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Dr James Alexander
Australia
127 Posts |
 Posted - 01/24/2013 : 18:08:03
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In my on-going search for psychotherapeutic approaches which are most helpful in dealing with chronic pain, i have recently come across Coherence Therapy. From my investigations, i can see that it is entirely compatible with the TMS approach to dealing with chronic pain (and other chronic health issues), and would prove a useful intervention for people who it seems a purely informational approach is not sufficient. I know that many/most people can recover from TMS by simply processing accurate information, however there remains a portion of people who continue to suffer, despite good information. Such people could well benefit from face-to-face therapy: we know that brief psychoanalytic therapy works; EMDR works (especially when pain is related to psychological trauma events); and i would now add to this list Coherence Therapy.
if you want to know more about it, go to
www.drjamesalexander-psychologist.com
and click on 'About the Book'- then look to the left where you will see 'Coherence Therapy' under Addendums to the book. You will find links there to podcast interviews with its originator, as well as links to their website where you will be able to request contact details of Coherence Therapy practitioners in your part of the world.
James |
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pspa123
672 Posts |
Posted - 01/24/2013 : 18:25:52
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| James what is the relationship between brief psychoanalytic therapy and ISTDP (Intensive Short Term Dynamic Psychotherapy)? Is the latter a form of the former? |
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bryan3000
USA
513 Posts |
Posted - 01/24/2013 : 18:38:20
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As a side note, there is an excellent ISTDP therapist in Los Angeles if anyone needs to work with one in the area.
PM me if anyone wants the contact info. |
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Dr James Alexander
Australia
127 Posts |
Posted - 01/24/2013 : 19:53:16
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pspa 123. The honest answer is that i dont know the relationship between the two, as i've never pursued either professionally or personally. By the closeness in their names, i would have to suspect that they are fairly similar approaches though. Perhaps other people on the forum has had experience in either or could answer that question?
James |
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pspa123
672 Posts |
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pspa123
672 Posts |
Posted - 01/24/2013 : 20:50:54
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| Hillbilly once referred to a poster's being uncertain whether to pursue psychodynamic therapy or CBT as a "paragdigm dilemma." I can definitely relate, as I find myself in the same boat. |
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Dr James Alexander
Australia
127 Posts |
Posted - 01/25/2013 : 17:03:29
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pspa 123. These are my own personal views of CBT, based on my own experiences, observations, readings and research over 30 years. Like all other types of psychotherapy, CBT has been demonstrated effective for a range of psychological issues (research shows that 80% of people receiving psychotherapy are better off than people with the same problems who are not receiving it- and the choice of therapy makes no difference to this general outcome). Despite this 'as good as' status, many CBT practitioners have behaved as zealots, advocating that it is the one and only useful type of therapy- clearly not the case. Also, whenever another approach is found to be effective, it somehow gets captured under the CBT label, as though it is a variation when in fact it may be quite different in its epistemology, its basic assumptions and its method (I have read EMDR being referred to as 'CBT with a novel variation'). And some innovators will (i suggest) deliberately define their new approach as a variation of CBT in order to get some coat-tail credibility (e.g i think Hayes, who developed ACT has done this, and demonstrated that it is a useful strategy- i think there are more differences between CBT and ACT, such that it is a different enterprise and CBT really cant legitimately claim it).
Now, when it comes to chronic pain, i observe that not all therapies are the same. CBT (in its pure Beck form) at best can help people adjust to being in pain so as to decrease their catastrophising, black and white thinking ('my life is over'), etc. This is helpful, in that it can decrease the amount of emotional distress associated with chronic pain, and may lead to a decrease of the pain due to a decrease in emotional tension. In my book, i refer to an ex-client of mine who was not open to my approach, but did actually get over his pain via the standard CBT in a pain management program. This is (in my observation) unusual- it rarely happens. The more common reaction is a greater acceptance of being in pain. While any relief is welcome, i think its a bit like learning to live on your knees when you can in fact learn to walk again.
Sarno has used Franz Alexander's model of chronic illness (derived from Freud's model of the psyche) and created a depth-psychology approach which is delivered in a cognitive-behavioural (psycho-educational) bottle. It is ironic, as 'cognitive-bheavioural' does not usually sit in the same sentence as 'depth-psychology', unless they are presented as a juxtaposition.
