Your Clinical Orientation

[Therapist4Chnge]

I was posting in another thread about my orientation, so I thought it'd be interesting to see what clinical orientations people prefer. Obviously most of us are still students, so we may be trying out a few types, so don't feel like you have to stake your claim.....people have been known to change a couple times.

Short answer: psychodynamic

Long answer: (see below)

I seem to lean towards the writings of Aaron Beck, Judith Beck, Sigmund Freud, Margaret Mahler, Harry Stack Sullivan, and Hilde Bruche. In addition, I have also drawn from people like Carl Rogers and Irvin Yalom for guidance in developing a healthy therapeutic relationship. I <3 books.

I started out firmly in an object relational approach, but I have since added some of the above influences (Bruche with anorexia, Kohut with narcissism, etc). I'm still experimenting with the use of some basic cognitive techniques to deal with surface level issues, and psychodynamic techniques to deal with all of the underlying issues. I've found it works conceptually, though I don't really consider it eclectic since I have a solid framework in object relations, with the cognitive aspects being more superficial. It is definitely still a work in progress, though I've gotten some great feedback and interest from some senior clinicians I've shared it with.....my twist on a classic!

-t

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[irish80122]

Cognitive Behavioral, though I do have touches of Humanistic from my undergrad. My program is quite behavioral, however, and they keep trying to convince me that cognition is merely a behavior. I still have my doubts, but they still have 3.5 years to convince me, we shall see.

 

[socialcog]

CBT, generally speaking.
Gottman for couples.

 

[wdd]

This may be a question for another thread, but when would you all say you made this decision (or discovery, as the case may be)? Was it a leaning before you started your doctoral program, a firm belief you held in undergrad, or something that you feel was influenced by a particular professor--or something else entirely?

I'm asking because I am simply not sure if I'm "supposed" to know this at this point--about a year away from applying--or if this will come to me as I take some more classes prior to applying, or when I'm actually in a program.

I have a general leaning toward CBT (with a dash of the Gestalt) simply because, when reading short descriptions of each school of thought, it's the one that jumps out at me and makes the most logical sense when it comes to dealing with current (not necessarily deep-rooted) personal/adaptation issues. (I know, of course, that this field does not work with a one-size-fits-all approach.) It also seems to gel with my definite leaning toward neuropsychology.

That said, I love seeing defense mechanisms in action, as I do every day (my own, and those of others). But I don't think that necessarily makes me inclined toward the psychodynamic ... [spooky voice] Or does it ...... [/spooky voice]

 

[PsyKardinal]

CBT/Gestalt - for most individual and family work with adults, I do believe you can deal with deep seated issues with CBT...we will just have to disagree T4C
Play/Game therapy/CBT/Gestalt - for kiddos and adolescents, leaning more to Play and Gestalt
Refer out fast - Borderline, Couples, and Eating DX

As to how you pick a theoretical orientation, I say it has a lot to do with experiences gained during grad school and what you feel works best with your style as a clinician. As you continue to work in the field you will grow and develop and recognize the techniques that work for you and your clients and the ones that do not. Some people call this an ecclectic approach, I think we stick with a particular orientation and utilize approaches from other orientations when appropriate.

Jeff

 

[Therapist4Chnge]

This may be a question for another thread, but when would you all say you made this decision (or discovery, as the case may be)? Was it a leaning before you started your doctoral program, a firm belief you held in undergrad, or something that you feel was influenced by a particular professor--or something else entirely?

I think it is different for each person. I know my leanings during the beginning of my undergrad experience were more towards a Rogerian approach. As I explored different theoretical orientations, I realized my beliefs lined up more closely with a psychodynamic approach, though I felt the many of the aspects that Rogers spoke about were important parts of the therapeutic relationship.

As for CBT.....it wasn't a popular approach amongst the faculty, but it was one of those things that they said was prevalent. I thought it was good to learn, but even back then I thought it was limited. I believe in the conceptualization, but I think it fails to account for (or at least fails to pay enough attention to) early childhood and relational experiences. This isn't to say I'm wild about Mahler's specificity about the first handful of months of life, but I do believe that the first relationships we have with our parents have a profound effect on how we will view the world. The interactions, support, autonomy, validation, etc.....are all important aspects of the relationship, and failure to have a healthy relationship can have a detrimental effect on how the person relates to themselves, others, and the world.

