CBT and transference. Oxymoron?

Is it true that most CBT therapists have had little to no training regarding transference (erotic or otherwise)? I realize they don't place as much emphasis on the relationship, but aren't there certain ways they are supposed to handle it?

My CBT therapist is constantly dismissing it, or viewing it as a "problem" that just needs to "work itself out?" Or, there is also the "Okay, so you have feelings. Great. Accept them, and let's do the real work, as we have kinda veered off, here."

He's had to at least opened a book or two or experienced it firsthand with another client (which he claims, but I'm starting to not believe it). I don't feel that any of those above examples are really all that effective, and feel bad if this is how other clients were treated when they shared some deep and painful feelings.

I also see a psychodynamic therapist, and I am working out all this **** with him, properly. I'm happy about that. However, the whole POINT though, is that I wanted to work through this with CBT T. If he lacks the training, then, fine. I understand and won't hold it against him if this is just the area he chose, and does not deal with transference in any way, shape, or form.

I just wish I knew if this was related to lack of training or him being a complete asshole. It's like neither of are budging on our stance regarding transference. He doesn't see it as part of the work, but I feel that it IS the work...100%. And before anyone asks, I have talked about this with him. Doesn't seem to go anywhere. We do just fine when we don't talk about my feelings for him, but obviously, some emotional work is missing. I feel very alone in my whole experience with him, and it shouldn't be like that.

If he can't handle it, shouldn't he refer me out? He has kind of an ego, and refuses to do so. Though...I've also told him I would be absolutely distraught if he DID give me the boot. I feel like he's waiting for me to sever ties, and it's not fair. I shouldn't have to. He did say once that the reason we can't be together is because it wouldn't be professional, and it had nothing to do with the fact that he found me unattractive, unintelligent, etc. That's it. He wants to keep it appropriate, and if I can keep my end of the bargain, then we are apparently "good." This feels unfair...again. That's all he has to say about it? No exploration? Ugh. It's so "matter of fact." I hate it. Guess that's what I have psychodynamic T for...stupid I have to see two, though I think both of them bring some unique things to the table.

I sense that you're feeling out of control of your therapy, and want to reassure you that you are in control. First, you don't "have" to see two and I don't think either is acting inappropriately. You're the expert on yourself, so it's up to you to leave if it's best. Therapists won't typically refer you out just because you don't like their style, that's different than not being able to work with you or address your presenting issues.

I know two therapists work for some (though I think it's often because they're working on two different issues, like an eating disorder with a specialist and relationship issues with another, so I get that) but mine advises me it's best to keep the relationship in the relationship: I work through my concerns about her with her. If I couldn't, I'd leave. Not to say I've never done a reality check elsewhere, but at the end of the day, I strengthen the relationship and heal the transference by being honest and assertive with her directly.

As for it feeling unfair to you that he's not interested in exploring your romantic feelings for him... what are you looking for specifically from him in that regard? I can see how he wouldn't want to 'explore' if that meant increase the attraction, some providers really don't just go there.

What kind of solution are you looking for? Have you considered taking the best of both and finding someone new who offers that, or maybe simplifying by just seeing the one?

I can feel your frustration. I actually don't know what to say. I think transference and the relationship are the vehicle through which therapy works so I just don't understand how it would work otherwise.

But I do psychoanalytic and haven't done CBT. I had heard that CBT people were now trying to add in stuff about the relationship, but I don't know how it would be handled.

Strange because the therapeutic relationship has more effect than the theoretical approach so you would think that all therapists would consider it part of the therapy.

I agree with you that the transference is the work, but CBT is just not that kind of work. It gives you coping skills so you can do the work. At least that's how I see it.
It sounds like your T is a behavioralist - he works from the viewpoint that changing your behaviors will effect change on your emotions. I guess this approach works for some people, but I find it somewhat 'cold'. I think it can work for some things, but it's just window dressing on deep wounds.

It's just I know that there is a lot pain from somewhere that brought this transference on in the first place. The longer it goes on, the more I'm reminded over and over again of certain men from my past and how they treated me. Not to mention my father. I just wanted to find out what it all meant.

But I am making these connections with the second therapist. I just wonder why it's so important to the other therapist that I talk about this, when with my original one, it's a topic that causes both of us much discomfort. I can tell it's not his favorite subject, which is why I hesitate to bring it up a lot.

