cbt equivalent of object relations- Searches Answered #1

Every now and then in my stats I see that someone showed up here using an interesting search term looking for something that isn’t answered directly in my blog.

Today “cbt equivalent of object relations” popped up.

I like this question, because I think the idea that CBT is not the opposite of Psychodynamic therapy is important. Often with differing theories people are using different words for similar concepts

I think first what’s important to establish is what is meant by object relations. Object relations theory as a whole gets into a lot of things. But I am guessing this person was interested in object relations as in the idea that early ways of relating to people are repeated in future relationships.

My knowledge of cognitive behavioral ideas are more limited so excuse any over simplification.

One way of looking at this with CBT is the idea of schema (http://en.wikipedia.org/wiki/Schema_(psychology) ) both involve a mental set defined early in life.
Or also possibly you could say that a person’s interactions with their caregivers can lead to stimulus generalization (http://psychology.about.com/od/sindex/g/stimgen.htm) where they interpret others as reacting like their parents even if they are not.

Even if there may be some overlap, CBT has nothing on Object Relations Theory when it comes to evocative imagery.

And on that note, I will leave you with two Harry Guntrip Quotes:
“A patient who fantasized standing with a vacuum cleaner (herself, empty and hungry), and everyone who came near she sucked into it. At a more normal and ordinary conscious level this is expressed by a patient thus: ‘I’m afraid I couldn’t make moderate demands on people so I don’t make any demands at all.”

“love made hungry is the schizoid problem and it rouses the terrible fear that one’s love has become so devouring and incorporative that love itself has become destructive”

I relate strongly to the second quote.

Also if you are interested in things that make different types of therapies similar you might be interested in reading about Common Factors.

The more you need help the less willing people are to provide it + the intersection of work and treatment

A few weeks ago I decided to give CBT another shot. How is it fair for me to fully reject it as a treatment option for myself, when my experience with it has been so poorly applied?
I picked out a local prestigious research center and gave them a call.

I felt that maybe the failures with my previous efforts to get “real CBT” were because I was looking for treatment in the community rather than from researchers. Maybe this “empirically supported treatment” only exists in the magical world of academia. The treatment outside might share the same name, but maybe it is something different.

In the past I’ve avoided treatment research studies (even though I’ve participated in many other types of studies) because I worried about the guilt I’d feel when I didn’t get better. I don’t want to ruin their study.

I don’t talk about my work here much, both to maintain my anonymity and due to confidentiality rules. I love what I am doing and I am making amazing professional connections. It is doing wonderful things for my developing career, but not so good things for my ability to find treatment. I am very concerned about keeping my crazy separate from my professional life. Most of the people I work with are therapists.
As my therapist list grows longer and longer and my work social network also expands I’m running into increasing problems of overlap between the two. I know that both therapists number 23 and 25 in particular had some form of connection to people whom I work with. I’m sure others have had connections I don’t know about.

S.M has tried to assure me that some amount of this problem is very typical for folks working in the mental health field and that clinicians should be able to handle it tactfully. The problem is that most people only have one therapist they are awkwardly avoiding in their professional life. I have 25 and counting.
If I knew for sure, ‘ok this therapist is the last one I will ever have to see, because this therapist will be a good fit’ then I might be less concerned about the therapist possibly knowing a coworker or attending some of the same conferences as me. The problem is that in all likelihood therapist number 26 won’t be able to help me any more than the other 24 (S.M is excluded as I only left him because he’s located far away). As I see more and more therapists I cut off more and more career options. I wish I could wipe my identifying bits of information out of a therapists head after I fire them.
The ideal therapist for me would be completely professionally isolated, the problem is that someone that isolated is not likely a very good clinician.

It may seem like I got a bit off topic in the above paragraph from my thesis sentence, but here’s where it connects. Something that made this Prestigious Research Center (henceforth known as PRC because psychologists love acronyms almost as much as Unitarian Universalists) a wonderful choice for my treatment is that I have zero desire to work there. We have differing theoretical interests and this is a place that would be particularly hostile for a person with my perspective to work. I could go there as a patient and not feel like I am blocking off a future job opprotunity.

I played telephone tag for a week with PRC and finally got in touch with a fellow who conducted a phone screening interview. I prefaced the interview by letting him know that I realize I’m not the ideal person for their research, due to my large amount of treatment experience and number of co-morbid diagnoses. He said this was fine, because the research clinicians also see patients there outside of the studies.
I thought this was great. I could get the research clinician without the guilt of sabotaging their study.
He said that sometimes they do have to refer people out with certain kinds of problems that they don’t work with e.g. substance abuse. As substance abuse is not a problem of mine, I wasn’t concerned.

