 29, 2002, at 11:10:33
I should admit up front that my introduction to CBT was at the hands of someone who believed it was the ONLY treatment for depression and that has left me a little sour.
It's basic premise is that dysfunctional thoughts are always the cause of depression. I think that they are a symptom instead. I believe this because I have found those thoughts can totally disappear with AD's. Because I experience the thoughts as an intrusive overlay to what I feel. Because I don't think my core beliefs, the ones that CBT claims underlie depression, change consistently on a monthly basis with my menstrual cycle. When I read the case examples in Burns' book (or perhaps it was Beck's) I had absolutely no feeling of recognition. Those people were not like me at all.
So I think that even if CBT can reason someone out of every dysfuntional thought, every black and white exageration, they can still be depressed. All that has happened is that you proved to them that the vocabulary they were using to describe what's the matter with them is wrong. In other words, they will no longer say they can't get out of bed in the morning because everybody hates them. Instead they will be unable to get out of bed because of some undefined feeling that they can't put words to. But they will still be lying in bed. At least that has been my experience.
Could it have some benefit? Probably. Believing that everybody hates you is certainly going to make coping with depression harder. Acting on it by dumping your job or friends will do additional damage to your life. So perhaps it prevents side effects. Perhaps it helps get you out of bed 1 day out of 5. I think perhaps it makes it easier to "fake it" too by telling you what you are supposed to think in order to be like everyone else.
Jane
Posted by sid on January 29, 2002, at 14:26:24
In reply to my reservations about cbt, posted by jane d on January 29, 2002, at 13:34:06
Thanks Jane.
I think that with CBT, for some people (for me at least), the distorted thought pattern can be changed. Not just what you say without believing it, but the actual functioning of the brain. Some of my distorted thoughts never changed with CBT however, even though I realized they were distorted. Meds seem to work for them now. CBT can do the same thing as meds for some people, it takes longer however, and efforts.I am not sure if the distorted thoughts came with the depression or if I had them before, all I care about is that CBT worked for me.
I do disagree with your therapist however that CBT is all that can help and that depression is caused only by distorted thoughts and behavior. It can be a mixture of many things, and every person's experience differs, in my opinion. SInce ethere is no one clear answer, the debate continues...
- Sid
Posted by IsoM on January 29, 2002, at 16:03:51
In reply to Re: my reservations about cbt » jane d, posted by sid on January 29, 2002, at 14:26:24
Sid, you said in your first post here, "So my contention is that people dealing with depression ought to consider many approaches to heal their illness since if one approach does not help, another might. Also, many approaches might help, and together they might help faster."
I've been depressed, had friends who have been depressed, & dealt with it in others so I've seen some of what it can do. My experience is still limited though - there are literally millions with depression & I don't know how each one thinks.
That said, I've noticed that many people can develop distorted thinking patterns if they've been depressed for a long time. Some had a healthy mental outlook before the depression but long-term problems can alter their reasoning processes. Like a person who's had an injury may favour the injuried spot, building up muscle tension & strength on the opposite side. Even after being healed, they may still favour that side. So to with thinking processes.
That's why I thoroughly agree with you in tackling it from all angles. Some people after being initially helped by meds can adjust their own thinking by themselves as they weren't ill for long & no longer need meds. Others will continue to need meds even with improved thinking patterns. And then I've seen others who after initially feeling good from treatment with meds, have refused to change harmful & unhealthy thinking pattern. These people often slip back into depression because they unconsciously sabotage their healing process.
Not that I'm imply to anyone that all those who slip into depression again have unhealthy thinking patterns. There's many reasons a med doesn't continue to work. What I'm saying is IF someone does have destructive thinking patterns, meds will never cure them alone.
What all my 'blithering' boils down to is I agree with a multi-pronged attack on depression & just because one avenue doesn't work, doesn't mean they all won't work. And unfortunately, there's still a few that 'nothing & everything' doesn't help.
Posted by mist on January 29, 2002, at 16:54:29
In reply to CBT and other experiences, let's talk, posted by sid on January 29, 2002, at 11:10:33
I tried the exercises in David Burns' book Feeling Good but they didn't help me. I found them to be too superficial and artificial for my needs. For me, deeper insight is more helpful (as to the origins of underlying beliefs, etc.) although it's not always easy to acquire and doesn't automatically lead to change. But I think for me it's an important starting point.
I also think if I could tolerate meds better they would eliminate some of the negative thinking automatically. 5-HTP is helping some with that; I need to take it a few more weeks to be sure of its full effects.
> Anyone up to talk about this?
>
> Jane d mentioned that my redirect protests might have made people shy away from continuing the CBT thread, so let's talk here, if anyone is up to it.