-t

 

[Therapist4Chnge]

I do believe you can deal with deep seated issues with CBT...we will just have to disagree T4C

I definitely see how CBT can be effective to helping the person see the distorted cognitions, how those cognitions effect their behavior, etc.....but I think it can fall short in the areas of dealing with defense mechanisms, root causes of the distortions, and some of the unconscious and sub-conscious issues that run throughout.

Of course, for certain Dx's, CBT is the way to go, and all of the research supports that. I think certain psychodynamic approaches suffer in the research because the researchers can't or won't quantify the clinical effectiveness of the approach.

Refer out fast - Borderline, Couples, and Eating DX

Borderlines and EDs are my wheel house! Axis-II?....I'm for you! I'd refer out the couples though. I prefer to not work with the elderly, any kind of violent felon, and/or chronic substance abusers. Higher functioning is definitely my preference, as are the 12-55 crowd....though I've enjoyed the work with the younger population (mostly play therapy), I couldn't do that every day.

-t

 

[JockNerd]

This is a really interesting discussion, T4C. Thanks for starting the thread!

I'm really just starting out. I've seen clients before in in-persons crisis intervention and single-session situations, but haven't seen anyone on an ongoing basis yet. So, I haven't had a chance to really try the "orientations" on for size yet.

I'm going to be one of those "...I'm eclectic" people. I'm not convinced that I see the purpose in establishing an "orientation" for yourself. Is it to serve as a starting point for case conceptualization? That seems fine, but it seems to me that people are often picking an orientation in order to establish some sort of sense of legitimacy or competency for themselves. Not a fan of that.

One way I see it is that the most important theoretical orientation is the client's. As a personal example, I was in therapy for body image issues, and knew for myself that homework and reframing were not going to be of assistance, so my therapist adopted a VERY Rogerian approach to me. Worked fantastically. In contrast, I probably would have left therapy if the therapist started trying to make me try to change my cognitions (I knew that wasn't the issue) or started talking about my childhood (I knew that wasn't the issue either). I think adopting a scientific approach to therapy (establishing a hypothesis, testing it with the client, seeing the results, and modifying your conceptualization based on the outcome) is the way I'm going to try to take things. I also think that that conceptualization immediately lends itself to flexibility in interventions.

If I HAD to pick something? Person-centered therapy (specifically, a particular variant called evocative empathy that no one other than RD and I know about) and REBT (Ellis' conception, which is quite different from some of the more recent work I've read on REBT) are the two modalities I'm attracted to most. Family therapy theories are awesome too, although it looks fantastically difficult. As an orientation, Gestalt, strictly behavioristic, and Adlerian therapy appeal to me the least.

 

[GiantSteps]

1. Primal Therapy

and

2. A strict disciple of Wilhelm Reich (please do not tell the government). I am off to Home Depot now to buy wood to build another orgone box! (RayneeDeigh - I can send you one to live in. The orgone keeps the bugs away). I wonder how much orgone goes for these days on the internet?

As you can all see, I live on the edge!

 

[Therapist4Chnge]

I'm going to be one of those "...I'm eclectic" people. I'm not convinced that I see the purpose in establishing an "orientation" for yourself. Is it to serve as a starting point for case conceptualization? That seems fine, but it seems to me that people are often picking an orientation in order to establish some sort of sense of legitimacy or competency for themselves. Not a fan of that.

I think establishing a strong foundation in one orientation will allow you a frame of reference, and then from there you can start exploring other orientations. The issue I have with eclecticism is that to be effective, I really believe the person needs to have a strong understanding of all aspects of the orientations they are drawing from. I think it would become problematic to pick and choose techniques without knowing if one violates the conceptualization of another. Sometimes I heard 'eclectic', but I see someone who doesn't really have a firm grasp on any one orientation so they pick and choose what they know. I don't consider myself officially eclectic, though I can see how I can grow into that approach as I become more grounded in alternative orientations and conceptualizations.

1. Primal Therapy

Primary Scream Therapy is the coolest!

-t

 

[psychwanabe]

What an interesting and timely (for me) thread! The first years in my program just had a seminar yesterday in which we got the talk about comps ("no pressure! ...is your dissertation done yet?" ). The Director made a comment about choosing our CCE committee members "based on your orientation." This, of course, began the questions flying around my head regarding how will I know what my orientation is, when should I "decide," etc.

