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An interesting thread, I started talking to someone for anxiety stuff myself. Just one session so far. He pointed me to read on cognitive distortion. I am curious for the OP's opinion on frequency of sessions. I set up every other week to start with but perhaps that's too remote? I did have some life stuff come up that I am chewing on. I am also curious how you would engage with clients who did have sincere religious beliefs that were not necessarily traumatic, since that came up for me - mostly it was in the context of, "sure, if you want to recommend mindfulness stuff to me I won't fight you," and some reference to Buddhist concepts I had to summarize that were motivating some stuff I was talking about.
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Dec 5, 2022 20:35
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thehandtruck posted:I can't answer your question the way you want me to because that's not how things work! I don't look at someone and say, "ope! abuser. racist. sexist. rapist. predator" People are more grey than that. Again, it's not binary. You have probably hurt somebody in your life but you're probably not an abuser in your eyes. Have you ever emotionally abused your partner? Ever yelled at them? Ever ignored to the point they were hurt by it? What about your child? Ever ignored your child for over 24 hours? Some would say that's abuse, coercion through silence, etc, I certainly would! Does that make the parent an abuser? A predator? It's grey! There's no identifier for -*-Predator-*-. It's not like some tag in a youtube category. So I don't have to identify anything like that to conduct therapy. I have a singular goal for all clients which is to create a space where somebody can learn their own story and grow IF they want to. That's it. That might not be enough for the outside world, that's fine, then they can develop a new system of getting people to stop hurting other people because at the current moment showing lovely people the safety and love they never got is the best option we have. It doesn't work all the time, but it works more than whatever the justice system does. Okay, so here you identify some behaviors you would consider abusive. If a new/newer client came to you and told you about how they regularly engage in behaviors you consider abusive or manipulative, but not illegal, what would you do? How do you build trust with this person without giving them the impression that these behaviors are okay?
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Dec 5, 2022 20:58
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thehandtruck, did an angry ex-client give you that new avatar, or...?
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Dec 5, 2022 22:13
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The therapy room is not the place for society to be made better. It's not the room where bad people get turned into good people by someone who "knows better". There's a lot of seeking that out instinctually in our personal lives but it for sure doesn't belong in the therapy office. That room is there to address the specific issues of the client, and if that requires not being yelled at for being a creep/pedo/abuser for an hour a week then that's the point. It is not the therapist's job to admonish a person's bad behavior, and working with a hosed up person doesn't sanction that. IN FACT IT MAY BE THE ONLY WAY TO CHANGE THE BEHAVIOR
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Dec 6, 2022 00:51
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Jorge Bell posted:The therapy room is not the place for society to be made better. It's not the room where bad people get turned into good people by someone who "knows better". There's a lot of seeking that out instinctually in our personal lives but it for sure doesn't belong in the therapy office. That room is there to address the specific issues of the client, and if that requires not being yelled at for being a creep/pedo/abuser for an hour a week then that's the point. It is not the therapist's job to admonish a person's bad behavior, and working with a hosed up person doesn't sanction that. IN FACT IT MAY BE THE ONLY WAY TO CHANGE THE BEHAVIOR Who is this directed at? All I'm asking is how a therapist straddles the line of providing support to someone without giving the impression of tacit approval of their behavior.
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Dec 6, 2022 01:32
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So what I'm hearing in answer to my question is that you don't attempt to determine the truth, you don't think it matters if your client is an abuser or predator, and you treat everyone the same way regardless. Maybe this is the misunderstanding, but to me "hand-holding" means "gentle, super caring guidance," which seems to be what you're describing.Anne Whateley posted:I know a couple serial sexual predators who were in private therapy (not court-ordered or anger management or anything) and I definitely do not understand how that goes down. He gets antidepressants and reassurance and unconditional support and "you have to stop being so hard on yourself, we're all human,
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Dec 6, 2022 01:41
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i like nice words
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Baronash posted:Who is this directed at? All I'm asking is how a therapist straddles the line of providing support to someone without giving the impression of tacit approval of their behavior. Mostly finger-gunning at Anne Whateley's really weird insistence that therapy is some kind of positive, affirming sanction of sex abusers. Your question is interesting and I'd also be interested in the answer.