>
> I have talked some about my experience with CBT, that it helped me get rid of major depression, along with acupunture. And I use it everyday now without realizing it most of the time at this point.
>
> I am convinced it can be a good complement to meds for many people, although, like meds, it does not work for everybody. Acupuncture works in about the same proportions as meds, but it works for some people for whom meds do nothing. So my contention is that people dealing with depression ought to consider many approaches to heal their illness since if one approach does not help, another might. Also, many approaches might help, and together they might help faster. I did not take meds for my major depresion (I now take them for dysthymia and anxiety), but if I had to do it all again, I would take meds too in order to get all the benefits faster. I took a very long way home, I finally got there, but I got discouraged many times along the way. Also, I started yoga recently and I find that it helps a lot with the anxiety.
>
> That's my story, in a nutshell. So please, if you feel like sharing your stories, do. About CBT and about other things that may help.
>
> The forum is open.
>
> - Sid
Posted by susan C on January 29, 2002, at 18:08:52
In reply to CBT and other experiences, let's talk, posted by sid on January 29, 2002, at 11:10:33
CBT, cognative behavior therapy. Hmmmm, how does that make you feel?
I have not formally responded to this topic before. I agree the idea to use a multifacited approach to illness is always a good idea. Being an informed patient, having a 'medical advocate' (some one who you share everything with, other than the doctor) is one of the the things I am particularly vocal about) in addition to demanding and getting the best care you can with the resources at hand.
As far as different TYPES of Talk Therapy, to be specific, not saying this or that, all or none, but comparing different kinds...I think for me, a lot of it comes down to trial and error. If it works, great, If it doesnt dont give up, just keep trying.
For me, at the beginning of my mental health care odyssy, the pdoc provided intensive talk therapy. I dont know what kind it was. I benefited greatly from it and along with the desyerl that got me to sleep, it helped me survive long enough to get some perspective and ephiphanies, hormones and to Prozac. By the time everything fell apart again, and we knew it was organic, my doctor had somehow changed. Some level of trust, or perhaps, his technique had changed.
Several doctors and hunting for therapists later, I am now working hard on not going to see anyone new. I just dont want to talk about all of this to someone new again.
hmmm, but this is what i am doing now...?
And, this is why I decided to come here to read and respond. PB and PBS is what I consider group therapy.
Now, can group therapy include cbt?
a confused mouse in a maze of psycho-logical terms
Posted by Dinah on January 29, 2002, at 18:24:46
In reply to CBT and other experiences, let's talk, posted by sid on January 29, 2002, at 11:10:33
It seems like I've posted ad infinitum on the topic of CBT lately. Everything I have thought or could think about the topic. In my slightly manic mood, I consider my thoughts to be absolutely brilliant (I'm kidding here) but completely unreproducable (sp?). If I knew how, I'd provide links, but if anyone is interested, there are about three posts of mine on PB about the benefits and drawbacks of CBT and DBT.
I'm really glad the topic is continuing though. I'm very interested in hearing everyone's opinions about the different types of therapy, especially DBT, which I've been wanting to try. Although Linehan openly admits to building a relationship with her clients so she can blackmail them with it!!! Her clients must be much less stubborn than I am. It kind of put me off the DBT idea, which is just as well since no one around here does it.
Hmmm, it looks like I did have something more I wanted to say.
Posted by sid on January 29, 2002, at 18:53:57
In reply to Re: CBT and other experiences, let's talk, posted by susan C on January 29, 2002, at 18:08:52
Hi Susan,
I am taking meds now for dysthymia, but I did CBT and talk therapy before to fight a major episode of depression.
I am like you: I don't feel like telling my life story to someone else again (although I am somewhat doing it here too! But change makes me feel good sometimes). So I am taking meds now because I feel I made all the efforts I could for mow. I may go back to therapy at some point if I feel like it and think it could help further. At this point I prefer to let the meds do the work because I am tired of making efforts, and they don't seem to work on my dysthymia, even though they worked on the major depression.
I am stubborn in many ways, one of which is not to give up on being mentally healthy and doing everything I can to get there. If different approaches are useful for me, I will use them all!
Posted by sid on January 29, 2002, at 18:56:18
In reply to Re: CBT and other experiences, let's talk, posted by Dinah on January 29, 2002, at 18:24:46
What is DBT? Can you tell us more? Perhaps I know about it but the acronym doesn't ring a bell (English is not my mother tongue, so that may be why too).
