Discussion in 'Nursing and medical-related degrees' started by laferney, Nov 12, 2005.
That's why Reality Therapy/Choice Theory, REBT, and CBT are so wonderfully productive!
Although sharing a similar foundation, coaching and psychotherapy are not comparative due to the fact that they are disparate professions working with different client populations with distinct goals and objectives. Psychotherapy is oriented to assisting individuals with psychopathology and painful symptomotology while coaching is geared towards working with a more "healthy" client population who are striving to realize specific life/career goals. The mechanics and process of these disciplines differ as well as the level and depth of the formation of the relationship.
Not that straightforward. As Hubble, Miller and Duncan demonstrate from a review of the psychotherapeutic outcome research literature, cognitive models of psychotherapy have not been conclusively proven to be generally more efficacious than psychodynamic interventions. Yes, certain psychopathology such as phobias or specific behavioral issues may warrant a cognitive/behavioral intervention. However many patients present with significant characterological/personality disordered conditions that require the formation and maintenance of a strong therapeutic relationship/alliance in order to establish the level of trust necessary to implement whatever psychotherapeutic approach the therapist favors. A cognitive therapist may not pay the same level of attention to the therapeutic relationship as would a psychodynamically oriented therapist. However, this does not negate the level of importance they place on this relationship leading to a successful therapeutic outcome.
Actually they have, especially with the so-called personality disorders as well as with schizophrenia and body image dissatisfaction (Franklin, Grant, Rosen, Vanderbilt University, and others).
My own experience is that Simon is exactly correct. While there are a number of specific techniques or methodologies that can be quite effective (such as DBT, and various other cognitive or behavioral approaches, etc.) they all require that the client trust the Therapist. While there are a number of different factors that contribute to the formation of that trust it seems quite clear that a warm, nurturing naturally helpful person as has been described is frequently the best at getting the client to that "ready" position in therapy.
Not to convert this a forum into a discussion of the psychotherapeutic outcome literature but please provide the specific journals/books you reference above so that others can review your definitive conclusions.
Jack, as you aptly note any experienced therapist, regardless of the school of psychology they subscribe to, understands the significance of forming a trusting relationship and bond with a client in order to implement their respective interventions. Without this alliance and emotional attunement with a client there is a much greater possiblity of a therapeutic breach leading to a irrevocable rupture in the therapy (Safron, jeremy, "Widening The Scope of Cognitive Therapy: The Therapeutic Relationship, Emotion and the Process of Change", 1998). In other words, a failed therapy.
I noticed that no one has mentioned alternative psychotherapies. Besides some Cognitive Behavioral and Psychodynamic methodologies, I use NLP (I'm a Master Practitioner), Energy therapies, and Applied Kinesiology for emotional issues and root cause diagnosis. Most of my clients/patients experience massive healing in the first session using these modalities. A very good psychologist with over 20 years in the field and friend of mine heavily uses EMDR for almost everything. It is simply another modality that uses bilateral alternations while focused on the presenting problem/trauma memory/etc. Just my two cents.
How would you describe your experience at Capella? thanks.
Where is it written that CBT therapists don't form trusting relationships? Drs. Judith and Aaron Beck most definitely subscribe to this idea.
In the book Cognitive Therapy of Personality Disorders, by Aaron Beck, Arthur Freeman and Associates, concerning Borderline Personality, the authors specifically discuss the establishment of trust between therapist and client (pps. 190-200).
As far as your questions about citing books and journals, why didn't you do so when you mentioned Hubble, Miller, and Duncan?
If we are expected to take your word, then you can take mine!
On second thought, I'll placate you.
Garner, D.M., (1997). The 1997 body image survey results. Psychology Today, 30, 30- 41.
Grant, J.R., & Cash, T.F., (1995). Cognitive-Behavioral Body Image Therapy: Comparative Efficacy of Group and Modest-Contact Treatments. Behavior Therapy, 26, 69-84.
Rosen, J.C., (1995). Body Image Assessment and Treatment in Controlled Studies of Eating Disorders. International Journal of Eating Disorders, 20, 331-343.
Rosen, J.C., Orosan, P., & Reiter, J., (1995). Cognitive Behavior Therapy for Negative Body Image in Obese Women. Behavior Therapy, 26, 25-42.