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Dec 6, 2022 02:04
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Anne Whateley posted:So what I'm hearing in answer to my question is that you don't attempt to determine the truth, you don't think it matters if your client is an abuser or predator, and you treat everyone the same way regardless. Maybe this is the misunderstanding, but to me "hand-holding" means "gentle, super caring guidance," which seems to be what you're describing. No that's not what I'm describing. I don't do guidance and have never used that word. I feel like you're mad that I'm even seeing "predators" as clients, and by somehow doing so I'm sanctioning their behavior. This isn't the same as when Joe Rogan platforms nazis and by not disagreeing with them in the moment he's sanctioning their behaviors. Anne Whateley posted:It seems like my original post was 90% correct. Again, I definitely can't propose a flawless replacement for the entire system, but it still seems to me like this one isn't ideal. We will have to disagree about that. No I don't believe it's correct. I also didn't say it was ideal. Ideal is not the same as least bad. It seems like we've exhausted the possible communication and it'll stay where it stays. And that's okay  !Baronash posted:Okay, so here you identify some behaviors you would consider abusive. If a new/newer client came to you and told you about how they regularly engage in behaviors you consider abusive or manipulative, but not illegal, what would you do? How do you build trust with this person without giving them the impression that these behaviors are okay? I would do nothing different than I normally do. I would create a safe space where people can explore themselves and their stories. Sometimes with a client I had who was a shopping addict she'd say, "it really helps my anxiety to shop!" and I'd say "does it?" and sometimes the space we're in and my containment gives her the safety to really explore if it actually does help her anxiety or not. To your question, if someone says they ignore their spouse or whatever and say it helps the relationship there might come a time when they say it helps and I say "ya but does it?". I build trust with that person the same way I build trust with anyone. By listening, containing, engaging, and being non-judgemental. It's not my job to tell them behaviors are okay or not okay in our society. My job is to create a space where they can figure out if a behavior is beneficial for them. I get the feeling some people want therapists to be the arbiters of what behaviors are okay and not okay in society. That's not my job. And, don't ever forget, therapists used to diagnose gay people with mental illness, tell them they were wrong, that their body was wrong, and that their behaviors were wrong. Some gay people killed themselves over stuff like that. What if we look back in 50 years and see we're currently making other mistakes. That's one reason to be hesitant to tell people what's right and wrong. It's not the point of therapy and it doesn't work anyway. You end up just being one more person in their life like their teacher or parent or pastor to tell them what to do how to think who to gently caress. I never start a session with the goal of changing someone. I hope they become the person they want to be. a strange fowl posted:thehandtruck, did an angry ex-client give you that new avatar, or...? I definitely didn't buy it!
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Dec 6, 2022 03:03
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I didn't think seeing a therapist as a guide (through the psyche, their struggles, whatever) was controversial. Your example was a therapist as a parent lovingly guiding children across the road.thehandtruck posted:I feel like you're mad that I'm even seeing "predators" as clients, and by somehow doing so I'm sanctioning their behavior. quote:I get the feeling some people want therapists to be the arbiters of what behaviors are okay and not okay in society. That's not my job.
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Dec 6, 2022 03:15
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I might be able to answer some of the questions being put in recent posts in this thread; I'm a clinical psychologist who moved into a forensic psychology practice (and who is now completing a fellowship in forensic psychiatry). In particular, I recently completed a role working with Dangerous Sexual Offenders (the legal term "dangerous" is applied to offenders who have been assessed at a very high risk of recidivism such that they remained detained on a corrections order past the end of their sentence). I don't want to step on any toes or hijack the conversation; working in this space is highly sub-specialized and answers from this space isn't a good representation of the usual work of being a therapist or psychological therapy. Among other things, my practice is (by necessity) highly coercive and, at times, adversarial in ways that my clinical psychology practice was not. But it might not be a good fit in a thread about therapists or therapy in general.
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Dec 6, 2022 05:43
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Nessus posted:An interesting thread, I started talking to someone for anxiety stuff myself. Just one session so far. He pointed me to read on cognitive distortion. I used to not mind working with people less than once a week but it just ended up feeling really flat for everyone. With such space between meetings I think it's harder for them to trust me and for rapport to be built. Therefore sessions were more check-iny and telling me about their week rather than their inner world. And when they did get to stuff, having to wait 2 more weeks to talk to me again really pushed them to other ways of dealing with what they're going through rather than bringing it to the room. So it's unusual that I agree to see people less than once a week unless it's a longtime client or for a few months or whatever. I know other clinicians who do that and it seems okay, just not my style. For your other question: I will speak whatever language the client speaks. If they want to talk about their pain in terms of religious figures then I will absolutely do that with them. I meet them wherever they're at. Does that answer your question?
