![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Estella on August 24, 2006, at 3:03:12
i've been seeing this lady for a while now. she is nice. but... i'm not sure that she knows how to help me. i'm not sure that she understands what i'm talking about half the time. i've come to learn that some conversation topics are kind of off limits because she doesn't understand. the kind of advice she offers isn't really helpful. i feel bad saying that :-(
i feel ungrateful. she really is nice. she really is trying to help me. i understand that. but i'm not sure that we click all that well. sometimes conversation is hard work. for the both of us, i guess. i think maybe it is that we don't click very well. i'm not sure that i can do examples. maybe i can.
i was telling her about how i get anxious in seminars and can't ask questions. about how when people yell i feel upset.
and she launches into this little thing on the board about cognitive distortions and about how you have to challenge those.
and i said that the problem was that i have a heightened startle response. when people start yelling... people see me physically startle :-( that is whats hard. and when it happens i breathe slowly and try and reassure myself that its okay and nobodies going to beat me up but i still feel scared. well... i can still feel my heart racing and i find it hard to think clearly and follow what they are saying and stuff.
like how when i was a little kid and a teacher is giving me some math equation and saying 'what is the answer hurry up...' and i feel so anxious i can't think i can't think... except i never got to tell her that latter bit 'cause sometimes i think she is too busy trying to give me helpful stuff that she isn't really listening to what i'm saying.
:-(
so...
she isn't trained to work with mental health issues. but that isn't it. 'cause i've had similar stuff happen with people who have been. poor fit, i guess. i guess i'm hard to work with 'cause this happens a lot :-(
i'm going to a GP next week. i'll ask about p-docs and medication and therapy and stuff. maybe can get a referral. don't know whether it will work out or not. i'll see i guess.
i feel bad / guilty though. i mentioned to her today about meds. she tried to dissuade me. i appreciate that. but then i also appreciate that... if i get really stressed and go a little nutso (as i've been known to do every now and then) then... what is she going to do? call psych services. i didn't realise she wasn't with psych services. methinks they misrepresented their service. methinks they did. damn them.
why can't i just be happy that she is willing to work with me?
Posted by Estella on August 24, 2006, at 3:13:02
In reply to my t, posted by Estella on August 24, 2006, at 3:03:12
because i said on my intake interview...
that i was concerned about being terminated. because that has happened to me a lot :-( and i worry about that.and she said i didn't have to worry. they could be there as long as i needed.
(which i know better than to believe but at least they weren't thinking time limited right from the start which was kinda reassuring)
and i also said that i was concerned that they were equipped to deal with me (i think i put it like that). and she said yeah that would be fine. that they did a lot of DBT stuff (though not with people with BPD i'm thinking unless psych services give those clients back to womens health). but that there could be additional supplimentary stuff if that was called for. i wondered a little what she meant. now i see. psych services. that was what she was talking about. f*ck. you would think that when people come out of the blue with a long psych history that they would at least give them a psych evaluation BEFORE deciding whether supportive councelling or mental health stuff is more appropriate.
f*ck.
but then... i don't know who / what i am at any rate.
what am i going to tell the GP?
my usual strategy is to try and figure... what is the version that is least likely to have them try and get me out the door as soon as possible. what do i say? i don't know.
am i just setting myself up for another rejection?
i guess the gameplan (so to speak) is to worry about...
meds. so a referral to a p-doc if possible. (i have enough trouble with p-docs getting that right i don't want a GP 'having a go'. maybe seroquel would be a good idea... just a tiny dose...)
therapy. a referral to mental health services for that could be nice. but depends on their wait lists i guess. whether they are going to be nice enough on their interpretation on 'resident'. i wonder what variety of therapy they do over here...
am i just setting myself up for repeating the cycle
round and round
and co
?i can't tell
Posted by Jost on August 24, 2006, at 12:25:28
In reply to my t, posted by Estella on August 24, 2006, at 3:03:12
>
> i was telling her about how i get anxious in seminars and can't ask questions. about how when people yell i feel upset.
>
> and she launches into this little thing on the board about cognitive distortions and about how you have to challenge those.
