![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by dawnfawn on December 16, 2004, at 10:01:28
From my readings on this and the babble board I am getting a picture of people doing long term therapy utilizing CBT. I would like to know how and why this is being done. From my readings on this modality I have gotten a picture of a short-term (relatively 1 to 2 years at the most using a schema approach) treatment goal. This is even for deep depression. May I ask people in therapy how they feel CBT is helping them if it is longer than this time period. My own knowledge or interpretation has been that it is retraining of thinking. any comments.
Posted by fallsfall on December 16, 2004, at 12:34:36
In reply to Length of CBT treatment, posted by dawnfawn on December 16, 2004, at 10:01:28
I think it is wonderful when CBT can cure a severe depression in 1 - 2 years. Unfortunately, it does not always work, and that is why I ended up in longterm CBT. In hindsight, I probably should have changed therapists after 4 or 5 years, instead of waiting 8 1/2, but there were a number of different reasons that the change didn't happen.
I started therapy in Jan. of 1995. I was overly dependent on my best friend, and starting to drive her crazy with my obsessiveness. My GP referred me to an experienced, competent CB therapist. She said at the end of our first session that she would see me 6 - 8 times and things would be better. She also recommended that I go back to my GP and get medication (which I did).
Over the first couple of months, it became clear that my obsession with my friend was a real problem, so clearly I wasn't going to be "cured" in 6 - 8 sessions. We extracted me from the obsessive relationship, but that caused me to start to be suicidal for the first time in my life. So, we needed to work on skills to keep me safe. By August I was hospitalized. I saw her twice a week for a year (?) after that and became more stable as far as suicidality was concerned, but also became more dependent on her. The CBT response to dependency is to force separation so that the client can learn that they are able to stand on their own two feet (at least that was the tact she took). This was excruciating for me.
In the next couple of years we did significant work on self-esteem. I left my husband after 19 years of marriage. I contemplated other very significant changes in my definition of who I was. And the dependency continued. So, during this time I *was* making progress in many areas (including the dependency, well, I learned not to call and to survive until my next appointment). There was no point where I was "stable", when it would have made sense to stop - I always had major things going on.
I was out of work on disability for 5 years, but was able finally to go back to work fulltime. I worked for 2 years, and reduced sessions (I actually had an appointment scheduled for 3 months!!!), but after 2 years I crashed again and wound up back in the hospital. So we did try reducing therapy while I was doing better (with some success), but then, since I was suicidal again, stopping therapy didn't seem like a very good idea. It was hard to even *talk* about stopping, or about changing therapists because I was so attached to her. This was probably a red flag - she couldn't even bring up making a change because I would freak out. So she kept trying to reduce sessions, and that just made me panic more.
After about 8 years things started getting worse. I was caught in a transference where I felt that she was angry and disappointed, so I tried harder to please her. Every session was excruciating because I couldn't please her, and I would work between sessions trying to figure out what to do. I finally became so suicidal that I figured that if I kept doing what I was doing I *was* going to die, so thinking that I *might* die if I left her started to look more attractive. Because that meant that if I left her, I might *not* die.
To make a long story short, I switched to a psychodyanmic therapist. Within 6 weeks I was back in the "he's angry/disappointed in me" transference, and within a couple of weeks we came out the other side of that transference.
So, why did I stay 8 1/2 years? Because I *did* keep learning stuff. Because I *was* making changes in my life. Because I adored her. Because she *IS* a good therapist (it is just that after a while I needed something different). Because I was scared to leave and she was scared to throw me out. I probably should have left when I crashed after working for those two years, but I felt too vulnerable to make a major change like that.
That's my story. If I had been cured after 1-2 years, I would have gladly ended therapy. But CBT is not always successful the way it is "supposed" to be. She accepted me as a patient because in the beginning it looked like I was a fairly "normal" depression patient. By the time it became clear that CBT wasn't doing it for me, I was in deep enough that it was very hard to get out.
P.S. When I did leave, and was interviewing new therapists she did make a comment, sort of under her breath, "And did any of them say anything about the fact that you have been in therapy for EIGHT AND A HALF YEARS??". Clearly this wasn't the norm for her, either.