My leanings are similar to Irish, with definite CBT and a dash of Humanistic thrown in. Having said that, I am currently in a class with a psychodynamic oriented professor and so I am learning a tremendous amount about this practice. My UG was strongly Bio/CBT and I think Freud was a cuss word to most there (I'm joking but I'm sure you all know what I mean) so I had little to no exposure to the psychodynamic orientation. I am very interested in the process and I certainly see the value in many of the therapeutic applications. I have no idea where I will wind up, and I don't feel compelled to "pick" anything just yet. Knowing myself, I will probably practice with a solid blend of several orientations.

...as an aside, is this question the psychologist's equivalent to "what's your sign?"

 

[spillsomepaint]

I was posting in another thread about my orientation, so I thought it'd be interesting to see what clinical orientations people prefer. Obviously most of us are still students, so we may be trying out a few types, so don't feel like you have to stake your claim.....people have been known to change a couple times.

Short answer: psychodynamic



-t

I just came out of my Test and Measurements class (I'm undergrad), and the teacher really seemed to stress that there aren't many real practicing psychoanalytic/psychodynamic practitioners anymore. In my personal experience and reading, this doesn't seem true, but I'd love to know what you think and encounter as you're farther along in the field. I'm pretty interested in this approach, and my first choice school has a strong number of faculty ascribing to it, but I like another poster feel like I haven't been exposed enough to really know what I identify with.

 

[psychwanabe]

I just came out of my Test and Measurements class (I'm undergrad), and the teacher really seemed to stress that there aren't many real practicing psychoanalytic/psychodynamic practitioners anymore. In my personal experience and reading, this doesn't seem true, but I'd love to know what you think and encounter as you're farther along in the field. I'm pretty interested in this approach, and my first choice school has a strong number of faculty ascribing to it, but I like another poster feel like I haven't been exposed enough to really know what I identify with.

Not true! I think about 1/4 of my faculty are psychodynamic. This was a big surprise to me as my UG had taught a similar belief as yours.

I think it must depend on where you go. It didn't even occur to me to consider this when applying to grad schools, but now I would give the advice to applicants to look for schools with a faculty that has a wide range of orientations. This will give you great exposure to them during your graduate years and help you decide on your own main focus.

 

[Therapist4Chnge]

*this is a big tangential, though I think it opens up the discussion to why certain orientations are chosen over others*

I just came out of my Test and Measurements class (I'm undergrad), and the teacher really seemed to stress that there aren't many real practicing psychoanalytic/psychodynamic practitioners anymore. In my personal experience and reading, this doesn't seem true, but I'd love to know what you think and encounter as you're farther along in the field. I'm pretty interested in this approach, and my first choice school has a strong number of faculty ascribing to it, but I like another poster feel like I haven't been exposed enough to really know what I identify with.

I think it really depends on where (location) and what (focus) you want population you want to focus on. Places like NYC, Boston, and SF have very strong psychodynamic ties. I think strict analysts are fewer in number than say 30-40 years ago, but I think other areas are still do well. I think there has been an effort to shift away from dynamic work because of the flood of literature for other orientations, in addition to a societal (and HMO) pressure for the 'quick fix'. In addition, I think to be competently trained in a psychodynamic orientation takes longer than many other methods. Every orientation has nuances, but I believe that because psychodynamic training isn't as readily available, the nuances are lost and the clinician isn't able to fully realize the potential of the work.

I believe in evidenced based practice, but I think there is a gap in the work. Some flavors of psychodynamic work are more present in the research (time-limited psychodynamic and manualized methods can be found in the literature, but it is much harder to find a more traditional psychodynamic approach). I'm sometimes caught between a rock and hard place because I've see the effectiveness of certain methods, though there isn't a mound of literature to support the work. Surprisingly (or not), much of the research out there is so specific, sometimes it is hard to really see how the findings generalize outside of the strict confines of the study.

With the HMOs pushing shorter and shorter treatment schedules, I fear that it will become a moot point for anyone other than those who can afford longer-term private pay options.

Ironically, my particular area of interest lacks a truly research supported talk therapy intervention (low-weight anorexia nervosa), so it allows me a bit more flexibility and forces me to dig through what little research is available and also related case studies to see if I can find anything that fits. People have incorrectly assumed you can synthesize the work done with bulimia and then apply it to anorexia nervosa, though the literature is now showing that this doesn't work. (I could go on and on about this topic, but I'll pause here. I think I started a thread about ED treatment, I may have to bump that later if I have time).