>~~ She ain't been in no graduate seminar recently if she thinks that there is a cognitive distortion.
>
> why can't i just be happy that she is willing to work with me?~~You can be happy about that, and unhappy about the fact that she seems not to be doing a terribly good job of it. How's that? You know, like being happy about having a doctor, but unhappy if he keeps misdiagnosing things and giving you the wrong prescription.
Also, aside from not understanding what it's like in grad school, she shouldn't talk against meds. If you need meds you should get them. Seriously, I saw lots of Ts who were against meds, and I wish they had been a little more up to date, and pro-science and not so head-in-the-clouds about it. Cause I need them and they make (and could have made) a big big difference in my life.
(I've got to go, but I'll be back later, these are just a couple of thoughts.)Jost
Posted by Jost on August 24, 2006, at 12:29:31
In reply to Re: my t, posted by Estella on August 24, 2006, at 3:13:02
PS Tell your Gp you need meds. If that's what you mean.
I'm not sure there, if the second she was the T or the GP. If GP doesn't like meds, definitely ask for referral to pdoc who specializes in psychopharmacology. Cause they probably know the best (best chance, anyway).
Jost
Posted by Racer on August 24, 2006, at 13:38:56
In reply to my t, posted by Estella on August 24, 2006, at 3:03:12
> >
> why can't i just be happy that she is willing to work with me?Maybe because that's not enough?
Honestly, maybe a little more relevant experience and skill would improve the whole picture. The fact that she doesn't have them does not mean that YOU lack gratitude. It means that SHE lacks relevant skills and training.
As for the "no meds" business, it's ever so easy for people to stand back and say, "The Proper Way to Get Over depression/anxiety/whatever, is through Talk Therapy and Hard Work." Great -- if you don't have to do ANYTHING else at all. I mean, I wouldn't need the meds, and could do it with only therapy (ha!) -- if I didn't have to do anything else that taxed my resources, like dress myself, brush my teeth, shower... I've got an opinion on this, so I'll stop before I start banging my shoe against the table...
(Am I the only one here who kinda misses Khrushchev?)
As for the fact that you needed more, and that need could have been, you know, foreseen, lemme tell you a little about what happened to me a couple of years ago. Some here may remember this, so forgive the repeat...
I didn't have insurance, was being seen by The Agency From A Very Warm Climate, where I was assigned to the Therapist With Delusions Of Adequacy. She triggered a recurrence of anorexia, as well as agoraphobia, hugely increased anxiety, etc. When it became clear that I was getting MUCH worse daily under her "care," I was transferred.
Keep in mind: I was no down to a BMI of about 17 or so. I wasn't able to leave the house, except to come to appointments there. I couldn't make eye contact with anyone, for any reason. I was in bad shape.
You'd think they'd find someone clearly competent, with experience, someone who wouldn't make things even worse, right?
HA!
They handed me off to an intern, who was Not Helpful. By the time I told her I was not going to continue therapy with her, I was down another ten pounds, and was in even worse shape. It took about another year and a half to recover enough to be even marginally functional.
So, no -- it doesn't necessarily follow that they'll make decisions that are in your favor. I'm sorry this happened to you, but I hope it helps to know you're not alone.
Good luck, Essie.
Posted by james K on August 24, 2006, at 14:53:05
In reply to Re: my t, posted by Estella on August 24, 2006, at 3:13:02
Hi Estalla.
A lot of this reminded me of some things that I've been through. I don't want to confuse the issue with bringing up new ideas, but it really struck me. First off, I think you need to be with people right for your history and issues and these may not be them.
When I was in the clinic earlier this year, I knew I was in the best place there was. I knew and agreed with these doctors' and counselors' philosophy and approach. But I still was second guessing them. Every question I tried to find the right answer and then to have the solution to the problem that my answer exposed. Finally my individual therapist got me to look at it like "Would you take your car to the mechanic, give him the diagnosis, then chastise yourself for not having fixed it already?, so why are you doing it in you mental and physical health?." I wish I could have worked with him longer.
There is a real danger with those of us who maybe have high IQ's and have done research to give our providers what we think they want in order to get what we think we need. I felt when you talked about going to a GP, I recognized that attitude.
