Questions Answered
Some common questions about cognitive-behavioral
psychological therapy:
Q:
What should I expect when I go to the office for my first appointment?
A: The first appointment is an evaluation. This is not a commitment on
my part and not a commitment on the patient's part. I'll ask many questions to
try to figure out what the problem is and I'll describe how we might solve the
problem together. The patient has to decide if this makes sense to them and if
it's something they would like to do at this time in their life. If so, then we
go on to schedule the first treatment session.
Q: What is different about cognitive-behavioral
psychological treatment (as compared to traditional therapy)?
A: Cognitive-behavioral psychological treatment (CBPT or CBT) is not
traditional talk therapy. It is a scientifically tested treatment that involves
the therapist making very specific recommendations and teaching specific
techniques for improving behaviors, thoughts, and feelings. Think of it more
like a coach and an athlete. It's the coach's job to think of exercises that
are not too difficult and likely to make the athlete's abilities improve and
it's the athlete's job to be willing and able to work hard.
Q: Do you take insurance?
A: No, we do not take insurance at my practice. However, we have a
sliding scale and are very often able to come up with an appropriate fee.
Q: Why should I see a clinical psychologist? There are many kinds of
therapists.
A: Clinical psychologists, as
opposed to other types of therapists, are trained at a doctoral level to conduct
therapy, assessment, and diagnosis. The training to be a clinical psychologist
requires completing classroom courses in these areas as well as two externships
and a clinical internship. Many other types of therapists conduct therapy
without having this formal training. As a result, they often do little more
than talk with clients. Psychologists are also required to conduct at least one
major research project, called a dissertation and most psychologists conduct
more research than this. Being able to conduct research results in a more
empirical style of thinking. Psychologists are skilled in conducting and
interpreting research and this makes them effective consumers of others'
research projects. Psychologists are more able to approach problem solving in
therapy from a logical, scientific perspective.
Q: For what conditions has CBT been demonstrated to be
effective?
A: CBT has been demonstrated to be the
most effective treatment for anxiety disorders, such as OCD, Panic Disorder,
Social Anxiety Disorder, and phobias. It has also been demonstrated to be
highly effective in managing behavioral disturbances in childhood, such as
Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder
(ODD), and Conduct Disorder. Mood disorders, such as Major Depression and
Bipolar Depression have been found to respond to cognitive-behavioral
interventions as well. Repetitive conditions, such as tics, hair-pulling, and
skin-picking also respond to CBT.
Q: Is CBT effective for more chronic, lifelong problems,
such as personality disorders?
A: It is difficult to make progress
with lifelong conditions, such as personality disorders because of the fact that
the sufferer is unlikely to acknowledge the problem and seek out treatment.
However, a type of CBT has been developed that is effective in helping
individuals with Borderline Personality Disorder (BPD). BPD is a disorder that
causes instability in a person's relationships. Individuals with BPD are prone
to becoming extremely upset with people when they perceive that they are not
loved or rejected and these individuals can display maladaptive behaviors as a
result of these feelings. The type of CBT that helps with BPD is called
Dialectical Behavior Therapy (DBT) and some cognitive-behavioral therapists can
provide it.
Question of the month (submitted):
Q: I've heard that you have to get
to the root of a problem in order to get rid of it. Does CBT get at the root of
the problem?
A: This question implies that there are
deep-seated, unresolved issues at the root of the problems that we treat, such
as anxiety, anger, or sadness. However, this is not always the case. Cognitive-behavioral research has demonstrated that, while there are no single
causes for these problems, there are factors that can play a role or contribute
to the development and maintenance of psychological disorders. Such factors
include the presence of certain psychological traits, the presence of certain
behaviors within an individual or a family, an individual's genetics, and the
individual's learning history. For example, the research seems to support the
idea that obsessive-compulsive disorder (OCD) can stem from a genetic
predisposition (whether family members have had the condition), psychological
traits (such as perfectionism & inflated responsibility), and sometimes even
exposure to certain bacteria at a very young age. CBT for OCD involves making
changes to behaviors and thoughts that result in long-lasting, measurable
changes to brain chemistry as well. In the case of OCD, for example, CBT
clearly addresses some of the root causes but cannot address such causes as
genetic predisposition. Remember, though, that the idea that the "root cause"
has to be some unresolved conflict from childhood is only one way of looking at
a problem and not necessarily the most scientific way.