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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by lpslpslpslpslpslps on June 11, 2010, at 13:45:10
In reply to Re: Brainstorming alternate treatment options » lpslpslpslpslpslps, posted by violette on June 6, 2010, at 1:02:30
> Many of those with strong defense mechanisms, say-intellectualization, can benefit from psychodynamic therapy, which is about "feeling".
Can you tell me more about psychodynamic therapy? I've asked my psychiatrist about different types of therapy in the past, but he tends to do his own thing. He basically just asks me to talk about what is going on in my life, and he periodically asks follow-up questions, or makes suggestions about possible connections between things I have said, and if I ask him to suggest a course of action he will give me a little guidance.
After med school and residency this guy spent several years training at a psychoanalytic institute, so I trust that his approach to psychotherapy is based on some expertise, but I don't know if he really 'takes requests' when it comes to forms of psychotherapy.
He's always been supportive of my interest in psychiatry and psychopharmacology. He loans me issues of the academic journals he subscribes to, he gave me his old PDR, and he's loaned me a couple textbooks that's he's used when teaching at the UCLA med school. And if I come in for our weekly session and I ask him a bunch of questions about treating schizophrenic patients or about his experience running a psych hospital (which he did when he was younger), he's happy to talk to me about that for the whole time. It's like having weekly one-on-one access to an expert in a field I am intensely curious about, in addition to having a caring doctor that I like.
In short, I really like this doctor. He doesn't talk down to me, he doesn't tell me things that he knows I already know (and he has a good sense for what I do know and what I don't know). A few times, he has told me that a pharmaceutical rep has recently given him samples of a new drug, and he wants to know what I've seen about that drug in the literature. Of course, I suspect he does this in order to facilitate transference-- heck, I don't know how much I would trust him if he really made it a practice of consulting non-expert mentally ill patients about medication-- but in any event I like it b/c I feel like he's one of the only people in my life that takes me completely seriously. In three years, I've never gotten the "how cute, the patient thinks he knows something about psychiatry" condescension that I expect I would get elsewhere. He's the only person in my life I haven't had to prove myself to.
But, I have no idea if the form of psychotherapy he offers is optimal, b/c I've got no basis for comparison. I do notice two things though: 1) I generally feel better after our appointments than I did before the appointment, even if he hasn't said hardly anything, and 2) often when I am by myself, I start talking to myself mentally as if I were talking to him -- several hours a week of this, in fact, and it feels as effective as the actual therapy. And I never did anything like that before, so who knows.
Posted by chujoe on June 11, 2010, at 13:45:10
In reply to Re: Brainstorming alternate treatment options » Leo33, posted by lpslpslpslpslpslps on June 7, 2010, at 20:10:42
LPS, I've been thinking about you, perhaps because we both have academic interests, but also because of the ADHD component in your dx. I have found that 30 mg of Ritalin spaced out over the day is very effective for me, but I have no idea how that would interact with your other meds.
Basing my opinion on your own descriptions, I would also like to suggest that there are psychological issues you ought to consider. At one point in a poet you said something to the effect that it was frustrating to still have problems with issues "the pills are supposed to solve." In a spirit of friendship and solidarity, let me gently suggest that "pills" won't "solve" anything, though they may give you the clear space you need to solve the problem yourself.
I have the sense that your fascination with psycho-pharmacology is an avoidance strategy in two ways: 1.) It is a complex body of knowledge you can focus on instead of what you're supposed to be doing; 2.) it underwrites your reluctance to take responsibility for the garbage filling your apartment (and your life & your mind). So let me recommend what I think is an important book that concerns itself with the human behaviors people on this list are dealing with. The book is Richard P. Bentall's "Madness Explained: Psychosis and Human Nature".
Bentall's text is not a self-help book, but an exhaustive look at the psychological literature on mental illness; nor is it one of those partisan anti-psych screeds or an indictment of the pharmaceutical industry. He hardly concerns himself with those things and he is in fact quite friendly to biological approaches to psychosis, depression, anxiety, etc. It's just that he begins from the premise that, while the brain certainly influences the mind (and behavior), the mind (and behavior) also influence the brain. It's a scholarly book & Bentall cites his sources, but it is not difficult to read. In any case, I think it offers an exceptionally productive framework for thinking about the issues many of us here are facing.
Posted by lpslpslpslpslpslps on June 11, 2010, at 13:45:10
In reply to Re: Brainstorming alternate treatment options, posted by chujoe on June 8, 2010, at 19:41:45
Thanks! I'll take a look.
Posted by violette on June 11, 2010, at 13:45:10
In reply to Re: Brainstorming alternate treatment options » violette, posted by lpslpslpslpslpslps on June 7, 2010, at 19:19:23
Hi lps,
Psychodynamic therapy is a form of psychoanalysis--and from what you have written, I am fairly certain that you are already in that type of therapy with your PDoc. If you weren't, you probably wouldn't meet with him weekly for 50 minutes or so or have the reactions you describe.
"The Efficacy of Psychodynamic Psychotherapy" is a pretty good summary of the process:
https://portfolio.du.edu/pc/port?
(full text)That type of therapy is influenced by oject relations, attachment theory, self-psychology, etc., usually focusing on the actual relationship between you and your therapist, the transference, unconscious motivations.
