Milestones in Alcoholism

[fabrisse]

Tonight my sister and I took Mom out for dinner. Sis and I hit this restaurant about once a week, and tonight, as usual, we ordered the Matzo ball soup. It was good.

Mom ordered a very dry martini on the rocks with extra olives. I quote: "That's my idea of dinner."

On a lighter note (sort of), I've seen a competent doctor who prescribed a book called "The Feeling Good Handbook." I bought it, but I'm a bit put off by the author's tone. Does anyone know more about it?

Comments

[siderea]

My opinion is probably longer and more involved than will fit in the margin of this post. ;) Not least because it involves a lot of equivocating.

The whole premise of the cognitive-based therapies (CT, CBT, REBT, et possibly cetera) is that they endeavor debug a patient's thinking. That's what cognition is. I'm all about debugging people's thinking, so, clearly, I think there's a lot of utility to that premise. But it's also fraught with a bunch of issues, and I get every impression that the proponents of the cognitive-based therapies have absolutely no respect for any of those issues. They really think their therapy can be used to treat anything from anorexia to cancer (OK, slight exaggeration, but I've read a case of CBT being used to treat warts), and all too frequently it is coupled with an attitude of "all other therapeutic modalities suck."

While all modalities (stupidly, IMHO) have a rivalry thing going on, this attitude is not only (IMHO) currently worst among the cognitivists, it's also particularly unfortunate in that cognitive approaches are the most superficial. That's actually one of their bragging points, that they only treat symptoms and do not do depth or insight-based psychology.

From my point of view CBT is sort of like Band-Aids(tm). Band-Aids(tm) are awesome; they are a boon to western civilization, no question, and they do a world of good. But nobody thinks you can use Band-Aids(tm) inside your body, and nobody thinks that there's no need for other forms of treatment now that we have Band-Aids(tm).

CBT (and CT and REBT) is a heck of a lot more powerful than Band-Aids. Maybe penicillin is a better analogy, though it loses the "superficial" concept. But at the end of the day, it's not enough to solve all problems. Root causes can matter. Other branches of the mental health field explore different possible locations of causes of distress, whether it's psychiatry investigating brain chemistry, or gestalt psychotherapy investigating figure-ground relations, or humanist therapies investigating feelings and socialization, or existential therapies investigating beliefs, or psychoanalytic therapies investigating internal dynamics arising from childhood, or whatever. There's a lot which can go awry, a lot more than merely cognition.

The partisans of the cognitive approaches really seem to have come to believe that if only you can get people to think "right" you can solve any problem, even if that problem is not with cognition. It is as if they have jumped from the idea that insight into the patient's problem is not necessary in therapy to the conclusion that insight into how humans work is not necessary to developing and applying therapies.

And, of course, that "right", above, alludes to other related issues. The cognitive therapies embody within them certain ideas of "right thinking". They're actually pretty good, as far as I can tell! But if a practitioner's interpretation of "right thinking" is substantially mistaken in a patient's case, the therapy collapses -- and can even be quite toxic as it becomes normalizing, unwittingly applying a pressure to conform to inappropriate standards.

As you might suspect, one of the places where even a talented, kind and reasonably informed CT/CBT/REBT practitioner is likely to err is dealing with people who are GT. In fact, if you go to the Amazon page for your book, you'll find one of the currently prominent reviews is from someone who didn't find it useful because it kept trying to get him to disown his perfectionism, and then later found a much more useful, humane approach in learning he was GT and through the GT literature. The cognitive-based therapies are all about training people what is reasonable to think and expect of themselves, and that is different with GTs. The expectations of GTs must be calibrated to their capacities.

[cont.]