- Sid
Posted by Dinah on January 29, 2002, at 19:09:28
In reply to DBT? » Dinah, posted by sid on January 29, 2002, at 18:56:18
It's an adaptation of cognitive behavior therapy designed for borderline, suicidal, and self injurious patients. It combines CBT with eastern philosophy (mindfulness, wise mind, etc.). It also has some components relating to dealing with this group of patients (for instance, they encourage calls between sessions rather than discourage them). I wouldn't change my current therapist, but I wouldn't mind learning emotional regulation and distress tolerance skills which seem to be central to DBT. I've got the book, the training manual, and both videos and I'm trying to learn what is useful to me from those. Of course, since I'm doing it on my own, I sort of stop and start with it depending on my mood. That would be the point of doing it in a group, I think.
Of course I could tell you more, far more, about it. :) But I won't bore you. But I am interested in seeing if it's useful in the real world, with real people.
Posted by trouble on January 29, 2002, at 21:59:40
In reply to DBT? » Dinah, posted by sid on January 29, 2002, at 18:56:18
Hello Dinah,
I posted some about my own experience w/DBT on the GETTING JERKED AROUND BY MENTAL HEALTH thread. As usual, take it w/ a grain of salt, I was in a hotheaded mood that day.
P.S. "Linehan" is the name of the lady who came up w/ the genius method, and yeah, the therapy was followed to the letter straight from the manual. It really, really, makes me mad.
Posted by Emme on January 30, 2002, at 9:38:21
In reply to depression, stress and relationships » Emme, posted by sid on January 29, 2002, at 13:08:27
Hi Sid,
Thanks for your post. Glad you are feeling better and ready to get back into the swing of things. I agree that depression takes a toll on relationships. Who wants to call up their friends and when asked how you are, have to truthfully reply "Horribly*? And it gets tough to keep up appearances of cheerfulness when you're really depressed. So I worry about losing friendships, and it's been helpful to discuss it with my therapist. On the flip side, I do find that friends have been receptive even when I haven't been in touch for a while. Think about it. Who doesn't want a nice surprise in their e-mail box or on their answering machine from someone who they may have been just thinking about (you)?
As for meeting new people, yeah, it's hard work. Definitely. But if the crowd is friendly and relaxed then I can talk to people easily. I am not introverted - my normal self likes a full social calendar! But I also find that I get a bit overstimulated with too much intense interaction. So I know what you mean about needing to recharge batteries a bit. Schedule a couple of hours of socializing at the end of which you can give yourself some time alone. Take it in small steps. One step at a time and don't look too far ahead. Just little steps.
Here's an idea. If you are introverted and have a hard time getting to know new people, think about finding group activities where you are doing a task - for example volunteering for a soup kitchen, or a work crew for trail building if you like the outdoors, or a committee to plan something, you get the idea. You see that way, you're with people in a setting where you are all focused on the task at hand and can start talking about what you need to do. Then gradually you can start talking to them about other things. It'll throw you into a situation where maybe you don't have to make as much small talk right away, or say a lot about yourself right away, and can just pitch in and see what the crowd is like. Just a thought.
Good luck and keep posting.
Emme
> Thanks Emme for sharing your experience. I'm glad you are finding ways to cope with your illness.
>
> I have a question for you, and anyone else who might have an answer. I have decreased stress to help deal with my depression, as you suggest. I am an introvert, that is people take energy away from me instead of giving it to me, as would happen with a more extraverted person. Hence, people are a major factor of stress for me. So over time I have become relatively isolated, and I am well enough now to want to be around people more. But I do need some time alone each day, to "regenerate my batteries." So at this point I kind of want to expand my social activities, but I am tentative about it... not sure how, not sure if, not sure that it won't be detrimental either.
>
> Have you felt that? It is one thing to push people away to get better, but then when you're ready to see them again, they may not be too open to it anymore. That's still a sore area of my life. And I am ambivalent about what to do about it.
>
> Depression takes a toll on relationships. I am much better now, but I'm not back on the relationship train (family, friendships as well as romantic relationships) and I feel like I should probably give it more of a try, but it seems like a lot of work for the introverted that I am.
>
> Rings a bell, anyone? And Emme, keep posting and letting us know how you are doing.
>
> - Sid
>
> > Hi there. I'm back after a few days of not reading posts. I agree with the idea of a multi-pronged approach to managing mood disorders. My therapist uses the word "manage" as it is a chronic illness for me. Her job, together with my psychopharmacologist's job, is to help me keep symptoms in remission as best as possible and to help me find the way to recover as rich a life as possible. She quakes in fear at the very thought of me being without medication because she sees the profound change - when I'm off or between meds - it's not pretty.
> >
> > So...the components of the multi-pronged approach? When the chips are really down, minimize stress and responsibility as much as possible. Don't feel bad about not making it to things I just can't get to. If I can't manage to wash dishes, uses paper plates for a short while, splurge and pay for laundry drop-off service once in a while if I can't handle doing laundry, etc.