Patients were once treated for the psychological aspects of mental disorders until pharma/insurance companies overpowered how most psychiatrists currently practice.It's really sad reading how people spend years going from drug to drug while most psychiatrist never addresses the psychological causes of the symptoms. I think for many who have had depression and anxiety for an extended period of time, or treatment-resistant for many years, such issues have become a part of personality/self. I'd like to see psychiatrists go back to therapy and meds, but that will likely never happen.
Shame is at the core of many chronic illnesses, influencing how we feel from day to day. Using medications, although I believe they should be used for most of us in therapy because we need them to function better, rarely address these underlying issues. Meds prolongs the symptoms, keeping them buried inside. This article describes the effects of toxic shame:
http://www.soulselfhelp.on.ca/tshame.html
(It mentions spirituality, which I'm not trying to promote (am not religious anyway), but it is a good synthesis of how shame effects us and the article has influences of self-psychology.)
Your PDoc sounds so much like mine. Like most therapists, it sounds like he is a bit eclectic, but mainly psychodynamic and maybe even somewhat psychoanalytically oriented. For people harder to reach/ego-syntonic, straight psychoanalysis is more effective, I believe, because it encourages more transference and feeling that some need to come out of denial. One who practices orthodox psychoanalysis would not be so chatty with you and likely would not discuss all the academic research. You seem ego-dystonic. Many who are ego-syntonic don't end up in therapy until their life is falling apart, are coerced by family, or are court ordered.
"I do notice two things though: 1) I generally feel better after our appointments than I did before the appointment, even if he hasn't said hardly anything, and 2) often when I am by myself, I start talking to myself mentally as if I were talking to him -- several hours a week of this, in fact, and it feels as effective as the actual therapy. And I never did anything like that before, so who knows."
That's the effect I get from psychodynamic therapy too. It works all week! I also have conversations with him in my mind-that's actually very comon. The transference and our discussion of my unconscious motivations and associations leads to insights and feeling states that I had repressed for so many years. It can be painful, but after each time, I feel a sense of grief-then feel a bit better each time. Sometimes I get a release of emotional tension after sessions. It's really intense because I feel those emotions physically. The tension release is a physical feeling, yet its not the same as taking a xanax and feeling anxiet relief-it feels as if some long-time buried anxiety actually has physically left my body. I think some of this is due to having childhood problems before I could talk-so I have a lot of emotions that manifest somatically.
The relationship between you and your PDoc sounds great, and that is so very important for effective therapy. I think you are doing just what you should be doing and defintely stay with this guy...I'd be interested to hear if you 2 discuss the intensive research you do, exploring whether or not you are using an intellectualizing defense to resist addressing deep, painful emotions.
You might not be doing this, but when I read your messsage, it sounded so similar to what I was doing, which is why I responded to your post. First, reading about all the medications to get better. That wasn't working so well after a few years. Then in psychodynamic therapy for the first time, and feeling amazing insights after sessions, I realized I never processed all my childhood stuff, and that medications were not going to "cure" me and were only prolonging my conditions. So, I started researching all about psychodynamic therapy, object relations, attachment theory...I am slowly weaning myself off doing this-its gotta stop. It's sort of like an OCD thing-intellectualizing everything defends the psyche against feeling painful emotions and blocks anxiety from surfacing.
I just suspected you were doing this to keep the unconscious feelings from emerging--that's what we do-we have defense mechanisms to avoid feeling pain. We do it this in several different ways and sometimes one, such as intellectualization, becomes our dominant defense mechanism.
You really do seem to be just where you need to be. It might be helpful to ask your PDoc about intellectualizing hindering your progress for the possible reasons I stated. (I'm curious, too!) I also think the lack of motivation and procrastination are oftent he result of unconscious mental conficts. It can be difficult to treat and to discover the underlying cause.
Some possible causes of lack of motivation (doesn't really get at all of them though):
http://www.psychologytoday.com/articles/200308/procrastination-ten-things-know
It just takes time. I expect to be in therapy for a few more years...but I am getting better one day at a time and have even progressed since I cut down on all the researching!
But...since you are a research person:
http://www.apa.org/news/press/releases/2010/01/psychodynamic-therapy.aspx
http://jama.ama-assn.org/cgi/content/abstract/300/13/1551
Even though the obsessive researching had adverse affects of my progress for quite some time, I do admit that understanding the therapy process and concepts in great detail has been very beneficial to my therapy results. It's time to quit, though, and let my doctor take over-he is a wonderful therapist. Your therapist sounds awesome too. I hope this information is helpful to you. Good luck with the meds too, and take good care!
Best,
Violette
Posted by violette on June 11, 2010, at 13:45:11
In reply to Re: Brainstorming alternate treatment options » lpslpslpslpslpslps, posted by violette on June 9, 2010, at 8:37:27
Here's the correct link to some full text articles about psychodynamic therapy:
https://portfolio.du.edu/pc/port?portfolio=jshedler
Posted by desolationrower on June 20, 2010, at 2:10:42
In reply to Re: Brainstorming alternate treatment options » Leo33, posted by lpslpslpslpslpslps on June 7, 2010, at 20:10:42
its important to work smart, not just hard.
if goals don't spontaneously assert themselves to guide your efforts its easy to get stuck doing less valubale things while important (albeit mundane) things like taking out the trash don't get done.
give yourlself a break every so often, and ask <is what i'm currently working on moving me toward a goal i value?>
i think that has helped me some.
-d/r
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