My daughter is taking some of her classes for college online. This past semester she took a Christian counseling class, and I got to benefit from that class indirectly. One of the ways to study something is often by explaining it to someone else. So I asked her to explain to me cognitive therapy.
As she explained I began to understand how this could help a lot of people if they could just get over the attitude of "shrink", "touchy feely" counseling, therapy is for the rich, and talk therapy as being just that--talk. Once we get over those hurdles, I think most of us with invisible illnesses, mental health issues, could get quite a bit out of cognitive therapy.
I think part of the problem with the stigma of going through therapy is that we don't realize where the therapy is going. We can't see the big picture.
So perhaps we should think of cognitive therapy in the same way we think of building a home. Think about layers. First there is the foundation. The foundation is the most important step in the therapy we are involved in. You are establishing a trusting relationship upon which to build the recovery process. I wonder how many of us who have gone to therapy even made it through this stage? I'd be willing to bet many of us just got a taste, thought this ridiculous and a waste of time and quit. We never really got that foundation built to specs.
The next layer could be the flooring. We're still talking about basics, so this is more of a teaching and learning phase. If we even get this far, it can accomplish the task of opening up our eyes to patterns in human behavior--in our behavior. Those of us with psychology backgrounds (I have a minor in it--I always did love to study human nature) realize how very important understanding behavior patterns is to education. And I'm not just talking about elementary education. Kids go through stages of development. But did you know that adults do too? Wouldn't it be worth knowing where you are on the scale? And mental illnesses do have patterns. I think it is extremely valuable information to know these patterns and recognize them when we experience them.
The very few who make it through this stage actually get to the down-and-dirty work of the part of couseling I call "the framework." Within the framework is the nuts and bolts of therapy. This is where we get to work through our issues one by one. Many of us who have given up on therapy don't even get to this important stage, much less finish it. Working out the nuts and bolts is perhaps the most uncomfortable phase because it is very personal.
The final level in my oversimplification of the cognitive therapy process is the finish. This is the resolution stage. At this point, the therapist will pretty much know if you need continual maintenance from this point on, if you need to repeat a few steps from the past, or can actually "graduate". There are times when things occur in our lives and we regress. Back issues have to be re-addressed. The extreme few who make to this finesse stage may actually graduate altogether. Perhaps a few may have to repeat, repeat, repeat over and over previously worked out issues, some for long periods of time. This is an individual issue which can only be determined by you and your therapist together. Some of us have thick heads and don't learn our lessons the first time around. Destructive habits are difficult to break even when we really want to break them.
I think one reason why therapy gets such a bum rap is that it is highly indivualistic and for that reason some of us feel manipulated by the system and by the therapist, not really trusting them to know when we are actually making progress and when we need to backtrack. To us the sessions seem to stretch on and on infinitum. And of course, the few therapists who are taking advantage of this timelessness and are dishonest make it difficult for the rest of us to trust our therapist to know what is best for us. Therapists are human, and some of them are better at what they do than others. All this combines to make our recovery pretty much look like a guessing game. It's no wonder there is still a stigma out there.
Because so many of us with mental health issues are missing out on useful therapy, I have seen some success in taking the building process apart and presenting it in pieces as classes open for the public. Sometimes these classes are presented through our local hospitals. That seems to be a more acceptible alternative for some of us. That way we see a beginning and an end. It doesn't seem to stretch on forever. But in doing therapy this way we are giving up something valuable. That something is the foundation building I explained above. Going to a class presumes that you are going to skip building a foundation and go right to the flooring stage (in my analogy)--the information and learning stage. I realize that this is the easiest and least expensive means to an end, but I just want to caution you that doing this is only a partial solution to the therapy dilemma.
The reason this is only a partial solution is because we are, after all, human. We tend not to follow through with information we have just learned. If we were better at this, we could all get our college degrees on our own, using good information in the libraries. What we are missing is accountability. Humans are lazy and don't follow through. So we should realize that when we take classes we are getting good information, but we are not working on those nuts and bolts and actually using the information to resolve issues. That is why I believe therapy is the better option overall. We get accountability, and someone who should be taking a personal interest in our progress (ideally). The therapist is the building contractor who oversees the entire process from foundation to resolution and maintenance.
So now I'm wondering where you stand on this issue?
rate
email
print
link to this page
Comments: 29
1. It takes the right therapist matched with the right patient. Therapy is an art and good therapists really have to be able to listen to their patients and figure out the problem. It isn't as specific as looking at an x-ray or taking a blood test but is part intuition and part science.