I've found that my orientation described above has been pretty effective, though I haven't done anything more than some informal case studies to support this (yet).

*even more tangential*

AN in particular is tricky because of the number of complicating factors that can negatively impact treatment (co-morbid medical concerns, the prevalence of polypharmacy, common axis-II and substance abuse co-morbidities, etc). I'm actually poking around the literature now to see if I can find any decent data on effective pharmacotherapy for the population (preferably post-hospitalization / post-refeeding). I'd like to eventually look at a talk therapy + pharmacotherapy intervention using a modified version of the orientation I described above. I'm not sure if I'd be able to effectively structure it into a set number of sessions (I hasten to say 'manualize', because I think that is the wrong term). I'd probably have to start with some case studies before being able to secure the kind of funding necessary to do it right.

I'm not primarily a researcher, so I don't have the time for a full blown study (nor the desire to trudge through the day to day work), but I'd love to do some of the initial case study work to see if there is anything there worth turning into a larger study.

-t

 

[RayneeDeigh]

I remember in one of my UG classes we were taught that in the East orientations are more psychodynamic, in the midwest it's more CBT, and in the West more clinicians are humanists.

That could be crap though. I remember thinking at the time that it seemed like a superficial description of the regions.

 

[Therapist4Chnge]

Not true! I think about 1/4 of my faculty are psychodynamic. This was a big surprise to me as my UG had taught a similar belief as yours.

I think it must depend on where you go. It didn't even occur to me to consider this when applying to grad schools, but now I would give the advice to applicants to look for schools with a faculty that has a wide range of orientations. This will give you great exposure to them during your graduate years and help you decide on your own main focus.

I think having a diverse faculty can REALLY enhance your experience. I was hesitant to apply to places that were 90% one thing, and 10% something else....with little else available. In retrospect I wish my program had my of a psychodynamic slant, but not at the expense of having access to the other orientations.

-t

 

[GiantSteps]

Primary Scream Therapy is the coolest! -t

AAAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHH!!!!!!!!!!!

That was good!

After I announced that I am buidling Reichian orgone accumulator boxes, I do not understand why none of you are mailing me to place your orders. The boxes might be a problem if you are religious but most of you are not. Even if you are religious, you do not have to go into the boxes yourselves, you can just have your clients go in while you harvest the orgone!

The students at Notre Dame, Marquette, St. John's University, and Yeshiva University probably are not allowed to learn about this (and they all claim to be producing knowledgeable clinicians). Do not worry, if you place your orders, I will include instructions! I hope the government which went after Reich has not already gotten to all of you!

 

[Ollie123]

Death Therapy
(if you don't know what I'm talking about, you clearly have gained most of your knowledge of psychology from legitimate theory and research instead of popular media)

On a more serious note - I guess I would qualify as ecclectic, though I'd be more interested in the administrative end of clinical work (e.g. running a center) than I would be in actually being a private practice clinician, so I'm perhaps less concerned with "picking one" than some would be. I intend to go where the research tells me to go...right now for my areas of interest that is largely CBT, though there is some pure behaviorism and plenty of other things mixed in there as well. I don't like to use the word "orientation" though because that implies it is more ingrained in me than it actually is. I think (and hope) I would be perfectly willing to shift my beliefs about how to treat people as I learn more about the field on my own through classes, research, and teaching, and as new research comes out.

 

[socialcog]

CBT...I believe in the conceptualization, but I think it fails to account for (or at least fails to pay enough attention to) early childhood and relational experiences. I do believe that the first relationships we have with our parents have a profound effect on how we will view the world. The interactions, support, autonomy, validation, etc.....are all important aspects of the relationship, and failure to have a healthy relationship can have a detrimental effect on how the person relates to themselves, others, and the world.

-t

CBT addresses this in the most pertinent ways with respect to how these (faulty) early relationships impact a client's life in the here and now. Specifically in schema change and continuum work, we often reflect on early relationships to see the formulation and evolution of a core belief. We need to examine these early formative years to better make sense of the development of negative schemas and underdeveloped schemas.

The major difference, generally speaking, between CBT and psychodynamic work is the 'why' vs the 'what now.' We are all about the action plans even after we make sense of the 'absolute truths' we formulate about ourselves.

