Help - how to engage with therapy

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I am reading some therapy materials that I need to engage with, and would appreciate some help to clarify my thoughts and get the best out of the therapy, which is CBT for anxiety.

1. My first problem is my antipathy to the vocabulary - I do not like to hear that my negative thoughts and anxiety are "faulty thinking", "distorted thinking", "abnormal" or a disease state. I have always suffered from anxiety, sometimes with good reason and the rest of the time because it is my version of normal. I need to see how engaging with the CBT language and definitions will help me.

2. My second problem is that therapy blames the patient for failing - obviously some patients are at fault, but in CBT it is always the patient's fault. I think this extract illustrates blaming the patient:

The "signs of not taking responsibility" look like a good summary of the top topics in this forum!

3. My third problem is about how a lack of self-awareness (especially alexithymia, not recognizing your own emotional state) affects therapy. Many of the techniques rely on recognizing an impending anxiety attack, through recognizing whether the unpleasant feelings are appropriate to the circumstances. For me, this is a bit like recognizing your own psychosis, the very definition of which is an inability to distinguish thoughts from reality - so only outside help can tell you that you are psychotic, and drugs are an effective treatment.

Any thoughts on getting the most out of therapy are welcome - there are other threads on Slaying the Therapist for negative comments.

My understanding of your second point is that it isn't so much putting blame on the patient. For example a CBT approach to a fear of dogs is based on; one sees a dog, holds some inner conviciton that all dogs bite and so this leads to a fear response. CBT addresses the mistaken belief that all dogs bite as its this that illicits the fear, not really the dog. In CBT I don't think it matters so much why the belief exists so it's not really an issue of blame.

Vocabulary - I see what you mean. I too have a lot of trouble learning anything when the first step is to take on board a host of new terms and concepts. I will immediately feel angry at the authors for failing to express their ideas without expecting me to reconstruct my head first. I often don't want to read a book because I don't trust that the knowledge gained will be worth the effort of learning to think like the author does. I guess a key question for you would be, what is the success rate of these people in helping anxiety? If it's good, then they might well be worth the effort.

Blaming the client - again I agree with your view - it looks very "I'm OK, you're not OK, doesn't it? Most of those "signs of not taking responsibility" are perfectly acceptable behaviours, as long as they're in the right context. And the thing you quoted seems rather sweeping - are they really saying that everybody who wants to try CBT is burying their heads in the sand like that? But there could be ideas of value in there somewhere, if you can hold your nose long enough to unpick the paragraphs and find grains of wisdom among the waste.

Effect of alexithymia - do these therapists understand autism, or is this just a general work for NTs? I would want to be sure that any "head therapist" I engaged was well aware of my autism and how to adjust the therapy to suit my brain wiring. I can recall being told in Relate counselling sessions that it's all a matter of knowing my feelings, and that made me feel for years as if I must be repressing mine a great deal, so I thought my mind must be crammed full of murky Freudian stuff.....lots of NTs have trouble identifying their feelings but their reasons are different from those of the alexithymic client, and without autism awareness, both client and counsellor can be led up the garden path. Of course, unawareness of feelings is still a huge obstacle to any deliberate emotional progress. The only advice I can give is to keep trying to identify those feelings (it's often much easier for me when the events are well in the past and I've had time to ponder awhile). I go a lot on physical signs such as overheating, pacing up and down, consuming more nicotine and comfort foods, "stomach butterflies," and "wiping" my head with my hands when it's not wet. If you do any noticeable kind of stimming, that's usually a good sign that life is getting tense for you.

Hope this helps.

Anxiety is a very strange word. What does it really mean?

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What word is the opposite of anxiety?

A-Z

Assured
Calm
Peaceful
Relaxed

or what?

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Problem solving - Wikipedia, the free encyclopedia
Problem solving is a mental process and is part of the larger problem process that includes problem finding and problem shaping. Considered the most complex ...
Overview - Europe - USA and Canada - Characteristics of difficult ...
http://www.en.wikipedia.org/wiki/Problem_solving - Cached - Similar

(Google)

http://www.mindtools.com/pages/main/newMN_TMC.htm (Problem Solving Techniques)

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Radical, alternative view on the topic of anxiety:

This is neither a recommendation for or against the following point-of-view. It is simply mentioning it as one of many options.

