This one time in fourth grade…

Do you ever feel like this in therapy? You’re talking about something random that happened in your childhood that you’re nearly POSITIVE has nothing to do with your issues today?

For example….

Before kindergarten I got to try out three different schools — and my parents did not send me to the one that I liked! And then I had to play with this girl who my mom was friends with who I did not get along with. Trauma! Oh, and there was this boy in kindergarten who would always kiss me and I hated it. And I finally told the teacher and she didn’t care and told me to deal with it!

Clearly this is the source of my issues with intimate relationships. I’m afraid of letting people in because they might get TOO close and I might not be able to do anything about it. And this teacher reinforced the idea that my feelings do not matter and that the world doesn’t care about what I’m going through. Being made to play with a girl I didn’t like is one of many examples of my parent’s control issues. Maybe even some enmeshment, since they weren’t letting me choose my own friends.

Now, I’m not saying that the past doesn’t matter. It absolutely helps shape you and plays a role in what you’re dealing with today. And everyone is impacted by things differently…. maybe being kissed by that boy would be traumatic for someone else. I am not trying to minimize these events. I have known professionals who want to just start at the beginning of your life and work through the whole thing… and who think that this is necessary for recovery.

What do you think — how much analysis of the past is necessary for ED recovery?

Maybe the world doesn’t WANT more CBT…

I have just been waiting to write about this article all day!

Cognitive Behavioral Therapy

“The [UK] government has earmarked £173m to increase the number of cognitive behavioural therapists in the NHS.””Professor Mick Cooper, an expert in counselling at the University of Strathclyde, told the conference at the University of East Anglia that although he welcomed the increased funding for psychological therapies, the focus on CBT was not logical.

He and three colleagues from the UK and US issued a statement saying there had been more studies on CBT, but that did not necessarily mean it was more effective than other types of therapy.

“It is scientifically irresponsible to continue to imply and act as though CBTs are more effective, as has been done in justifying the expenditure of £173m to train CBT therapists throughout England.

“Such claims harm the public by restricting patient choice and discourage some psychologically distressed people from seeking treatment,” he said.”

This argument reminds me of my Dr. Drew Westen grad seminar days… Everyone is using CBT because it’s the easiest to research, has the most funding, etc. etc. Can’t say that I disagree — there is definitely too much hype about CBT. However, I don’t think that most professionals follow CBT guidelines even 75% of the time — it’s just not practical! Dr. Cooper has a great explanation of this:

“What is more, where researchers have allegiances to one particular approach, the control ‘therapies’ that are developed to test these approaches against often bear little relationship to those approaches as actually practiced in the field, and cannot really be considered therapeutic at all (Wampold, 2001, p.104) (Shapiro and Shapiro (1982) refer to these approaches as ‘straw men’). In the Foa et al. (1991) study of PTSD in women who had been raped, for instance, therapists in the ‘supportive counselling’ condition were instructed that, if their clients started to talk about their assault, they should redirect them to focus on current daily problems! “

Every therapist is going to respond similarly to some extent… maybe one is going to focus on though restructuring more than childhood, but you’re still going to have that consoling feeling. I think that whatever this common feeling is makes up the healing component of therapy… which is why the best predictor of treatment outcome is therapeutic alliance. This common set of elements that spans the different types of therapies has been termed the ‘Dodo bird’ verdict. I’ll have to write a post on that later…

Anyway, it’s nice to see someone arguing against CBT for a change! The world (and psych field) could use a little more psychoanalysis 🙂

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Maybe the world doesn't WANT more CBT…

I have just been waiting to write about this article all day!

Cognitive Behavioral Therapy

“The [UK] government has earmarked £173m to increase the number of cognitive behavioural therapists in the NHS.””Professor Mick Cooper, an expert in counselling at the University of Strathclyde, told the conference at the University of East Anglia that although he welcomed the increased funding for psychological therapies, the focus on CBT was not logical.

He and three colleagues from the UK and US issued a statement saying there had been more studies on CBT, but that did not necessarily mean it was more effective than other types of therapy.

“It is scientifically irresponsible to continue to imply and act as though CBTs are more effective, as has been done in justifying the expenditure of £173m to train CBT therapists throughout England.