It is hard when our brains can go down so many different avenues and our problems are deep and longstanding to find professionals willing and able to keep up.
I think for a therapist and a pdoc, you are going to have to find someone that is your equal and right for your issues, then trust. It doesn't sound like you've found that person yet, but watch out for yourself when you do.
I hope I'm not putting too much of my issues on your situation. I was just reminded of some things that might happen to me, or I would say. I was having sessions where my T would ask a question, I would think for a minute, have a mini-breakthough, encapsulate it in a sentence, then beat up on myself for not working that out or acting on it earlier. Then my psych would mention a drug, and I would explain why its side-effects didn't fit my desire, and my philosopy against that kind of med etc. on and on.
I'm so glad you're getting therapy at all right now. I hope you find the way to make it work.your friend,
james k
Posted by Estella on August 24, 2006, at 20:45:26
In reply to Re: my t, posted by Jost on August 24, 2006, at 12:25:28
thanks Jost. yeah... i worry about being ungrateful, i guess. i dunno. thanks for your thoughts though. haven't been to the doc yet but when i go i think i'll mention seroquel. i little teeny tiny dose might be helpful. but i'll see about talking to a p-doc. thanks.
Posted by Estella on August 24, 2006, at 20:47:02
In reply to Re: my t » Estella, posted by Racer on August 24, 2006, at 13:38:56
Thanks Racer. Sorry you had a crap time trying to get help.
Yeah. I think I do need to see what other options there are.
She is lovely. But sometimes all the best intentions...
Thanks.
Posted by Estella on August 24, 2006, at 20:48:29
In reply to Re: my t » Estella, posted by james K on August 24, 2006, at 14:53:05
Hey James.
Yeah, you are right. Therapy should be hard enough with all the issues that arise. But issues aren't really arising. It isn't working out so well. Yeah. Thanks for your support.
Your friend,
Estella.
Posted by sleepygirl on August 24, 2006, at 22:01:08
In reply to my t, posted by Estella on August 24, 2006, at 3:03:12
Estella,
ya make good sense to me
I don't know how to articulate it...
I just know that I probably know a bunch of stuff (ie what cognitive distortions are) but my problems are about a lot more than that.I'm sorry you don't connect. :-(
-sg
Posted by Estella on August 24, 2006, at 23:50:33
In reply to Re: my t » Estella, posted by sleepygirl on August 24, 2006, at 22:01:08
thanks sleepy.
yeah... trouble connecting, thats precisely what it is. still, i'm not planning on running away or anything. i'll keep working on it. but i'll suss out my other options at the same time. i already said i was going to, so she knows. she was fine with that. said she was still happy to see me even if psych services pick me up.
yeah...
cognitive distortions...
correlation doesn't entail causation
do the 'faulty cognitions' cause the distress or does the distress cause the 'faulty cognitions'?
correlation doesn't entail causation...and moreover... why do they assume you have faulty cognitions? well becasue faulty cognitions are the CAUSE of distress. clearly. by definition.
crappy crap crap
Posted by Racer on August 25, 2006, at 1:18:43
In reply to Re: my t, posted by Estella on August 24, 2006, at 23:50:33
>
> yeah...
>
> cognitive distortions...
>
> correlation doesn't entail causation
> do the 'faulty cognitions' cause the distress or does the distress cause the 'faulty cognitions'?
> correlation doesn't entail causation...
>
> and moreover... why do they assume you have faulty cognitions? well becasue faulty cognitions are the CAUSE of distress. clearly. by definition.
>
> crappy crap crap
>
>I'm sorry for laughing, but I can't think of *anyone* less likely to be taken in by that particular argument! Obviously haven't identified their audience if they try that one on you, huh?
Best luck, and I hope psych services takes you on, with a really good (and I hope psychodynamic, but I have my own bias) T.
Posted by Estella on August 25, 2006, at 1:51:44
In reply to Holding my sides laughing... » Estella, posted by Racer on August 25, 2006, at 1:18:43
lol. well they don't say it *quite* like that, but that seems to be the way it goes... they say that *of course* you have cognitive distortions and if you deny it then they say that they are *unconsciously endorsed*.