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Dec 6, 2022 07:14
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thehandtruck posted:I used to not mind working with people less than once a week but it just ended up feeling really flat for everyone. With such space between meetings I think it's harder for them to trust me and for rapport to be built. Therefore sessions were more check-iny and telling me about their week rather than their inner world. And when they did get to stuff, having to wait 2 more weeks to talk to me again really pushed them to other ways of dealing with what they're going through rather than bringing it to the room. So it's unusual that I agree to see people less than once a week unless it's a longtime client or for a few months or whatever. I know other clinicians who do that and it seems okay, just not my style. On the second, I think it gets close enough to meet my curiosity, sure.
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Dec 6, 2022 07:36
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Anne Whateley posted:I mean, it literally is an aspect of therapists' jobs in the US. In all 50 states, therapists are mandated reporters, especially when kids are involved. The picture being painted here is "I'm treating that person for their anxiety driving, not my problem that they're a pedo" and "so that parent neglects their kids, who am I to judge them?" But my understanding is that there are hammered-out legal definitions and therapists are actually legally required to report any suspicions of those behaviors. To me that seems on the whole like a positive, even if it doesn't help the pedo achieve their goal of driving confidently. I mean if the paedophile is seeing a therapist for driving anxiety, I have a hard time seeing how their being a paedophile would come up in the discussion to allow the therapist to shrug about it. I doubt therapists and psychologists are significantly better at mind-reading than your average person, they can only work with what they've actually been told. How often would abusive, predatory people be open about their behaviour or intent for it to be responded to in the first place? On topic, how do/can you effectively work with patients who struggle with identifying or articulating thoughts and feelings? I spent years making little to no progress with therapy partly because I fundamentally don't know what's really going on in my head beyond 'feels good/bad man', and none of the professionals I dealt with through various hospital stays and outpatient settings seemed to be aware that it was an actual problem I was having and not just me being coy. It took receiving an ASD diagnosis and doing research on that for me to even realise it was a real issue and not some weird personal failing. Moving away from CBT and trying DBT instead helped a lot with my overall mental state, because I got tools I can use to deal with the results of my emotions even if I still don't fully know what they are, but it's still a real bugger for overall mental health and interpersonal effectiveness reasons.
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Dec 6, 2022 08:25
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trashbadger posted:On topic, how do/can you effectively work with patients who struggle with identifying or articulating thoughts and feelings? I spent years making little to no progress with therapy partly because I fundamentally don't know what's really going on in my head beyond 'feels good/bad man', and none of the professionals I dealt with through various hospital stays and outpatient settings seemed to be aware that it was an actual problem I was having and not just me being coy. It took receiving an ASD diagnosis and doing research on that for me to even realise it was a real issue and not some weird personal failing. Moving away from CBT and trying DBT instead helped a lot with my overall mental state, because I got tools I can use to deal with the results of my emotions even if I still don't fully know what they are, but it's still a real bugger for overall mental health and interpersonal effectiveness reasons. Yeah, another case were CBT fails. How can you curb your thoughts or feelings if you can't even identify them. Anyway, I see this a lot. There are two main avenues for your specific question that work with my clients and my style: 1) Somatic therapy. I've talked about this a few pages back. It's really powerful and applies often, but here even more so. If we were working on this and you said, "feels good" I'd probably pester you: "feels good where? what color is it? describe it. bring it back. do it again." and I'd probably sit with you while you're uncomfortable in that space for a while. 2) I don't know what this intervention is called, something Relational maybe, but I will kind of model the thought and emotion that's appropriate for a situation. So if a client says their spouse yelled at them for being too depressed, and in my own body if I am mad FOR my client, in an ally/protector kind of way, I'll call that out! I'll say, "wow I'm noticing as you tell that story I'm getting really upset, not at you, but at this other person!" This happens often when the client can't connect with their anger (for example), and I'm modeling it for them but also allowing them to vicariously feel anger through me. Then I also model that I (and subsequently they) can be angry without exploding, or getting hurt, or getting yelled at, or becoming dysregulated. I can model that anger is normal and healthy and we can express it in healthy ways without bad things happening. I see this a lot in men, and some of them have asked me if they were autistic and weren't sure if they were or not. After working with them for a while they realized that actually they were not on the Autism spectrum, but had been trained from a young age through abuse, trauma, and social/capitalistic norms not to emote, not to have inner awareness of thoughts and feelings, and certainly not to connect with those. It's pretty cool to watch them learn how to feel their feelings. thehandtruck fucked around with this message at 08:48 on Dec 7, 2022 |
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Dec 7, 2022 03:07
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great thread! ive been in therapy for 8 years now with the same provider. worked through some problems with my parents, which at first i thought were political (they're lifelong republicans), but later came to understand were more about my own sexual preferences and how they reacted to that. (we now are very close, it was successful!) "men not allowing themselves to experience their feelings" resonates strongly with me - this is what we've worked the most on over the years. now i only go every other week, it's more about maintenance and dealing with everyday anxieties / life changes. it's great to have somebody who i can talk to without judgement and who won't be burdened by it. often there are times with my spouse where, without the therapy, i would probably keep something bottled up until it spilled out in a bad way.
