ysabetwordsmith: Cartoon of me in Wordsmith persona (Default)
[personal profile] ysabetwordsmith
This article talks about the declining effects of cognitive-behavioral therapy.  I am fascinated to explore why something that used to work pretty well is now not working as well. 

I can think of some possibilities not mentioned in the article:

1) The longer a therapy is around, the wider it is known.  That means more people have access to it before  official therapy.  You can go online and find CBT theory, techniques, thought distortions and how to fix them, worksheets, and other tools.  This raises the chance that someone already knows CBT and has tried at least some of its methods before seeking professional help.  So if the therapist then does more CBT, it looks less effective measured from the start of therapy,  because the client already did some of that stuff and got whatever benefit they got from it earlier.  In this case, CBT only has a high rate of helpfulness for people who really need guidance and/or advanced techniques that don't work well alone.

2) CBT is terrific at treating certain types of problems, but mediocre or useless for others.  If you have bad tape, this is a go-to therapy for fixing that, and you should definitely try it.  Same with any other logical or practical problem.  It's also ideal for people who do better with facts, logic, numbers, or other objective things than with subjective things.  But if you are feeling unheard, your emotions are bent, unacknowledged memories are gumming up your subconscious, or your biochemistry is out of whack, then CBT is not ideal for those problems and won't help much.  It is possible that certain types of problem are more or less common in different decades.  If the problems presenting now are something other than logical/practical ones, this therapy will seem less useful overall.

Bottom line: If you have head problems that you need help with, start by identifying them as best you can.  Then look at the available options for treatment.  Each type of treatment is good at some things and bad at others.  Pick one that's a good match for your problem(s).  Try it for a while.  If it doesn't help, drop it and try something else.

(no subject)

Date: 2015-07-13 03:21 pm (UTC)
redsixwing: A red knotwork emblem. (Default)
From: [personal profile] redsixwing
>>As a logical person, I actually loathed it, because I couldn't see the logic in 'lying to myself to make myself better' given that self-deception was the reason I had such bad self-hatred issues in the first place (a conundrum and a paradox, and one easily solved by bypassing the cerebral cortex and getting down into deeper areas of the brain first). <<

I can understand this. The antidote to self-deception for me was truth, truth, more truth - which hurts like blazes but gets the job done. (Is still getting the job done, after the therapeutic relationship was test-suspended and never resumed.)

>>...in some cases believed that they could literally fix anyone. <<

This is becoming a red flag for me: if someone professes this belief, I tend to get very suspicious of them.

Also, IDK because: have not studied this. When you look at therapeutic techniques in media, do they seem to be well-executed? I wonder if people get the belief that fixing a mind is like assembling Ikea furniture from a cardboard-cutout portrayal that doesn't hint at the difficulties one will encounter going in unprepared.

(no subject)

Date: 2015-07-13 03:40 pm (UTC)
moonvoice: (ghibli - sa - haku)
From: [personal profile] moonvoice
The antidote to self-deception for me was truth, truth, more truth

I can get behind that, but only if it resonates as being the truth. And sometimes unpacking a bad record in one's head that has something like 100 responses to a CBT technique needs more than just words. Which I'm fine with, because eventually the words help too. But thought stopping is not so useful as an initial way to broach an issue for me. It doesn't feel like truth until I know what's going on beneath.

When you look at therapeutic techniques in media, do they seem to be well-executed?

Almost never.

That doesn't mean they're without use, or that they don't have truth to them (someone who sees Good Will Hunting and experiences a kind of resonance and validity and then goes and seeks out a therapist - like, it's not well-executed therapy, but it's done a good thing), it's just that portraying therapists with ridiculously bad boundaries is somewhat the norm. There's been a decent use of a therapist with Olivia Benson towards the end of Law & Order: SVU, and otherwise... like for example, the western version of In Treatment is both a really good show, about a therapist with miserable boundaries who tries his hardest. He sees a therapist in turn (a supervisor) who has *terrible* boundaries, and it's not until the last season that you come to see (if you haven't seen it earlier) he is both a) too invested in his clients b) takes their downfalls too personally and c) that his previous supervisor (played by Diane Weiss) was like...not good for him pretty much at all. Even The United States of Tara didn't do so well on a few fronts, while doing well on others. Not enough for me to recommend it based on how they represented therapy though.

But it's a great show, lol. Gabriel Byrne is incredible. It's a well-executed show. But it doesn't shine a very good spotlight on what healthy therapy should be.

Good representations of healthy therapy in television and cinematic media are rare. You're more likely to find it in fanfiction, I think, and I've encountered some stuff which has made me think 'oh yeah, this is real.' Therapy tropes common to media are things like 'the one big cry will help fix everything,' and 'your therapist treating you as more special than their other clients will give you a better chance of recovering' (that's a dangerous thing to transmit in media - though I can tolerate that a bit more in shows like My Mad Fat Diary, which at least make an effort to show a therapist establishing boundaries with a client for their own protection).

It was one of my areas of special interest at university, how media intersected with mental health representation (specifically, trauma recovery - I also hate the way that media tends to represent flashbacks, but that's a whole other thing). I am both drawn to and excited by and disappointed in mental health representation in the fictional media. I think it's good that it's there. I think there's a lot of unhealthy stuff and some shitty tropes. I think it's getting better over time. I think the media's 'general literacy' around mental health is expanding like it is in society overall. It's a complicated area, for sure. But overall - not well-executed, and often poorly researched. And in comedy shows like Episodes (which I love), downright offensive.