> >
> > Then, when I perk up a bit...get back to exercising as soon as possible ( which I willingly do), do yoga, play my violin, get out of the house as much as possible, initiate contact with friends as best I can, etc. Yeah, all this is totally obvious. But for a while I wasn't really doing the most helpful things for myself at the right times, feeling stress over not keeping up at times when I just couldn't. I don't find all of this easy. But the encouragement helps.
> >
> > And in active therapy, she uses her own style of CBT (she's certainly familiar with Burns' book, and with Beck's work). She doesn't get into breaking it down into which of the 10 categories a though falls into. But she'll say "that's a cognitive distortion", explain why, and we work on it from there. Many of my fears and worries have some elements of cognitive distortion, and can be tackled with *concrete examples* of how things can be different from the way I perceive them. We've found that I'm helped a lot by being given specific examples of how things have worked for other people to offset the negative examples I've seen and internalized. And we've gradually evolved a set of what we humorously call "mantras" for me to keep in mind.
> >
> > So...taking my medicine is crucial, and I'm not aruing against an organic source of brain illness by any stretch. I feel the most dramatic help from the medication when we find something that works. Right now I don't think about whether I'll ever go off meds. That's to think about sometime in the future and if the answer is ultimately no, then so be it. The multi-pronged approach gives me some other tools to help things along the way.
> >
> >
> >
> > Emme
Posted by trouble on January 30, 2002, at 11:04:43
In reply to DBT=Dialectical Behavior Therapy » sid, posted by Dinah on January 29, 2002, at 19:09:28
I'm being very borderline about this DBT therapy. Black/white, all good/all bad, etc.
Thanks for your description, that's exactly what I'd say if I could be lucid about it. Better to recommend a book that made me long for the kind of treatment described within.
It's caalled PTSD/Borderlines in Therapy, Finding the Balance by Jerome Kroll. It cost 40 dollars but to me it was worth it. He's so astute, I mean close the book and stare ito space smart, he's a humble skeptic, and he has that old-school attitude I trust, ie psychology is an exploration, it is about questions not answers. In over 20 years of non-stop therapy that's always who helps me, the ones who don't know for certain, so that's what I believe- answers in psychology are red flags, but today that's practically all you find-the Way, the Truth and the Life; research supported Religion.
I read Dr. Kroll's book as an inspired introduction to my rude, rotten BPD self. He SO has the Borderline's number- and not in the goddamn behavioral sense like the other experts-what's so hard about describing Borderline behavior and labeling it dysfunctional? Plus, he proposes that BORDERLINE PERSONALITY DISORDER become a manifestation of PTSD, and the research has always been there to show the two conditions are co-occuring. He's not a conspiracy theorist but I sure as hell am and I can come up w/ plenty reasons why BPD is not a subset of PTSD. Obviously the latter is an insult, the former a reaction to external trauma, you poor thing. No stigma.Basically, Dr. Kroll's book about 20 case studies shows what's going on inside me, that's where I need my healers to go, and CBT therapies won't go there. So how am I going to stop the insane and fantastical projections and transferences that characterize the Borderline? It's a compulsion, the patterns repeat as if they have a life of their own. This is psychodynamic territory.
I've never met a Borderline who wasn't deep as an abyss, and personally I don't trust the intellect of un-movable CBT therapists-- talk to them, have a cappucino w/ them man to man and you'll find that evil categorical thinking mode I've lambasted in previous posts.
You know who understands Borderlines? Shakespeare, Sexton, Dostoyevsky, Chekhov, Raymond Carver, David Lynch, rock-n-roll. What do the DTB therapists read? Non-fiction. DEALBREAKER!! Nothing against Thich Nhat Hanh. But wellness, exclusively? The good and the nice as a defense, perhaps? What are those consciousness/recovery/self-help books if not proscriptive? Eat your vegetables, they're good for you. Pardon me, I've got some acting out to do. My DBT group made me more out of control than usual (I just read a journal article that said this outcome is not un-common) And I still don't know why, but my therapists were humorless, and I understand Marcia Linehan believes humor is crucial in doing her therapy. It might have helped.And w/out "process" I don't know or trust what someone's trying to accomplish. My subjectivity is irrelevant? Or are you too stupid to take a stab at the intra-psychic realm? I saw too many extreme affective states going ignored in my group, it made me so angry I'd do instant therapy during the break trying to contextualize my co-member's guilt and depression while the therapists focused solely on ways they could remind themselves to follow the techniques. One night people stood in line to speak to me, why? I let them off the hook!