Giving my life to Jesus Christ cured my depression/anxiety

http://www.paxilprogress.org/forums/sho ... p?p=678727

http://www.creationscapes.com/

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Modern secular psychiatry and psychology use two words quite frequently: anxiety and depression.

Modern secular psychiatry and psychology literally earn billions plus of USA dollars when they use those two (code) words with regular customers: anxiety and depression.

Anxiety and depression is big business (like car companies and phone companies).

Modern secular psychiatry and psychology have no words such as are used in Christianity such as:

Anxiety-free
Joy of the Lord

For the most part, modern medicine has only medicines to sell to customers to deal with anxiety and depression.

At the same time, it is clear that modern medicines do actually work a little for a few persons (not everyone) who try them. None of the medicines used to treat anxiety or depression are cures at all.

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Are those who practice Buddhism free of anxiety (due to meditation/whatever)?

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http://en.wikipedia.org/wiki/Cognitive_ ... al_therapy

http://en.wikipedia.org/wiki/Philosophy

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http://www.beliefnet.com/

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http://www.daytimer.com/birk/

http://www.daytimer.com/

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Neurological challenges such as subtle concussions and some of the non-convulsive epilepsies can cause unwanted feelings of anxiety.

http://www.sportsconcussions.org/

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You don't have a problem to solve, you have a decision to make.

- Anon.

http://en.wikipedia.org/wiki/Decision_making

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http://www.chickensoup.com/
http://www.dreambigcollection.com/

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Other

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Temple Grandin has said she takes a medicine for her anxiety.

http://www.hbo.com/movies/temple-grandin/index.html

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http://en.wikipedia.org/wiki/Alexithymia

http://en.wikipedia.org/wiki/Emotion
http://en.wikipedia.org/wiki/List_of_emotions

http://en.wikipedia.org/wiki/Prosopagnosia
http://en.wikipedia.org/wiki/Facial_recognition_system

etc.

The problem with the language is just a preference. Think of it as less 'fault' and more about responsibility. If your problem is depression for example, then being empowered to take responsibility, and knowing that you can be responsible for it is of course positive.

CBT always assumes that the patient has thinking/relating habits that are problematic, hence the 'bias'. If this was not the case, they would not prescribe it, and if you really have no problems in this regard, then you need something else instead.

About Alexythimia; Vipassana (some call it 'insight' or 'mindfulness') meditation is a great way of putting you in touch with feelings/emotions. You might get some training in being mindful as part of your CBT, I don't know; I've only discussed other people's CBT and never undergone it myself.

If not, you can do this part on your own. Sit somewhere quiet and make an effort to observe your feelings, and thoughts. See what causes what. See how a thought can cause a feeling or vice versa. Observe how you dwell on particular thoughts and feelings. Try to label your thoughts and feelings as you notice them.

Good luck. Hope you get something out of your therapy. Try to have an open mind about it.

I do think that "faulty" or "distorted" thinking is not a good description for it. Everything we do, including our thoughts, has a purpose. If you assume it's just "faulty", you're likely to try to deal with it without understanding the reason; and things that are suppressed without being understood usually come back, or pop up in another form and with a vengeance.

The idea that the patient is "at fault" is not something CBT would agree with; it's something some CBT therapists would agree with, but they're not thinking very hard about the problem. If by "at fault" they imply "you're willingly doing this," or, "you don't want to change this," then they're in most cases not making true statements. If by "at fault" they imply "this is something going on in the patient's brain rather than in the world around him," then yes, that's true; but why should you use such accusative terminology to say it? CBT focuses on thoughts, feelings, etc., and is based on the idea that you can learn to understand and control them; it ignores external factors that cannot be controlled, except by controlling your response to them (which is something it does address).

People do try to evade their problems, but therapists should not use blame to try to get them to stop doing it, for the simple reason that it doesn't work. The majority of these people are already blaming themselves and feeling very guilty; that's a further block to improvement that nobody needs. If anything, therapists should shift focus away from guilt/blame to what can be done now to change the future.

The program is within a general psychiatric unit, but my psychiatrist and the course facilitator are aware of my status. He describes the alexithymia as like colour-blindness, so I feel emotion without the ability to distinguish between the normal range of emotions. I think a good analogy to some therapy would be trying to teach a colour-blind person to recognise the colours, instead of altering the contrast or colour theme on their computer display. The emotional equivalent might be to clarify the context of an emotion by asking the shop assistant "are you being rude to me, or just grumpy with everybody this early in the morning?" (although I would actually ask someone else who shops there).