“Such claims harm the public by restricting patient choice and discourage some psychologically distressed people from seeking treatment,” he said.”

This argument reminds me of my Dr. Drew Westen grad seminar days… Everyone is using CBT because it’s the easiest to research, has the most funding, etc. etc. Can’t say that I disagree — there is definitely too much hype about CBT. However, I don’t think that most professionals follow CBT guidelines even 75% of the time — it’s just not practical! Dr. Cooper has a great explanation of this:

“What is more, where researchers have allegiances to one particular approach, the control ‘therapies’ that are developed to test these approaches against often bear little relationship to those approaches as actually practiced in the field, and cannot really be considered therapeutic at all (Wampold, 2001, p.104) (Shapiro and Shapiro (1982) refer to these approaches as ‘straw men’). In the Foa et al. (1991) study of PTSD in women who had been raped, for instance, therapists in the ‘supportive counselling’ condition were instructed that, if their clients started to talk about their assault, they should redirect them to focus on current daily problems! “

Every therapist is going to respond similarly to some extent… maybe one is going to focus on though restructuring more than childhood, but you’re still going to have that consoling feeling. I think that whatever this common feeling is makes up the healing component of therapy… which is why the best predictor of treatment outcome is therapeutic alliance. This common set of elements that spans the different types of therapies has been termed the ‘Dodo bird’ verdict. I’ll have to write a post on that later…

Anyway, it’s nice to see someone arguing against CBT for a change! The world (and psych field) could use a little more psychoanalysis 🙂

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eating disorders, anorexia, bulimia, CBT, talk therapy, psychotherapy, therapist, psychology, psychoanalysis, NHS, psych research, treatment, mental illness, mental health, Dodo bird

Therapists are like Starbucks Drinks

Choosing a therapist these days can be like ordering a drink from Starbucks:

I’ll have a grande CBT lite DBT Gestalt-free psychotherapy with two shots of psychoanalysis and breve IPT.

This image came to mind have after dinner with a friend last night. She’s been in therapy for several years, and has decided to switch to someone with “a little more of a CBT focus… who still integrates interpersonal therapy but spends less time talking about family.” Hmm… good luck with that search, Rach.

The reality of it is, there are so many types of therapy out there. Just to give you an idea of how many:

• Art therapy
• Cognitive-behavior therapy (CBT)
• Dialectical-behavior therapy (DBT)
• Exposure therapy
• Family therapy
• Gestalt therapy
• Group therapy
• Integrative psychotherapy
• Interpersonal therapy
• Hypno-therapy
• Marriage counseling
• Music therapy
• Narrative therapy
• Play therapy
• Psycho drama
• Psychoanalysis
• Psychodynamic psychotherapy
• Psychoeducation

… and on and on and on. Granted, some of these are much more common than others, and you could probably lump a lot of them together, but you see my point — what therapy is right for you?

No one therapy has been proven to be the best choice with eating disorders (especially anorexia), so your perception of recovery and ED etiology will be largely influenced by your first therapist. I think very few people have much information on all of the available types of treatment (not to mention the different kinds of therapists, psychiatrists, social workers, doctors, nutritionists, counselors, etc.). And even if they did… how do you know which therapy to try? And what exactly is the focus of therapy supposed to be? What is the interaction between you and your therapist supposed to be like? How are you supposed to feel when walking out of therapy?

There are so many beliefs in the psych field right now, that maybe you do need to customize your treatment like you would your Starbucks drink. And beyond that, maybe you’ll need to just around between types of treatment… not necessarily because you chose wrong in the first place (although that’s common), but because you have different needs at different times in your life and stages of your disorder.

Where this gets tricky, though, is with the concept of “bad therapy” — and if you’ve read my other posts, you’ll know that I believe that there is bad therapy. Maybe the kind of therapy that you gravitate towards is appealing is because it allows you to perpetuate your disorder or to ignore some issue. You can draw pictures forever in art therapy and never change any eating behaviors. Or, you can talk about your meal plan every single week with a nutritionist and never bring up a bad relationship that you’re in. So, I guess what I’m asking… is to what extent is therapy supposed to be comfortable? Is it no pain, no gain?

Any input would be appreciated…

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