<rolls eyes>
yeah, whatever.
> Obviously haven't identified their audience if they try that one on you, huh?
yeah. i did find myself getting a bit cross about then...
> Best luck, and I hope psych services takes you on, with a really good (and I hope psychodynamic, but I have my own bias)thanks. me too.
Posted by Estella on August 25, 2006, at 2:14:47
In reply to Re: Holding my sides laughing... » Racer, posted by Estella on August 25, 2006, at 1:51:44
When I thought I was going to write my thesis on emotions I got to reading...
There has been much debate over whether judgements (cognitions, thoughts) are necessary causes of emotions or whether emotions can occur in their absence.
James and Lange agreed that emotions are feelings of bodily changes. James offered the 'argument from subtraction' which goes a little like this... If you imagine feeling intense fear and then subtract the feeling of sweaty palms and racing heart and all the bodily changes... Then what you are left with is a cool cognitive state that isn't an emotion at all.
Then Cannon came along (at least he is next up on the way I'm telling the story) and said that different emotions can have the same pattern of bodily changes so there must be more to emotions than patterns of bodily changes (ie there must be judgement or cognition).
But that was in the 60's (or maybe 50's) and thats because we didn't have many fine grained measures of the differences. (Failure to find a difference doesn't entail there is no difference to be found). Damasio and Ekman have done some interesting work on that...
Zajonc did some experiments and found he could induce emotional states by subliminally presenting stimuli (if you are presented with a picture in less than 250 milliseconds you don't become consciously aware of it). But... You can still experience an emotional response to it. One guy who has a commissurotomy (split brain operation where the corpus callosum is severed so the cerebral hemispheres can't communicate so well) reported feeling afraid but he didn't know why. They had presented some scarey picture to his right (mute) hemisphere which managed to communicate fear but not verbal awareness of WHAT he was afraid of to his left (verbal) hemisphere.
Then (was this Cannon?) there were experiments that were supposed to show that judgements / appraisals / cognitions are necessary causes of emotions. This is how the experiment went:
There were three groups. The first was injected with amphetamine and were told that it was a viamin (or similar) and they should wait in this room for the experimentor to come and fetch them to do the experiment. There was a person in the room who acted euphoric playing with hula hoops and making paper airplanes and stuff like that.
Those people were observed to act euphorically and they subjectively rated themselves as feeling happy or elated.
The second group was told the same but while they were 'waiting for the experiment to begin' they were asked to fill in this survey. The survey purposely asked rude questions like 'how many men aside from your father has your mother slept with? 5 or less. between 5 and 30. between 30 and 50. 50 or more.' (or something like that). The other person in the room expressed rage and indignation about the questionare and the subject was observed to express similar rage and indignation.
The control group... I can't remember what happened with them.
Anyways... That is the significant experiment that is supposed to show that emotions aren't just feelings of patterns of bodily change... They are the result of interpretation or judgement or appraisal.
But the results haven't been replicated so well...
Also... For what it is worth... The subjects in the second group reported feeling similarly elated. Apparantly the experimentors failed to report that because it didn't fit so well with what they wanted to show.
Also...
What is there to show that the subjects in both conditions were in the same physiological state? Sure they were both given a shot of adrenaline, but a shot of adrenaline isn't an emotional response.
But that seems to be the data that cognitive behaviourist theorists cling to with their cognitive restructuring in order to feel better notions.
I have some sympathy. One can surely wind oneself up by thinking about things in a certain way. But the point is that emotions are physiological responses. Evaluation / judgement / appraisal happens at the sub-personal level and can't be changed by our conscious will. Just like... The line and edge detectors involved in vision work at the sub-personal level and we can't be aware of them at the conscious level. (sorry about that structuralists).
Sorry for the rant... But pisses me off yup.
Posted by Racer on August 25, 2006, at 9:57:58
In reply to Re: On a related note..., posted by Estella on August 25, 2006, at 2:14:47
I've got my own problems with CBT style therapy. For one thing, I think a lot of the CBT crowd kinda say that it works For Everyone. Ergo, if it doesn't work for you, you're not doing it right. (I actually had a therapist tell me I "wasn't doing it right" when I tried to tell her I had a problem with it. Uh, not helpful, except in that it convinced me to fire her.) I don't think ANYTHING works for EVERYONE, ya know?
