How does that make you feel?
January 8, 2016 1:45 PM Subscribe
CBT vs Psychoanalysis, Round 2016 [The Guardian]
“What happens in therapy,” Pollens said, “is that people come in asking for help, and then the very next thing they do is they try to stop you helping them.” His smile hinted at the element of absurdity in the situation – and in the whole therapeutic undertaking, perhaps.
“What happens in therapy,” Pollens said, “is that people come in asking for help, and then the very next thing they do is they try to stop you helping them.” His smile hinted at the element of absurdity in the situation – and in the whole therapeutic undertaking, perhaps.
Would I be a total weirdo if I said that both talk therapy and some CBT techniques have been very helpful to me? And that they are somewhat mutually reinforcing, so that, for instance, it's a lot easier to stop the negative voice when you know that the negative voice seems to draw some of its power from your awful childhood?
posted by Frowner at 2:11 PM on January 8, 2016 [46 favorites]
posted by Frowner at 2:11 PM on January 8, 2016 [46 favorites]
I thought it has been demonstrated that the type of therapy is a lot less significant than the skill of the specific therapist. Perhaps the opposite has now been demonstrated. Science moves so fast.
posted by Grangousier at 2:19 PM on January 8, 2016 [2 favorites]
posted by Grangousier at 2:19 PM on January 8, 2016 [2 favorites]
Me: "I didn't do the thing I wanted to do! Fuck!"
My last shrink: "It's ok! Go easy on yourself!"
Bro I've BEEN going easy on myself and as a result I am failing to do things I want to do, please give me some fucking STRATEGIES here?!
Urgh.
posted by showbiz_liz at 2:21 PM on January 8, 2016 [16 favorites]
My last shrink: "It's ok! Go easy on yourself!"
Bro I've BEEN going easy on myself and as a result I am failing to do things I want to do, please give me some fucking STRATEGIES here?!
Urgh.
posted by showbiz_liz at 2:21 PM on January 8, 2016 [16 favorites]
The sweary, freewheeling Ellis
...is the name of my new sockpuppet through which I will be able to reveal dark psychoanalytic secrets
posted by Greg_Ace at 2:24 PM on January 8, 2016 [3 favorites]
...is the name of my new sockpuppet through which I will be able to reveal dark psychoanalytic secrets
posted by Greg_Ace at 2:24 PM on January 8, 2016 [3 favorites]
“I don’t think anything has ever made me feel as lonely and isolated as having a computer program ask me how I felt on a scale of one to five, and – after I’d clicked the sad emoticon on the screen – telling me it was ‘sorry to hear that’ in a prerecorded voice,” Rachel recalled.I'm relieved to find, rereading this, that she was at least having some sessions with a human therapist, but this is the kind of grim dystopia that would push me to never talking about my mental health with any professional.
I don't really believe in much Freud said, but my best therapist was a psychodynamic therapist (not just in terms of how much I liked her personally, but in the fact that I went from having panic attacks every week to not really having them except when I foolishly attempted to go to the holiday market at Union Square on a weekend). But I read Feeling Good, and I read When Panic Attacks, and I got some experience with CBT-ish identifying your irrational thoughts and arguing with them; it was all useful stuff; it just never seemed like all of the problem.
posted by Jeanne at 2:43 PM on January 8, 2016 [3 favorites]
Any therapist who states "My way is the right way" and utilizes a single modality for every client/patient is doing it wrong. Therapists who feel a need to debunk and cast doubt on modalities they don't use should probably not be trusted.
Any good practitioner utilizes a variety of techniques and approaches, depending on the needs/status/situation/beliefs/etc of his/her clients.
I utilize concepts from traditional psychoanalysis, ideas from transactional analysis, heavy doses of CBT, some pretty free flowing talk therapy, and sometimes my younger patients and I sit and play catch in my office, or walk around the pond outside looking for frogs, as we ask each other questions.
My statement to clients is frequently "There may well be a value in, eventually, determining the root of your anxiety/depression/anger/fear/whatever by examining your childhood, but, in the meantime, using some pretty understandable techniques from CBT and other less analytic schools of therapy, we can make some significant changes in how you feel, think and respond to the world happening around you today and greatly improve your functioning".
Let me add, too, that psychoanalysis is pretty useless for children and early adolescents whose cognitive abilities and abstract thinking skills aren't fully developed, whereas they often can understand some of the very useful tools of CBT.
Good post, good article...thanks!
posted by HuronBob at 2:44 PM on January 8, 2016 [38 favorites]
Any good practitioner utilizes a variety of techniques and approaches, depending on the needs/status/situation/beliefs/etc of his/her clients.
I utilize concepts from traditional psychoanalysis, ideas from transactional analysis, heavy doses of CBT, some pretty free flowing talk therapy, and sometimes my younger patients and I sit and play catch in my office, or walk around the pond outside looking for frogs, as we ask each other questions.
My statement to clients is frequently "There may well be a value in, eventually, determining the root of your anxiety/depression/anger/fear/whatever by examining your childhood, but, in the meantime, using some pretty understandable techniques from CBT and other less analytic schools of therapy, we can make some significant changes in how you feel, think and respond to the world happening around you today and greatly improve your functioning".
Let me add, too, that psychoanalysis is pretty useless for children and early adolescents whose cognitive abilities and abstract thinking skills aren't fully developed, whereas they often can understand some of the very useful tools of CBT.
Good post, good article...thanks!
posted by HuronBob at 2:44 PM on January 8, 2016 [38 favorites]
Just a datapoint, but:
CBT helped me see that I was broken and pay attention to potential adjustments.
Hiring a coach helped me build reasonable expectations of myself.
Diving into Jungian psych helped me completely rebuild the vision of my future self, lose 80 pounds, accomplish waking up regularly at 4 a.m., and flourish in a new leadership position as a complete introvert.
posted by circular at 2:48 PM on January 8, 2016 [13 favorites]
CBT helped me see that I was broken and pay attention to potential adjustments.
Hiring a coach helped me build reasonable expectations of myself.
Diving into Jungian psych helped me completely rebuild the vision of my future self, lose 80 pounds, accomplish waking up regularly at 4 a.m., and flourish in a new leadership position as a complete introvert.
posted by circular at 2:48 PM on January 8, 2016 [13 favorites]
Perhaps the opposite has now been demonstrated.
It has, in favour of psychoanalysis in some studies, per TA, and CBT in others.
But also as per TA, it's unclear how faithfully any of these therapies are adhered to in different experimental studies, or in actual treatment settings. My experience has been that the B part of CBT gets short shrift, in practice. Also IME, it's the B part - actually doing things - that's most effective, whether it's structured & graduated (as it's supposed to be, in therapy) or occurs in life by way of happy accident - like by lucking into a new and well-suited job or relationship, or just moving, sometimes, because the natural rewards of life are so powerful. (Though of course accidents aren't always so happy.) The C part is really narrative, too, or it should be. I think that gets watered down, yeah for cost reasons, among others.
posted by cotton dress sock at 2:56 PM on January 8, 2016 [2 favorites]
It has, in favour of psychoanalysis in some studies, per TA, and CBT in others.