I became even more attached to PRC when he told me that all of their patients go through a thorough assessment prior to therapy (things like personality measures, structured clinical interview etc) with an accompanying report.
I have a large stack of neuropsychological testing, but never any formal assessment, independent of the treatment, about the rest of my crazy. If nothing else I was excited about the idea of a beautiful organized report with charts and standard deviations. I adore data. Even if this therapy didn’t work out at least I’d have a report (albeit one biased towards militant CBT research) to show future clinicians.

The phone interview lasted an hour and a half. I was told I’d get a call back from the main desk to book an appointment for the assessment. Instead the fellow from the phone interview called me back to say they were unable to work with me. He’d talked to his supervisor who told him they had a policy of not working with anyone who has had more than 2 hospitalizations in the past 5 years (I’ve had 3). Then he offered me a referral to Other Prestigious Research Center.
The problem? Other Prestigious Research Center is where I work. Not in the specific part he referred me to, but very closely affiliated with it. This isn’t just a matter of me being obsessed with boundaries where I avoid people even loosely associated with my work. This is closely related enough that it would be unbelievably inappropriate for me to look for treatment at this particular location.
I was so taken by surprise that I actually told him why I couldn’t use that referral. An unusual self-revelation for me.
He got back to me the next day with more referrals except this time for people in private practice. When I googled them it turns out they both worked at the same Other Prestigious Research Center that I have to avoid.

So my plan of getting CBT was foiled again. I called S.M. asking for a referral. I feel so awful coming back to him over and over. He has a hard time making these referrals because he doesn’t know many people in my area.

For the past couple of years he’s been trying to get me to see a “senior analyst” for a consultation. Someone too busy (or mostly retired) to take on any new patients, but who could be a fresh set of eyes for my problems and would know clinicians in my area well enough to select a strong match.
I’d been turning him down, because I didn’t want to add an extra person who knows my problems to the world unless they were someone I was planning to meet with long term. I finally agreed to give this a shot.
He told me a name and I googled her to establish sufficient separation from work. She is loosely connected but far enough apart that I can tolerate it. S.M told me he would give her a call and see if she could see me for a consultation.

It been a couple of weeks. I’m not sure what’s going on. I guess she’s not answering his call? S.M. keeps telling me he expects to hear back soon, but it hasn’t happened.
Meanwhile I’m waiting, feeling like I can’t try to pursue other options (as if I even have any) until this sorts itself out.
I’ll go to work next week where I’m surrounded by therapists, while I am still unable to find a therapist for myself.

Galvactivator

I stumbled across the website today for the Galvactivator. It’s a glove that’s a skin conductance sensor with a light built into it that lights up at higher levels of conductivity. Made by some folks at MIT.

Website is here: http://www.media.mit.edu/galvactivator/index2.html *
As you may know anxiety/emotional arousal is one of a number of things associated with higher levels skin conductivity. Here's a plot of data from their website, showing changes in skin conductivity.
I could see something like this having useful applications for therapy.

One of the major reasons therapy hasn’t worked out for me has been that I didn’t feel like the therapist understood me. We’re very out of sync. These therapists can’t all be so out of sync with all their clients. Something I’m bringing to the table must make it more difficult. Aside from the obvious problem of my attachment issues, I think it’s possible that my facial expressions are also harder to read than average.

I’m very practiced at hiding reactions. It’s not that I don’t show facial expressions, of course I do, but there’s a lot that’s hidden too. It’s not at all unusual for me to get a sudden panic about something while in class or a meeting. My heart rate will go out of control, but no one notices, because my face doesn’t show it (at least not that I’m aware). A lot of this unintentionally carries over to my therapy. I’m sure it complicates things if they’re working from fewer visual clues.
S.M (the one therapist who gets me, but sadly does not work in the area) has a particularly large chair in his office. He’s commented to me how he can tell when I’m getting upset by how far down I’ve slid down the chair. Sometimes I nearly fall out. Therapy is a cycle of sliding down the chair and then realizing I’m going to fall out and sitting up again.

Something like this could be an interesting tool in therapy, because it would be an added piece of visual information about a client’s emotional state. It does get suspiciously close to the fantasy of wanting mind reading I was once accused of by a therapist, but is safer, because it would still be up to the wearer to choose to share the content/cause of the emotions.

What do you think?

It’s too bad they’re not for sale. The faq says someone is looking into making them for sale though, so maybe they’ll be available eventually. I would definitely buy one.

*It’s a shame the website uses frames, really I expect better webcoding from MIT. It’s not 1998 anymore. Also in-line CSS and tables used for layout. Eww. Why? Maybe the website is old?