2. Those who seek therapy are stigmatized. No question about it, people are afraid of those who can't solve their problems without therapy. There is no shame in getting treatment for a heart attack or broken leg. But watch how people react if a person seeks therapy. People can even get fired from work (eventually) for this. Presidential candidates have gone down in the polls when it comes to light that they've sought treatment for depression, even though many cases of depression are biochemical and run in families.
Online PTSD Treatments for Vets
Interesting explanation of CT. I do not use purely CT or C/BT as a therapist. I tend to use a more eclectice approach as a counselor. Theories on which different forms of therapy are based are great for explaining things, but I believe people are much too complex to confined to one theory or one therapeutic approach. However, we each have some of what Dr. Craig Burns called, "Twisted Thinking," which, with hard work, can be "straightened" if you will, with CBT. As far as the length of time spent in therapy I explain what has been called the 90/10 rule to my clients. I don't recall where I learned it myself. The rule states that only ten percent of the benefit of the work will occur during the hour in the office with me, while 90 percent will be gained by their "practice" of what they have learned, outside of the office setting.
Keep up the good work!
I am greatly encouraged about what Teresa, JC, Heather and Maria have said so far. I have never found any good therapists although I believe in good therapy. I wouldn't mind the stigma either (they can't fire me, I don't have a job anyway). I would love to get some real help especially in dealing with the bipolar issues and my lack of friendships. All your comments are great!
In all my years of therapy; the stigma is what I have had to battle more than anything. It isolates me more than the physical shortcomings! And psychosymatic pain IS real! It shouldnt be labeled psychosymatic!
I hope I can see more articles on these subjects! May this new year be even brighter for all of us!!
On thing that really caught my eye in this article, which is very well written and filled with information is the statment: WE TEND NOT TO FOLLOW THROUGH WITH THE INFORMATION WE HAVE LEARNED. I believe if someone really learns something, it sticks through life, and there is a definite behavior change. Many times we say we have learned, but all we have done is memorized, not internalized. Thank you for the article, and giving me the opportunity to respond.
I am back once again. I see in the comments that the "fit" of the therapist is the hot topic. To tell you a bit more about myself, I am a LCSW. In addition to the 90/10 Rule, I also talk about fit with each of my clients because it is one of the most important dynamics in the therapeutic relationship. Much more important than my retaining a client.
I also believe that the healthiest of individuals would profit from therapy if they are willing to do the work. I am terrible about remembering who to credit with quotes and discoveries. I only remember what they said or did. And I recall that someone, in citing what they believe to be the reason "talk therapy" can make a difference in a person's life. It was said, "I don't know who I AM until I tell YOU [another] who I AM. In other words, the value is in the process of thinking of my inner self/thoughts/beliefs in order to communicate that information to another person. Another has said, "It is the relationship that heals......"
I also read the comment of someone who spoke about "heart." They made a very true statemen. Yet, how does one ever know about a therapist and "fit" at the outset of their work. There is no real way. The best one can do is seek the recommendation of for a therapist from others who have had a positive therapeutic experience. Even then, there are so many variables involved, the "fit" may not be perfect. On the other hand, an okay "fit" can grow into a good "fit" between the two if given time to mature.
Strickly a personal opinion, I believe those therapists who have had their own struggles, worked hard to overcome them and wish to turn around to use what they have learned to help can often mold themselves into being a "good fit.". I do not believe it has be a similar set of issues or even close to the same. I believe it is about the pain, the work, and the learning that things can be better. Such lends a deeper understanding, perhaps patience, and any number of other intangibles that cannot be found in books. I believe someone has called these "wounded healers." Some things cannot be taught in the classroom. Let me add...I am not making a blanket statement about counselors here........All "wounded healers" do not make "good fits" and all "good fits" are not "wounded healers." It is simply a general statement of personal belief.
Psychiatry has long been ridiculed by other fields of medicine. That is not a good start.
Psychiatrists often go into psychiatry because they do not want to be a medical doctor per se but want to make a lot of money, rather than go into social work or get a PhD in psychology, like my husband, where people make a lot less money than psychiatirsts.
Many people who choose the mental health field as a profession are going into it for exactly the same reasons as are patients: To find out what makes them tick, to help themselves feel better. So that means a lot of practitioners may have been abused or neglected in life. If they themselves have resolved their own issues, they can be helpful, depending on their level of insight and empathy, for one.
Social workers are a great deal more social than say, psychologists, who may tend to be introverted. The males in these professions are generally very different from the females, in their own psychological makeup and their own personality characteristics.
My husband mostly hangs out with male social workers.
Psychiatrists especially in the Northeast, in Boston and NY, still rely a lot on psychodynamic therapy and on old Freudian therapy. That is not good.