But also as per TA, it's unclear how faithfully any of these therapies are adhered to in different experimental studies, or in actual treatment settings. My experience has been that the B part of CBT gets short shrift, in practice. Also IME, it's the B part - actually doing things - that's most effective, whether it's structured & graduated (as it's supposed to be, in therapy) or occurs in life by way of happy accident - like by lucking into a new and well-suited job or relationship, or just moving, sometimes, because the natural rewards of life are so powerful. (Though of course accidents aren't always so happy.) The C part is really narrative, too, or it should be. I think that gets watered down, yeah for cost reasons, among others.
posted by cotton dress sock at 2:56 PM on January 8, 2016 [2 favorites]
It might be advisable to spell out what CBT stands for either in the title or the article. Being more familiar with BDSM than mental health, I had a considerably wrong first impression of what was being talked about.
I could believe the other CBT is therapeutic for some people, though. Masochism is a hell of a drug.
posted by Bringer Tom at 3:03 PM on January 8, 2016 [23 favorites]
I could believe the other CBT is therapeutic for some people, though. Masochism is a hell of a drug.
posted by Bringer Tom at 3:03 PM on January 8, 2016 [23 favorites]
It might be advisable to spell out what CBT stands for
Computer-Based Training, right?
posted by Greg_Ace at 3:05 PM on January 8, 2016 [6 favorites]
Computer-Based Training, right?
posted by Greg_Ace at 3:05 PM on January 8, 2016 [6 favorites]
Which, to be fair, can also be pretty masochistic.
posted by Greg_Ace at 3:06 PM on January 8, 2016 [4 favorites]
posted by Greg_Ace at 3:06 PM on January 8, 2016 [4 favorites]
Great, now you've got me thinking about a simulator that trains people in psychoanalytic balls torture.
posted by aw_yiss at 3:08 PM on January 8, 2016 [8 favorites]
posted by aw_yiss at 3:08 PM on January 8, 2016 [8 favorites]
"It might be advisable to spell out what CBT stands for either in the title or the article"
It is clearly identified in the article. And, honestly, having to define CBT as Cognitive Behavioral Therapy in this day and age (especially in a post that is clearly related to mental health/therapy) is akin to defining what LSD is when talking about Mr. Leary....
posted by HuronBob at 3:08 PM on January 8, 2016 [4 favorites]
It is clearly identified in the article. And, honestly, having to define CBT as Cognitive Behavioral Therapy in this day and age (especially in a post that is clearly related to mental health/therapy) is akin to defining what LSD is when talking about Mr. Leary....
posted by HuronBob at 3:08 PM on January 8, 2016 [4 favorites]
Greg_Ace and Bringer Tom, I'll tell you what I told myself -
Not *that* CBT, the *other* CBT!
Cognitive Behavioral Therapy
(I looked it up :-)
posted by Jefffurry at 3:10 PM on January 8, 2016
Not *that* CBT, the *other* CBT!
Cognitive Behavioral Therapy
(I looked it up :-)
posted by Jefffurry at 3:10 PM on January 8, 2016
I suppose for me "Feeling Good" and the concepts behind CBT were useful as a kind of frame shift in thinking about depression. Viewing this set of experiences as a thing called "poor mental health" that can be addressed pragmatically in the same way that, say, flossing regularly addresses bad breath and eventual dental problems. As opposed to both feeling like shit and agonizingly analysing what precisely went wrong with me when and why.
And once I got some breathing room to figure things out without falling into a black hole of self-referential angst, surprisingly enough it turns out to be all my ridiculous parents' fault...
posted by 3urypteris at 3:10 PM on January 8, 2016 [1 favorite]
And once I got some breathing room to figure things out without falling into a black hole of self-referential angst, surprisingly enough it turns out to be all my ridiculous parents' fault...
posted by 3urypteris at 3:10 PM on January 8, 2016 [1 favorite]
Being more familiar with BDSM than mental health, I had a considerably wrong first impression of what was being talked about.
You are my kind of people.
posted by Sternmeyer at 3:12 PM on January 8, 2016 [3 favorites]
You are my kind of people.
posted by Sternmeyer at 3:12 PM on January 8, 2016 [3 favorites]
No matter. My depression crushes both methods with one arm debilitatingly tied behind its dark, sorrowful back.
posted by Thorzdad at 3:15 PM on January 8, 2016 [24 favorites]
posted by Thorzdad at 3:15 PM on January 8, 2016 [24 favorites]
Would I be a total weirdo if I said that both talk therapy and some CBT techniques have been very helpful to me? And that they are somewhat mutually reinforcing, so that, for instance, it's a lot easier to stop the negative voice when you know that the negative voice seems to draw some of its power from your awful childhood?
I think they compliment each other well, at least in broad strokes. I often liken it to the differences between "strategy" and "tactics." Psychoanalysis is the strategy, concerning itself with the "big picture" stuff, such as the mental equivalents of things like geographic terrain, political powers and their motivations, relative strengths, etc. CBT is the "tactics," that focuses on the best ways to support and employ the smaller forces at hand to reach the strategic goals depending on the individual situation - politics (understanding and dealing with the different 'factions' in your head), intelligence gathering (mapping the causes/effects of various triggers), as well as the mental 'boots on the ground' (exercises of awareness and control to avoid negative/unwanted reactions). To wrap up the military analogy, while psychoanalysis can be good at identifying the "conflicting powers," CBT's strength lies in helping to make sure you're not sending endless waves of saber-weilding cavalry against a modern tank battalion.
But that's just my take on it, and I may just be more open to the idea of CBT because of my tendency to see things from a more systematic/mechanical perspective in general.
posted by chambers at 3:58 PM on January 8, 2016 [9 favorites]
I think they compliment each other well, at least in broad strokes. I often liken it to the differences between "strategy" and "tactics." Psychoanalysis is the strategy, concerning itself with the "big picture" stuff, such as the mental equivalents of things like geographic terrain, political powers and their motivations, relative strengths, etc. CBT is the "tactics," that focuses on the best ways to support and employ the smaller forces at hand to reach the strategic goals depending on the individual situation - politics (understanding and dealing with the different 'factions' in your head), intelligence gathering (mapping the causes/effects of various triggers), as well as the mental 'boots on the ground' (exercises of awareness and control to avoid negative/unwanted reactions). To wrap up the military analogy, while psychoanalysis can be good at identifying the "conflicting powers," CBT's strength lies in helping to make sure you're not sending endless waves of saber-weilding cavalry against a modern tank battalion.
But that's just my take on it, and I may just be more open to the idea of CBT because of my tendency to see things from a more systematic/mechanical perspective in general.
posted by chambers at 3:58 PM on January 8, 2016 [9 favorites]
I saw Ellis at a conference many years ago back when there was a lot of energy around synergizing different modalities of human improvement work, including therapy, meditation, etc.
First memorable thing is that his "sweary" presence on a panel served as a model for others. After Ellis would talk, pretty much every other presenter would start to loosen up and throw in swear words. It was kind of hilarious.
Second memorable thing was that a Buddhist therapist was talking about the concept of nirvana in Buddhist practice and how it was impossible to explain in words, but it implied the absence of longing, desire, sensation, emotions (both sad and happy), and so on. On the panel, Ellis sputtered "WELL, WHO THE FUCK IN HIS RIGHT MIND WOULD WANT SOMETHING LIKE THAT like that!?"
posted by jasper411 at 4:19 PM on January 8, 2016 [9 favorites]
First memorable thing is that his "sweary" presence on a panel served as a model for others. After Ellis would talk, pretty much every other presenter would start to loosen up and throw in swear words. It was kind of hilarious.
