The benefits of psychodynamic therapy

[clairenyc]

My two cents

Shtriemel, I tried to respond to ActionGirl's original question by posting a description of analytic therapy because it was a constructive response to the previous thread. When I said that I didn't want to add to the divisiveness of the conversation, I was referring to your posts. You said you're not trying to add to the number of clients who seek therapy. Well, I am. I care deeply about the reputation of the profession because I believe in what I do. I don't believe that everyone needs therapy, but I want people who are suffering to see therapy as a promising option and certainly a source of safety.

So for that reason in addition to all the others that have been mentioned, add me to the list of people who are unhappy with the way you've treated others on this BB. And yes, I have found GTD extremely helpful in reducing stress and allowing me to focus on important things.

 

[TesTeq]

Bye, bye...

Again, I believe many of the responses to my posts/comments reflect the truth of my observations. Not THE TRUTH, but the truth nonetheless.

Discussion with you is a complete waste of time because you do not listen - you already know that you are right and we are wrong.

I do not think you are right. Besides it is dishonest to criticize GTD using false quotations or your own opinions treated as facts.

I have many exciting and satisfying things to do in my life and I can do more of them using GTD.

Do not expect any more posts from me concerning your posts.

Bye, bye...

 

[CosmoGTD]

B-I-N-G-O.
Most therapists who believe in 7-23 years of therapy with their patients, don't seem too keen to examine their own "unconscious" profit-motives at work here, and keeping patients in therapy for as long as possible, and even creating an extremely neurotic and damaging dependence on the therapist.
Its more than a little self-serving to say everyone "needs" $50,000 worth of therapy, and somehow this is a noble calling.
That is part of the design of long-term therapy, and why Freud said it was only for the rich.

This is why some long-term Freudian therapists despise the behaviorists and the cognitivists, as it makes them look bad as others can get RESULTS in 16 weeks, that a non-directive therapy might NEVER achieve.

There is a doctrinal belief within much of psychotherapy (a belief that is, among other things, in tune with therapists' own profit motives) that everyone comes to the therapeutic encounter burdened by deep unsolved issues borne of inherent psychological conflict.

 

[CosmoGTD]

DA very cleearly says many times you CANNOT have it all, and you CANNOT do it all. That is why GTD exists!
You know, ironically, seeing GTD distorted in such an extreme fashion, actually makes me appreciate it much more for what it is!!

I haven't noticed that David said "you can have it all"!

I think that he rather says "you can do anything but not everything".

In "Ready for Anything" he also says that:

I do not think it is dangerous thinking.

 

[CosmoGTD]

There have been some excellent posts in this thread pointing out the fallacies and errors being made, and the inherent irony in the approach, so I won't add to that. Its ironic that the proponent of long-term Freudian psychotherapy, seems to lack all of the skills and personality traits that this long-term therapy is supposed to confer upon you. The lack of rational arguments being made is evidence enough to avoid that approach. There are countless cases of people who have painted themselves into a corner of misery, and have really damaged their lives by getting over-involved with an arrogant, dogmatic, controlling, long-term Freudian style therapist. There IS a very powerful transference that occurs, and you better be very careful the therapist you are involved with knows what they are doing, is competent, and also a good-hearted person. As if you get involved in long-term therapy with a "bad therapist" who builds dependence into people, and is shaming, controlling, arrogant, and dogmatic, you can really create some very serious problems in your life. This area of therapy is rife with abuse. Power corrupts, and therapists have lots of power over people in long-term therapy.

On the other hand, some obviously well-trained and wise therapists have made some valuable comments in this thread, so that is very useful and helpful. This is why its essential to "interview" a therapist before you get too involved with them. Set a limit of maybe 5 sessions, or even less sometimes, and carefully analyze whether this person is someone who is helping, or hurting. Sadly, there are many bad therapists out there, as well as many great therapists. Buyer Beware in this field, its your mind, after all.

But just a few general points.