 

[Logic Prevails]

My theoretical approach/view in undergrad was very much "CBT is all you really need." Throughout my grad work, I picked up a bunch of things that eventually led me to a view very similar to T4C. I would only add that my theoretical orientation also pulls from the neuroscience stuff (I really like Dan Siegel's "interpersonal neurobiology"), though in actual application, it's less useful. In my application, I also use a bit of Yalom's Existential Therapy stuff (which is very dynamic as well).

 

[Neuro-Dr]

I would be curious to know how many of you plan to work with children in some capacity and, if so, does that change your theoretical approach.

 

[Therapist4Chnge]

CBT addresses this in the most pertinent ways with respect to how these (faulty) early relationships impact a client's life in the here and now. Specifically in schema change and continuum work, we often reflect on early relationships to see the formulation and evolution of a core belief. We need to examine these early formative years to better make sense of the development of negative schemas and underdeveloped schemas.

The major difference, generally speaking, between CBT and psychodynamic work is the 'why' vs the 'what now.' We are all about the action plans even after we make sense of the 'absolute truths' we formulate about ourselves.

I understand the role of schemas, though I often think that the rush to the 'what now' is problematic because the 'why' is usually not nearly explored enough.

My theoretical approach/view in undergrad was very much "CBT is all you really need." Throughout my grad work, I picked up a bunch of things that eventually led me to a view very similar to T4C. I would only add that my theoretical orientation also pulls from the neuroscience stuff (I really like Dan Siegel's "interpersonal neurobiology"), though in actual application, it's less useful. In my application, I also use a bit of Yalom's Existential Therapy stuff (which is very dynamic as well).

I enjoy the biological aspect of MH. I am starting to strengthen my background in neuro and it has really informed my clinical abilities.

I would be curious to know how many of you plan to work with children in some capacity and, if so, does that change your theoretical approach.

When I work with kids I definitely go about it differently (the interaction), though my conceptualization usually doesn't change. Ironically I did behavioral research and intervention for a year, so I have used that in the past. My bias is that behavioral work is very limited, but in the right cases it can be a great intervention.


-t

 

[PsyKardinal]

In my work with children, it has changed my prespective quite a bit. I am much less directive then I once was. It really helped me to integrate a lot of the Humanistic prespective into my practice.

Jeff

 

[Jon4PsyD]

I pretty much agree with you Jeff. I think most of my work being with children has played the large part in me being Humanistic.

 

[toroharo]

AN in particular is tricky because of the number of complicating factors that can negatively impact treatment (co-morbid medical concerns, the prevalence of polypharmacy, common axis-II and substance abuse co-morbidities, etc). I'm actually poking around the literature now to see if I can find any decent data on effective pharmacotherapy for the population (preferably post-hospitalization / post-refeeding). I'd like to eventually look at a talk therapy + pharmacotherapy intervention using a modified version of the orientation I described above. I'm not sure if I'd be able to effectively structure it into a set number of sessions (I hasten to say 'manualize', because I think that is the wrong term). I'd probably have to start with some case studies before being able to secure the kind of funding necessary to do it right.-t

AN is a really thorny disorder. Evidence for pharmacotherapy in AN is tenuous, and the best approach is family therapy if you are treating adolescents.....

I did my master's thesis on AN and have a bunch of references that you may want to look at.....feel free to pm me.

 

[spillsomepaint]

AAAAAAAAAAAAAAAAAAAHHHHHHHHHHHHHHH!!!!!!!!!!!

That was good!

After I announced that I am buidling Reichian orgone accumulator boxes, I do not understand why none of you are mailing me to place your orders. The boxes might be a problem if you are religious but most of you are not. Even if you are religious, you do not have to go into the boxes yourselves, you can just have your clients go in while you harvest the orgone!

The students at Notre Dame, Marquette, St. John's University, and Yeshiva University probably are not allowed to learn about this (and they all claim to be producing knowledgeable clinicians). Do not worry, if you place your orders, I will include instructions! I hope the government which went after Reich has not already gotten to all of you!

I'm sure I'm not the only UG on here who has no idea what those boxes are care explaining?

 

[psychwanabe]

I'm sure I'm not the only UG on here who has no idea what those boxes are care explaining?

There's a great explanation on Wikipedia. Don't feel bad, I'm a first year grad student and I'd never heard of them either.