Second memorable thing was that a Buddhist therapist was talking about the concept of nirvana in Buddhist practice and how it was impossible to explain in words, but it implied the absence of longing, desire, sensation, emotions (both sad and happy), and so on. On the panel, Ellis sputtered "WELL, WHO THE FUCK IN HIS RIGHT MIND WOULD WANT SOMETHING LIKE THAT like that!?"
posted by jasper411 at 4:19 PM on January 8, 2016 [9 favorites]
Just once I would like to hear about a school of therapy whose origins weren't basically, "pushy guy decides he knows how the mind works, attracts a thousand disciples through sheer force of will, has his simplistic ideas accepted by the culture at large without the slightest evidence." The Tavistock study is not an illustration of the success of psychoanalysis; its tepid results on its microscopic sample size were only positive when compared to the absolutely abysmal efficacy of "treatment as usual."
I despair for therapy. I am glad it works for people, of course. But I wish we could fast-forward to the days when we actually understood what a thought was, what an emotion was--not the armchair philosophizing of an aggressive young doctor, but an actual understanding of how our heads work--so that we could start building a therapy that respected us, rather than honoring dusty scriptures about the unconscious and the automatic thought.
posted by mittens at 4:24 PM on January 8, 2016 [8 favorites]
I despair for therapy. I am glad it works for people, of course. But I wish we could fast-forward to the days when we actually understood what a thought was, what an emotion was--not the armchair philosophizing of an aggressive young doctor, but an actual understanding of how our heads work--so that we could start building a therapy that respected us, rather than honoring dusty scriptures about the unconscious and the automatic thought.
posted by mittens at 4:24 PM on January 8, 2016 [8 favorites]
@jasper411: As a caveat, I don't think 'absence of longing, desire, sensation, emotions (both sad and happy), and so on' is the most accurate way of putting it, and Ellis's derisive reply is part of the misinformation noise. I'm reading Pema Chodron's "When Things Fall Apart" and it has one of the best ways of explaining it:
"The middle way is wide open, but it’s tough going, because it goes against the grain of an ancient neurotic pattern that we all share. When we feel lonely, when we feel hopeless, what we want to do is move to the right or the left. We don’t want to sit and feel what we feel. We don’t want to go through the detox. Yet the middle way encourages us to do just that. It encourages us to awaken the bravery that exists in everyone without exception, including you and me." It then goes on to discuss how meditation is a way of training for the middle way.
As for me, I am not a huge fan of either psychoanalysis or CBT, mostly because psychoanalysis puts way too much blame on my parents (which is incredibly alienating as someone who grew up with some ideas of filial piety, plus my parents are doing their best and were really okay. And yeah, my past haunts me, but whose past doesn't? ) and CBT was initially only useful for the 'hard-stop' of recognizing malevolent patterns of emotions and understanding the impact of my environment around me, but the approaches after aggravated my cerebral over-thinking and anxiety attacks.
I am fortunate to have found my current therapist, but I think we bonded on a synergistic and philosophical level even before we met, when I saw her website and did an over the phone consultation. My therapist and I have been most successful in learning to how to sit and manage emotions, which might be closer to DBT, but is also very tied to how I've found some Buddhist philosophy to be very healing. But my therapist has never actually labeled herself and her approaches...she just always encouraged me to sit with my feelings, even if it took us months to really figure all of that out.
posted by yueliang at 4:32 PM on January 8, 2016 [6 favorites]
"The middle way is wide open, but it’s tough going, because it goes against the grain of an ancient neurotic pattern that we all share. When we feel lonely, when we feel hopeless, what we want to do is move to the right or the left. We don’t want to sit and feel what we feel. We don’t want to go through the detox. Yet the middle way encourages us to do just that. It encourages us to awaken the bravery that exists in everyone without exception, including you and me." It then goes on to discuss how meditation is a way of training for the middle way.
As for me, I am not a huge fan of either psychoanalysis or CBT, mostly because psychoanalysis puts way too much blame on my parents (which is incredibly alienating as someone who grew up with some ideas of filial piety, plus my parents are doing their best and were really okay. And yeah, my past haunts me, but whose past doesn't? ) and CBT was initially only useful for the 'hard-stop' of recognizing malevolent patterns of emotions and understanding the impact of my environment around me, but the approaches after aggravated my cerebral over-thinking and anxiety attacks.
I am fortunate to have found my current therapist, but I think we bonded on a synergistic and philosophical level even before we met, when I saw her website and did an over the phone consultation. My therapist and I have been most successful in learning to how to sit and manage emotions, which might be closer to DBT, but is also very tied to how I've found some Buddhist philosophy to be very healing. But my therapist has never actually labeled herself and her approaches...she just always encouraged me to sit with my feelings, even if it took us months to really figure all of that out.
posted by yueliang at 4:32 PM on January 8, 2016 [6 favorites]
I despair for therapy. I am glad it works for people, of course. But I wish we could fast-forward to the days when we actually understood what a thought was, what an emotion was--not the armchair philosophizing of an aggressive young doctor, but an actual understanding of how our heads work--so that we could start building a therapy that respected us, rather than honoring dusty scriptures about the unconscious and the automatic thought.
I agree! I've had conversations with my therapist about this, and she was incredibly healing in being so radically centered on my story and my narrative, and not trying to actively diagnose me just because I shared stories. We would discuss and talk about emotions that were under the surface, and always made lots of time for silence so that it could percolate. It was always "my time." And I think all of these approaches are incredibly well meaning, but ultimately serve to further alienate if the tools that don't work for the patient, keep getting pushed.
For anyone who is really interested in a history of psychotherapy and different approaches, The Body Keeps the Score: Brain, Mind, Body in the Healing of Trauma has some amazing history that critiques and discusses the ways that different approaches are taken. It's really not a monolith, and there are so many different factions and approaches. If it is possible, find a therapist who agrees with you and you holistically.
posted by yueliang at 4:42 PM on January 8, 2016 [9 favorites]
I agree! I've had conversations with my therapist about this, and she was incredibly healing in being so radically centered on my story and my narrative, and not trying to actively diagnose me just because I shared stories. We would discuss and talk about emotions that were under the surface, and always made lots of time for silence so that it could percolate. It was always "my time." And I think all of these approaches are incredibly well meaning, but ultimately serve to further alienate if the tools that don't work for the patient, keep getting pushed.
For anyone who is really interested in a history of psychotherapy and different approaches, The Body Keeps the Score: Brain, Mind, Body in the Healing of Trauma has some amazing history that critiques and discusses the ways that different approaches are taken. It's really not a monolith, and there are so many different factions and approaches. If it is possible, find a therapist who agrees with you and you holistically.
posted by yueliang at 4:42 PM on January 8, 2016 [9 favorites]
I read this earlier in the week. Burkeman probably has little say on the headline, but I did find it overstates the case somewhat, and the entire premise of the piece undermines its own arguments - or rather, circles around arguments without ever successfully prosecuting one, before settling on the clear reality which is that therapy is under-researched, therapy of any kind seems better than nothing, and that different models of interaction are common in therapy, whilst nearly everyone can agree the basis of Freud/Jung remains unproven nonsense.
He tries gamely, but I thought his case for psychoanalysis was actually remarkably weak for an article purporting to deal with its strengths. The studies into CBT are overwhelmingly better, and the detail on its decline in efficacy is too sketchy for my liking; there's more meat to get into there, and I feel a more interesting story hiding about therapy, relationships, story-telling and mental health etc.