Depth-psychology has a range of assumption, an epistomology and sweep of methods which are in contradiction to cognitive-behavioural approaches (well, until Sarno- and some notable others- combined them). From all the people who get better just by reading Sarno's or similar books, it is clear that this cognitive level change can result in decreases and even eradication of chronic pain. However, the type of cognitive and behavioural changes brought about by TMS books or information is not the type of cognitive-behavioural changes brought about by CBT. The TMS approach is utilising notions of the unconscious mind, and suggesting that symptoms serve a purpose to the unconscious. CBT (as per Beck) barely even acknowledges the existence of the unconscious, and give no causal role to it in generating symptoms- the focus is clearly on our surface level cognitions and behaviours, the stuff we are aware of. The change strategy is to dispute what we are telling ourselves with evidence about 'reality' which we gather, much like a scientist gathering evidence from research. On some levels, this is appealing- it is relatively 'clean', free of messy emotions and confusions, and it makes some intuitive sense. We all suspect that our thoughts play some role in our problems. However, its model of emotions (ie. they are derived from our thoughts) is demonstrably wrong, as evidenced by decades of research in neuroscience. As such, pure CBT practitioners are teaching clients a myth (their causal model of emotions), in the hope that it will generate therapeutic changes. The impression that i wound up with from practicing CBT and RET is that it was largely a placebo effect- it created an expectation of change, and often this would result. The real question is 'does it work with chronic pain?'. My answer is, generally, no.
If chronic pain is being generated by the unconscious mind/brain in order to protect us from threatening emotional material in the unconscious (our 'emotional truths'), then the most helpful approaches are going to be ones that acknowledge and utilize the unconscious. We know via success stories from TMS books that pure information (cognitive change) can help, but it needs to be information which is highlighting the role of the unconscious- not cognitive information which is focused on what we are consciously telling ourselves at a surface level. The TMS book cognitive change will be helpful for many people, as all they need is to become aware (on a cognitive level) of what is going on to generate pain, and this creates an experiential shift which is deeper than the mere cognitive level. However, there are people for whom this is not sufficient- they need more than this level of change, and it appears that a depth-psychology therapy is what they need. The ones i am aware of are brief approaches to psychoanalytic therapy, EMDR, and Coherence Therapy (see my other recent post).
James |
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pspa123
672 Posts |
Posted - 01/25/2013 : 17:31:56
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| James, thank you for that very helpful answer. It's too bad you weren't around for some of the past discussions about the merits of "distraction" theory and the role of the unconscious in chronic pain, as there were very intelligent and thoughtful posts on both sides of the issue. While perhaps in the final analysis it doesn't matter which side one is on, as long as one is in the mindbody and not the physical camp, it does seem to have implications for what therapy one might choose to pursue if one feels one needs more help. Thus the "paradigm dilemma" (copyright Hillbilly circa 2008). |
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alix
USA
434 Posts |
Posted - 01/25/2013 : 22:47:28
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I had a few sessions of CBT therapy. I really do not think it would have been very helpful for me to pursue long term.
In short they were sessions to convince me that "the pain was not such a big deal after all".
I can definitely see the value when it comes to self-esteem or relationships where a turnaround of your thoughts may be just what you need.
But to me when it comes to chronic pain, it is borderline brainwashing. When you eventually start to question some of your new turnaround upbeat new thoughts, it can be pretty devastating because chronic pain is indeed a big deal that affects your life no matter how you look at it.
Ironically the CBT therapist I know is the most resistant person to Sarno's ideas (obsolete, such a joke, my pain is "real") even that he suffers himself from chronic pain. |
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shawnsmith
Czech Republic
2048 Posts |
Posted - 01/26/2013 : 15:31:28
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There are five questions which are asked in the article which are worth considering:
1) Review your psychological history, and see if you can identify significantly distressing events in your past (use the self-analysis questions in Ch 9 of ‘The Hidden Psychology of Pain’ to assist with this).
2) Begin thinking about what were the learnings about yourself, other people and the world in general which you picked up from those experiences (note: these need not be positive learnings, although some may have been).
3) What are the emotional truths (not necessarily factually true) which these learnings have led you to? eg. I am ......... Others are ........ The world is .............
4) In what way did your symptom represent an actual or potential solution to these emotional truths in the context in which they originated?
5) In what way does your symptom still serve you, in order to protect you from dangers and pain inherent in the emotional truths? |
Edited by - shawnsmith on 01/26/2013 15:32:57 |
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Coherence Therapy for chronic pain