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Dec 7, 2022 18:54
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(i was an egg, but i hatched) one big problem i noticed with cbt versus psychoanalysis was that the cbt therapists that i saw would not touch historical trauma. they were very "don't focus on the past, focus on the future!" but for some families, the past is inescapable. my psychoanalyst actually encouraged me to delve into that history and explore how it affects us today, while the cbt people seemed to think that doing so would cause more problems for me than it solved. is that a feature of cbt, or just the practitioners that i encountered? a while ago now i developed an all-consuming phobia of asteroids, comets, and other space disasters obliterating humanity suddenly and without warning. the cbt therapists couldn't deal with this any deeper than "when you are suddenly paralysed by visualisations of the end of the world, just do breathing exercises!" but my psychoanalyst was able to follow the phobia back to the very real fear of obliteration, either of humanity as a whole or just me and my loved ones, and once i dug up the stuff in the past (and the present) that had instilled me with such a fear, the phobia disappeared. i think about this a lot with the trend of asteroid movies over the past few years. a strange fowl fucked around with this message at 23:47 on Dec 8, 2022 |
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Dec 8, 2022 08:08
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a strange fowl posted:(i was an egg, but i hatched) Yeah it's one of the pillars: "The focus of CBT is problem-oriented, with an emphasis on the present. Unlike some of the other talking treatments, it focuses on 'here and now' problems and difficulties. Instead of focusing on the causes of distress or symptoms in the past, it looks for ways to improve a patient's current state of mind." https://journals.sagepub.com/doi/full/10.1177/1755738012471029 A perfectly unsystemic neoliberal approach to anguish.
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Dec 9, 2022 17:59
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The most neoliberal form of therapy, lol
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Dec 9, 2022 18:02
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thehandtruck posted:Yeah it's one of the pillars: in my case, i grew up knowing very little about my family's history on either side (because they were forced to forget and to lie to themselves, which also did huge intergenerational damage) and once i found out our original name and had something to google, i got all the terrible news at once in the space of about 24 hours. the news may have been eighty years old, but the effect that it had on me was in the here and now. it was in the aftermath of this that i sought therapy. being told to simply stop thinking about everything i'd just learnt was the opposite of helpful. a strange fowl fucked around with this message at 22:35 on Dec 9, 2022 |
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Dec 9, 2022 22:32
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How many consecutive days would you say is "too many" to think about something you can't change? Is there an upper limit? At what point would you recommend seeking help?
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Dec 9, 2022 22:33
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It sounds as though CBT techniques may be helpful as "first aid" but having it as an entire discipline is like making a school of medicine... out of first aid.