I read that book by the psychoanalyst he mentions a couple of years ago. I can see why it topped bestsellers; it's written in limpid, concise language that's very accessible. The stories themselves are simple, clean, just-so stories with clear cause (Childhood trauma) and effect (bad shit happening when you're an adult). It lacks any sense of ambiguity, confusion, inconsistency, diversion, and thus I found it a bit too neat and unbelievable.
As Burkeman himself notes, psychoanalysis is shunned in academia, and its proponents use a mystical, mythical basis to attest to it's efficacy. I don't buy it. Ironically, the lack of introspection is itself a problem.
posted by smoke at 5:09 PM on January 8, 2016 [6 favorites]
He tries gamely, but I thought his case for psychoanalysis was actually remarkably weak for an article purporting to deal with its strengths. The studies into CBT are overwhelmingly better, and the detail on its decline in efficacy is too sketchy for my liking; there's more meat to get into there, and I feel a more interesting story hiding about therapy, relationships, story-telling and mental health etc.
I read that book by the psychoanalyst he mentions a couple of years ago. I can see why it topped bestsellers; it's written in limpid, concise language that's very accessible. The stories themselves are simple, clean, just-so stories with clear cause (Childhood trauma) and effect (bad shit happening when you're an adult). It lacks any sense of ambiguity, confusion, inconsistency, diversion, and thus I found it a bit too neat and unbelievable.
As Burkeman himself notes, psychoanalysis is shunned in academia, and its proponents use a mystical, mythical basis to attest to it's efficacy. I don't buy it. Ironically, the lack of introspection is itself a problem.
posted by smoke at 5:09 PM on January 8, 2016 [6 favorites]
Layered therapy is the way to go. Supportive, CBT, psychodynamic, existential. If people come back and want to understand the meaning of their illness and who they are / who they are still allowed to be after a severe episode. CBT doesn't provide that kind of help and some patients want and need it. And I do believe it is essential in illness prevention, along with CBT skills. But some people don't feel the need to come back and make sense of it all after they are well, and good for them. Being psychologically minded can be a curse. I do wonder what it would like to be one of the "resilient" folks who doesn't get a little crushed by self-doubt after setbacks and just keep chugging along. Not sure if I would want to be but then I've never had the opportunity. The biggest tragedy is how little training psychiatrists get in therapy of any modality these days.
posted by fraxil at 5:30 PM on January 8, 2016 [4 favorites]
posted by fraxil at 5:30 PM on January 8, 2016 [4 favorites]
The future is neurotropics.
posted by humanfont at 5:58 PM on January 8, 2016 [1 favorite]
posted by humanfont at 5:58 PM on January 8, 2016 [1 favorite]
(yueliang's mention of pema chodron, and the happy memory that brought back of reading chodron's book on meditation during a particularly difficult time a couple years ago, made me think about comparing schools of therapy in a different way, by comparing the literature they produce, the voice of that literature, the way it makes you feel to read it.
freud, confident mansplainer of all culture and thought, fun to read but always with that sense of being lectured to by someone either much smarter than yourself, or maybe just a guy making stuff up. freud would be so happy on the internet. set him next to whatever that dad-voice is david burns uses in feeling good, where the voice means well, keeping it light, trying at mild humor, but you keep getting the sense he's going to bust out with a metaphor about how your mind is like a pile of tools, and we should keep our tools properly labeled on a pegboard, and here is your list of chores, and if you do all your chores good things will happen, just work hard. thanks, dad dave.
and then you read someone like pema chodron and you feel a little less like you're reading a book by someone, and more like you're reading something about yourself, about the crazy things your mind gets up to, but those are okay, it's not all disease and disorganization; in her warmth and kindness you see a possible vision of yourself, how you could be--how you might actually be, it's just you haven't realized it yet.)
posted by mittens at 6:23 PM on January 8, 2016 [8 favorites]
freud, confident mansplainer of all culture and thought, fun to read but always with that sense of being lectured to by someone either much smarter than yourself, or maybe just a guy making stuff up. freud would be so happy on the internet. set him next to whatever that dad-voice is david burns uses in feeling good, where the voice means well, keeping it light, trying at mild humor, but you keep getting the sense he's going to bust out with a metaphor about how your mind is like a pile of tools, and we should keep our tools properly labeled on a pegboard, and here is your list of chores, and if you do all your chores good things will happen, just work hard. thanks, dad dave.
and then you read someone like pema chodron and you feel a little less like you're reading a book by someone, and more like you're reading something about yourself, about the crazy things your mind gets up to, but those are okay, it's not all disease and disorganization; in her warmth and kindness you see a possible vision of yourself, how you could be--how you might actually be, it's just you haven't realized it yet.)
posted by mittens at 6:23 PM on January 8, 2016 [8 favorites]
One thing that I don't think should be left out of a discussion touching on the adoption of the idea CBT as the "rigorous" kind of therapy, at least in the American context, is insurance reimbursement policies.
posted by PMdixon at 6:57 PM on January 8, 2016 [13 favorites]
posted by PMdixon at 6:57 PM on January 8, 2016 [13 favorites]
Freud is out of fashion these days because many of his weird Freudian concepts have been rightly discredited, and his big idea about the unconscious is now often taken for granted. But his approach to the talking-cure is interesting, because it reflects his personal experiences with drugs.
When Freud was young and high on cocaine he was a big advocate of cocaine therapy, but when he learned about the negative side-effects it made him skeptical about using drugs as a therapeutic short-cut. Conversation seemed a reasonable alternative. Freudian Psychoanalysis is expensive, imperfect and awkward, but it's not the worst therapy ever devised, and some aspects of it are preferable to relying on chemical cocktails.
posted by ovvl at 7:03 PM on January 8, 2016
When Freud was young and high on cocaine he was a big advocate of cocaine therapy, but when he learned about the negative side-effects it made him skeptical about using drugs as a therapeutic short-cut. Conversation seemed a reasonable alternative. Freudian Psychoanalysis is expensive, imperfect and awkward, but it's not the worst therapy ever devised, and some aspects of it are preferable to relying on chemical cocktails.
posted by ovvl at 7:03 PM on January 8, 2016
I really liked Owen Renik's Practical Psychoanalysis for Therapists and Patients (2006).
Also, I've been meaning to check out (the psychoanalyst and essayist) Adam Phillips's biography of Freud, about which he is interviewed here.
posted by mbrock at 7:06 PM on January 8, 2016 [4 favorites]
Also, I've been meaning to check out (the psychoanalyst and essayist) Adam Phillips's biography of Freud, about which he is interviewed here.
posted by mbrock at 7:06 PM on January 8, 2016 [4 favorites]
Bro I've BEEN going easy on myself and as a result I am failing to do things I want to do, please give me some fucking STRATEGIES here?!
Do you always yell Fuck! when you're going easy on yourself? Start there.
posted by Cool Papa Bell at 8:24 PM on January 8, 2016 [3 favorites]
Do you always yell Fuck! when you're going easy on yourself? Start there.
posted by Cool Papa Bell at 8:24 PM on January 8, 2016 [3 favorites]
Do you always yell Fuck! when you're going easy on yourself?
You do NOT want to know what I yell when I'm giving myself a hard time.
posted by Greg_Ace at 9:07 PM on January 8, 2016 [4 favorites]
You do NOT want to know what I yell when I'm giving myself a hard time.
posted by Greg_Ace at 9:07 PM on January 8, 2016 [4 favorites]
Mindfulness-Based Cognitive Therapy has worked wonders for me. At least in the last eight months or so since I've been practicing it. I can wake up in the morning and face the day without feeling like a total nervous wreck and a complete failure. By being mindful (and meditating), I can work my way through the day without a severe anxiety attack. It's an incredible improvement.