Can you accomplish what you want with just the psychodynamic therapist since you prefer his style? Many will incorporate elements of CBT into the work if they are flexible and it is what you need. Or is there a reason you need to see two different ones? Your CBT t is handling the transference fine, it's just that it isn't really part of the work in this type of therapy. CBT is usually centered in the here and now, so he would be more interested in how you cope with your feelings for him than where they originate from. What kind of outcome are you looking for in an in depth conversation with the CBT T? I'd think discussing your feelings for both of them with with the psychodynamic T would be just as productive. It's not really the individual men as people but what they represent. That's not something a T who's strictly CBT oriented is going to get into. Its not right or wrong it's just not what CBT is really about.

In my experience, CBT therapists deal (to some extent) with "transference" and conceptualize it in a very different matter. CBTers tend to think of transference as more based on "real" present time reactions to another person, as well as patterns developed to cope with negative "core beliefs" (discussed below). That is, transference has nothing to do with projection/unmet wishes/etc.

CBTers acknowledge that you tend to like some people and you tend to dislike others, this manifests itself in the therapeutic relationship - that is, like in "real life", some people click and others don't...it's not necessarily "transference" or "resistance".

Erotic transference is simply viewed as a reasonable reaction to having someone who is so attentive, kind, emphatic, etc. That is, it is a reasonable, real reaction given the therapeutic situation. Most CBTers would handle "erotic transference" by 1) praising you for bringing up something so deeply personal that makes you vulnerable, 2) saying they are flattered (or something like that), 3) they will tell you they accept and normalize your feelings and state how it is common given the setup of the therapeutic relationship. And probably nothing else unless it begins to interfere with the work.

CBTers who do "deeper work" - that is, work with the cognitive restructuring of "schemas" (or core beliefs, e.g. "I am unlovable" and "I am a failure") are interested in schema-based interpersonal patterns that manifest themselves in the room. If they know what they are doing, they will identify this and point it out. However, even though the relationship is considered critical, there are no "interpretations" of transference or what is going on.

Also, in terms of transference the philosophy is "if it ain't broke, don't fix it". That is, as long as it's not interfering with treatment or serves no purpose, it will not be brought up and certainly not analyzed.

My CBT leaning T and I have not discussed this, but I've held off talking about my feelings for him because it doesn't seem he does "that kind of work" but those are my words not his. Grimtopaz puts it really well. Very likely outcomes of bringing it up.

CBT T's see the therapeutic relationship as important in a real world context - it is important that you like them and that you trust them, much like other people you choose to spend time with in your life. Sometimes you are just drawn to people and it is what it is. I think because of this viewpoint it's an awkward conversation for CBT T's- it's not much different than telling your lawyer that you find him attractive, for example. If you told them they might or might not be flattered, but then wonder what you want to do with the information (continue with business as usual, have an affair or get a new lawyer?)

I brought it up with my pdoc and we talked about it indirectly. His take is that it's human to be drawn to people and to enjoy the process. He said if you want to talk deeper about it with the person, have it clear in your head what you hope to get from the talk, which I think was good advice in any situation. So I use my time with him as social skills work - I sit there for 20 minutes and to interact with him like a normal person. I am know the feelings stem from feeling overly judged by my dad and brother, so going into it with him won't serve much purpose for me would feel redundant.

A t is supposed to talk about whatever YOU want to talk about.

Yes, even in CBT you should talk about it, but as it applies to your therapy, not just because you want them to know. Otherwise it can become a diversion and may not be helpful.

For me, seeing two therapists has helped me a lot. In general, I think transference can happen anywhere - not just with therapists. Pure or mostly CBT, as I understand it, does not go there as part of the therapy situation. I would see this as if one therapist is incompetent at something, I go to the other and quit trying with the one who I think is inadequate for that particular thing.

I agree. If I was seeing two T's but wasn't getting exactly what I need from one of them, I would stop going. But if I was seeing two T's for very specific reasons and felt both were competent, I'd use each one for the unique purpose they serve.

I just was reading some stuff about how CBT has been criticized by not considering the therapeutic relationship enough and now are trying to address that type of claim, which is considered exaggerated but justified. There is almost universal recognition that the relationship is a key factor to effectiveness, more powerful than technique/method, and since CBT remains focused on being evidence-based, it admits that that cannot be overlooked.