Posted by Joslynn on December 16, 2004, at 13:20:42
In reply to Long treatment, long post » dawnfawn, posted by fallsfall on December 16, 2004, at 12:34:36
That's an interesting and thought-provoking story for me. I am not doing CBT, but I can see certain similarities, for example, the times that I had severe depressive episodes, it was always after extricating myself from an obsessive relationship or being extracted from it by circumstances, i.e., someone moved etc.
It is that the obsession hides the depression lurking underneath and then when the obsession is gone, the depression surfaces? OR is that depression comes first and causes me to become depressed? It is a chicken-and-the-egg question for me in my life.
Thanks for the long post.
Posted by fallsfall on December 16, 2004, at 17:47:31
In reply to Re: Long treatment, long post, posted by Joslynn on December 16, 2004, at 13:20:42
I think that for me the obsessive relationships allow me to cope with my depression - I get needs met in those relationships that allow me to keep going. When the relationship ends, I am left to my own resources - which are inadequate to keep the depression at bay. I could be different for you...
Posted by Miss Honeychurch on December 16, 2004, at 18:52:15
In reply to Length of CBT treatment, posted by dawnfawn on December 16, 2004, at 10:01:28
I know this doesn't answer your question, but I've been with CBT almost 1.5 years. I am now tapering off to every two weeks and soon once a month. I expect within 6 months I should be "done."
I always thought I spent a lot longer in CBT than usual people. Seems everything I have read states that 15 sessions usually does the trick!
Posted by gardenergirl on December 16, 2004, at 19:25:10
In reply to Re: Length of CBT treatment, posted by Miss Honeychurch on December 16, 2004, at 18:52:15
Most of the research that reports CBT treatment of 12-15 or so sessions is based on very narrow problems. It's kind of the nature of most research that you study just one problem at a time. Since many of us have multiple issues, it makes sense that we might not be finished in the "normal" time because there's more to work on.
I remember when I was studying occupational therapy. I learned how to treat people who had a stroke. I learned how to treat people with arthritis. I learned how to treat people with joint replacements. I learned how to treat people with balance problems. One of my first clients had all of these! Wait a minute...that's not like in the book...... ;)
gg
Posted by dawnfawn on December 17, 2004, at 6:25:55
In reply to Long treatment, long post » dawnfawn, posted by fallsfall on December 16, 2004, at 12:34:36
I have to admit then That I guess CBT is not for me. I thought it was short term. I am looking for help with Health Anxiety or as it is more commonly known Hypochondria. I do not want to discuss my mother, my father, my husband, you get the drift. I have been in psychotherapy before for these issues. I have only one problem to address right now. I am very disappointed in CBT. The reason, I feel it is the NIKE approach to moods--eg. Just do it. If you feel anxious just stop being anxious, talk yourself out of it. If I could talk myself out of it would I be anxious? A real paradox. It is just another approach in a shotgun approach to mental health in the talk therapy area. Does anyone have a helpful suggestion for my problem.
Posted by Dinah on December 17, 2004, at 6:41:58
In reply to Re: Long treatment, long post, posted by Joslynn on December 16, 2004, at 13:20:42
My experience was the same as Falls'. Obsessions were a coping mechanism of sorts. Looking back, I can even see how it happened.
I went into CBT for OCD, and it did a great job. Then the bottom fell out, because OCD was keeping a lot of other things out of awareness.
Posted by Dinah on December 17, 2004, at 6:44:08
In reply to Long treatment, long post » dawnfawn, posted by fallsfall on December 16, 2004, at 12:34:36
That was a nasty comment, Falls. I'm sorry.
My therapist normally does 12 sessions up to a year. He said that he has sought consultation for me over the years if for no other reason than that long term therapy isn't the norm for him. But he's very accepting that different people need different things.
Posted by Dinah on December 17, 2004, at 6:47:33
In reply to Re: Long treatment, long post, posted by dawnfawn on December 17, 2004, at 6:25:55
CBT *can* be exactly what you're looking for. You just need to screen prospective therapists carefully. I had the exact same reaction to the CBT concepts of changing thoughts, but my therapist framed most of the interventions in terms of changing behaviors, not thoughts, and that helped. Challenging assumptions maybe, but not "just think differently".
Sometimes you just need to shop around a lot.
And remember that a lot of us are on this board because 12 week CBT wasn't what we needed. Those of us who started with CBT had therapists who acknowledged that and adapted.