But there's lot in my life that fed into that anxiety in the first place. On one hand, I do want to explore it and maybe figure out why I got to be such an anxious wreck in the first place. I know it's navel-gazey, but sometimes I feel that digging down deep and getting underneath all that inner turmoil will help me understand myself better, and maybe lead me to some greater peace.
On the other hand, I feel that maybe I should just leave that all in the past and just focus on myself as I am right now, since I'm pretty OK right now.
I guess what I'm saying is that I'm someone who benefited from CBT but I still understand the value of the psychoanalysis approach. Every once in a while, I think "Damn, I could really use some really good psychotherapy" but I also think that the CBT is good enough to keep me good going forward.
Or in other words, I can understand why psychotherapy works for some, but CBT works for others. Or in other other words, what HuronBob said.
posted by mcmile at 9:34 PM on January 8, 2016 [5 favorites]
But there's lot in my life that fed into that anxiety in the first place. On one hand, I do want to explore it and maybe figure out why I got to be such an anxious wreck in the first place. I know it's navel-gazey, but sometimes I feel that digging down deep and getting underneath all that inner turmoil will help me understand myself better, and maybe lead me to some greater peace.
On the other hand, I feel that maybe I should just leave that all in the past and just focus on myself as I am right now, since I'm pretty OK right now.
I guess what I'm saying is that I'm someone who benefited from CBT but I still understand the value of the psychoanalysis approach. Every once in a while, I think "Damn, I could really use some really good psychotherapy" but I also think that the CBT is good enough to keep me good going forward.
Or in other words, I can understand why psychotherapy works for some, but CBT works for others. Or in other other words, what HuronBob said.
posted by mcmile at 9:34 PM on January 8, 2016 [5 favorites]
"Bro I've BEEN going easy on myself and as a result I am failing to do things I want to do, please give me some fucking STRATEGIES here?!"
I hear THAT. I think mine is out of ideas as to what to do with me, honestly. Then again, I'm out of ideas as to what to do with me. I can't seem to get past the stuff that's bothering me no matter what strategy I've been trying. Then again, those are very good reasons and I'd have to be like, whoppingly high or nuts to not consider them. :P
posted by jenfullmoon at 9:45 PM on January 8, 2016
I hear THAT. I think mine is out of ideas as to what to do with me, honestly. Then again, I'm out of ideas as to what to do with me. I can't seem to get past the stuff that's bothering me no matter what strategy I've been trying. Then again, those are very good reasons and I'd have to be like, whoppingly high or nuts to not consider them. :P
posted by jenfullmoon at 9:45 PM on January 8, 2016
I've had both and found basically no connection between the two. CBT was clearly 'right, how are we going to get you back on the road being a father and employed person?', whereas Freudian therapy was a totally random amazing exploration of thought, language, sense and everything, with no purpose other than perhaps containing outbursts within a safe space. And my CBT therapist was a lot more expensive per hour, unlike the psychoanalyst who negotiated fees based on my income in a way that I think is pretty unique to that tradition, so there's that.
posted by colie at 2:42 AM on January 9, 2016
posted by colie at 2:42 AM on January 9, 2016
Both CBT and psychoanalysis teach you that you don't need to be a slave to your mood. CBT tells you it's based on irrational beliefs and psychoanalysis tells you it is the result of historical situations which no longer are the case. And then meditation tells you that your thoughts are just thoughts and you should watch them and not identify with them. You'd think there would be a lot more agreement between practitioners.
posted by Obscure Reference at 6:18 AM on January 9, 2016 [9 favorites]
posted by Obscure Reference at 6:18 AM on January 9, 2016 [9 favorites]
You'd think there would be a lot more agreement between practitioners.
I've found a pretty direct correlation between efficacy of behavioral health professionals and their willingness to not try and draw sharp lines between modalities ("Today we're doing CBT! Next week we're doing analysis!") but rather to look at where I am in the moment and offer what's helpful for that --- so to the extent I'm in the throes of acute anxiety it might be more "Okay, anxiety is a habit of thought, you know how to break habits, let's refresh on your coping skills (and btw this is probably related to family of origin shit)" or "Okay, you're worried about that -- what does the evidence you have available to you logically imply?" (best therapist I have had basically has me lean into the intellectualization rather than trying to quash it), and if I'm more feeling overwhelmed by big picture shit or negative self talk, going more for the psychoanalytic/psychodynamic style of thing.
So basically I'm suggesting that among good practitioners, I've found more agreement than not.
posted by PMdixon at 6:44 AM on January 9, 2016 [4 favorites]
I've found a pretty direct correlation between efficacy of behavioral health professionals and their willingness to not try and draw sharp lines between modalities ("Today we're doing CBT! Next week we're doing analysis!") but rather to look at where I am in the moment and offer what's helpful for that --- so to the extent I'm in the throes of acute anxiety it might be more "Okay, anxiety is a habit of thought, you know how to break habits, let's refresh on your coping skills (and btw this is probably related to family of origin shit)" or "Okay, you're worried about that -- what does the evidence you have available to you logically imply?" (best therapist I have had basically has me lean into the intellectualization rather than trying to quash it), and if I'm more feeling overwhelmed by big picture shit or negative self talk, going more for the psychoanalytic/psychodynamic style of thing.
So basically I'm suggesting that among good practitioners, I've found more agreement than not.
posted by PMdixon at 6:44 AM on January 9, 2016 [4 favorites]
I like to plug hypnotherapy for mental health repair for much the same reason I think you should turn off your car before attempting engine repair.
posted by mrjohnmuller at 6:53 AM on January 9, 2016
posted by mrjohnmuller at 6:53 AM on January 9, 2016
Does anyone have knowledge of what's alluded to in the pullquote - the ways people are found to resist help? It's quoted and placed like it refers to a set of things that's common knowledge, but I'm not sure what to include there - or rather, I'm not sure what therapists and other people finding clients resisting help would say.
posted by lokta at 7:03 AM on January 9, 2016 [1 favorite]
posted by lokta at 7:03 AM on January 9, 2016 [1 favorite]
Resistance is a big part of psychoanalytic theory; fortunately wikipedia has saved me from having to dig around in books, by providing a relevant quote from Freud: "There is, however, another point of view which you may take up in order to understand the psychoanalytic method. The discovery of the unconscious and the introduction of it into consciousness is performed in the face of a continuous resistance on the part of the patient. The process of bringing this unconscious material to light is associated with pain, and because of this pain the patient again and again rejects it".
posted by mittens at 7:42 AM on January 9, 2016
posted by mittens at 7:42 AM on January 9, 2016
(of course, to resist implies an interplay of forces, and Freud is acquainted with the use of force. He is the inquisitor, and should his patient deny what Freud knows to be true: "We must not be led astray by initial denials. If we keep firmly to what we have inferred, we shall in the end conquer every resistance by emphasizing the unshakeable nature of our convictions.")
posted by mittens at 7:50 AM on January 9, 2016
posted by mittens at 7:50 AM on January 9, 2016
Does anyone have knowledge of what's alluded to in the pullquote - the ways people are found to resist help?