CBT has nothing to do with Jungian Analysis. I don't know where that came from, but they really are opposite ends of the spectrum. Jungian archetypes are fun though, when taken as a metaphor.

Medication can be extremely helpful to many people. Sure, the drug companies are out to make money and do bad things, but many people have had their lives saved by the right medication. The scientific evidence is very clear in this area.

The idea that CBT or REBT has NOTHING to do with your childhood, is also false. This is where your beliefs were formed, and CBT does deal with childhood issues, and explore them in great detail, especially if they involved trauma. But you don't get STUCK there. But again, more erroneous statements being made.

Also, CBT does deal with Dreams, but it doesn't put them up on some pedestal and get into Mind Reading dream analysis. CBT can deal with ANY subject, in the appropriate time and manner.

In CBT, the therapeutic relationship is critical. This is very well understood. Cultivating that relationship is crucial, and much effort and research has gone into this. This is explained in the most basic CBT texts, so its obvious that anyone who does not know this, has not even been exposed to the most basic knowledge in the field.

Notice how the subject of the thread has come up pretty barren.
The BENEFITS seem to be unmentioned.
I would like to see the scientific evidence and proof that certain methods actually work.
Again, I will post a summary of some of the research into CBT.

http://www.beckinstitute.org/FolderID/194/SessionID/{20D25B59-1998-4298-BD3C-3A632C2C513D}/PageVars/Library/InfoManage/Guide.htm

or

http://tinyurl.com/9of3v

Lastly, many "regular therapists" actually do practice cognitive-behavioral therapy, but just don't call it that! "Talk Therapy" is a cognitive therapy.
But there are many sub-forms of cognitive therapy, but in my view the most effective are the ones coming from the research of Aaron Beck.

But its not for everyone. Each person needs to figure out what works best for them. What I like about the Beck CBT stuff, is you get a set of tools that you can use on your own, without a therapist.
There is a massive, practical list of tools you can use, like the Thought Record, which work extremely well, for many people. This is an excellent book for folks just starting out with this stuff.

Mind Over Mood
http://tinyurl.com/e3hb5

 

[CosmoGTD]

I would be extremely skeptical with this type of writing, personally.
I know this fellow is "convinced" that his model for the operation of the human psyche is correct, but where is the evidence for this?
This business about the "inner conflict" might sound nice, but there is really no real evidence that this is what is really happening inside the brain and psyche.

He states that "all" psychiatric symptoms are coming out of these "inner conflicts". This is most certainly incorrect. What about people with brain damage?
What about the serious mental illnesses and personality disorders?
"Certainly" much of this is coming out of biological disorders, the evidence is very clear in this area.

This is why good therapy does Outcome Studies.
Because we don't really know what is going on inside the brain, yet, then we try and measure the results.

Does it work?
And if so, in what ways?

There are endless books and theories about how the human psyche works. You could spend decades just trying to look at them all.
But for example, Dr Aaron Beck tried to validate some of the theories and precepts like the ones mentioned below, and he found the scientific evidence did not support them. They were shown to be false.

Many, if not all, of the theories in psychoanalysis were swept away by the Cognitive Revolution in how the human brain works.

There are other theories that the personality disorders evolved as adaptations in evolution. There are dozens of different theories, and many of them conflict with each other.
So what has to be done is to bring science into it.
Build theories that are falsifiable and testable (Popper), and then go about testing them.
People can pontificate and write literature for decades, and they have, but DOES IT WORK? Does the therapy they are selling actually W-O-R-K?

I think its fine for people to spin fancy theories until the cows come home, but they have to be TESTED to see if they WORK.
These have to be controlled Outcome studies, not anecdotes and stories from a private practice.

There is lots of work that has been done showing how to construct a proper scientific theory and then how to test it. That is a study in and of itself.
Bringing science into therapy is what has lead to many of the advances in therapy we can now benefit from.