Anyway thanks for giving me a chance to "process" my 12 weeks of DBT. I'm sure it's a fine addition to the protocol of people ready to learn about new and healthier ways of being, but I just wish they'd call it therapy for yoga students or something instead of shoving it down the throats of me and my kind, who are devious, manipulative, complex loonies.
Therapy from a manual, Good Lord what next, accreditation from a family of chimps?
> It's an adaptation of cognitive behavior therapy designed for borderline, suicidal, and self injurious patients. It combines CBT with eastern philosophy (mindfulness, wise mind, etc.). It also has some components relating to dealing with this group of patients (for instance, they encourage calls between sessions rather than discourage them). I wouldn't change my current therapist, but I wouldn't mind learning emotional regulation and distress tolerance skills which seem to be central to DBT. I've got the book, the training manual, and both videos and I'm trying to learn what is useful to me from those. Of course, since I'm doing it on my own, I sort of stop and start with it depending on my mood. That would be the point of doing it in a group, I think.
> Of course I could tell you more, far more, about it. :) But I won't bore you. But I am interested in seeing if it's useful in the real world, with real people.
Posted by trouble on January 30, 2002, at 11:12:54
In reply to ANTIDOTE TO Dialectical Behavior Therapy, posted by trouble on January 30, 2002, at 11:04:43
> I'm being very borderline about this DBT therapy. Black/white, all good/all bad, etc.
> Thanks for your description, that's exactly what I'd say if I could be lucid about it. Better to recommend a book that made me long for the kind of treatment described within.
> It's caalled PTSD/borderlines IN THERAPY, Finding the Balance by Jerome Kroll. It cost 40 dollars but to me it was worth it. He's so astute, I mean close the book and stare ito space smart, he's a humble skeptic, and he has that old-school attitude I trust, ie psychology is an exploration, it is about questions not answers. In over 20 years of non-stop therapy that's always who helps me, the ones who don't know for certain, so that's what I believe- answers in psychology are red flags, but today that's practically all you find-the Way, the Truth and the Life; research supported Religion.
> I read Dr. Kroll's book as an inspired introduction to my rude, rotten BPD self. He SO has the Borderline's number- and not in the goddamn behavioral sense like the other experts-what's so hard about describing Borderline behavior and labeling it dysfunctional? Plus, he proposes that BORDERLINE PERSONALITY DISORDER become a manifestation of PTSD, and the research has always been there to show the two conditions are co-occuring. He's not a conspiracy theorist but I sure as hell am and I can come up w/ plenty reasons why BPD is not a subset of PTSD. Obviously the latter is an insult, the former a reaction to external trauma, you poor thing. No stigma.
>
> Basically, Dr. Kroll's book about 20 case studies shows what's going on inside me, that's where I need my healers to go, and CBT therapies won't go there. So how am I going to stop the insane and fantastical projections and transferences that characterize the Borderline? It's a compulsion, the patterns repeat as if they have a life of their own. This is psychodynamic territory.
> I've never met a Borderline who wasn't deep as an abyss, and personally I don't trust the intellect of un-movable CBT therapists-- talk to them, have a cappucino w/ them man to man and you'll find that evil categorical thinking mode I've lambasted in previous posts.
> You know who understands Borderlines? Shakespeare, Sexton, Dostoyevsky, Chekhov, Raymond Carver, David Lynch, rock-n-roll. What do the DTB therapists read? Non-fiction. DEALBREAKER!! Nothing against Thich Nhat Hanh. But wellness, exclusively? The good and the nice as a defense, perhaps? What are those consciousness/recovery/self-help books if not proscriptive? Eat your vegetables, they're good for you. Pardon me, I've got some acting out to do. My DBT group made me more out of control than usual (I just read a journal article that said this outcome is not un-common) And I still don't know why, but my therapists were humorless, and I understand Marcia Linehan believes humor is crucial in doing her therapy. It might have helped.
>
> And w/out "process" I don't know or trust what someone's trying to accomplish. My subjectivity is irrelevant? Or are you too stupid to take a stab at the intra-psychic realm? I saw too many extreme affective states going ignored in my group, it made me so angry I'd do instant therapy during the break trying to contextualize my co-member's guilt and depression while the therapists focused solely on ways they could remind themselves to follow the techniques. One night people stood in line to speak to me, why? I let them off the hook!
> Anyway thanks for giving me a chance to "process" my 12 weeks of DBT. I'm sure it's a fine addition to the protocol of people ready to learn about new and healthier ways of being, but I just wish they'd call it therapy for yoga students or something instead of shoving it down the throats of me and my kind, who are devious, manipulative, complex loonies.