Posted by dawnfawn on December 17, 2004, at 7:32:53
In reply to Re: Long treatment, long post » dawnfawn, posted by Dinah on December 17, 2004, at 6:47:33
Dinah, thank you. I was hoping that the 12 to 15 week treatment would help because it is so widely touted. You are right, I have run into a variety of unusual therapists (hopefully unusual in that they were a little quirky and not helpful, one was harmful) in this field. I have come up with at least 20 screening questions for the next therapist but this is very unnerving for me. Possibly CBT is not the route to go. You say it is that it is the therapist not the modality. The last therapist had me record a mood journal and then we talked about the moods--I tryed to speak about things that were going on as well, I also said that not all my moods were about the health anxiety and that I have spent years developing my own coping. When the panic about my heart hits I try very hard to talk to myself about the fact that it is not true. Confusing to me as well. She said it wasn't working and would take a long time did I want to quit. I finally said why yes. Not an encouraging session at all. It was the 12th session.
Posted by Dinah on December 17, 2004, at 14:07:38
In reply to Re: Long treatment, long post, posted by dawnfawn on December 17, 2004, at 7:32:53
That *would* be discouraging. Obviously that therapist could use some lessons in technique.
I think maybe they focus on wider issues to see if there is a pattern between other things going on in your life and your health concerns. Based on my own experiences, that's probably a valid technique.
It might be hard to find someone who does things just the way you'd like them done, but you should be able to find someone who is able to focus on your main concern, and explain the relationship between what they are asking you to do and how it will help the issue you are concerned with.
I can't think of any treatment other than CBT that would so specifically target a single issue and try to be very swift about resolution. Anyone else have any ideas? EMDR?
Posted by fallsfall on December 17, 2004, at 17:29:52
In reply to Re: Long treatment, long post » fallsfall, posted by Dinah on December 17, 2004, at 6:44:08
I didn't see any nasty comments in your post... So certainly don't feel badly about anything...
Posted by peacefeline on December 17, 2004, at 19:59:13
In reply to Re: Long treatment, long post » dawnfawn, posted by Dinah on December 17, 2004, at 14:07:38
I was thinking EMDR, too. Especially if there's any clue as to what might be behind the health anxiety, such as a trauma of some kind. No matter how long ago the trauma happened, EMDR could successfully make it tolerable in very few sessions, in most cases.
Posted by Dinah on December 17, 2004, at 21:33:02
In reply to Re: Long treatment, long post » Dinah, posted by fallsfall on December 17, 2004, at 17:29:52
I didn't even remember writing that post Falls. It gave me quite a start when I read my own post and didn't remember it. But now I've placed it in context. I think I meant that the comment by your therapist might have been hurtful. I don't recall now why I used the word nasty. That's what I get for early morning posting. I shouldn't try to post when half asleep.
Posted by littleone on December 18, 2004, at 17:28:45
In reply to Re: Long treatment, long post, posted by dawnfawn on December 17, 2004, at 6:25:55
> I am very disappointed in CBT. The reason, I feel it is the NIKE approach to moods--eg. Just do it. If you feel anxious just stop being anxious, talk yourself out of it. If I could talk myself out of it would I be anxious? A real paradox.
Hi dawnfawn,
I'm in long term therapy at the moment, but I have read a zillion CBT books (okay, maybe a slight exageration there) and my T has tried Behavioural Therapy on me.
Even though I'm not concentrating on CBT as such at the moment, I can certainly identify various faulty thinking patterns within myself. When I think these things, I just feel absolutely terrible, so I try to replace my thoughts with a more rational script.
However, when I do this, I often don't *feel* better. I've corrected my thoughts and am thinking along a more rational line, but it doesn't seem to flow through to feeling better.
When I asked my T about this, he said that often just changing the thoughts isn't enough. That there are underlying beliefs at play. You need to change the belief to *feel* better. And you can't change a belief by thinking about it. You need to experience real life experiences (sorry about the shoddy wording there) that disprove the belief. And you need to experience that disproving over and over.
And I would tend to agree with others here that hypochondria is a way to deal with underlying anxieties. You may have done long term therapy previously, but the fact that you still have an underlying anxiety seems to indicate that something is unresolved or you haven't come to terms with something or whatever.
You could do all the CBT you want and eradicate the hypochondria, but if you don't address the underlying anxieties, they will come out another way. Whether that be via a mental health issue or a physical ailment or whatever.
Just my 2 cents.
This is the end of the thread.
Psycho-Babble Psychology | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.