The words "faulty" and "distorted" (and several other similar terms) are used frequently in the written materials and the sessions. I think that my issue is that some behaviours are viewed as the consequence of "problematic thinking", rather than functional adaptation - for instance, avoidance of social contact is seen as a pathological state, not as a preference that is normal to a particular person with ASD.

In the context of attending a regular psychiatric hospital anxiety course, my issues of social withdrawal, meltdowns / panic attacks, general lack of affect and emotional confusion are seen as deriving from "distorted thinking" and are seen as problematic behaviours. They are not seen as problematic contexts - e.g. if I change the context to a different shopping environment (outdoors instead of the mall), I can cope well, but this is seen as pathological avoidance.

In practical terms, there is a collection of statements about patients "not taking responsibility" that include some typical ASD traits, some that I have - the list is actually quite a good match with many of the top threads on this forum.



Yes, I take a similar, extremely small dose of anti-anxiety medication more-or-less on demand, in anticipation of stress. It works extremely well.

not too sure to what degree this connects ... but i try a lot to master or deal with my own anxiety myself. and i feel my methods are a bit CBT-like perhaps. (i've also had a little CBT long time ago.)

living in a very small world is basically my thing these days. i remember once seeing an ant very clearly in my mind's eye and then feeling i was adviced by my unconscious to try to find a really very very small perspective on things.

i guess to me it is big part to do with a certain "directness". not to be premeditated or abstract. so to find that emotional perspective i often picture a kitty or a puppy dog. they are very vulnerable and seem to live entirely in the present. so less thinking ahead .. or even less thinking. period to my mind inner silence is great help.

i guess this sounds all very far fetched .. but to me it works most of the time. also stuff to do with avoiding sensory overloads. lots of .. light, sound, people ... ... stay small and connected and real. even playful. meditation and things like that help me a lot too. i think of it as being grounded. real.

i agree about the catching it early thing. i too feel that is very important. recognising the signs early. in my case almost always to do with sensory overload, i realize ever more. what i do then is simply shut my eyes and ears with my hands and think about being overloaded. also touching my face helps me reconnect to myself, emotionally.

i also agree with the taking responsibility thing. to my mind connecting to being a responsible keeper of this tiny kitty or puppy. making the puppy feel safe and happy. not scared or rejected or ignored or left out.

all this of course just what i find myself doing these days. big FWIW.

I like your answer - apart from anything else, I am keen on macro photography, and amazed by the perspective that photographing insects and the insect scale of life presents.

I feel that your answer is very different from CBT - you seem to talk about changing the context, staying safe and physical mechanisms for reconnection and grounding. Yes, I like the Mindfulness that I have worked with. The physical procedures (touching your face) are perhaps like adjusting the contrast / colour theme on a display for a colour-blind person, because they provide a different set of data to understand the unpleasant emotional response you are feeling.

CBT seems overwhelmingly to concentrate on the abnormality of the patient - fear of going to a cafe or bar, getting on the bus, meeting people or talking to a group are "abnormal anxiety". The patient is blamed for not taking responsibility (as in the quote in my first post), for failing to engage and for failing to disclose to the "safe" therapeutic environment. And, of course, the recipient becomes "a patient". Above all, there is an unwillingness to understand the thoughts and coping strategies of adults, which are invariably described as "distorted thinking" or "faulty thinking".

I have to admit that I have a negative bias because of my previous experiences of CBT where therapists have used forceful "emotional challenge" techniques that are supposed to establish trust and safety - the therapist asks you to recall the most horrific and upsetting things that you can, to wallow in the upsetting feelings and then cry or otherwise emotionally release to the therapist. This was a terrible experience and I was accused of holding back / disrespecting the therapist / sabotaging my recovery / refusing help and so on, because I did not show emotion.

I was going to post initially, then didn't want to rain on your parade, but see you have come back to questioning the imposed mantra of 'personal responsibility.'

Dont buy this personal responsibility thing.

It applies to a point, but then becomes a scape goat for world powers to shift responsibility to the individual, from responsibity of the state.

I would not engage with therapy any more. You are being brain washed

Personal responsibility is responsibility we take for ourselves, for what we do and how we respond in the world.