Re: Thoughts

Date: 2015-07-14 12:13 pm (UTC)
moonvoice: (wczuciki - sparkling moonflowers)
From: [personal profile] moonvoice
I am curious about what you hate in media portrayals of flashbacks, what you would change.

Well, as I said in my response, fanfiction normally does a far better job than visual media - so fics like yours and other people's are doing a great job. :)

But as for television/cinema media, I am so fucking tired of jump cuts and juxtaposition where the past memories go through all post-production (desaturation, saturation, filters etc.) to make it very clear to an audience 'OH LOOK AT THIS DISTURBING MEMORY AREN'T YOU DISTURBED TOO'. (I've been informed that Mad Max does a lot of this to disorient, but it's such a damned cliche. Like, yes, it can be effective, and, yes, that's *sometimes* what visual flashbacks are like, but...eh).

It's effective (I remember the resonance I felt the first time I saw the technique back in the late 80s), but it's troped and lazy and cliched and no one tends to push past it in the visual mediums, especially in scriptwriting. It completely ignores things like sensory flashbacks: what about someone experiencing mysterious but serious gut pain for several days that happened to coincide with witnessing a show about stomach surgery, while they themselves have experienced traumatic hospital experiences? Sensory flashbacks are very common, yet hardly acknowledged. Where's a character who talks about phantom pains and goes through years of trying to explore chronic illnesses and many invasive tests only to one day learn that sensory flashbacks with no attending visual flashbacks happen? Ditto auditory and olfactory flashbacks (which are sometimes stronger and more pervasive than visual flashbacks for some people - and yet can be undiagnosed for ages, or misdiagnosed as atypical migraines).

I mean yes it makes sense that visual mediums would lean too heavily on visual flashbacks - it's what the format is for. But you meet someone who has PTSD and knows a bit about their own disorder and still don't understand olfactory/auditory/sensory flashbacks are a thing because it's just about never reflected back to them in mainstream media representations of PTSD (for me, PTSD also encompasses C-PTSD and PDSD there, as well). It's disappointing.

But then, since it's my area of personal interest, I've specifically consumed an awful lot of media based solely on representations on trauma and post-trauma and trauma recovery, so you do end up with a sense of 'same shit different day.' Sometimes it's done better, sometimes it's done worse. If I'm going to write a text including visual flashbacks, I have a rule for myself to include at least one sensory / auditory / olfactory flashback as well.

Anyway, fanfiction is definitely making strides where mainstream visual media is not.

(no subject)

Date: 2015-07-14 07:55 pm (UTC)
redsixwing: A red knotwork emblem. (Default)
From: [personal profile] redsixwing
It doesn't feel like truth until I know what's going on beneath.

Fair enough! I had to use words to break through resistance so that I could /get/ to the subconscious stuff - before a good therapist and some serious internal work showed me the way, the words were basically an emergency brake - I had to stop the runaway train so I could go fix the tracks. (That thing about positive affirmations? Yeah, I still can't because they just seem hokey and and they trip the BS-o-meter even if they're factually true.)

It's based on your recommendations that I want to see United States of Tara at all, hah. Your treatment of media absolutely fascinates me.

Given that a lot of people don't read fanfiction or a lot of original fiction ([personal profile] ysabetwordsmith's examples here) and with the tremendous power of media to propagate ideas, I'd love to see more /good/ representation.

I like your point below about sensory flashbacks. (Also a serious "oh!" moment on some of those - did not, actually, realize that some of that is a possibility and it explains things. The More You Know.) Since I'm currently working on a gigantic fanfic with several characters who've been rather badly traumatized (literal world-ending events in game got sort of blown off) I'll make notes to myself to include these. Since recovery is a main theme of the fic, it'll fit right in.

Re: Thoughts

Date: 2015-07-14 08:00 pm (UTC)
redsixwing: A red knotwork emblem. (Default)
From: [personal profile] redsixwing
>>Very sensible. That also fixes gaslighting.<<

It certainly helps to spot it, and to figure out the extent of the damage before doing other things to fix it. One tool in the toolkit, really.

>>How will we know if the treatment is helping, having no effect, or actively making matters worse?<<

That's a good point! I live in a world of design/test/check/retest and tend to forget that not everyone does, and particularly in the wild and hairy world of mental injury and illness, not having this sort of a pattern in effect seems like a good way to run right off a cliff.

>>Media portrayals show a lot of the mistakes that actual therapists make. <<

..which can be useful as an anti-pattern but is a disaster when trying to assess when one needs help, and what kind, and to what extent. Gah.

Your stuff is pretty awesome. Honestly? Came for the Avengers, stayed for the good representations of mental harm and recovery.

This is incidental to this conversation, but I owe you thanks: I took training last week for my company's emergency handling plans, and am adding EFA to my study list in earnest, largely because of your writing.

Re: Thoughts

Date: 2015-07-16 10:40 pm (UTC)
redsixwing: A red knotwork emblem. (Default)
From: [personal profile] redsixwing
>>My whole frigging life is a science experiment.<<

Sympathies - that's a rough spot to be in. I'm not quite that far from the bell curve, but it's enough to make supposedly-mundane things nontrivial a pretty good chunk of the time. (If you ever want to rant about this, I'm open to it.)

>>This is my favorite handbook:<<

I've purchased a copy. :)

Profile

ysabetwordsmith: Cartoon of me in Wordsmith persona (Default)
ysabetwordsmith

August 2025

S M T W T F S
      1 2
3 4 5 6 7 8 9
10 11 12 13 14 15 16
17 18 19 20 21 22 23
24 25 26 27 28 29 30
31      

Most Popular Tags

Page Summary

Style Credit

Expand Cut Tags

No cut tags