Do you read AskMetafilter at all? There are a lot of people who present problems with reasonably clear-cut next-steps, if not solutions, who explicitly say, "I can't do [obvious thing] for [spurious reasons]." That type of explicit resistance certainly shows up in therapy, too, and is one of the reasons therapists generally don't give explicit advice except in life-or-death crisis situations -- it tends to spark that type of resistance.
There are more questionable unconscious things labeled as "resistance," which mittens alludes to -- clients are often labeled as "resistant" when they don't automatically trust a therapist, for instance, or automatically accept what that therapist is saying. Sometimes that is resistance; I've worked with clients who have very consciously acknowledged and changed long-standing patterns in their lives, but when that pattern pops up in a new context (e.g., your new romantic partner is treating you in similar ways as your abusive father did), they refuse to see it, at least for a while. I think that's kind of garden-variety denial, in a lot of ways. Sometimes what's labeled "resistance" is more that the client is not submitting to the therapist's power plays, though, like not trusting them right off the bat. (I tell new clients they're perfectly right not to trust me, because they don't know me. That seems like a sign of healthy boundaries to me, not resistance, but I have certainly seen therapists label clients as "resistant" simply for not liking the therapist.)
But I think the pull-quote is actually more subtle that that. Most people who start therapy (and here I'm going to display my own psychodynamic tendencies...) tend to have fairly simple problems that have become complex because the coping mechanisms that worked for them as children (or at least in the past) don't work for them as adults (or at least now), but they haven't recognized that, and most people, when their preferred coping mechanisms don't work, tend to just use those same coping mechanisms even harder. For example, someone who deals with her anxiety by putting everyone else's needs first may decide that her anxiety is because she's being selfish and therefore work even harder to squelch her own needs, or someone who deals with his anxiety through anger and controlling others may decide that his anxiety is because he's not being controlling enough. I can often see that that sort of imbalance is the case very early in the therapeutic relationship, and so we'll start with slowly working back toward balance, but clients tend to be very attached to their coping mechanisms, in large part because those coping mechanisms often got them safely through past traumas, and they are generally very skeptical that going through life in a new way is going to be possible or desirable, even though they want the benefits of change.
I'm not sure if that was at all clear... basically, I would say that at least 80% of the clients I've seen for therapy come in with the desire to feel better without having to change anything in their lives or in themselves, even if they don't outright say that and even if they don't necessarily understand that's what they're presenting to me. I mean, that's kind of the whole idea of patterns in one's life, they're behaviors and thoughts and emotions that keep people stuck. If people could unstick themselves, they wouldn't come in for therapy, so the people coming in for therapy are the ones that have accepted those patterns as somewhat inevitable, if that makes sense? And I certainly understand why -- a lot of clients who do well in therapy have to renegotiate almost all the relationships in their lives, and many of those clients lose friends or family members or partners who want to keep the client stuck in dysfunctional patterns and sick relationships. (It's actually considered ethical best practices for therapists to mention this as a potential side effect of therapy.) So the incentives for not changing can be really high, and a lot of times the therapist is just slowly trying to help the client reach the understanding of what not-changing costs -- which is basically working with resistance. (And which is different from the power-play of deciding exactly what the client should be doing instead.)
posted by jaguar at 8:24 AM on January 9, 2016 [33 favorites]
Do you read AskMetafilter at all? There are a lot of people who present problems with reasonably clear-cut next-steps, if not solutions, who explicitly say, "I can't do [obvious thing] for [spurious reasons]." That type of explicit resistance certainly shows up in therapy, too, and is one of the reasons therapists generally don't give explicit advice except in life-or-death crisis situations -- it tends to spark that type of resistance.
There are more questionable unconscious things labeled as "resistance," which mittens alludes to -- clients are often labeled as "resistant" when they don't automatically trust a therapist, for instance, or automatically accept what that therapist is saying. Sometimes that is resistance; I've worked with clients who have very consciously acknowledged and changed long-standing patterns in their lives, but when that pattern pops up in a new context (e.g., your new romantic partner is treating you in similar ways as your abusive father did), they refuse to see it, at least for a while. I think that's kind of garden-variety denial, in a lot of ways. Sometimes what's labeled "resistance" is more that the client is not submitting to the therapist's power plays, though, like not trusting them right off the bat. (I tell new clients they're perfectly right not to trust me, because they don't know me. That seems like a sign of healthy boundaries to me, not resistance, but I have certainly seen therapists label clients as "resistant" simply for not liking the therapist.)
But I think the pull-quote is actually more subtle that that. Most people who start therapy (and here I'm going to display my own psychodynamic tendencies...) tend to have fairly simple problems that have become complex because the coping mechanisms that worked for them as children (or at least in the past) don't work for them as adults (or at least now), but they haven't recognized that, and most people, when their preferred coping mechanisms don't work, tend to just use those same coping mechanisms even harder. For example, someone who deals with her anxiety by putting everyone else's needs first may decide that her anxiety is because she's being selfish and therefore work even harder to squelch her own needs, or someone who deals with his anxiety through anger and controlling others may decide that his anxiety is because he's not being controlling enough. I can often see that that sort of imbalance is the case very early in the therapeutic relationship, and so we'll start with slowly working back toward balance, but clients tend to be very attached to their coping mechanisms, in large part because those coping mechanisms often got them safely through past traumas, and they are generally very skeptical that going through life in a new way is going to be possible or desirable, even though they want the benefits of change.
I'm not sure if that was at all clear... basically, I would say that at least 80% of the clients I've seen for therapy come in with the desire to feel better without having to change anything in their lives or in themselves, even if they don't outright say that and even if they don't necessarily understand that's what they're presenting to me. I mean, that's kind of the whole idea of patterns in one's life, they're behaviors and thoughts and emotions that keep people stuck. If people could unstick themselves, they wouldn't come in for therapy, so the people coming in for therapy are the ones that have accepted those patterns as somewhat inevitable, if that makes sense? And I certainly understand why -- a lot of clients who do well in therapy have to renegotiate almost all the relationships in their lives, and many of those clients lose friends or family members or partners who want to keep the client stuck in dysfunctional patterns and sick relationships. (It's actually considered ethical best practices for therapists to mention this as a potential side effect of therapy.) So the incentives for not changing can be really high, and a lot of times the therapist is just slowly trying to help the client reach the understanding of what not-changing costs -- which is basically working with resistance. (And which is different from the power-play of deciding exactly what the client should be doing instead.)
posted by jaguar at 8:24 AM on January 9, 2016 [33 favorites]
Also, I haven't read it, so I could be wrong, but I think Eric Berne's Games People Play is all about resistance, though not just in therapy -- basically, what keeps people stuck in certain patterns.
And maybe it would be helpful to point out that in psychodynamic therapists, at least (I don't know enough about psychoanalysis to make claims, though I assume it'd be the same), the assumption is that the relationship the client has to the therapist is similar to the relationships the client has with others in "the real world," and so in studying the therapist-client relationship, one can get insight into how the client functions outside the therapy room. So the distinction between "resistance in therapy" and "resistance in life" is not particularly drawn.
posted by jaguar at 8:28 AM on January 9, 2016 [1 favorite]
And maybe it would be helpful to point out that in psychodynamic therapists, at least (I don't know enough about psychoanalysis to make claims, though I assume it'd be the same), the assumption is that the relationship the client has to the therapist is similar to the relationships the client has with others in "the real world," and so in studying the therapist-client relationship, one can get insight into how the client functions outside the therapy room. So the distinction between "resistance in therapy" and "resistance in life" is not particularly drawn.
posted by jaguar at 8:28 AM on January 9, 2016 [1 favorite]
So the distinction between "resistance in therapy" and "resistance in life" is not particularly drawn.
