Symptom Removal Vs. Psychodynamic Therapy

The field of psychotherapy offers a plethora of different and often opposing approaches. Hundreds of diverse schools of thoughts with their own techniques claim to have the solution to human suffering.

This fragmented and chaotic field appears to offer a vast selection of therapeutic approaches to choose from. However, when you observe them carefully, you realize that there are only two major categories, namely Symptom-Oriented Therapies and Psychodynamic Therapies. All schools of therapies fall under these two big umbrellas.

Cognitive Behavioral Therapy (CBT)

The most well known school of therapy belonging to the first category is Cognitive Behavioral Therapy (CBT). This approach overshadows the others mainly because it is dominant in the university setting, and also CBT-oriented research projects receive more funding. For these reasons, most professionals in the filed of clinical psychology receive their training in CBT or a modern version of it such as Acceptance and Commitment Therapy (ACT).

The main goal of CBT, whether in its classical form or its modern versions, is to reduce the symptoms. CBT therapists use techniques to help their clients gain control over their symptom. For example if you were afraid of flying, they would teach you how to control your physical reactions using relaxation techniques. They would also challenge your beliefs and irrational thinking that flying is dangerous, and teach you a technique to cancel your negative self-talk.

Psychodynamic Therapy

On the opposite side, you find Psychodynamic Therapies. The representative of this stream of thought is Psychoanalysis. This approach seeks ways to help the person to gain an insight into their core identity and unconscious desires. Psychoanalysts believe that you need to address the underlying causes of your problem before you can get rid of your problematic symptom. If the clients gain a deep understanding about themselves, they could overcome the symptom.

The chief goal of dynamic therapy is to gain insight first. This is accomplished through a long process of analyzing the unconscious defense mechanisms rooted in the first childhood experiences and exploring one’s neurotic traits and the relationships with one’s parents.

For example, if you sought their help for the fear of flying, they would investigate your past, seeking the root causes of your problem. They would ask you about childhood memories, your relationship with your parents, your fear of death, and other aspects of your core self.

To summarize, if the symptom-oriented therapists see the observable irrational fear as the problem, the unconscious-oriented therapists consider the underlying causes that are below your conscious awareness as the problem. I must also admit that in the past few decades the gap between these two opposing streams of thought has become less wide.

Which Approach is Better?

It is tempting to simplify a complex field such as psychotherapy. Nowadays, most therapists are eclectic and use a combination of approaches. So maybe this is not a good question to ask. A better question is: which therapist is most competent?

When you want to assess the effectiveness of a school of therapy, you must keep an important detail in mind. A therapeutic approach, including all its techniques, is like a toolbox. Simply owning a set of tools does not guarantee that you are a competent craftsman. Craftsmanship requires not only the most sophisticated state of the art tools but also the skills to use them. Thus, you can find exceptional therapists in either category.

As we said, the competency of a therapist is the key to make or break the effectiveness of a specific approach. Next to this ability comes the usefulness of the tools. Therefore, when you look for a therapist, you are better off focusing on their competency as a professional rather on their school of therapy.

I Feel Anxious When My Sister Insults Me

A young woman (let’s call her Katie) in her early forties sought my help for anxiety. After explaining in detail her problem, Katie told me that her major source of anxiety was her relationship with her sister. For the last several years, her older sister didn’t respect her and whenever she had a chance she insulted her. No matter what Katie did, her sister would belittle her with negative comments. As a result, Katie would go home and cry.

Katie had done everything to stop her sister’s negative behaviour. She had remained silent and tried to ignore her sister insulting her. At times she would argue with her defending herself that her older sister didn’t have the right to speak with her with disrespect. At some occasions, contrary to her character, Katie even had fought back by shouting and insulting. However, none of these strategies worked for Katie to stop her older sister’s verbal abuse.

As I talked to Katie I found out that she used to go to her mother’s coffee shop every day. Later in the afternoon her three children would also go to the coffee shop to see their grandmother and their aunt (Katie’s older sister) and have some snacks. Two details draw my attention. First of all Katie’s mother didn’t let her pay for her coffee and for children’s snacks. Secondly, the coffee shop was co-owned by Katie’s older sister.  These two important details gave me the information about how to stop her older sister’s verbal abuse.

I asked Katie to add up the costs of her coffees and her kids’ snacks for one month. She realized that it was an important sum of money. I told her that she could go to visit her mom as usual for coffee and chatting. She could also let her children drop by for snacks. However, from now on, she should pay for her coffees and the snacks. If her mom said that she was part of the family and didn’t have to pay, Katie had insist saying that she would not have coffee nor let her children have snacks unless she paid for them. When her mother saw that Katie was determined, accepted to get paid.

That day Katie’s older sister was not in the coffee shop. However, her mother must have told her the news because the next day Katie’s older sister stopped her verbal abuse. Katie told me that she was amazed because it was like magic. Without saying a word about the rude behaviour of her older sister or confronting her in any way, she stopped insulting Katie. This was a major breakthrough for Katie’s anxiety. We dedicated three more sessions to address other sources of anxiety in her life.

 

Why People Leave Psychotherapy Prematurely

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Needless to say, most psychotherapists dislike when their clients decide to quit therapy prematurely. They have a variety of reactions. Some become upset when their clients complain about lack of results, and there are also those psychotherapists who throw a temper tantrum when someone informs them that they want to abandon therapy!