Check it out http://en.wikipedia.org/wiki/Orgone

 

[brightness]

I'm a UG, so I don't exactly know what I am talking about, lol. But, from my experience being IN THERAPY, some therapists spend too much time focusing on the WHY you're jacked up, and some therapists spend too much time on just HOW to fix it. What I am wondering is, what is an orientation that doesn't just focus on the why or the how? Or is that more of an issue of combining the two orientations?

 

[Therapist4Chnge]

AN is a really thorny disorder. Evidence for pharmacotherapy in AN is tenuous, and the best approach is family therapy if you are treating adolescents.....

I did my master's thesis on AN and have a bunch of references that you may want to look at.....feel free to pm me.

YGM...I'm a sucker for references, you can never have enough!

I'm a UG, so I don't exactly know what I am talking about, lol. But, from my experience being IN THERAPY, some therapists spend too much time focusing on the WHY you're jacked up, and some therapists spend too much time on just HOW to fix it. What I am wondering is, what is an orientation that doesn't just focus on the why or the how? Or is that more of an issue of combining the two orientations?

I think it depends more on the person than the orientation.

-t

 

[Therapist4Chnge]

*bump for the new people*

 

[JackD]

Of course my knowledge of the field is more general right now, however, I am most interested in the social-cognitive theories and humanistic theories.

 

[serotonin]

Cbt!

 

[Therapist4Chnge]

CBT + Positive Psychology

plus whatever will allow me to self-disclose and show emotion a lot, haha.

That would make me break out in hives.



It is all about the blank slate....I think rapport can be built on other things, without disclosure, unless it is absolutely necessary.

Okay, not really....but I think the most my patients know about me is that I'm from the northeast, I like sports, music, and movies...and that is between all of them. I think it is important to not have my stuff interfere with their stuff.

As for emotions...I'm more flexible with that, since I think it is important to model appropriate affect and emotion.

 

[JR in SB]

Death Therapy
(if you don't know what I'm talking about, you clearly have gained most of your knowledge of psychology from legitimate theory and research instead of popular media)

HAHA!!! Baby Steps, anybody???

 

[Therapist4Chnge]

*bump for new people*

 

[psybee]

Anybody here doing health psych? How do you think that has informed your orientation?

I'm just about to start grad school, so I'll be interested to look back at this post and see how my orientation changes, but right now I see CBT for crisis intervention, short term needs and then more existential and psychodynamic theory joining up with CBT and informing longer term work (such as copng with chronic illness or illness experience). I may have to do some extra coursework or focused externships to get enough psychodynamic training, though.

 

[AlairaK]

I really like what I've seen of Adlerian psychotherapy, from the Corsini and Wedding text. He's not used very commonly, but I think his methodology is great.

 

[Cosmo75]

Anybody here doing health psych? How do you think that has informed your orientation?

I'm just about to start grad school, so I'll be interested to look back at this post and see how my orientation changes, but right now I see CBT for crisis intervention, short term needs and then more existential and psychodynamic theory joining up with CBT and informing longer term work (such as copng with chronic illness or illness experience). I may have to do some extra coursework or focused externships to get enough psychodynamic training, though.

I'm specializing in health psych and am CBT oriented. My supervisor for my therapy & adv practicum is more behavioral than cognitive.

I really like Ellis and REBT. Though I'm not nearly as *rough* as Ellis was It works well with most folks, and fits into the health psych model, especially if you work with people with chronic health conditions or disability. I like REBT because it blends cognitive behavioral theory with humanistic psychology and ethical humanism.

My orientation probably started in undergrad, even though I didn't necessarily realize it. My mentor was CBT oriented and I did some research projects with him under the model.

 

[Therapist4Chnge]

Anybody here doing health psych? How do you think that has informed your orientation?

I've worked a bit in this area, and it seems that many people trend towards a CBT approach, while taking into account biological and neurological issues that may effect the work. In some cases the person may be in a place where many types of therapy may not be effective because of severe cognitive impairment (temp. or perm.), so something in the area of supportive therapy may be the best course of action.

 

[psybee]

I've worked a bit in this area, and it seems that many people trend towards a CBT approach, while taking into account biological and neurological issues that may effect the work. In some cases the person may be in a place where many types of therapy may not be effective because of severe cognitive impairment (temp. or perm.), so something in the area of supportive therapy may be the best course of action.