The other thing is abuse.

There's a big difference. You have to know which is which.

Everyone should examine for themselves what they can and should be responsible for and do as much as they can to take it.

Likewise, everyone should examine for themselves what they are not really responsible for and refuse to take it.

Therapy is brainwashing in a way. You can use therapy to clean away the 'dirt' that clogs your mind and keeps one dysfunctional. It changes the way one thinks, how one relates to one's thoughts. That's not a bad thing, if you are the one who decides how the newly washed brain should behave. It should be an active process that one participates in, not giving over one's mind to some other party to tinker with.

Just like any power, the power to affect a mind can be used to great good or great harm.

You can use CBT to become a 'productive citizen'; maybe. You can also use it to drastically reduce the causes of distress, disorder and unhappiness.

CBT isn't for everyone.

I agree 100% that governments use exactly that device, but I'm not so sure that therapists do it for the same reasons. Nonetheless, it's grounds for suspicion and I'd recommend keeping your head. It's possible, I think, to reject the term without rejecting the whole CBT deal.

Surfman, have you ever heard of survival of the fittest? We have to learn their ways to eventually dominate them.

That's a joke. Sort of.

I agree that you have to be careful not to assume full responsibility... especially if you're a perfectionist already. It can become a daunting task.

Can you explain why taking responsibility is a bad thing, or why you should not take full responsibility.

And how you tell when the personal responsibility mantra becomes abuse.

I am trying to understand why I find this type of therapy hard, and perhaps this is the issue. I have always been blamed, or I have always felt that I am being blamed, for failing to engage with therapy. For instance I did not break down into tears when therapists tried that, I have been unable to name and describe my emotions when asked (I was told I was non-compliant), I have strongly felt that some things (like fear of strangers) are just my character, and unchangeable.

This is my take.

Say if you were gay, people said you had a disease, hated you and beat you up, until gay rights happened, now with normalisation via media, gays are accepted and in fact now usually well liked and useful members of a society.

Now if your autistic, society has not been taught nor is teaching to accept the normalisation of autistics. Until race riots(people were taught that Africans were biologically inferior) and gay pride marches occurred, the populace gobbled down all the PR BS imposed on them, by the state and society.

Those recent english 1minute ads on autism(that were posted on WP this weekend), are a very positive step toward our acceptance, and are very good examples of good media for aspies.

As an autistic, our biggest responsibility is to protest for equal rights and fair representation amongst non autistics all around the world. Not only does this free our mind of taking responsibility for the shortcomings of society and poor reactions of others to our manner and conduct, we educate and pave the way for future autistics. Just like not going to war when society tries to force us to fight and kill.

Conscientious objectors to war, like Jehovah Witnesses et al, have done many people a great service. By being locked up and persecuted, marching and protesting, we no longer have the draft. We really need to acknowledge and thank many religious groups for that.

Sucking up to erroneous NT BS, is only going to make you a house n****r that supports his oppressors, just like pavlovs dog. Yet, much therapy would consider this as ideal progress to becoming a better person.

Personally, I think its society, and government employee inner circle party members like therapists that needs to take responsibility, for expounding a (past used by date), doctrine of survival of the fittest. We have rounded a bend in world history, and a new testament is now required, autistics are a very big part of this new world future, and hopefully the alpha male 'alls fair in love and war' PR superhero of the global unconscious, will finally be exposed as unsustainable, dishonest, greedy and consumed with personal power, including power over others.

Our weakness can be a strength. Where would the world be today, if not for autistics and artists who shape the world with inventions and ideas, these are our strengths and purpose. A technician class

But being constantly compared to NT, and reminded of our condition in negative terms, no one benefits no one in the long term. Potentially highly productive aspies, are reduced to state of inadequate and useless. Most psychologists, when faced with obsessive ideation, state that little good comes from it, when in fact new technologies are born by these social misfits who can obsess.

Our only responsibly is to further humanity positively. If poorly programmed NT's freak on our ways, its not my responsibility. Its my responsibility to avoid reaffirming old doctrine that serves corporate and/or unethical regimes, and promotes suffering of others, wars, overconsumption and stupidity.

Last edited by Surfman on 26 Sep 2010, 3:15 pm, edited 1 time in total.

What you said was so valuable to me that I'm going to print it out and tape it up next to my desk at home.