I’m not going to apologize for my lack of posting, because I hate reading those.
After firing therapist number 23, I thought I might take a break from therapy for a bit. I was very angry at him, but leaving was a huge relief and immediately had a positive impact on my mood. The relief lasted a bit, but soon, without another outlet, some grumpyness began to ooze into my professional life.
I really like psychodynamic theories. The therapist who I have liked the most was psychodynamically oriented, while the one who kicked me out of school was into CBT.
I keep seeking out these psychodynamic therapists in an effort to replicate the therapy I had with this other therapist (S.M.). I want this idealized perfect therapy that I read about in text books. I want one where there are insightful interpretations and the new relationship disproves the assumptions from my old object relations.
My best and worst ideas are impulses that come to me while trying to sleep or taking a shower. I lept out of bed to the computer. I needed something completely different.
I searched on the ABCT therapist directory. I would find a CBT therapist.
This was harder than I expected.
Despite living in an area with a relatively high population of therapists, the list was short. Many of the names were names of researchers working at one particular research center. I didn’t want to participate in a study. I’d feel too guilty when I didn’t get better.
I narrowed the list to two choices and went to sleep.
I made a call to one therapist in the morning.
After the call I began rationalizing my impulsive, poorly thought out decision.
“This isn’t real therapy”, I thought. “This is rebound therapy”.
I don’t believe CBT has the ability to ultimately fix my problems, but I thought maybe I should give it another shot
temporarily. After all it is really the B part, behavioral, I object to, the C part, Cognitive, is not so bad. If I could find a person using the right balance of minimal B and mostly C, maybe it could work.
I figured it could be short term and might shove me out of my therapy rut.
Whenever I disagreed with my previous therapist’s interpretations he would argue that maybe the process he was speaking of was unconscious. It was infuriating, when he would pull things out of seemingly nowhere and say this. How can you argue with the unconscious?
At least with CBT I could dodge that.
I made an appointment and began to feel guilty.
I have so much anger towards the CBT therapist who got me kicked out of my school much of which has generalized to the theoretical perspective as a whole. This poor woman would have to be subjected to this. She had no way of knowing what she was getting into. She’d done nothing wrong yet, I’d not even met her, but I was feeling intense rage and fear towards her.
I felt awful about what I would put this poor woman through and decided I needed a peace-offering to begin with.
Where do CBT and I have common ground? We both like data. I keep track of a number of variables in my life.
I decided to print out an excel sheet of the past several months of certain variables, complete with averages at the bottom of each column.
As it turned out, I never showed her the spreadsheet, because the timing was never right.
I built her up in my head as this monster I needed to defend myself against. When I arrived at the first appointment to discover she had only one head and no visible fangs it was a relief. Almost anything she could have done would have been better than my expectations.
Much of the anger dissipated once I entered the waiting room for the first appointment and behind it I was terrified.
She won some points for acknowledging how traumatic the whole getting kicked out of school mess was.
I decided to keep meeting with her.
I never told her where I go to school or where I work. It started to feel silly after awhile, but it was a nice little extra level of safety. She couldn’t use that information to hurt me if she didn’t possess it.
She’s a psychologist, so she can’t prescribe. In the first week of August my Klonopin was going to expire. That date acted as a deadline for when I needed to transition therapy to a psychiatrist or at least find a psychopharmacologist.
Through a misunderstanding, she thought I wanted to end at the end of June. I’d been thinking more like the end of July, but decided to leave it at June.
I went to her looking for CBT and received supportive therapy, not CBT.
That’s not useless, but also not what I’d been looking for.
For all of ABCT’s posturing about empirically supported treatments and manualized therapies, I didn’t see much of that. I shouldn’t really be that surprised that outside of a research setting CBT can mean anything really. Both CBT and Psychodynamic ideas have problems with inconsistencies in their implementation. Finding that specific treatment you want out in the world is not so simple.
I was even willing to fill out worksheets. There was not a single one. I have trouble believing it’s real CBT without a worksheet or two.
She did admit that it wasn’t really CBT.
Maybe getting something other than CBT from a CBT practitioner was all I could really handle. If nothing else it was some exposure therapy to just show up.
I had such a problem during the spring semester in one of my classes. My intellectual feelings about CBT differ from my emotional feelings. Speaking in class I need to be so careful to only speak from my frontal cortex rather than from my amygdala. Too often I’ve allowed bit of emotion to bleed into my words.
Professionally I need to be able to separate the two. More and more I am encountering situations that push my limits with exposure to CBT outside of my own personal therapy.
Villainizing CBT can be too easy when working with psychodynamically oriented therapists. There is a long history of animosity between the two groups. They tend to collude with me in this issue. The difference is that they are objecting to it theoretically (although emotions are certainly there, but they are an effect rather than a cause), while I am objecting to it emotionally and finding intellectual reasons to rationalize that emotional reaction.
I do feel I got some benefit from the therapy, even though it was clear the therapist felt she’d failed me somehow. Most sessions were me spending an hour going through my massive to do list. I was so busy and exhausted that directing therapy towards a goal was way outside of my present abilities.