... which can be helpful, but which can ignore a lot of structural inequality issues, including the fact that the therapist is an authority figure (as well as educated, usually white, usually economically well-off, etc), and lead therapists down some bad paths, especially with clients from traditionally marginalized populations (e.g., Freud and "hysteria").
posted by jaguar at 8:31 AM on January 9, 2016 [2 favorites]
... which can be helpful, but which can ignore a lot of structural inequality issues, including the fact that the therapist is an authority figure (as well as educated, usually white, usually economically well-off, etc), and lead therapists down some bad paths, especially with clients from traditionally marginalized populations (e.g., Freud and "hysteria").
posted by jaguar at 8:31 AM on January 9, 2016 [2 favorites]
Would I be a total weirdo if I said that both talk therapy and some CBT techniques have been very helpful to me?
No I think you would probably be right on the button, in that not only do different modalities work differently for different people but also, in my opinion, for the same people at different times of their lives or for different issues they might have.
I am training at the moment in attachment-based psychotherapy with person-centred counselling techniques, but I am very mindful these are just tools I will use in my career, along with other tools.
I think we should be suspicious of any hypothetical therapist who is not open to the efficacy of different techniques, to constant learning, and to modifying their own approach.
posted by walrus at 9:57 AM on January 9, 2016 [1 favorite]
No I think you would probably be right on the button, in that not only do different modalities work differently for different people but also, in my opinion, for the same people at different times of their lives or for different issues they might have.
I am training at the moment in attachment-based psychotherapy with person-centred counselling techniques, but I am very mindful these are just tools I will use in my career, along with other tools.
I think we should be suspicious of any hypothetical therapist who is not open to the efficacy of different techniques, to constant learning, and to modifying their own approach.
posted by walrus at 9:57 AM on January 9, 2016 [1 favorite]
[Yesterday]
My therapist: "Hey, we found something you don't hate about yourself!"
Me: "And it only took eighteen months."
I've got nothing against CBT techniques in isolation, but doing the discursive upbringing/experience work of psychodynamic therapy feels like necessary, useful context for why your brain is like it is (whatever the flavour).
posted by terretu at 10:36 AM on January 9, 2016 [1 favorite]
My therapist: "Hey, we found something you don't hate about yourself!"
Me: "And it only took eighteen months."
I've got nothing against CBT techniques in isolation, but doing the discursive upbringing/experience work of psychodynamic therapy feels like necessary, useful context for why your brain is like it is (whatever the flavour).
posted by terretu at 10:36 AM on January 9, 2016 [1 favorite]
All types of psychotherapy are generally beneficial depending on the therapist that wields them.
The key is -- and always has been -- is to find the right therapist that practices a type of therapy that resonates most with you. This is a trial-and-error process that can take some time, unfortunately. There's no short-cut to finding the "right" therapist.
As to the article, it's very long and glosses over the complexities of the studies it cites that support its POV. It even gets wrong the Tavistock study's design. Only 19% of the control group in that study received CBT therapy, and at 1/4 the treatment time. If the control group had been equivalent (e.g., 100% CBT, and 100% of the same time as the psychoanalytic group), it would have been a fair fight. Otherwise, it doesn't really demonstrate anything.
Science is all about how you design the study. Once the study has been designed, the outcome is largely predetermined. The Tavistock study cited was designed specifically to achieve the desired outcome.
posted by docjohn at 1:54 PM on January 9, 2016 [3 favorites]
The key is -- and always has been -- is to find the right therapist that practices a type of therapy that resonates most with you. This is a trial-and-error process that can take some time, unfortunately. There's no short-cut to finding the "right" therapist.
As to the article, it's very long and glosses over the complexities of the studies it cites that support its POV. It even gets wrong the Tavistock study's design. Only 19% of the control group in that study received CBT therapy, and at 1/4 the treatment time. If the control group had been equivalent (e.g., 100% CBT, and 100% of the same time as the psychoanalytic group), it would have been a fair fight. Otherwise, it doesn't really demonstrate anything.
Science is all about how you design the study. Once the study has been designed, the outcome is largely predetermined. The Tavistock study cited was designed specifically to achieve the desired outcome.
posted by docjohn at 1:54 PM on January 9, 2016 [3 favorites]
CBT-sorta-stuff made a huge difference for me as a kid - note that this is for OCD which perhaps particularly among mental illnesses is an experience completely changed by understanding your own thought processes and framing them in the "right" way.
Trying it in my early 20s for anxiety/depression/pathological procrastination/not getting basic life shit done didn't really work (at least the first pass) because I simply ignored all the stuff I was supposed to try, over and over. No therapist can do much about that. (I got better eventually no need to give me recommendations here.)
I always liked talking about myself and my history in therapy but I couldn't do analysis that gets into the real Freudian mumbo-jumbo - I'm just too predisposed not to believe in it.
posted by atoxyl at 3:45 PM on January 9, 2016
Trying it in my early 20s for anxiety/depression/pathological procrastination/not getting basic life shit done didn't really work (at least the first pass) because I simply ignored all the stuff I was supposed to try, over and over. No therapist can do much about that. (I got better eventually no need to give me recommendations here.)
I always liked talking about myself and my history in therapy but I couldn't do analysis that gets into the real Freudian mumbo-jumbo - I'm just too predisposed not to believe in it.
posted by atoxyl at 3:45 PM on January 9, 2016
I've experienced several different schools of therapy but the one thing that really works for me is not so much the school but whether or not the therapist feels really present and engaged in our session. Is this someone who really sees me? Is this someone who is really present when we talk? Is this someone who is actively engaged in working things out with me? That's made all the difference. I've even had crappy therapists give me bad advice who were nonetheless more fully present and connected, and I think I'm better off for them.
That said, I am somewhat envious of people who have undergone the full psychoanalytic treatment. The idea of seeing someone several times a week and going as deep as I'm able to into psychological, philosophical, and existential issues sounds wonderful on the surface. There's just no way I could afford it. And I'm also not convinced I would come out of it as a psychologically healthier person (but maybe that's a common concern).
posted by treepour at 3:51 PM on January 9, 2016
That said, I am somewhat envious of people who have undergone the full psychoanalytic treatment. The idea of seeing someone several times a week and going as deep as I'm able to into psychological, philosophical, and existential issues sounds wonderful on the surface. There's just no way I could afford it. And I'm also not convinced I would come out of it as a psychologically healthier person (but maybe that's a common concern).
posted by treepour at 3:51 PM on January 9, 2016
I've experienced several different schools of therapy but the one thing that really works for me is not so much the school but whether or not the therapist feels really present and engaged in our session.
Yeah I should add - as a requirement of buprenorphine maintenance I have to meet with the prescribing doctor monthly, who, while she's been working in addiction medicine for a long time, is only formally qualified as a physician. But - in exchange for having to pay a lot of money out of pocket - I get a full hour of her time to talk about whatever and it's pretty cool I like her a lot.
(I'm still sometimes a little reserved about bringing up this part of my life on MeFi but I mean I have plenty of times before so I might as well)
posted by atoxyl at 4:02 PM on January 9, 2016 [1 favorite]
Yeah I should add - as a requirement of buprenorphine maintenance I have to meet with the prescribing doctor monthly, who, while she's been working in addiction medicine for a long time, is only formally qualified as a physician. But - in exchange for having to pay a lot of money out of pocket - I get a full hour of her time to talk about whatever and it's pretty cool I like her a lot.
