Hello, friends! This is a nice Q&A episode where I answer three really interesting questions covering topics which include managing a child’s outbursts, fixing a relationship, and switching therapy types. Plus, you can check out my answer to the 4th bonus question over on my Patreon.
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Hi Dr. Duff,
I love the show and have found it immensely helpful, and I was hoping you could answer a question I have been pondering for a while.
I am a 39 year-old woman in the UK, going through her third diagnosed bout of depression and anxiety, spanning 20 years. I’m on citalopram and have been having psychodynamic therapy for 10 months. The therapy has been really useful at identifying issues from my childhood that have caused me to struggle so much and for so long (no capital-T Trauma, but many years of emotional difficulty that I was under-equipped at the time to deal with).
My question regards moving on to a different type of therapy. Whilst my therapist is excellent he is very much a psychodynamic therapist, and has actually said to me in the past “this isn’t CBT”. I feel that at some point I’ll reach the stage where digging around in my past is no longer helpful and I’ll need to find new strategies for moving forward.
Is it accepted to move on from one type of therapy to another as you progress? I don’t want to diminish the progress I’ve made through psychodynamic therapy, but I’m a very solutions-orientated person and feel that at some point I’m going to need to try out new ways of navigating this world, and maybe another type of therapy would work better for this.
Is this something people do, and what are the pros and cons of trying a different type of therapy?
First off, great job doing the work and participating in therapy along with your medications. That’s great and I’m happy to hear that it has been really useful for you. To answer your last question – yes it’s totally accepted to move from one type of therapy to another as you progress or as your circumstances change. Remember, you’re the consumer and ultimately you need to find the right fit that suits you.
Psychodynamic therapy vs. CBT
Psychodynamic therapy is an interesting beast. It comes from the psychoanalytic traditions of people like Freud. The classic model is long-term. A lot of the classic therapy images that you see in the media are based on this type of treatment – lying on the couch free associating or talking about your mother. The objective is typically to bring unconscious wishes and motivations to the surface. It often involves diving into the past and understanding the origins of patterns. It’s a very relationship-based therapy, meaning you are looking at ways in which different interpersonal relationships have impacted you. The main way that this is different than something like CBT is it’s often very open-ended. If you get yourself a very classic psychoanalyst, you might be having frequent sessions for years. There are brief psychodynamic therapy protocols, but that doesn’t sound like what you are working with here. There is nothing better or worse about psychodynamic therapy when you compare it to something like CBT or ACT. In fact, there is some really interesting research (Shedler, 2010) that shows how depth-based and insight-oriented approaches can create more enduring change over time.
BUT – if you have a psychodynamic therapist that literally pushes back on you trying to build skills by saying “this isn’t CBT”, you are definitely going to have a limited scope in what you can do with them. I believe that most therapists these days have a blended approach, myself included, that combines elements of different types of treatment. But that’s not the case for everyone. You still have some purists out there that very heavily focus on one type. My personal belief and therapeutic approach is that both action-oriented and depth-based elements of treatment are necessary.
The CBT work is going to help you establish some coping tools. Breathing strategies, ways to challenge negative thought patterns, behavioral experiments to highlight faulty assumptions, and other practical things that you can actually do about your situation. These are great for getting through life and preventing your symptoms from ruling your every action. I tend to call this first phase of treatment “stopping the emotional bleeding”. From there, the idea is that you have a little more space to work with emotionally. Medication can have this effect as well. As you stop suffering so much from the moment to moment struggle, you have more mental space to consider some deeper things, such as where these patterns came from in the first place. That’s where I start to integrate more psychodynamic and depth-oriented approaches.
There’s nothing wrong with the way that you’ve gone through things. If you have been open to diving deep in the psychodynamic therapy that you’re doing right now, that’s a great sign that you are ready to really make some changes for yourself. You’re essentially just inverting the arrow of my typical treatment approach and I think it could totally work for you. One thing to consider is that therapy is supposed to help you get better, right? I often run into people who have been in therapy with someone for years and I’m like “so is it working?” and they don’t know how to answer that. To me, the ethical thing to do is to try to work myself out of a job. I don’t want anyone to be in therapy for their whole life unless they simply want to always have someone to talk to and they understand that’s what they are getting.