One of my clients (I’ll call her Joanne), a forty year-old woman, broke up with her partner because she caught him in bed with another woman! He kept contacting her on a daily basis. She felt attracted to him but was not sure about her feelings. Joanne told me that she was still in love with him but didn’t want to continue the relationship. She was anxious because her mind wanted to forget her ex but her heart desired him. She needed help to clear up her thoughts and emotions.

I asked her what she had done so far to solve her problem. Joanne explained that she had been seeing a psychotherapist for ten sessions without any positive results. She had spent about $700 for a therapy that wasn’t helping. For this reason, on the tenth session, she informed the psychotherapist that she decided to quit.

As soon as her therapist heard that Joanne didn’t want to continue the therapy, she became upset and threw a temper tantrum! The psychotherapist, a psychiatrist specializing in psychoanalysis, criticized her by saying things like:

“You can’t stop our therapy now because you are worse than you think you are.”

“You will continue your blind steps.”

“That trip you mentioned with your son, it’s just an excuse. Instead of spending your money on this trip, you should be coming to therapy twice a week!”

After few weeks, Joanne sought my help. It took Joanne three sessions to sort out her mixed emotions and clear up her thoughts. She overcame her anxiety and was congruent about her decision to avoid her ex and start her new life.

Most therapists don’t realize that they are selling a service. People have the right to hire and fire them. Clients bring a problem and want a solution. Competent therapists know this. First of all they are good at what they do and in most cases are able to make a difference in the lives of others. Secondly, they don’t get upset or blame the client for wanting to drop out prematurely.

It’s true that there are some clients that are difficult to work with and they sabotage the treatment. However, most people seeking help have a desire to cooperate, and if they show any resistance is because of fear of change. A professional therapist must have the necessary skills to help clients solve their problems, regardless of their degree of cooperation and resistance. Labelling a client as “resistant to change” denotes mediocre therapeutic skills.

References:

Ogrodniczuk JS, et al. “Strategies for Reducing Patient-Initiated Premature Termination of Psychotherapy,” Harvard Review of Psychiatry (March–April 2005): Vol. 13, No. 2, pp. 57–70.

https://uit.no/Content/418448/The%20effect%20of%20CBT%20is%20falling.pdf

Wu Wei: Let It Flow

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For some people life seems tought! No matter how much they struggle, they cannot reach their goal. If you can relate to this, maybe you are trying too hard!
 
Wu Wei is the art of letting your life flow without excessive effort. It means being flexible enough to adapt yourself to ever-changing circumastances. Like a flexible tree branch that bends under the weight of the snow and remains intact.

Wu Wei is one of core principles of Taoism. Lao Tse repeatedly mentions it throughout his well-known Tao Te Ching. Wu Wei means “non-doing”, however, despite this literal translation, it does not refer to “doing nothing”. Lao Tse’s advice is to live life without anxiety. Wu Wei refers to acting according to the circumstances with a serene attitude and regardless of their outcomes.

In other words, Wu Wei is a practice of detachment. Let’s say you have a goal. Once you decide what you want, you begin taking actions toward your goal. However, your actions and thoughts are free from the anxiety of achieving it. You work toward your goal without excessive effort.

This may sound like a paradox. You may ask, “How can I achieve a goal with this principle of non-action?”

Let’s see an example. Most smokers who give themselves an ultimatum, have a lower probability to succeed. I-must-quit-or-else- attitude generates anxiety that sabotages their goal. It works better when smokers make a firm decision to quit but are relaxed about the outcome.

Lao Tse encouraged people to live their lives spontaneously. Instead of forcing the situations or getting upset and anxious when the circumstances don’t turn out as you wish, you can let it flow!

“Tao invariably takes no action, and yet nothing is left undone.  If the lords can keep to this, all things will transform with spontaneity.” Lao Tse

Why Men Cannot Read Women’s Subtle Messages

Joe

After almost a year of separation, Joe, a thirty year old man, and his wife signed the divorce papers. What must have been a relief became an anxiety-producing event for Joe.

After signing the papers Joe and his ex wife went for a walk and had lunch together. She, who had been acting distant and cold since their separation, showed a warm and nurturing attitude toward Joe.

For most people her kind attitude would have seemed normal. However, her kindness caused Joe much confusion because suddenly he felt attracted to her! The same woman, who, according to Joe, had caused him much suffering, now was so kind to him. Joe felt that he still loved her but wasn’t sure about his feelings.

This anxiety and confusion were the reason Joe contacted me for an online session.

I recommended Joe to avoid talking or writing to his ex for couple of weeks. This would allow him to reflect on his feelings and clear up his thoughts in order to make the right choice.

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Men are Clueless

Usually men are clueless when it comes to read women’s subtle messages. It’s like opening a safe without either the combination or the key! Unfortunately (for men) women do communicate with indirect cues and non-verbal messages.

Several studies have shown that men mistake friendliness with sexual interest. Women’s communication is rich with emotional subtleties that female friends are good at deciphering. However, most men lack the skills of reading female’s non-verbal communication.

Joe, an emotionally vulnerable man, who has been suffering mainly due to loneliness, suddenly receives kind attention from a woman who once loved her. Joe, an emotionally hungry man, was confused because he failed to recognize that the attitude of his ex was not love, but kindness.

First of all, most women are polite with their ex. Secondly, it’s possible that she felt pity for Joe. She must also felt guilty. Politeness, pity and guilt were the main ingredients of her attitude to nurture a broken man.

Joe, however, interpreted her attitude as a green flag to get back together. This “lost in translation” phenomenon was the cause of his anxiety. It’s beside the point that she clearly communicated her desire to have a separate life by signing the divorce papers! Joe, like many vulnerable men, distorted the reality and saw what he wanted to see.