I've mostly worked with the SPMI, and that's what I've found among individuals whose illness (or whose medication), or other comorbid problems, like health issues, drugs, etc have cause cognitive impairment. But then among family members of the seriously ill or individuals who are in recovery or are chronic, so many deep existential issues come up as the illness has completely transformed thier lives in ways the well may never understand, so it seems to me like health psychologists have to have many a tool in their theraputic kit (i guess that's true for all psychologists, though)

 

[FrdLcnKln]

My orientation is psychoanalytic, and heavily influenced by French interpretations of Freud (Lacan, Grunberger, Chasseguet-Smirgel, Green), and seasoned with things taken from Klein and the post-Kleinians (Winnicott, Bion, Symington).

 

[erg923]

I think this is quite the dirty word at our school.... To me, this implies that you buy into a certain theory of personality/behavior that explains normal behaviors as well as pathological behavior (i.e., psychopathology). My program has always reinforced the idea that this is overly simplistic, and encourages us to treat psychopathology with a multi-factorial view.

 

[psybee]

I think this is quite the dirty word at our school.... To me, this implies that you buy into a certain theory of personality/behavior that explains normal behaviors as well as pathological behavior (i.e., psychopathology). My program has always reinforced the idea that this is overly simplistic, and encourages us to view and treat psychopathology from a multi-factorial view.

a lot of the cognitive/behavioral folks try to use it as an overarching theory too, i think to similar detriment.

I like analysis for thinking and for exploring art and other cultural texts, but who knows, i plan to supplement my CBT-heavy training next summer with a psychodynamic institute course, so maybe I'll become a convert.

 

[psychdude5469]

"I prefer to not work with the elderly." T4C quote

May I ask why?

 

[Therapist4Chnge]

"I prefer to not work with the elderly." T4C quote

May I ask why?

This is serendipitous in timing, as I was recently speaking to a colleague about her experiences with the elderly population. I guess my preference is based on some limited experiences with the population, and having it not really fit my core areas of expertise. Specific geriatric concerns like Alzheimer's, Dementia, confronting mortality, etc....aren't really what I want to be focusing on, as they are pretty far from my research and clinical interests.

I actually have become much more interested in the biological and neurological aspects of Alzheimer's and varies types of Dementia....though not really on the therapy side. In regard this discussion, I don't think they'd be part of my practice work, though I could see myself doing some work in hospitals that may touch on some of these areas.....particularly with the growing needs of the Baby Boomer population.

 

[Expsychstential]

My interest in an existential approach to psychology developed long before I know about existential psychotherapy or existentialism. I like the emphasis on personal responsibility, value/self congruency, and understanding how a person has chosen to/been relating to the world and others.

 

[Cosmo75]

I don't know about others, but in my experience once you get out and start working with clients you find yourself mixing and matching more than you probably think you would. I've implemented techniques and ideas from existentialistic, systems, CBT, and *gasp* psychodynamic. I don't consider myself qualified to do analysis though. I will conceptualize my client from a mainly CBT perspective, but sometimes it's glaringly obvious that you need to borrow from other areas of the field. It's quite amazing how they all fit together sometimes.

 

[Therapist4Chnge]

T4c has some thanatos related issues. Old people remind him of his own mortality

Seriously! I know my limits, and if I'm still grappling with my own mortality, I'd rather not work with a patient who is struggling with his or her own issues of mortality. I consider it my first encounter with existential crisis, and I'll probably have a few more as I go through life.

 

[cara susanna]

I don't want to work with the elderly, either.

 

[Therapist4Chnge]

I think elderly patients have often been among my most interesting. They have existed in a world I simply wasn't a part of (e.g., holocaust survivors, though they are increasingly rare, Viet Nam, Korea, and World War II vets, people working in fields that don't exist anymore because of technology, etc. . .).

That is what my colleague was sharing with me, the amazing perspective they have because of living though those moments in history, and how it is a much different experience working with someone at this point in their lives where they really are in their last few months/years and what that means to them.

My nightmare patient, when I did therapy, was always the 20-40 something depressed woman. I think everyone has strengths and weaknesses as clinicians.

I can only imagine the look on your face if you entered your office to find a room full of soccer moms and neurotic middle aged men/women looking to talk about their feelings with you.

I happen to enjoy working with 'tweeners, teenagers, and young adults with a range of Axis-II, EDs, etc....though I know many who would run screaming the other way with those combinations. Often my toughest patients are the ones I enjoy working with the most....when I'm not pulling my hair out in frustration.