It’s okay to switch
If you are stagnating and not making progress in therapy then I think you should do something about it. It could be talking with your therapist about that fact and seeing whether you might be able to make some adjustments to push things forward or it might mean looking for another type of treatment. Nothing about switching should feel like a failure. In fact, you might think of it as a sort of graduation. You made enough progress that you are ready for the next thing. And it very well could be that you go and do some more solution-focused therapy for a while and then return to a more depth-oriented approach later on to continue the digging. Either way, you’re allowed to change your approach and try different therapies, especially when it’s coming from such a positive place.
My 11 yr old daughter is beautiful, independent and smart. I am worried about her as I think I have ruined her. She is often very lazy. She refuses chores, doesn’t like to take her puppy out when asked. I know hormones are at play but she often reacts very strongly to conflict or being challenged on anything.
She sometimes ends up very very angry. She will yell, throw things and cuss me out. She has always been dramatic but this is a new and scary level. She has stated that she doesn’t remember most or anything during these rages but to me I think she is avoiding taking responsibility and for trying any of my suggestions on how to handle her behavior.
I am a single mother. Her father was deported when she was a newborn and she has only had limited contact. I have recently divorced her stepdad (we were together for a total of 7yrs). She blames him as well as me for all of her emotional strife. I will state that my ex was often harsh and I also do not handle confrontation well. It’s easy for me to get emotional as well. She is also very jealous of any and all attention paid to her 4yr old brother.
I feel like I am losing my chance to reach her before it’s too late. I worry about her all the time. Please help
Wow. What a tough spot to be in. Thank you for writing in with this question. I think that there is a lot here to unpack. Let me first address the very last thing you said.
You said that you are feeling like you’re losing the chance to reach her before it’s too late. That’s not the case. I think the worst thing that you could do is minimize and pretend like there is nothing going on. But that’s not what you are doing. It’s okay to struggle and it’s okay to not know what to do. You give a shit about her and her upbringing. That matters. Not everyone cares like you do. You need to have some grace with yourself and with her. This is a tough situation. I wish life wasn’t like this for you guys, but let’s look at the facts here: You have a young adolescent kid going through all sorts of physical and identity changes as a normal developmental process. The father was deported before she was ever able to establish a relationship with him. She has witnessed a difficult relationship with your ex-husband that ended in a recent divorce.
The system of your little family is going through a lot of crap right now and it’s normal for a system to react when this happens. Some people may turn inward, some people may externalize with difficult behaviors. It’s a lot to adjust to and it’s normal for there to be a reaction. That doesn’t mean that there can’t be some accountability and expectations, but just keep all of this in mind as context. Sometimes there isn’t some big mysterious reason for all of these behavior changes. The answers might be staring you right in the face and it’s more about trying to figure out how to deal with the situation.
Let’s talk strategy. What can we do here?
First off, take a look at the relationship with your daughter as a whole. Obviously, with the behaviors she’s been exhibiting, there are going to be a lot more arguments and difficult interactions. Are you also having good experiences? I know it may not feel like you should be praising her, doing nice things, or otherwise reinforcing the problematic behaviors that she’s showing, but sometimes one of the best things that you can do to balance a system that is out of wack like this is to increase the reinforcement and positive interactions. It’s normal for resentment to grow when you are feeling like she doesn’t listen to anything you say and she is feeling like all you do is nag her. Try balancing that out with positive interactions. Is there a way that you can add in some special alone time with just her to do something that you both enjoy? Is there a way to praise or reinforce her for some things that she is doing well? This isn’t going to solve anything, but sometimes bringing a little bit of balance to the scenario suddenly gives her a reason to care more about contributing to this system.
It also probably makes sense at this point to integrate some professional help if you haven’t yet. I can think of a few ways that this can be helpful. First off, it shows that you are taking the situation seriously. She very well might push back against things like family therapy, but at the very least she will know that you see how hard this is for everyone and are trying to do something about it. If there are parenting classes available to you these could be really helpful as well. I’m thinking about the behavior modification classes that we used to teach at my internship. They focus on learning how to effectively use reinforcement and punishment. It may be that you need to start withholding certain things that are high-value for her so that she can earn them with better behavior. One thing that I have seen a lot of parents do is become afraid of taking away the kid’s main thing. For my little brother this was music. My parents would never take away his guitar or remove him from certain involvements because they felt that it was just wrong to do so. As a result, none of their demands had any teeth because there was really nothing else that he cared about. I would highly suggest either taking classes or meeting with a private parent educator to help you identify the best strategy for your particular situation.