> Therapy from a manual, Good Lord what next, accreditation from a family of chimps?
>
> > It's an adaptation of cognitive behavior therapy designed for borderline, suicidal, and self injurious patients. It combines CBT with eastern philosophy (mindfulness, wise mind, etc.). It also has some components relating to dealing with this group of patients (for instance, they encourage calls between sessions rather than discourage them). I wouldn't change my current therapist, but I wouldn't mind learning emotional regulation and distress tolerance skills which seem to be central to DBT. I've got the book, the training manual, and both videos and I'm trying to learn what is useful to me from those. Of course, since I'm doing it on my own, I sort of stop and start with it depending on my mood. That would be the point of doing it in a group, I think.
> > Of course I could tell you more, far more, about it. :) But I won't bore you. But I am interested in seeing if it's useful in the real world, with real people.
Posted by Dinah on January 30, 2002, at 11:19:50
In reply to ANTIDOTE TO Dialectical Behavior Therapy, posted by trouble on January 30, 2002, at 11:04:43
Where did you find the journal article you wrote of. I do know what you mean about rigidity. Rigidity in a therapy or in a group (I went to one Recovery Inc meeting) engenders rebellion in me. And I am not a particularly rebellious person. I just hate group-speak.
Dinah
Posted by robinibor on January 30, 2002, at 23:43:58
In reply to Re: my reservations about cbt » jane d, posted by sid on January 29, 2002, at 14:26:24
Just in case some of this is helpful, I went through a bunch of Dick's material and copied out 2 paragraphs on Psychotherapy and 3 on CBT that ARE NOT on our website.
Psychotherapy is the process of talking out one's problems to a trained professional. There are many ways of conducting psychotherapy, but all depend on an open, trusting relationship. For some patients, the opportunity to disclose to the therapist all the guilt and shame accompanying depression without being judged is enough to start recovery. For others, the therapist will need to provide guidance in such areas as assertiveness, communication skills, setting realistic goals, relaxation, and stress management, which are problems that commonly interfere with recovery from depression.
Psychotherapy can be provided by a psychiatrist (an MD specializing in mental disorders), a psychologist (Ph.D.), a clinical social worker (MSW), a psychiatric nurse, pastoral counselor, or substance abuse counselor. Note that anyone can hang out a shingle calling himself a "therapist" or "counselor." Ask directly about the individual's professional background and training. Ask if they are recognized as reimbursable by health insurance--if not, consider finding someone else. Finding someone you trust and can feel comfortable with is most important—people should feel encouraged to shop around. A patient definitely should ask about the therapist's background, training, and experience with depression. And if after a few sessions you have any doubts or don't feel you're getting anywhere, tell your therapist about it and get a consultation with someone else. Because medications can be so effective for depression now, their use should be strongly considered along with psychotherapy. Nowadays a good therapist should be associated with a psychiatrist who can prescribe needed medications.
Psychotherapy for depression need not take a long time. Two short-term approaches which have been reliably demonstrated to be effective with depression are cognitive therapy and interpersonal therapy. Cognitive therapy, based on the work of Aaron Beck, identifies a person's distorted thinking habits and recasts them in a more accurate light. For instance, "If my husband gets mad at me, that means he doesn't love me, and I can't live without his love" becomes "If he gets mad at me, that's unpleasant but expected he can be angry and still care about me." Interpersonal therapy, developed by Gerald Klerman and Myrna Weissman, focuses on communication skills: learning to interpret accurately what others are saying to you (instead of assuming you know), and learning to voice your feelings, desires, and needs effectively. Many experienced therapists will use techniques from cognitive and interpersonal therapies as needed by the individual.
Patients who request literature on depression from NIMH or other sources will often find cognitive or interpersonal therapy cited as the treatment of choice for depression. The reason why these approaches get this recognition is that they have been demonstrated, in experiments with all proper scientific controls, to be effective, at least as effective as medication. But the reason why they can be proven effective like this is because they have been elaborated to such a concrete level that one therapist's cognitive therapy is much like another therapist's cognitive therapy. This is not the case in most kinds of psychotherapy, where the personality of the therapist is such an important factor. This puts cognitive and behavioral therapy at a distinct advantage in the research, just because there is so little variability you are evaluating the effectiveness of a set of techniques, not an art. Experienced therapists sometimes denigrate these approaches as "cookbook" methods because they leave little room for creativity.