Psychiatrists are not necessarily well-rounded people.
These days, especially, psychiatry is not about therapy but only about medicating.
I find that many mental health practitioners, like people in many fields, spend far too little time thinking critically about many issues - such as what they were taught, what they are doing and what they and other people are all about - they simply believe what they have been taught. Not a good thing.
Cognitive therapy is interesting and can be helpful but sometimes people need some help from medication because we cannot really turn our thoughts inside out on our own - after we stop feeling a certain way we can see how we now feel differently, but if we are suffering from grief, depression, anxiety or panic, our thoughts will not make these emotions - which are manifestations of brain activity as we feel them in our bodies - go away on their own.
I am further opposed to letting psychologists have prescription privileges. I have seen far too many psychiatrists in the field who do not know enough about what they are diagnosing or prescribing to allow psychologists - even with courses - to begin prescribing.
I have met many psychiatrists and mental health practitioners both from my parents who also were in medicine and through my husband = who know their work very well and who are good people who help patients.
Patients need to rely on their instincts in choosing a practitioner. If the fit seems good, the relationship is likely to work. If the patient sees a red flag, get out. It could simply mean the person is not right for that patient.
Kathryn, I've read so many of your articles and writings, that it just makes sense that you could add much to this conversation with all the experience you have with professionals in the fields of psychiatry and psychology.
You make a good point that medications are necessary. I tried to add that to my article and to others I write that I believe we need to get our medications in order and then seek therapy. The two should be natural companions.
I enjoyed your assessment of the professions overall. You see that field of study from an insider's point of view. I find that valuable!
Feel Better Lets Have a Plan of Action
I agree that the right fit with a therapist is paramount. Also, meds can help to steer a person or open their mind a bit to therapy and new ideas abut themselves.
About the stigma of it all................ who is to know?
Happy New Year!!
First, your last picture...I just ordered Mood Therapy, together with a workbook. Within the context of your narrative, I am not quite sure whether you support this type of book and in particular this book. An older version had been loaned to me and I read enough that I thought it looked interesting and since I'm a highlighter type of person, decided I'd get my own copy...and the workbook.
I have been diagnosed as clinically depressed and have visited 3 psychologists and have taken a number of seminars related to functional issues, such as stress management. Most of my issues at the moment are sporadic and based upon flashback issues that are brought about by stressors in my daily activities.
One of the psychologists tried hypnotherapy with me (related to weight management) and she was unable to put me under. I am rather strong willed and do not easily give up control of personal life issues.
All of that is to say that I think the other half of your question is whether the client is the type of individual who can be helped via counseling. I believe I have been open to the possibility sufficiently enough; however, frankly I don't feel that I ever got past the first step you describe. I would not attempt to lay blame on either the professional or myself, but rather based upon my personality and the background leading to my diagnosis.
My overall opinion is that counseling is a wonderful opportunity for anybody who has the need...and, for individuals like me, having books like Mood Therapy is a good beginning to evaluate whether or not we can be further helped within a structured, formal basis.
Bottom line, I believe the individual must hopefully be capable of making the decision to undergo counseling and willingly enter into the relationship you describe. In those cases where the individual does not wish to enter counseling, I'm not quite sure how other than a surface relationship can develop due to lack of trust on the part of the client.
I hope my thoughts are of some response to your question. Interesting Article!
I do believe that some mental health practitioners may have suffered in their own personal lives, and that has led them to a field in which they can help others avoid suffering. As you pointed out, as long as those in the mental health field have worked through their own "stuff" and continue to observe their own pattern (usually by seeking ongoing supervision or participating in their own therapy) they can indeed be fine counselors.
On what do you base your assumptions that social workers are more social and psychologists are more introverted? I have never heard this before and find it to be rather specious generalization.
Obviously male and female therapists are different just as male and female truck drivers or teachers are different but why is this important to the discussion at hand? My belief about this is that as children we may have developed more trust in one parent than another; thus it may prove to be advantageous to go to a therapist of that gender but please note that I said "may prove" not "will prove." This is highly individual.
Some psychiatrists may not be "well rounded" but what do you mean by "well rounded"?
I do agree with you that medication can make an important contribution to one's mental health as some disorders like depression definitely appear to be related to brain chemicals.
I do believe that psychologists should have the option to prescribe medication if they also have a master's degree in psychopharmacology. This would be in addition to their Ph.D. or Psy.D. in Psychology (doctoral degrees). If nurse practitioners can provide medication, why should that privilege not be extended to those with a doctorate and a sufficent education in psychopharmacology?