The bigger problem with it for me, though, is that it does for me what anorexia does for me, and triggers anorexic behavior. I've seen two cognitive types so far, and NO MORE! The first was the therapist who triggered all the problems a couple of years back. (Poor GG gets calls from me about the residual obsession that broad implanted.) I put so much energy into trying to suck back, and suppress all emotions, that the only way I could do it was to be very hungry. The second time, I fired the therapist as soon as I realized she was so married to that model that she couldn't even see me. I tried to tell her to listen to me before she started telling me how to stop feeling, I tried to tell her I had a very good way to stop feeling already, but she just said that CBT was The Answer, and if it wasn't helping me, it was because I was doing it wrong.
That's another thing that bothers me about it -- for me, the things CBT says to do don't resolve anything at all. They just bury it all deeper, and they trigger a lot of feelings of hopelessness -- "they say it's all in my control, I'm still unhappy, therefore I must be making myself unhappy, therefore I just have to keep working harder and harder to hang on, with no chance of being able to relax and take a deep breath." Nope, just doesn't work for me. That whole control thing is too tied up with starvation for me.
Sorry, I went off on my own rant there...
Posted by Estella on August 25, 2006, at 10:18:59
In reply to Re: On a related note... » Estella, posted by Racer on August 25, 2006, at 9:57:58
It can be good to get it out sometimes :-)
The thing I hate most about CBT is its focus on change change change all the time. Kind of gives you the message that you aren't acceptable at all, you have to change in order to be acceptable. And yeah, when you don't change fast enough then they blame you for not doing it right or trying harder or whatever.
But that being said...
I do wonder sometimes...
That it isn't so much the style of therapy...
As it is poor therapist - client fit.
I wonder if there is something different in the personality types (or whatever is relevant) with respect to what therapists are drawn to what traditions?
That would be interesting...
Posted by Jost on August 25, 2006, at 12:01:06
In reply to Re: Woo hoo a rant fest :-), posted by Estella on August 25, 2006, at 10:18:59
There used to be a theory that different therapist/personalities would be drawn to different therapy modalities. It seems to have dropped form view, but it was there.
Also, there was a theory that if you were a freudian, everyone had hysteria (until hysteria disappeared, and then everyone had whatever freudians believed in, then), while biological types thought everyone had bad brain chemistry, and existentialists thought everyone needed to grapple with existential dilemmas.
So, for example, in the famous experiment where all these "normal" people went to psych hospitals and claimed to hear voices saying something (it wasn't something you'd expect voices to say, either--more like "balance your checkbook NOW" as opposed to "the fbi has planted receivers into my fillings")-- once people were in the hospital, nothing they did could convince anyone that they were sane. Everything was somehow consistent with the diagnosis of schizophrenia-- like they were paranoid, or resistant to treatment, or whatever.
~~
I also read somewhere that if a little boy and a little girl are crying, people will think the boy is angry and the girl is sad. Since arguably your judgments about what you're feeling are partly determined by what you're told you're feeling, these interpretations could be internalized, and elaborated. Even after people have other experiences in which they are angry or sad (or, as often, both at once), this could lead them to overidentify with the angry or sad elements of their emotions.
Emotions are an interesting subject. The CBTers seem awfully sure that there's one type of connection, which can be reversed or broken mechanically-- without having thought through the complexities or the full usefulness of their method. It has a superficial appeal, and is a contribution because psychotherapy focuses so much on reworking emotions, rather than reworking judgments. But it seems reductionistic--kind of like dripdry materials versus satin or brocade. Maybe good for the occasional hot summer day.
Jost
Posted by Estella on August 28, 2006, at 1:30:27
In reply to Re: Woo hoo a rant fest :-), posted by Jost on August 25, 2006, at 12:01:06
> There used to be a theory that different therapist/personalities would be drawn to different therapy modalities. It seems to have dropped form view, but it was there.