Cognitive therapy has become so accepted now as a standard treatment for depression that some are considering depression largely a symptom of dysfunctional thought processes. This runs the risk of encouraging the depressive's thinking that he needs more control, not less. If he continues depressed, he is likely to feel that he has done a poor job of applying cognitive methods, which just reinforces his sense of self-blame and inadequacy. Depressives need to get out of their heads and into their hearts and their bodies. The best therapists recognize that depression is a very complex condition and that changing faulty thought processes is just one of many possible ways of treating it, and that addressing these thought processes is going to have repercussions in other areas of the patient's life--how he processes feelings, how he communicates with those close to him, how he feels about himself.
Posted by sid on January 31, 2002, at 0:37:11
In reply to Re: depression, stress and relationships, posted by Emme on January 30, 2002, at 9:38:21
Posted by sid on January 31, 2002, at 0:46:47
In reply to CBT just one of many ways of treating depression, posted by robinibor on January 30, 2002, at 23:43:58
> Depressives need to get out of their heads and into their hearts and their bodies.
That's how I feel... now, not simplly that I need to do that, but I FEEL like doing it. Life is good sometimes. I hope it lasts.
Posted by Emme on January 31, 2002, at 8:22:15
In reply to CBT just one of many ways of treating depression, posted by robinibor on January 30, 2002, at 23:43:58
Very nicely put. And I do think the best psychotherapist is one who can adapt and use whatever technique(s) are helpful to someone at the time. A generali sort of CBT is one of several approaches my therapists have used.
Emme
> Just in case some of this is helpful, I went through a bunch of Dick's material and copied out 2 paragraphs on Psychotherapy and 3 on CBT that ARE NOT on our website.
>
> Psychotherapy is the process of talking out one's problems to a trained professional. There are many ways of conducting psychotherapy, but all depend on an open, trusting relationship. For some patients, the opportunity to disclose to the therapist all the guilt and shame accompanying depression without being judged is enough to start recovery. For others, the therapist will need to provide guidance in such areas as assertiveness, communication skills, setting realistic goals, relaxation, and stress management, which are problems that commonly interfere with recovery from depression.
>
> Psychotherapy can be provided by a psychiatrist (an MD specializing in mental disorders), a psychologist (Ph.D.), a clinical social worker (MSW), a psychiatric nurse, pastoral counselor, or substance abuse counselor. Note that anyone can hang out a shingle calling himself a "therapist" or "counselor." Ask directly about the individual's professional background and training. Ask if they are recognized as reimbursable by health insurance--if not, consider finding someone else. Finding someone you trust and can feel comfortable with is most important—people should feel encouraged to shop around. A patient definitely should ask about the therapist's background, training, and experience with depression. And if after a few sessions you have any doubts or don't feel you're getting anywhere, tell your therapist about it and get a consultation with someone else. Because medications can be so effective for depression now, their use should be strongly considered along with psychotherapy. Nowadays a good therapist should be associated with a psychiatrist who can prescribe needed medications.
>
> Psychotherapy for depression need not take a long time. Two short-term approaches which have been reliably demonstrated to be effective with depression are cognitive therapy and interpersonal therapy. Cognitive therapy, based on the work of Aaron Beck, identifies a person's distorted thinking habits and recasts them in a more accurate light. For instance, "If my husband gets mad at me, that means he doesn't love me, and I can't live without his love" becomes "If he gets mad at me, that's unpleasant but expected he can be angry and still care about me." Interpersonal therapy, developed by Gerald Klerman and Myrna Weissman, focuses on communication skills: learning to interpret accurately what others are saying to you (instead of assuming you know), and learning to voice your feelings, desires, and needs effectively. Many experienced therapists will use techniques from cognitive and interpersonal therapies as needed by the individual.
>
> Patients who request literature on depression from NIMH or other sources will often find cognitive or interpersonal therapy cited as the treatment of choice for depression. The reason why these approaches get this recognition is that they have been demonstrated, in experiments with all proper scientific controls, to be effective, at least as effective as medication. But the reason why they can be proven effective like this is because they have been elaborated to such a concrete level that one therapist's cognitive therapy is much like another therapist's cognitive therapy. This is not the case in most kinds of psychotherapy, where the personality of the therapist is such an important factor. This puts cognitive and behavioral therapy at a distinct advantage in the research, just because there is so little variability you are evaluating the effectiveness of a set of techniques, not an art. Experienced therapists sometimes denigrate these approaches as "cookbook" methods because they leave little room for creativity.
>
>
> Cognitive therapy has become so accepted now as a standard treatment for depression that some are considering depression largely a symptom of dysfunctional thought processes. This runs the risk of encouraging the depressive's thinking that he needs more control, not less. If he continues depressed, he is likely to feel that he has done a poor job of applying cognitive methods, which just reinforces his sense of self-blame and inadequacy. Depressives need to get out of their heads and into their hearts and their bodies. The best therapists recognize that depression is a very complex condition and that changing faulty thought processes is just one of many possible ways of treating it, and that addressing these thought processes is going to have repercussions in other areas of the patient's life--how he processes feelings, how he communicates with those close to him, how he feels about himself.