I will say that when making these adjustments, it’s normal to have push back, and you might want to take it gradually. Rather than saying, “okay, we are making this big change. I expect you to do these 20 things consistently all the time”, you can communicate that something needs to change and that you are going to be working toward more personal responsibility and then outline the plan and gradually introduce the changes – make it clear that there are aspects that you both need to work on. It’s also important to lead her toward resources. It can’t be you that teaches her things like how to better regulate her emotions, how to take a deep breath etc. You’re in the eye of the storm with her. Whether it’s videos, books, or working with a professional, she might need some tools.
You don’t need to be perfect
Again I just want to reassure you that this isn’t a lost cause. You don’t need to get all of this right. None of us know what the hell we are doing. We are all just trying to make it the best that we can. Express your love and care and concern for her. Let her know that you are trying the best you can and want to make sure that neither of you are suffering. And let her know that the ways she is treating you is unacceptable, even if you understand that it’s due to so many hard factors that are out of her control. You don’t judge her for acting how she is, but it can’t continue in this way.
You have time to continue communicating, clarifying, and trying things out. I know it’s hard. Pull in whatever resources you can so that you aren’t going through it alone.
Quick background is my mother is, I believe, unmedicated bipolar. I have worked in medicine and psych long enough to understand the tell tale signs. From the time I was a child she has been emotionally, verbally, and physically abusive. I’m almost 30. I have a longtime boyfriend. And more often than not I am ruining him like my mother did my entire family. I took a confident man and literally broke him. He has an ex who used him for 5 years repeatedly leaving and coming back and I have a severe fear she’ll come around. Part of me will NOT let that go either (July last year he just left me because I wasn’t “fun”), apparently he was sick of my abusiveness. I guess my questions are 1. How do I stop being my mother And 2. How do I trust he won’t leave again.
You are putting so much judgment on yourself. I think it’s great that you can recognize and push back on your own patterns. That is important. But this probably isn’t all on you. There are two people in the relationship. As a therapist with a strong cognitive-behavioral background, my first instinct is to question these assumptions that I’m hearing – that you took a strong man and broke him, that you are being abusive, etc. Are these things actually true? These terms can be somewhat vague – what would be abusive to you? What would breaking someone look like? How do you know that these are the case in your situation? You also said that he left in July because you aren’t “fun” – that kind of sounds like a BS excuse to me and there’s more going on there.
There’s obviously something that you are both getting from this relationship if you are both still in it at this point. Look for those signs as well. Again, I do think it’s important for you to notice these patterns though. Given what you’ve been through, I think that it’s definitely understandable for certain behaviors to be handed down from your mother or at least echoes of your relationship with her playing out in other relationships. But it doesn’t have to stay this way.
Break the cycle
What you can do differently is that you can do something about it. You said that your mother is undiagnosed. I assume that means she hasn’t gotten any kind of treatment or put any effort into taking ownership of her behaviors. This doesn’t have to be the case for you. Rather than letting the swirling vortex of your own thoughts convince you that you are the worst person in the world and that you are destined to ruin everything good in your life, maybe you could consider getting a therapist. Working with an individual or even a couples therapist (or both) might be a great tool to find a new way of living life and working through things rather than avoiding them.
Obviously this relationship is important to you, but I think that for you the issue is even bigger than just this relationship. This relationship may or may not last, but it does serve as an opportunity to practice a different way of being with someone that you care about. The lessons that you learn from this period of time will stick with you regardless of the outcome of the relationship itself. As always, I also think that communication is so important. Practice communicating with one another consistently and openly over time. Don’t just make assumptions and let things build up. Address them when they come up so that you don’t build festering resentments that eventually blow up. Instead, address them as they come up and talk about them.
As I said, there’s a reason you guys are together and if you look towards those reasons as the fuel for trying out these new ways of being together, practicing communication, intervening with therapy for yourself, etc. then you can take a big step towards breaking that cycle.
Bonus Patreon question:
Hi Robert, I just listened to your episode “Leaning into depression” with your wife and I was really impressed by how open you both were about her struggle with depression. I could hear in your voices that deep emotion that comes with overcoming lifes obstacles as a couple. I don’t have children but I am a wife and I have had some mental health difficulties on and off most of my adult life, and my question is: how do you protect the person you love the most in the world from yourself and your struggles? I try not to be a burden to my husband but I am also desperate to lean on him sometimes. Thank you for all your amazing work and your openness.
If you would like to hear my advice on this week’s bonus question, check out my Patreon!
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