(I'm still sometimes a little reserved about bringing up this part of my life on MeFi but I mean I have plenty of times before so I might as well)
posted by atoxyl at 4:02 PM on January 9, 2016 [1 favorite]
That NHS study that purportedly found psychoanalysis superior has major, major flaws— to start, the people getting psychoanalysis got nearly 4 times as many hours in treatment as the other people did and only 20% of the control group actually got CBT.
Now, you could argue that CBT is supposed to be shorter, but that's not for severe depression, which was what was being studied here and 80% of the control group didn't even get CBT. The other issue is that everyone in both groups was on medication, and increased the number of medications they were on over time (from 3 to 5 or something extreme like that).
If you compare a therapy received by 1/5 of the patients at 1/4 the dose to a therapy received by 100% of the patients at 100% of the dose, if it has any effectiveness at all, it's going to look better.
And, again, the 'dodo bird verdict"— where basically every therapy works if you have a good therapist who is empathetic— is not disproven by this at all. And that is basically what has been seen in all the large trials comparing different types honestly.
posted by Maias at 4:44 PM on January 9, 2016 [2 favorites]
Now, you could argue that CBT is supposed to be shorter, but that's not for severe depression, which was what was being studied here and 80% of the control group didn't even get CBT. The other issue is that everyone in both groups was on medication, and increased the number of medications they were on over time (from 3 to 5 or something extreme like that).
If you compare a therapy received by 1/5 of the patients at 1/4 the dose to a therapy received by 100% of the patients at 100% of the dose, if it has any effectiveness at all, it's going to look better.
And, again, the 'dodo bird verdict"— where basically every therapy works if you have a good therapist who is empathetic— is not disproven by this at all. And that is basically what has been seen in all the large trials comparing different types honestly.
posted by Maias at 4:44 PM on January 9, 2016 [2 favorites]
The biggest predictor of outcomes in therapy is the therapeutic alliance, which is the fit between the therapist and the client. It comes down to therapist selection, and patient selection. Cultures have changed over time, and the psychological and class profiles of those seeking treatment have changed. There are far fewer sexually repressed neurotics within the upper SES seeking treatment in developed nations than there were in the Victorian/Edwardian Era... and there are far fewer therapists specializing in treating symptoms associated with that presentation. However, every few years I have encountered a classic, sexually repressed person, often from a strict religious background or with an atypical trauma history, demonstrating hysterical conversion symptoms straight out of 19th century Vienna. if their main issue was, say, panic attacks and simple phobias, I might trial them with some light CBT to see how they respond, but I would also think strongly about recommending a dynamic therapy trial given its historical application in this area. Some of the choice will come down to available time and money. CBT is usually cheaper and shorter. But if their pathology is attachment-based, a short course of TLDP could be equivalent, and produce potentially more meaningful results.
Many specialized physicians get to specialise and accept only patients likely to benefit from their particular specialty, and reject as patients those unlikely to benefit or too ill or frail to undergo the treatment safely. A large part of improving medical outcomes is bucketing patients into disease categories and stages as part of this process. Because in therapy, the thing to be measured, bucketed and stages is so inchoate, the selection process tends to be diffuse and the outcomes are all over the map. Some individual therapists have very good outcomes, because they can be quite selective in either or both their choice of modalities or their choice of patients. But many others do not have the luxury of such choice.
This is the big Shedler meta-analysis review:
The Efficacy of Psychodynamic Psychotherapy
It reinforces this:
The Empirical Status of Empirically Supported Psychotherapies
The progressive decay in the efficacies of cognitive therapies over the past couple of decades mirrors the earlier fall into some disreput eof expressive therapies:
The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis
posted by meehawl at 9:07 PM on January 9, 2016 [7 favorites]
Many specialized physicians get to specialise and accept only patients likely to benefit from their particular specialty, and reject as patients those unlikely to benefit or too ill or frail to undergo the treatment safely. A large part of improving medical outcomes is bucketing patients into disease categories and stages as part of this process. Because in therapy, the thing to be measured, bucketed and stages is so inchoate, the selection process tends to be diffuse and the outcomes are all over the map. Some individual therapists have very good outcomes, because they can be quite selective in either or both their choice of modalities or their choice of patients. But many others do not have the luxury of such choice.
This is the big Shedler meta-analysis review:
The Efficacy of Psychodynamic Psychotherapy
It reinforces this:
The Empirical Status of Empirically Supported Psychotherapies
The progressive decay in the efficacies of cognitive therapies over the past couple of decades mirrors the earlier fall into some disreput eof expressive therapies:
The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis
posted by meehawl at 9:07 PM on January 9, 2016 [7 favorites]
The article links a more personal piece by Shedler on what psychoanalysis is and his own experiences with it, which is very much worth reading:
That Was Then This Is Now
It's really very good. One of the points he makes is that because the core insights of psychoanalysis coming out of the Freudian tradition are very common-sensical and in his view align well with how the human mind works, good therapists in many traditions tend to arrive at them and use them. He gives an example of how some CBT therapists are starting to use the concept of 'transference', except under another name and not acknowledging or perhaps even realizing its connection to the Freudian tradition.
One thing I think is very valuable about the Freudian tradition is that it truly recognizes the deep core levels of irrationality in the human mind, our rationalizing and self-defeating quality. For this reason it should be conducive to humility (although it isn't always, I think that is its tendency). It's a valuable corrective to an over-scientized culture, since science assumes we can use tools of rationality to get outside our own desires and 'rule' ourselves from an objective distance. Psychoanalysis may share that goal to some degree, but it's pessimistic about how possible it really is.
posted by zipadee at 3:34 PM on January 11, 2016 [1 favorite]
That Was Then This Is Now
It's really very good. One of the points he makes is that because the core insights of psychoanalysis coming out of the Freudian tradition are very common-sensical and in his view align well with how the human mind works, good therapists in many traditions tend to arrive at them and use them. He gives an example of how some CBT therapists are starting to use the concept of 'transference', except under another name and not acknowledging or perhaps even realizing its connection to the Freudian tradition.
One thing I think is very valuable about the Freudian tradition is that it truly recognizes the deep core levels of irrationality in the human mind, our rationalizing and self-defeating quality. For this reason it should be conducive to humility (although it isn't always, I think that is its tendency). It's a valuable corrective to an over-scientized culture, since science assumes we can use tools of rationality to get outside our own desires and 'rule' ourselves from an objective distance. Psychoanalysis may share that goal to some degree, but it's pessimistic about how possible it really is.
posted by zipadee at 3:34 PM on January 11, 2016 [1 favorite]
Damon Linker: What I've learned from my years on the couch
posted by the man of twists and turns at 10:13 AM on January 15, 2016
posted by the man of twists and turns at 10:13 AM on January 15, 2016
I am undergoing therapy now, and some of these comments, especially by those of you work in the field, are suddenly making a lot of sense. I met my therapist yesterday and it was a very difficult experience for me—at one point they said I was a poor fit for them. But understanding all these meta-issues going on around the project of therapeutic intervention itself, I can feel better despite knowing there's much work to be done, if I allow it.
posted by polymodus at 4:02 PM on January 15, 2016
posted by polymodus at 4:02 PM on January 15, 2016
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posted by saulgoodman at 2:06 PM on January 8, 2016 [13 favorites]