“I believe that humans possess a spiritual as well as a physical dimension, and that there are very real differences between brain, mind, and soul. I think of the soul as the experiencing self, the “I,” an ineffable whole that integrates processes happening at four different levels of experience—body, brain, mind, and spirit.” (6)

Frattaroli answers the question posed by this thread fairly explicitly at the end of part one:

“I am convinced that all psychiatric symptoms originate in the way I have just described—as adaptive mechanisms to relieve the anxiety generated by inner conflict—and that they are appropriately and effectively treated by a psychotherapeutic process (with or without medication) aimed at resolving inner conflict. The symptoms will no longer be necessary (and chemical balance will be restored) once the unconsciously conflicted, anxiety-provoking emotions have been fully accepted into consciousness, that is, once they are no longer provoking unmanageable anxiety.” (78)

Also: “What dynamic psychotherapy offers that all these methods lack is a unique synthesis of private inner experience and interpersonal process: a specific focus on inner conflict as the nexus of change combined with a method that takes advantage of transference as the vehicle for change.” (78)

 

[ActionGirl]

Hey Cosmo, I was just trying to quote a few lines that clarified for me where the psychoanalyst school was coming from. I will say that the overall tone of author was far different than this board's most representative of psychoanalysts. I would recommend the book (though certainly not endorse everyting in it).

The cognitive revolution has been so influential that the book is largely a reaction against it. There's been a similar trend in philosophy. With all the new science about the brain, many think that the role of the brain has been over-emphasized, and other aspects of personhood undervalued.

I've also checked out a Yale Univ Press book called "Does Phychoanalysis Work?"
(Multiple authors) http://www.amazon.com/exec/obidos/tg/detail/-/0300065272/002-3257247-0199221?v=glance

It attempts to consolidate and evaluate the empirical evidence about psychoanalysis. It's very dry and I have no intention of reading the whole thing, but it seems to express a good understanding of the difficulty of studying the question. Sorry the following quote is a bit long, but it seems to cover the overall findings (last page of book):

"Polular descriptions to the contrary, psychoanalysis is by no means lacking in empirical studies. As our review shows, in addition to the far-reaching clinical experience of the analytical community, there is ample systematic evidence for the efficacy of psychoanalysis in aiding many patients for whom it is an appropriate treatment. These systematic findings carry with them the characteristic stamp of good empirical investigation--negative findings that run contrary to the wishes and beliefs with which investigators started their study. These negative findings include that systematic investigation does not support the effectiveness of psychoanalysis when it is used to help otherwise untreatable patients and that within the range of ordinarily analyzable disturbances it is currently impossible to predict at the beginning of treatment which patients will do well in analysis and which poorly. The available empirical findings about the efficacy of psychoanalysis all have substantial methodological limitations. In addition, many of them reflect clinical practices of years ago, although many analysts believe that analytical practice has changed dramatically."

 

[ActionGirl]

At the risk of injecting a little humor into this thread, I want to recommend a novel by one of my favorite authors, David Lodge. The book is called "Therapy."

The protagonist pursues several different forms of physical and psychological therapy, all the while uneasy that one of his therapists would be offended to learn that he was seeing other therapists as well. There's a good bit on cognitive-bahavorial therapy in which he is instructed to make a list of both the positive and negative things in his life. His comes up with a healthy list of good things, and only one bad one: "feel unhappy most of the time."

Please don't go read the reviews of the book as most give away too much of the plot without really conveying how funny the book is. Below is the only half-decent one I could find:

David Lodge's novels are proof that contemporary mainstream fiction doesn't have to be depressing, sterile, or plotless. It doesn't have to leave you wondering why the author bothered. Heck, it can even have a happy ending and still be worth reading.

Therapy has it all. The sometimes self-deluding but always likeable Tubby is an intelligent and interesting main character, and Lodge keeps the reader turning the pages to see what will happen to Tubby next. (That last may sound like cliched praise, but it is nevertheless high praise: there are plenty of writers who CAN'T keep the reader's interest.) Lodge uses several writing styles in this book and he's so good he can make everything from philosophical musing to rather broad comedy work. He can go from the hilarious police statement by Brett Sutton to the near-poignancy of a remembered first love and make it all come together in one delightful whole. Bonuses: along the way we get a glimpse of the making of British sitcoms, a somewhat satirical portrait of our societal compulsion to therapy, a funny mid-life crisis, several surprises, and as much information about Kierkegaard as most readers will ever want to know. And, yes, there's even an upbeat ending.