Posted by trouble on January 31, 2002, at 10:29:44
In reply to Re: ANTIDOTE TO Dialectical Behavior Therapy » trouble, posted by Dinah on January 30, 2002, at 11:19:50
The article was a link to some psychology journal I don't remember tho, sorry.
But for a good definition of what I mean by therapist rigidity let's look at Jeffrey Kottler's view in COMPASSIONATE THERAPY, WORKING WITH DIFFICULT CLIENTS (1992). PAGE 173
"A major soursc of resistaance in therapy that stems directly from the clinician is a posture of certainty whereby the therapist communicates absolute paramaters of right and wrong, good and bad to the client (Bauer and Mills, 1989). These rigid beliefs regarding what constitutes reality or what clients REALLY mean when they act in certain ways are bound to stir up rebelliousness in many otherwise cooperative clients...
Confronted by a client who suddenly becomes stubborn, it is often helpful to ask ourselves in what ways we are being overly rigid...
...I have found that of the dangerous traits with which a therapist can hurt people rigidity can be most lethal. I have learned to be suspicious of therapists who believe they have found truth, not only for themselves, but for the rest of the world."
Isn't he a sweetie? I've read all his books (he writes groovy hand-holding tomes for practitioners with titles like THE IMPERFECT THERAPIST), that help me understand them better.
Hope this helps.
Posted by trouble on January 31, 2002, at 10:44:02
In reply to DBT=Dialectical Behavior Therapy » sid, posted by Dinah on January 29, 2002, at 19:09:28
THERAPIST 1:
OH LOOK, SHE'S SLAMMING HER HEAD AGAINST THE WALL.
NOT SO GOOD.THERAPIST 2:
NO, NOT GOOD AT ALL.T1:
DYSFUCTIONALT2:
TOTALLY.T1:
WHAT'S THE MANUAL SAY?T2:
IT'S NOT IN HERE.T1:
YOUR TURN TO WRITE THE GRANT PROPOSAL.T2:
SHOULDN'D WE TELL HER TO STOP FIRST?T1:
RIGHT. EXCUSE ME, MISS? HERE'S A LIST OF TECHNIQUES TO KEEP YOU FROM SLAMMING YOUR HEAD AGAINST THE WALL.BORDERLINE:
OH, THANK GOD. YOU DON'T KNOW HOW LONG I'VE BEEN WAITING FOR THIS. I'M GOING TO START RIGHT NOW, THEN I'M GOING TO BUY A DAYPLANNER AND OPEN A VEGETARIAN RESTAURANT.
T1:
THAT'S WHAT IT'S ALL ABOUT.T2:
MAKING A DIFFERENCE.T1:
NO, I MEANT THE GRATITUDE.T2:
THE GRATITUDE, RIGHT YOU ARE, AND WELL DESERVED IT IS!
Posted by sid on January 31, 2002, at 11:30:11
In reply to DBT INACTION (A SKIT), posted by trouble on January 31, 2002, at 10:44:02
Posted by Dinah on February 1, 2002, at 16:52:20
In reply to Re: ANTIDOTE TO Dialectical Behavior Therapy, posted by trouble on January 31, 2002, at 10:29:44
Even if all that is true, and believe me I'm not doubting it, there is still a lot of good to be had in CBT and DBT. I have willingly admitted that I hate CBT when it is rigidly applied. It makes me feel like a trained seal.
However, when you get a therapist who's good enough to convey the information in a non-didactic conversational style, it can change your whole way of looking at things. And yes, sometimes you do need to eat your vegetables. But it's your own health that's hurt by itif you don't. A good therapist helps you see the benefits of eating your vegetables and recognizes that it's your choice whether to do it or not.
Posted by martha429 on August 24, 2002, at 18:59:14
In reply to Re: ANTIDOTE TO Dialectical Behavior Therapy, posted by Dinah on February 1, 2002, at 16:52:20
A manual is only as good as the therapist using it. I certainly agree that rigidity is counterproductive. However DBT becomes more flexible as the person learns to stop dangerous behavior. A manual will be more flexible out of a research setting and in the hands of a skilled therapist. DBT can be a way out of a painful life, but not the only way.
Regarding the skit, one of the guiding principles in DBT is not to be judgemental of persons in treatment by either the person or the therapist. Lables hopefully are only for diagnoses, not persons. I would hope that a DBT therapist would make note of that in order to be compassionate.
This is the end of the thread.
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