Social Phobia and CBT (Negative review)

This Criticism was written by Mustafa Gödeş, Clinical Psychologist. Mustafa GÖDEŞ observed that cognitive behavioral therapy technique is not usually effective in moderate – to – severe cases and adults. There are two case examples. Customers in these examples received Cognitive Behavioral Therapy but had no positive impact.

Cognitive behavioral therapy is recommended by many specialists across the articles on the Internet for the treatment of “Social Phobia”. However, according to the information I have obtained from my clients, cognitive behavioral therapies are effective in mild social phobia cases and adolescents; I have experienced many times that it often doesn’t work in moderate to severe cases and adults. This information has been reported by the individual to many social phobia cases who have gone to at least one psychologist before coming to our clinic.

Clients’ opinions

CASE EXAMPLE 1: A 36-year-old male with moderate social phobia had received cognitive-behavioral therapy by a psychologist he had previously visited. When I asked him if he had any benefit from this therapy, he replied:

I’m afraid to enter the crowd, traveling in public transport. The expert I’ve been to before advised me in the first session:

When you get out of here, go home by taxi. Next day, take the dolmus. 3rd day on bus, 4th day on metrobus, 5th day on subway, 6th day Take the train. This way you progressively go over your fear.
This method, called “systematic desensitization” in behavioral therapies, was recommended to our client.

Our client, however, told us that he already knew this advice, that he had applied it before and that he could not see any benefit. He said that he found the methods to be recommended, and that he had lost his faith in psychologists after this incident.
 
CASE CASE 2: Another 24-year-old female consultant underwent cognitive-behavioral therapy by a specialist. In the same way I got information from him about this therapy. In the context of the applied cognitive methods, “negative automatic thoughts” were explained to him, and the subject was informed that the automatic thoughts were used and the client was informed about it. Later, assignments were given to make him realize where and how to use these negative automatic thoughts. However, the client said that “this kind of awareness was particularly good for him but he did not solve his problem”.

In many such cases, clients usually give the same answer: “Okay, we know them, but it doesn’t help.”

Cognitive-behavioral therapies, as the name suggests, focus on the individual’s thoughts and behaviors and try to change them. However, they do not take into account why the person has such a thought or behavior and the underlying dynamics of it. Therefore they remain superficial. “What has the individual experienced and has started to use these negative automatic thoughts?” and the methods of therapy that ask the origin of the problem are called “psychodynamic therapies”.
 
Cognitive-behavioral therapies 20-30 years ago were more effective than today. Because the possibilities of accessing information were not as advanced as today. Today, people can access information about the internet by means of internet. Due to the numerous personal development books published in recent years, individuals who have psychological problems judge cognitive behavioral techniques in many subjects.

For example, I read the book “Feeling Good“. Many of my clients, reading a book describing cognitive behavioral therapy techniques, stated that they could not solve their problems.
 
That is why, in recent years, the therapy schools in the world have started to focus on emotions rather than thoughts and behaviors. The origins of emotions are the parental experiences and the parental relationships that we call the first object relations. Psychodynamic (psychoanalytic) therapies working with emotions and past experiences ask the following question:
“Which past lives of the individual causes this problem?”

In psychodynamic therapies, it is examined whether a client with a complaint of social phobia is primarily damaged in personality structure. For example, a number of narcissistic personality structures (hidden narcissism) are so vulnerable to injury and fracture that the only way to protect themselves from injury and break is to isolate itself from society.

Individuals with schizoid personality disorder tend to retreat, stay away kay as they are concerned that they will be exploited by people with close relationships.

If there is damage in the personality structure of a client who comes with a symptom of social phobia, a long-term, personality-oriented dynamic psychotherapies are applied.

I tell my clients, who came to me with a more neurotic-level “social phobia” complaint, “I don’t know what social phobia is.” I want them to describe it to me. When they start to describe, I often notice that the underlying emotion is “shame and embarrassment.” Afterwards, the memories of the past embarrassment, humiliation and unworthy are commenced. There are memories with a slight feeling of emotion. In the following sessions, the memories that are kept by the person and printed by him for many years begin to emerge. Some of the clients experience such intense emotion emptying during the session: “I didn’t even think it would affect me so much.” They use the expression.
 
Some clients say that they did not have a problem in their past, they had a very good childhood. However, THERE ARE THE SECRETS OF ALL PEOPLE. The main source of the problem is that these are secrets that are often trivialed. A slap in the elementary school teacher, the shame of the father’s poverty, the sexual experience of the child of a conservative family, the misconception of anyone, the sexual play in childhood, harassment, traumas and thousands of other examples of social phobia may be their childhood experiences.

The level of being affected depends on the individual. For example, slap food from a teacher in elementary school can be regarded as a laughable moment for many people, but it can create a very intense shame and humiliation trauma for some people. As the poet says: “Everyone’s abyss is deep in itself.”
 
When the clients tell these experiences, they experience a very intense emotion discharge. Later, when they share these secrets with someone else, they realize that there is nothing unconscious minds. Even the expression of a small astonishment of a novice therapist may cause trauma to the individual again. Therefore, when the person sees that the deepest shame is shared with the therapist and not criticized, the first step of the change begins. Brain restructuring, new neuronal bonds begin to form. As a result of the emptying of the emotions, the potential of the amygdala is reduced. This situation allows the person who is facing a socially dangerous situation to remain calm.
 
In some clients, cognitive behavioral techniques such as “imagination study, emdr” can be integrated into therapy in later stages after adequate work with emotions. However, in the case of social phobia, the main pillar of psychoteapine should be emotions and past experiences. It would not be wrong to define this integration with a metaphor like this: “Psychodynamic therapies are coarse cleansing, cognitive behavioral therapies are fine cleansing.”

Finally, the “precise” information given by some experts about how long the psychotherapy process will take place and how many sessions will improve is also extremely wrong.
Because psychotherapy is an archaeological excavation. It is not known what will come out of this excavation. In order to make a prediction about this, it is necessary to give the individual several sessions. From this point of view, the improvement may vary from a few sessions to one year.

Mustafa GÖDEŞ

Clinical Psychologist

Source: http://www.psikoterapist.com.tr/makaledetay-107-sosyal-fobi-terapisi-vaka-ornekleri-ile.html

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