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Insight-Oriented Therapy: how it works - The Revolution of the Moon
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Sun, Feb. 5th, 2012 04:12 pm
Insight-Oriented Therapy: how it works

So I realized that, after about 9 years of paying therapists, I have learned some skills I can successfully apply to myself, but also that I didn't know exactly what those skills were. I do things and stuff happens, which is summarily unsatisfying as an explanation and doesn't allow for the possibility of communicating any insights I've had to other people. Thus, here is my first attempt to explain the process of therapizing as I've experienced it.

Prior to such work:
1. De-escalate any crisis
2. Develop and practice whatever techniques of relaxation will be used in later stages

Each application involves a couple steps:
Step 1: invoke whatever emotional or experiential state you want to modify
Step 2: create vulnerability while remaining present and aware, de-invoking any coping mechanisms being used to avoid the topic at hand
Step 3: identify the patterns that have been matched by current situation
Step 4: disrupt the identified dynamic and assists in replacing the now-maladaptive pattern matching with some alternative

Basically, it's like rebreaking bones that have healed crooked in order to reset them. It does mean things can get worse before they get better, especially if one is particularly skilled at denial, sublimation or externalization. However, the long term payoff can be astounding.

Insight-oriented therapy in particular assumes that we are the way we are for a reason and tries to identify those reasons before challenging now-false assumptions and changing the emotional incentive systems at work: it's basically Economics and Sociology combined and applied to our brains. I like it because as an economist and a theater person I assume everyone makes sense to themselves in their heads (however many convoluted justifications they may use to cope with the cognitive dissonance.)
It performs the first two steps by replaying things through the subjective, interpreted contexts in which they were learned or reinforced and the last two through analysis and the application of critical thinking, replacing the building blocks on which these behaviors were built.

Other options include:
EMDR, which addresses one specific maladaptive pattern-matching situation, traumatic memory storage that results from coping mechanisms being overloaded, through a technique that biologically changes how patterns are matched.
CBT, which focuses on behavior instead of the inner life and reprograms through repetition and is more helpful than insight-oriented therapy when the reason for "why" is "because my neurology is abnormal" or as a way to learn techniques that can be latter applied to interior work.
Pharmaceuticals, which directly manipulate the the endocrine system.

In software terms:
Insight-oriented therapy is like debugging: reproduce the behavior, figure out why it is happening, change the program so it does something different.
EMDR is like swapping to a more-suited database: it shouldn't change much about anything else in the program, but everything caused by storing data badly stops happening.
CBT is like introducing error-checking routines: it doesn't stop bad data from coming about, but it can vastly improve the apparent frequency of such instances, possibly to arbitrary levels of tolerance.
Drugs are like changing compilers or buying new hardware. It can compensate for whatever problem was creating the bad data, unless the problem was caused by the hardware in which case it is fixing the source of the problem. Even if the problem is in software, though, it may be possible to make it no longer a problem by adding more memory, and it can certainly make things easier to fix.

Also it turns out just journaling can do some of this without having to pay anyone for anything, much like keeping a food diary can lead to loosing weight even if nothing else changes.

The key insight that made insight-oriented therapy work for me was that every behavior, every thought pattern, every bit of self-loathing and nightmares and anxiety and depression I had was, either now or at some point in the past, adaptive and helpful and better than the alternatives I knew of. So root-cause analysis ended up being absolutely the most helpful approach for me.
I don't even think you need to be suffering significantly for insight-oriented therapy to make life better: I think an examined life can help or prevent many of the day-to-day interpersonal conflicts and let-downs and stresses we encounter. There is a brief book, "Be The Hero", that is targeted at CEO-types and even though it no where mentions therapy or insight or even empathy it is absolutely about teaching the basic skills of insight-oriented therapy to people who would otherwise not be willing to engage to make their already-pretty-awesome lives better. (Plus, if we all learned these skills the Republican party would cease to exist ;-))
Basically any time I feel defensive or I get offended or I get upset I try to ask "why?" instead of reacting motivated solely by my emotional response (that doesn't mean I succeed all the time, but I sometimes do now.) I identify what I'm reacting to, why it invoked the emotions I was feeling, and what the other person is expressing of their assumptions, defenses and internal life (and then fill in the blanks with some best-guesses that I think will be helpful.) I still often decide that I want to respond, but I can do so in a more productive way that has a chance of changing the causes of problem at hand, rather than reacting to make myself feel better.

When I started, therapists were vital for the process because I hadn't learned a couple of skills that they could provide for me:
1. The ability to identify and challenge assumptions I was making
2. The ability to remain present and analytically during emotional crises (note: there are biological mechanisms at work there, but I have been able to cultivate Terry Pratchett-style Third Thoughts over the years)
3. A portfolio of alternative skills and coping mechanisms that they could recommend as substitutes for those I was using
4. Pattern matching based on more than one life-experience: they are sort of a one-person consciousness raising group (for anyone who's participated in feminist groups) or design patterns (for software folks)

And finally, a good therapist still provides me with:
5. Reality checking, and a non-judgmental atmosphere to try out different understandings or explanations. This gives me some confidence that I'm not just turning myself into a narcissist and that my interpretations are both plausible and helpful (because otherwise the therapist will offer an alternative). I originally paid a therapist to play the part of my better self, helping me identify my point of view and consider it worth prioritizing. I now pay them to represent everyone else in the world while I practice relaxing my boundaries and address the current challenges I face in communicating my ideas with the world, to help me to empathize and maintain perspective.

Note also that not every therapist is awesome, and especially since I've employed a form of therapy that involves intellectualization I had to find therapists who were at least as smart as I was before I started making progress (though I could learn specific skills from therapists before that.) It is also super-helpful to find a therapist who is experienced with the particular dynamics you are engaging with (I found child psychologists better at engaging with childhood issues than adult psychologists with experience in anxiety or depression, for example.) For me finding a therapist is finding someone who can model these processes so I can learn by participating.
Finally, establishing therapy as a space where this work can take place typically takes 6 sessions. This work is like any practice or martial art or technical skill: it takes time to be willing to have your world shaken up, and then longer to get the benefits instead of feeling sore and awkward, and then it becomes a life-long practice. Unlike martial arts, though, it won't help you become a ninja.


Stumbling A Little
Tue, Feb. 7th, 2012 02:09 am (UTC)

It's hard to be a good ninja if one is depressed, anxious, full of self doubt, and having lots of body image issues. Just saying.

But somewhat more seriously, I really found this interesting, and a useful perspective on things, and I find it accurate to my experiences as well.

Tue, Feb. 14th, 2012 03:55 pm (UTC)

Thanks for this. It's interesting to me how different people experience different therapy styles.