:-)
There is probably some truth to that. There is probably something to do with the training too. Different orientations often have different training associated. I mean, many years of med school to do something psychodynamic, a more general arts / social science / science degree to do something cognitive / behavioural. Education to do the more humanistic type theories etc.> Also, there was a theory that if you were a freudian, everyone had hysteria (until hysteria disappeared, and then everyone had whatever freudians believed in, then), while biological types thought everyone had bad brain chemistry, and existentialists thought everyone needed to grapple with existential dilemmas.
Yeah. I guess there are different general frameworks and the frameworks are supposed to explain human development / normal human psychology fairly generally. As such, all behaviour is viewed through the general framework. Different theories about people are a little like different Kuhnian paradigms. Where different theorists are living in different worlds being driven by different questions, applying different research methods, to find different answers. I wrote something a little about this but I focused on behaviourism and the cognitive revolution as different Kuhnian paradigms and didn't even look at psychoanalytic models and humanistic models and so on and so forth...
> So, for example, in the famous experiment where all these "normal" people went to psych hospitals and claimed to hear voices saying something (it wasn't something you'd expect voices to say, either--more like "balance your checkbook NOW" as opposed to "the fbi has planted receivers into my fillings")-- once people were in the hospital, nothing they did could convince anyone that they were sane. Everything was somehow consistent with the diagnosis of schizophrenia-- like they were paranoid, or resistant to treatment, or whatever.Yeah. That was a bit of a scandal that was. It was done many years ago now. You aren't allowed to replicate it (ethics). People typically say that you wouldn't find that these days, but you aren't allowed to replicate so who knows.
> I also read somewhere that if a little boy and a little girl are crying, people will think the boy is angry and the girl is sad.I hadn't heard that one.
> Since arguably your judgments about what you're feeling are partly determined by what you're told you're feeling, these interpretations could be internalized, and elaborated. Even after people have other experiences in which they are angry or sad (or, as often, both at once), this could lead them to overidentify with the angry or sad elements of their emotions.
Yeah.
> Emotions are an interesting subject.I used to think so lol. Actually... I guess I still do. I just don't want that to be my main topic anymore.
> The CBTers seem awfully sure that there's one type of connection, which can be reversed or broken mechanically-- without having thought through the complexities or the full usefulness of their method.
Yeah. Though to be fair I guess they could allow that there is a feedback loop between physiological response and thoughts so that sometimes physiological response is what triggers the thoughts but the thoughts make the physiological response worse (or refire it) and round and round... And you have to break into the cycle somewhere so lets pick somewhere (thoughts) and just run with that. I think more enlightened theorists see it that way. Also, relaxation training etc targets the physiological responses more directly. I guess the trouble I have is the huge focus on thoughts. Maybe... It depends on what your problem is. Maybe... It depends on how sensitive your therapist is. I guess a good therapist goes with what the client finds helpful and is able to be a bit flexable and adaptable with respect to finding out what is helpful. Some therapists are okay with this. Others... Have their little tool kit and when things don't work out as the text books say they should then they are at a loss.
Reductionism is interesting. I'm reading some stuff at the moment on whether the biological level of explanation / treatment is fundamental (as the medical model seems to suggest) or whether the psychological and social levels might be fundamental for some disorders. Interesting... One notion is that the level where the generalisations are most robust is the fundamental level. For some disorders... Generalisations are most robust at the psychological or social levels of explanation whereas the neurology is a f*cking mess. I love philosophy sometimes :-)
Posted by Estella on August 31, 2006, at 20:31:00
In reply to my t, posted by Estella on August 24, 2006, at 3:03:12
Probably not getting a new t :-(
Went to the GP... She gave me a referral to see someone. She looked through the phone book to figure who to refer me to. I called to make an appoitment and asked them whether they do bulk billing on my health insurance. They don't. I can't afford to go. So there it is.
I might mention it to my GP. Maybe some do bulk billing but not others. Or maybe they can treat me as a resident and send me along to community mental health.
I've decided the seroquel is not a good idea. Dammit I should have been more assertive with the GP. I had forgotten how much medication zonks me out.
Oh well...
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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