[Gareth]

Benjamin,

I have nearly finished your book and must say I really enjoyed it. You explain yourself really well and many of your insights were very apposite to me. Particularly when you talked about how your symptoms came on - "I was desperate for mental rest, even for just five minutes of not having to think about the state of my mind. Having the mind on constant red alert monitoring the mind is an exhausting, lonely task." This is me to a tee - the difference seems to be that this has been me for 2 months now, constantly, with no relief apart from when in exhausted sleep.

As you have mentioned to me in other posts - I really don't feel that I need to understand any more about my condition than I have got from your book. I am not seeking a perfect diagnosis any more. It is about moving on and dealing with it now. This however presents new problems and new decisions. I don't want to get them wrong and waste more time.

My actions so far have been to seek counselling which I got free through the doctor. I have had 3 sessions, once a week, and while it is good to talk, I am finding that my symptoms are simply not on the wane and my general level of constant anxiety throughout the day is always with me, like a veil covering everything, all of the time. In the counselling we talk about the past and try to relate it to the present, and I do FEEL things, and am actually constantly on the verge of tears. I cry when I get home to my wife, in a way that I haven't cried since I was a child. I just don't know if this is because I am feeling things that have happened to me in the past, or because I feel so sorry for myself because of my current symptoms. And whether that distinction even matters?

In the final analysis, once a week counselling is not enough for me. It seems directionless and even after 3 sessions we are already going around in circles. I have the impression that my counsellor feels sorry for me and doesn't really know what to do with me. She seems bewildered by my symptoms.

I am torn now with an important decision to make. While I understand that labels are not helpful, I have been using the label of "Generalised Anxiety Disorder" in order to try to find an appropriate treatment for myself.

All of the research in the field of therapy indicates that Cognitive Behavioural Therapy (CBT) is the only form of therapy that can provide real results in dealing with anxiety disorders such as GAD.

I have an opportunity to see someone once a week for CBT sessions, at the same cost as seeing a more traditional psychotherapist twice a week. I feel I need lots of support at the moment, and I believe in the things stated in your book, so I am tempted to go to the psychotherapist, but the evidence in favour of CBT in dealing with anxiety disorders is so great, I feel I should give this a try. Plus, if my problems really are about experiencing the past, then will the more in-depth psychoanalytic study of myself provided through psychotherapy help me more than the initially more technique based approach of CBT? CBT does go into the past, but offers more of a promise of an inital release of symptoms, followed by more in-depth analysis tailored to changing behaviours and beliefs.

I suppose the difference is that with CBT you control the symptoms first, through "techniques" and THEN look at the past issues in order to understand them, and in psychotherapy you look at the underlying trauma and hope that through the release and understanding of this, the symptoms will be relieved.

Do you have any insights on this? I know you dislike labels and that you feel that all of these symptoms are caused by the release of trauma and it is coming to terms with this that matters. But the relief of symptoms for me becomes a more and more pressing issue, and I wish to find some way of relieving them without drugs (I have been prescribed Celexa but hope not to have to take it, I really want to beat this with my own mind and my own resources).

This is an important decision and as your insights have been so useful to me so far, I wondered if you had any thoughts on this. I will need to make this decision fairly soon. Whichever decision I make cuts the other path off as the opportunity will be gone if I don't take it.

Many Thanks,
Gareth

[Benjamin Fry]

I think that you summarise the issues very well. CBT focuses on delivering quick results but works more on the surface. In that respect it is somewhat analogous to the drugs that you are resisting. Psychotherapy is perhaps initially a more subtle process but it is more thorough, goes more at your pace (therefore perhaps safer and more comfortable) and it gets to the parts other therapies donít often reach.

What you are wrestling with are the differences between a ìtop downî and ìbottom upî approach. One treats the symptoms and the other the causes. I always recommend people to do both, but not usually both with ìtalking curesî. If you are going to commit to psychotherapy then you might allow yourself to take the drugs for some short term relief, safe in the knowledge that you are not ignoring the underlying issues. It is a shame the CBT and therapy are mutually exclusive. After all CBT is short-term (as I understand it) and therapy long-term so ideally you could use them both. Perhaps start with one and follow up with the other?