Rosen, J.C., Reiter, J., & Orosan, P., (1995). Cognitive-Behavioral Body Image Therapy for Body Dysmorphic Disorder. Journal of Consulting and Clinical Psychology, 63, 263-269.
Rosen, J.C., Saltzberg, E., & Srebnik, D., (1989). Cognitive Behavior Therapy for Negative Body Image. Behavior Therapy, 20, 393-404.
Veale, D., Gournay, K., Dryden, W., Boocock, A., Shah, F., Willson, R., & Walburn, J., (1996). Body Dysmorphic Disorder: A Cognitive Behavioural Model and Pilot Randomized Controlled Trial. Behaviour Research and Therapy, 34, 717-729.
Psychiatrists Assess CBT As Schizophrenia Treatment,
Psychiatric News November 15, 2002, Volume 37, Number 22,
© 2002 American Psychiatric Association, p. 18
Any book by the Becks.
JIMMY: Where is it written that CBT therapists don't form trusting relationships? Drs. Judith and Aaron Beck most definitely subscribe to this idea.
SIMON: Who said otherwise? No one indicted cognitive therapy as not forming "trusting relationships" as you misconstrue above. In fact contrary to your misinterpretation of my quote above, I CLEARLY indicated that ALL schools of psychotherapy focus on the therapeutic relationship.
In another passage I did indicate that psychodynamic oriented therapies place more emphasis on the therapeutic relationship (ie, interpreting the transference and countertransference, etc) than do cognitive models (including REBT and similar cognitive behavioral therapies). However, this is the core difference between these two schools of psychotherapy.
JIMMY:In the book Cognitive Therapy of Personality Disorders, by Aaron Beck, Arthur Freeman and Associates, concerning Borderline Personality, the authors specifically discuss the establishment of trust between therapist and client (pps. 190-200).
SIMON: You are not responding to anything I stated but to your misinterpretations of what I actually posted. What you are presenting above is elementary and primer level knowledge and no one disagrees? So stop arguing with yourself and deal specifically with the facts not your misinterpretations of the content of my posts.
JIMMY: As far as your questions about citing books and journals, why didn't you do so when you mentioned Hubble, Miller, and Duncan?
SIMON: My oh my are you defensive today! In fact I presented two of the authors' books in one of my posts that supports my statements and alludes to their findings if anyone wished to review or corroborate the information I presented. If you or anyone else needed more supportive data I would have gladly accommodated you. So now it is your turn to provide references that support your assertions in a nondefensive and open manner.
JIMMY: If we are expected to take your word, then you can take mine!
SIMON: So now we get to the core of the problem. You can't provide specific references (ie, names of the books or journals) that corroborate your assertions. I do not expect anyone to accept my word and I am receptive to feedback and questions that contradict my perceptions but am not open to attempts to distort the content of my posts.
So once again PLEASE present the references that I previously requested without mounting an unnecessary defensive position. It ain't looking too good to do so.
My friend you are not placating me but are being defensive. Nonetheless, please present the SPECIFIC references that provide solid research that proves your ORIGINAL point that cognitive therapy has been proven beyond a questionable doubt to be more effective that psychodynamic therapies in the clinical management of personality disordered patients. No more no less.
You made statements and I POLITELY asked you for references. However you misinterpreted my request as threatening your position which in fact was not my intention. I was ONLY interested in reviewing the data that may have changed my perspective and beliefs. However, due to your inordinate level of defensiveness you perceived my request as a challenge and a flame war and responded accordingly. Pathetic.
BTW, if anyone wishes to separate the myths from the facts regarding what works and does not work in ANY psychotherapy, based NOT on individuals' opinions but on substantive research and surveys, please review the informative data presented in the attached website below.
Just for info:
In the UK the term Chartered Phychologists need an honors degree plus training.
My daughter is in her final year earning a BSc and plans on becoming a CP as soon as she can.
If I misunderstood and/or misinterpreted your original post, then I apologize and stand corrected.
I did provide a list of specific references.
Every therapist has his or her specific therapeutic modality he or she uses and can cite reference after reference and study after study to validate that modality. The cite you provide is a case in point.
I have used CBT with a wide range of the so-called mental illnesses and have been highly successful.