Just being there with a CBT therapist, the content wasn’t important. What was important was the conflict free relationship with a CBT practitioner. This helped me work through some of the negative transference I’d been experiencing toward her before the first appointment. Really in this way the “CBT” therapy did more for my object relations than a lot of psychodynamic therapy has done.
I’m still messed up, but this feels like a teensy step in a good direction.
I feel embarrassed about going to see a CBT therapist. I called S.M. a couple of times while I was seeing her. I lied saying I wasn’t in therapy. I asked him for a referral for the new therapist I went to see after this CBT therapist. I also did not tell the new therapist who I saw on Thursday. I lied and said I’d been out of therapy entirely for the past couple of months.
I have to admit, I’m not sure if I understand everything I just read. We have been musing over on Harriet’s blog (http://harrietmwelch.com/?p=1647) about the differences between psychodynamic and CBT. Everyone seems to have wildly different experiences with it. I’m surprised your recent CBT experience had your therapist admitting it wasn’t really CBT.
When I brought up with my current T that my p-doc was pushing CBT ideas at me, that he said that CBT used to be the big thing 10-15 years ago but that its popularity is dying out. After I said I wasn’t interested in it, he admitted that he wouldn’t even know where he could refer me if I was interested.
I know each therapist is an individual and so is each client, but you would think there would be some level of consistency in both therapeutic models, wouldn’t you?
It’s tricky because coming from different theoretical perspectives sometimes the same intervention can be used because there can be different ways of understanding the same idea.
Getting “pure” is hard because none of these techniques are polar opposites. There is considerable overlap although each uses their own terminology.
Within any approach there is a lot of wiggle room for what might be done.
This article is often used as an example demonstrating this (http://ajp.psychiatryonline.org/cgi/content/abstract/159/5/775)
This one also interesting http://psycnet.apa.org/psycinfo/1998-00413-006 (You might not have access, not sure if this one is public) Therapy that was more like the idealized psychodynamic definition was more effective even if that therapy was calling itself CBT.
The pop-psych articles would have you believe that there is a uniformly applied method, but obtaining the exact thing you read about in a research article is not so easy.
I agree that with Harriet that “CBT ignores the complexity of human behavior” although I would throw the word often in there. There’s a range in abilities of CBT therapists.
There’s another study (http://cat.inist.fr/?aModele=afficheN&cpsidt=3142692) that I think is really interesting it found that rigid adherence to models is the problem.
I think this is CBT’s biggest problem. Rigidity. When you hand people a manual for the therapy and they’re less comfortable with it, they try to stick by the details too much even when it is not in that individual’s best interests. CBT creates a situation where it is all too easy to be excessively rigid.
I’m not sure what your T’s source is for saying CBT is not still big. At least in academia it is very hard to escape. In hospitals and partial hospital problems it is often the only option. Refuse it and you are labeled as difficult.
There’s some hope the psychodynamic therapy is making a come back what with the recent Shedler meta-analysis making it’s big splash is Feb, talking about the effectiveness of psychodynamic therapy, but for now CBT is dominant.
Check this out
Whenever you see someone refer to “Empirically Supported Treatments” they don’t mean just any treatment that has evidence. They mean ones on this list. It’s a very political, specific term that gets thrown around a lot in pop psych articles. Sounds good on the surface but look at how limiting the options would be if consumers were limited only to these.
If you look, most are CBT based.
I feel like maybe I went on a tangent. Not sure if I addressed your questions.
I ams still reading — will post after I’m done!
I tend to lean towards CBC (Cog behavioural coaching) quite a new area of psych but combines both CBT and coaching
there is much more info in google …
Happy 4th July (yesterday):)
Wow…it sounds like there is a lot going on in your mind. Your last paragraph tells me there’s a ton swirling around and maybe a lot left to deal with? It also sounds like the therapist you saw may have realized that and perhaps that guided her presentation of CBT to you. I agree with you that CBT typically contains worksheets, but it doesn’t always, and it may be that she was aware of your resistance.
There are tons and tons of highly qualified CBT therapists who are able to integrate different aspects of other theoretical backgrounds. I happen to think those are the best, but that’s just me. The other thing I want to point out is that not all CBT therapists are listed with the ABCT! I live in a major metropolitan area and both CBT therapists I saw myself as well as the majority of the CBT therapists I know professionally are not listed on it. I’ve found the best way to get a good referral is to ask for one.
I believe very, very strongly in (effective) CBT as a first line treatment for depression (in combinatoin with meds as necesary). For myself, I choose a more psychodynamic modality because I believe it meets my needs better, so I do hear what you’re saying. But, I have seen CBT therapists who were able to take from different modalities and they have been helpful (and no worksheets, either).
It’s great you’re aware of how strongly you feel opposed to this form of treatment. I just hope you don’t toss it out as an option entirely because of this experience.
Of course not all CBT practitioners are listed in ABCT, but it’s a good place to start from. Not everyone feels like paying the membership fee. I know plenty of psychologists without active APA memberships.
One of the first things I told her was about some of my problems with CBT. There’s no doubt that the treatment was guided by that.
I think I got what I needed from my “CBT” diversion and now I’m ready to go back to psychodynamic therapy which I think is more the answer for my problems.