You know from my book where the problem lies, what you are saying is that you need some relief as soon as possible. However what you will also discover later on is that you want to know that this wonít happen again. Doing the psychotherapy is perhaps the only way to the latter. Coping techniques, mind training, drugs, even crying are all good ways to address the former. Iíd throw in yoga and meditation too for good measure. They are the fundamental paths to quieting the mind.

Iíd conclude that for your long-term health psychotherapy seems like an essential (and twice a week is a great start). Your short term needs can be met in a number of ways, CBT being one of them. If you canít afford both, then perhaps look into an alternative to the CBT since Iím not sure that there is an alternative to psychotherapy. It might be worth considering though just doing it all for a few weeks. Then youíll be much better placed to decide for yourself. Financially there must be some sacrifices that you can make in order to make this viable.

It sounds like you are already making excellent progress with the counselling. If it is resulting in emotional releases then donít judge it to logically or worry too much about what it means. Crying is the release of trauma. The pressure of hanging onto the trauma is what is causing the anxiety. Let go.

[Gareth]

Thanks a lot for the quick reply.

Just one quick final thing! I can certainly think about trying to afford both psychotherapy and CBT at the same time, but I have been advised informally by other psychotherapists that it is not a good idea to do them both at the same time.

This is because the work you do in each approach should be concentrated upon fully, and the danger of conflicting approaches and ideas in each session will actually cancel out the benefit of each approach.

Do you have any thoughts on this?

I think it will either have to be CBT + psychotherapy or drugs + psychotherapy.

Thanks

[Benjamin Fry]

Thatís the right advice. It would generally be best to give yourself a chance to let one set of ideas stand up on their own. Most people would risk getting in a muddle. But I think you seem to have a strong enough intellect to cope. Itís really only something that you can determine by trial and error.

You are impatient, intelligent and relentlessly curious. Iíd give you a fighting chance of being able to cope with them in parallel and it may be that the saturation of work finally brings you a chance to relax about what you should be doing: because you are doing it all. If you do it and it feels wrong, then you can decide which one to focus on from a more informed position.

Or go for plan B. It does have an anecdotal history of being quite successful if you are committed to the "talking cure" and not seduced by the drugs.

Let us know how you got on. It would be interesting to see what you actually find helpful out of these options.

[tony]

I am currently having therapy but have no idea which kind it is. I said I would prefer psychotherapy having read benjamins book but I have been told that CBT is a form of psychotherapy.

So far all I have done is relaxation techniques and I think its a combination of both but I dunno i'm just a bot confused. I want to make sure I get 100% the right treatment so just hoping for some advice on it.


thanks

[Benjamin Fry]

CBT is a form of psychotherapy in the same way that a reliant robin is a form of transport. It is relatively cheap and (allegedly) gets the job done. However there is plenty of reputable dissent against it. The nay-sayers would argue that it is fine while it is on-going, but then it wears off. The Rolls-Royce of psychotherapy is (allegedly) psychoanalysis, which would be every day for many years. You can see how it becomes tempting to find an alternative.

The good news is that most research concludes that the primary factor affecting a satisfactory outcome is the relationship with the therapist rather that the technique employed. My advice would be not to be afraid of trying different people and to keep looking until one feels right; a bit like with other kinds of relationships.

[tony]

Thanks for the reply and advice.

My therapist seems a nice person although i'm not 100% sure what it is I think its a combination of things, (I think she's an occupational therapist) so i'll stick with her for now and hopefully some good might come of it. I've also had reverse therapy (not sure how common that is) but that didnt work out as well as i'd hoped for various reasons.

I'll have a read into psycho analysis but don't think I could hack it everyday to be honest.

Good show by the way, never thought i'd enjoy watching something like that to be honest but its certainly very good to watch esp if like me your having therapy yourself at the time.