When I worked in agency mental health, I had a client that had the BPD dx. The psychiatrist on staff said this client had the worse case of BPD she had ever seen.
The client was assigned to me. Within two years, using CBT, this person made such significant improvements I was told by other therapists--social workers, psychologists, psychiatrists--that they had never seen her doing so well.
Another case was a client who had an eating disorder and had been sexually abused. I argued for nearly 45 minutes on the phone with this person's insurance company that CBT would be efficacious. Finally, she authorized eight sessions. The CBT tx was successful.
One other case. I had a schizophrenic client. The psychiatrist was at wit's end and stopped the therapeutic process prescribing only meds. She asked me to see this person.
After two years of CBT this person became productive in spite of developing Tardive Dyskinesia from years of medication.
Simon, each person will use what has worked. No good therapist will limit himself or herself to any one modality. I use CBT more than any other type because it has worked for my clients.
Best of luck to you with your approaches.
It has been WONDERFUL!
I am not going for a Ph.D. to get doctoral level licensure. It is for the purpose of marketing (getting accepted by the masses, media, and the club of "doctors"), and acquiring more expertise in specific areas.
Capella was my first choice because it was one of the few distance schools that accepted a whole year of my masters credits right into the Ph.D., thus shortening it by one year. Most distance schools (and brick and mortar types) don't remotely do that. I understand that NCU is now doing that, also. I've enjoyed the colloquias (three of them for the Ph.D... I think two for masters required now). I also like Capella because they are committed to getting every single possible accreditation in their schools of business, psychology, technology, education, human service, etc. They already have gotten some accreditations. Besides Fielding (only in their Clinical Psych program), none of the other schools have moved, to my knowledge in that direction (Walden, Union, NCU, Saybrook, etc.). Capella has a good system, a humongous group of very competent faculty, and are market driven, which means that the consumer ultimately wins and is the goal to please. They have about 10,000 students now and continue to grow. They advertise in well known magazines and other media. They are co-owned by the mother company that owns Starbucks and Pearson publishing. There are probably more reasons. It is not perfect, but overall it is a good school and has good programs. They are in the process of seeking APA accreditation for their Clinical/Counseling Psych. program (Psy.D.).
Hope this helps.
I commend your success in treating these patients.
Have you even considered in getting further training in one of the alternative modalities such as EMDR, NLP, EFT, etc.? I think you could even go faster and see dramatic results, often in just a couple of sessions. I find many points of CBT quite helpful but I have often felt that traditional CBT is very linear and raw. It appears very limited with key influences such as past events (memories) where trauma-like limiting experiences/beliefs were installed. When such is the case, all the traditional CBT that one typically uses, is not as effective, especially it if deals only with the "here and now." It is like trimming a vine back but never getting at the root, where it was installed. It grows back and there is a re-emergence of the issue. I find that limiting beliefs, decisions, and debilitating emotions often get installed in a "significant emotional experience," which holds the power and keeps the person "stuck." EMDR, NLP, and some Energy Meridian approaches are able to quickly (one session) remove and neutralize these. These modalities can also be used to install powerful beliefs and resources in reverse by the installation of a "reverse trauma" that is positive and empowering. Not only can you neutralize negative things (limiting beliefs, phobias, negative emotions, etc.) but you can provide many of the resources a person needs in their early memories. This is done with elegance and in such a way that the mind then "updates the files" and morphs all subsequent memories with the new resources, thus empowering and/or bringing to fuller developmental maturity that individual.
I'm sure you are a "damn good" therapist. I surmise you can become the best of the best if you would incorporate modalities such as these. Word would get around that you do "miracles." That has happened to me and my buddy psychologist, in doing these approaches.
Just my two "respectful" cents.
Gentlemen: Debate over theoretical orientation is one thing.
May this ‘real psychologist’ respectfully submit this is a less than ideal forum to discuss, even obliquely and in the service of peer consultation, actual persons with whom you’ve had a professional relationship?
What? Respectfully, David, no names were given, no confidentiality was violated and furthermore, if you read the works of Beck, Haley, Glasser, Ellis, Goulding, Sullivan, Horney, and others, you will see descriptions of actual cases from each of these giants in the field.
Separate names with a comma.