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Dec 9, 2022 22:59
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Veryslightlymad posted:How many consecutive days would you say is "too many" to think about something you can't change? Is there an upper limit? At what point would you recommend seeking help? Can you elaborate with an example? 'Cause I don't fully understand your question. thehandtruck fucked around with this message at 09:12 on Dec 10, 2022 |
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Dec 9, 2022 23:01
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Nessus posted:It sounds as though CBT techniques may be helpful as "first aid" but having it as an entire discipline is like making a school of medicine... out of first aid. It's this. CBT is very good at short term symptom management. If you need that, for example because your Adderall prescription ran out and there's a shortage and now you're spiraling, CBT techniques can be very helpful in removing the guilt + shame thoughts that trigger the anxious avoidance cycle that is common in adults with ADHD. BUT let's say you've discovered a heart condition that runs in your family, so your goal is to stop taking stimulants altogether. The short term techniques are not going to carry you through, you need to address things like why certain things trigger shame and anxiety. Taking a deep breath and doing thought stopping or an analysis chain can help in the moment, but recognizing that in those moments you feel like a child again, afraid of punishment you can't avoid can help you actually reduce the times you enter those moments. It allows you to reframe your experience and connect with things that actually matter to you. It lets you tell yourself a new story for the future. It allows new internal systems to step forward and take on some of the load. None of that is CBT. Its motivational interviewing, narrative therapy, and internal family systems, actually. Folding the practical, hands-on regulation techniques of CBT into these more conversational, past-and-future acknowledging modalities is massively more useful than doing any one modality by itself. And frankly I will never understand the sneering "oh you're eclectic" poo poo that you'll sometimes get from folks at the Psychotherapy Networker convention. Yeah, Motherfucker, I do the poo poo that works and stop doing the poo poo that doesn't work, you wanna have a fistfight in the Sheraton parking lot about it?
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Dec 10, 2022 14:17
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thunderdome winner
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Chernobyl Princess posted:It's this. this makes a ton of sense
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Dec 10, 2022 18:49
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Chernobyl Princess posted:It's this. Those people are real shitters. Have you ever been in a therapist-only process group? They're full of those people. An annoying bunch but in the sessions they're locked in and its fun to let em have it  For the CBT, yeah, I dunno. I get that perspective, but I don't normally think it would even be the best option as the bandaid but sure. I think in a medium to worst case scenario it can actually be harmful because the person keeps bashing their head against the wall trying to be better, normal, healthy, etc. And I've been a client in those situations. I think it did literally Cause Harm. At no point did the therapist even say, "hey this is the bandaid, there's other things we can and will try" so I left thinking I was broken. I feel like if it'd regarded as the early bandaid there should be a disclaimer if it's even used at all. Thank God I eventually found a therapist who got me and tbh I just needed someone to listen to my pain for a solid 6months or so rather than try to improve or fix or change me. Hell, even the exposure therapy made things worse because I just kept trying harder and harder and the response to the stimuli got worse and worse. What did the therapist say about it? Their version of "well just pray harder then" which was "just do more exposures then". Anyway....if it works for some people, cool!
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Dec 11, 2022 01:46
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alright so having just started a "trauma-focused" cbt treatment, this felt extremely on point
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Dec 11, 2022 12:40
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i will now ask the burning question has a client ever fallen in love with you? (or another therapist you know?) and what did you (or they) do about it?
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Dec 11, 2022 12:58
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a strange fowl posted:i will now ask the burning question
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Dec 11, 2022 13:19
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Serrath posted:I might be able to answer some of the questions being put in recent posts in this thread; I'm a clinical psychologist who moved into a forensic psychology practice (and who is now completing a fellowship in forensic psychiatry). In particular, I recently completed a role working with Dangerous Sexual Offenders (the legal term "dangerous" is applied to offenders who have been assessed at a very high risk of recidivism such that they remained detained on a corrections order past the end of their sentence). Whoa, how did we pass this up?? I definitely want to hear from you! I have an immediate family member who is a forensic pyschologist who specializes in psycho/sociopathy with a focus on violent sexual crimes and as problematic as forensic pyschology probably is at times, I'm totally fascinated by the work and theory. I think the question of as a society how to do treat/what do we do with people who have transgressed is super important. In my tiny secular queer anarchist community the answer has mostly been show them the door forcefully, but more and more it's been apparent that that is a pretty poor fix if you try to implement it on a bigger scale :/
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Dec 11, 2022 16:03
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Sprue posted:Whoa, how did we pass this up?? I definitely want to hear from you! I have an immediate family member who is a forensic pyschologist who specializes in psycho/sociopathy with a focus on violent sexual crimes and as problematic as forensic pyschology probably is at times, I'm totally fascinated by the work and theory. I think the question of as a society how to do treat/what do we do with people who have transgressed is super important. In my tiny secular queer anarchist community the answer has mostly been show them the door forcefully, but more and more it's been apparent that that is a pretty poor fix if you try to implement it on a bigger scale :/ Same. 