Do something good for yourself already: forget the latest self-help book and its "twelve steps to recovery from all that ails you" pablum and read a David Lodge novel. If not this one, another one. (Read one and you'll want to read the others anyway.) Lodge will do more for your heart and mind than any amount of twaddle about inner childishness.

 

[CosmoGTD]

What I love is that all these guys are fighting against the cognitive revolution with cognition.
Sometimes the Emperors are not only naked, but butt neked.

Also, all sorts of therapy has been shown to work, to an extent.
Sometimes, people even have these wacky "theories" of why they think their brand of therapy works, when in fact it could work due to factors they are not even aware of. They can go on and on about the "unconscious" but what if they are totally wrong? What if there is no unconscious as they think of it?

As has been mentioned, often just the relationship with the therapist helps people to change. (but WHY this works is extremely complex and not understood. I think it just has to do with relearning responses, just like we learned them in the first place).

Also, they REFLECT on their life, they TALK about it, they create a VERBAL narrative, they THINK about changing...(this is all cognitive therapy, but don't let the secret out).
Then they go and try to BE different in the world, and act in new ways. (this is behavior therapy, but please don't tell them, they might have a heart attack!)
They also FEEL and cry, and explore their emotions...when they reflect on this, this is also cognitive, but please, we must not think about these things...

The reality is that there are many many theories, and no one knows for certain yet what is going on in the brain.
BUT, what they can measure is if there are changes and improvements in things that are measurable.
So why not focus on methods that have been shown to WORK, while people are trying to figure out what is going on in the brain?
That seems logical to me.

Some folks even want to leave "cognitive" therapy behind, and get into more "spiritual" things. But this is all still cognitive! If you are thinking about it, its cognitive! People have this absurd idea that cognition is some type of robotic brain function, and don't realize is all about human Consciousness, which includes all of the above.
Also, REBT and CBT include all of the human emotions, and behaviors, and somatic responses as well.
And REBT even can include anything from any type of therapy, if its PROVEN to work.
So ultimately, these things will be integrative therapies of what WORKS, if they follow the science.

But anyway, once you get into the theories and the science behind this stuff, it becomes amazingly complicated.
So I see two seperate streams.
You have the science, and the theories, and all that stuff behind the scenes, which is critical, but not useful for the average person.
Then you have practical methods, which may not be understood, but have been shown to work. So why not just use them?

I try to do both.
Use whatever is available, and keep an open mind, and experiment.
Also, keep up with the theories and science and philosophy going on behind the scenes.

But most folks don't want to know what's under the hood, they just want to feel better, and have a better life. So then in my view it seems logical to DO what has been proven to work, and has been tested in proper scientific studies.

It seems pretty obvious to me, even though this type of thing is very slippery and amazingly tricky.
But all of our experiences, emotions, behaviors, images, all are mediated in the human brain. Beck posits its all about how the brain is processing information from the environment, in order to enhance the survival and reproduction of the organism. I agree with this, but again, this stuff gets very complex and difficult, and gets into issues of Free Will, and what it is to be a person, human consciousness, and even the nature of objective reality, Constructivism, and a few hundred other things.

 

[mcogilvie]

David Lodge Yea!

Do something good for yourself already: forget the latest self-help book and its "twelve steps to recovery from all that ails you" pablum and read a David Lodge novel. If not this one, another one. (Read one and you'll want to read the others anyway.) Lodge will do more for your heart and mind than any amount of twaddle about inner childishness.

I'd also like to endorse David Lodge's books. Each one is a minor masterpiece of fiction. Honest, humorous, and kind.