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Dec 11, 2022 16:42
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a strange fowl posted:i will now ask the burning question I don't know about falling in love but yes erotic-transference has happened. In one instance I didn't bring it up with the client but I did bring it to my consultation group. I tightened up my boundaries and we continued working together. The therapists who end up in the back of the magazines in the wall of shame because they were inappropriate with their client are the ones who didn't acknowledge it and their own stuff mushed together with the client's. So, rule of thumb is bring it to your consultation group, or just a colleague, or your supervisor, etc. Much more manageable then. And yeah as someone said there is a pamphlet called Therapy Never Includes Sex. I did an intake call once and I heard maybe half a sentence and made a note to send it to her. A few sessions in I asked if a therapist ever crossed a boundary with her and she said yes. You can just tell.
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Dec 12, 2022 16:02
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thehandtruck posted:Can you elaborate with an example? 'Cause I don't fully understand your question. Generic grief. Death, abuse, a break up, maybe random passing guilt on random, transient mistakes. Everyone will go through a hardship or a loss or something thst can't be taken back, and it will cause them to feel immense pain to think about. Life wounds us. It is natural to grieve at the injury. Where is the threshold between being wounded and maimed? And if time is not the appropriate measurement to follow, then what is?
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Dec 12, 2022 20:42
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Actually, and I am making this a separate post because it is only tangentially related to my other question, but what, in your opinion, is the point? Who, for certain, do you feel like you can actually help?
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Dec 12, 2022 21:25
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Veryslightlymad posted:Generic grief. Death, abuse, a break up, maybe random passing guilt on random, transient mistakes. Everyone will go through a hardship or a loss or something thst can't be taken back, and it will cause them to feel immense pain to think about. Life wounds us. It is natural to grieve at the injury. I'll take a stab at these but if I'm missing the mark let me know, your posts were a little nebulous and poetic. There's no time frame on grief, if that's what you're asking. It's more about finding the space to grieve properly aka crying. Exercise, work, distraction, hell I'll even throw in artistic pursuits (with some nuance) aren't really grieving, in my opinion. Touching your hurt is grieving. The issue is there isn't always a safe time or safe space to grieve, so the grief gets shoved down into our bodies, often for generations and generations. Epigenetics tells the tale. I guess to lean into your question it's up to the person to decide when enough is enough. "I'm tired of being sad about my mom dying, I want to go to therapy." That's something that might happen, the person being fed up with living the way they do. That could be a year from the incident or ten years or a month, I dunno. But it's all unprocessed grief you know? That's the nature of growing up. Then we cry, and heal, and then we can move forward and not be bound by the past. There's no measurement that I can think of, or maybe I just don't understand the scenario you're painting. And I dunno what you mean by the difference between maimed and wounded, sorry.
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Dec 12, 2022 22:57
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Veryslightlymad posted:Actually, and I am making this a separate post because it is only tangentially related to my other question, but what, in your opinion, is the point? Point of what? If you mean therapy please refer to the first page, Tiggums did a good job of teasing it out of us. Veryslightlymad posted:Who, for certain, do you feel like you can actually help? I'm not certain I can help anyone.
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Dec 12, 2022 22:59
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So, if I understand you right, a person who is already able to cry and grieve and dive into their pain alone is beyond your help.
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Dec 12, 2022 23:35
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Veryslightlymad posted:So, if I understand you right, a person who is already able to cry and grieve and dive into their pain alone is beyond your help. No sorry, I must have miscommunicated. That person is doing the "right stuff" to heal and move on. That can be done with or without therapy. There are many available mediums, but therapy seems to be where people do it most often. thehandtruck fucked around with this message at 00:15 on Dec 13, 2022 |
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Dec 12, 2022 23:41
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That's what I thought you meant, it just paints the bleakest image that I can possibly imagine.
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Dec 13, 2022 00:14
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Veryslightlymad posted:That's what I thought you meant, it just paints the bleakest image that I can possibly imagine. Really? I can't think of anything happier in my days than having a good cry and getting it all out.
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Dec 13, 2022 00:26
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Neither can I. Thank you for the honesty.
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Dec 13, 2022 00:36
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