 

[ActionGirl]

I'd also like to endorse David Lodge's books. Each one is a minor masterpiece of fiction. Honest, humorous, and kind.

Yes, if someone reads David Lodge, all the nonsense in this thread has been worth it!

 

[CosmoGTD]

This brouhaha reminded me of a little checklist put out by the psychologist Arnold Lazarus, for helping to figure out if a therapist is any good for you. The points being made in the questions are very interesting.

There is also a book about this by Dr. Albert Ellis called, "Why Some Therapies Don't Work: The Dangers of Transpersonal Psychology".
http://www.prometheusbooks.com/catalog/book_594.html

There is plenty of research that shows that some people are harmed by the wrong type of therapy and bad therapists. There is even something called "therapist-caused deterioration", and I have actually seen this happen to people. One of the cardinal sins of any therapist, is when they claim "I am the therapist, you must listen to me, and you are just resisting me" and things of that nature. Its very important to simply fire a therapist who is making you worse off, but sometimes this is difficult to see.

It looks like I can attach a JPEG attachment, so I will give it a try. (thie file was 100KB and too big, but I found it online)
http://www.familynow1.com/chooseatherapist.htm

To do this questionnaire, you score it by....

0=never or not at all
1=slightly or occasionally
2=sometimes or moderately
3=a great deal or most of the time
4=markedly or all of the time

Then you add them up, and follow the guidelines at the bottom.

How To Choose a Therapist

In his book, I CAN IF I WANT TO by Arnold Lazarus, Ph.D., Dr. Lazarus provides an excellent guide.

1. I feel comfortable with the therapist. 0 1 2 3 4
2. The therapist seems comfortable with me. 0 1 2 3 4
3. The therapist is casual and informal rather than stiff and formal. 0 1 2 3 4
4. The therapist does not treat me as if I am sick, defective, and/or about to fall apart. 0 1 2 3 4
5. The therapist is flexible and open to new ideas rather than pursuing one point of view. 0 1 2 3 4
6. The therapist has a good sense of humor and a pleasant disposition. 0 1 2 3 4
7. The therapist is willing to tell me how he or she feels. 0 1 2 3 4
8. The therapist admits limitations and does not pretend to know things he/she doesn't know. 0 1 2 3 4
9. The therapist is very willing to acknowledge being wrong and apologizes for making errors or for being inconsiderate, instead of justifying this kind of behavior. 0 1 2 3 4
10. The therapist answers direct rather than simply asking me questions what I think. 0 1 2 3 4
11. The therapist reveals things about himself/ herself either spontaneously or in response to my inquiries (but not by bragging and talking incessantly and irrelevantly). 0 1 2 3 4
12. The therapist encourages the feeling that I am as good as he/she is. 0 1 2 3 4
13. The therapist acts as if he/she is my consultant, rather than the manager of my life. 0 1 2 3 4
14. The therapist encourages differences of opinion rather than telling me that I am resisting if I disagree him/her. 0 1 2 3 4
15. The therapist is interested in seeing people who share my life (or at least is willing to do so). This would include family, friends, lovers, work associates, or any other significant people in my life. 0 1 2 3 4
16. The things that the therapist says make sense to me. 0 1 2 3 4
17. In general, my contacts with the therapist lead to my feeling more hopeful and having higher self-esteem. 0 1 2 3 4

Now add up all the numbers you circled to get a total score.

Attached files

 

[ActionGirl]

Thanks for posting that. It's always difficult to evaluate a specialized service, but it seems especially difficult with therapy--just when you most need some sort of counseling, you may be least able to evaluate the therapist.

 

[CosmoGTD]

There is a lot of great info embedded in that questionnaire.

I think that checklist would apply equally as well to these so-called "life coaches" people are hiring as well these days.
Just add in a question something like...

18. When I tell them I am not going to use a contract for coaching, they simply accept it or reject it in a calm, professional manner, and their face doesn't turn blue as they try to con-vince you to sign their complex contract with all sorts of fine print about complicated financial cancellation penalties. 0 1 2 3 4