What I found interesting is that the relationship was considered so much more complex that the usual attention to beliefs or schemas is not considered the way to approach it. All the aspects that other types of therapeutic approaches consider (especially psychoanalytic) like interpersonal relating, attachment, non-conscious material, etc. was part of the CBT re-thinking of this issue and how to add it in.

So I wonder if one problem might be that some people with CBT training that is earlier may not be up to date on how CBT has modified its approach in order to accommodate the importance of the relationship.

I'm just impressed you're doing all this therapy at once. I don't have near that kind of energy.

I do think it also depends on the personalities and thought processes of the client and T alike when it comes to the therapeutic relationship. I agree that it is in some way vital to any therapy, because without some connection there won't be trust. But I don't think CBT Ts ever use the whole psychodynamic approach but definitely bits and pieces and I think the same is true in the reverse case. In my studies now we are learning about all the different approaches, and they are all valid, but most people will lean toward a certain approach(es) because of their personal philosophy.

The client base makes a difference too. People who work with autistic children use behavioral therapy, because that's what works the best for these kids. But if a client has Aspergers, they'll need a little more personal connection, so a strict behavioral T won't cut it and a mix of CBT/talk therapy might work well. But psychodynamic therapy would probably be frustrating and too abstract, so for some clients it wouldn't be helpful at all.

I totally get why different approaches would suit different people and situations. I guess I don't feel mixing and matching within one treatment, unless long term, or clarified, is the best way, but flexibility and modifications definitely.

The therapeutic relationship goes beyond the trust and safety of course and that has been the OP's issue since there is something deeper going on that is there but not being discussed or handled in a way that feels okay to that person and so the question is about the approach in general as well as the particular people.

While I get that CBT is very technique oriented, the thing is technique has been shown to be less important than the relationship. So yes, to some extent all techniques have validity, but the technique is the least important aspect of the therapy even if it seems like it is the most obvious and important. In fact I think the technique account for as much effect as just a placebo effect. The client factors and relationship account for like 70% of why therapy works.

But having a good therapeutic alliance doesn't necessarily mean focusing on transference, that's not the key point upon which efficacy rests, and not every therapist is going to go there. She can't transform her therapist into someone he's not, practicing a style he doesn't want to practice. I think it's important for the client to accept that and be realistic about what's going to occur in each therapy space. That is, of course, if indeed she's been straightforward regarding what she wants to discuss and work through, and I'm not perfectly clear on that as when she's described some past attempts at dealing with it, they've been very indirect and her perceptions have sometimes also been based on inferences rather than direct verbal communication.

But she's clear enough that she's seeing a second therapist who's style is more helpful regarding the transference, so... clearly she has found it easier to relate to that therapist regarding the deeper work she wants to do.

I do see your point. Not all people believe that considering transference of any type is useful or even something they know how to do. The stuff I was looking at about how CBT is reconsidering the relationship did acknowledge transference, and though it did say it would be conceptualized differently, it also said it would not be thought of in the normal categories that CBT uses for other things (beliefs, schemas). So it is placed as something more complex and different and also valid to address.

If a client has transference issues that are getting in the way or just an issue in therapy, it seems that it has to become part of what is handled regardless of theoretical orientation. It does disrupt the alliance part of the relationship so has a potential to disrupt the therapy overall.

Like I said, I wonder if this is a question of the particular person involved and whether or not he has considered these more recent additions to CBT.

Not sure if this is helpful, but anyway...
Often, in the uk, CBT is done by a psychologist, usually through the health service. It is very different training to a psychotherapist, usually cognitive based training. It is not nearly so much about the therapeutic relationship, not least because CBT, like most treatment on the NHS is aimed at being time limited. So CBT wold aim to give tools to help a person with cognitive processing issues. This is of course not true for all therapists or psychologists but seems to be the norm x

You're right - technique is the least important aspect of therapy in training to be honest. Graduate school for psychology is not terribly technique oriented unless you choose to receive additional training/specialization in a specific area (like Psychoanalysis, Marriage and family or substance abuse). Otherwise you learn about all the therapeutic approaches and learn the most through internships and residencies. You are taught their has to be a real relationship, but not really as it relates to transference, at least not in depth. Actually there is little to no training specifically for transference in social work or psychology programs. Only in depth psychoanalytic institutes where you get certified will give that amount of attention to transference. So it's not just the CBT therapists. Many therapists, masters or doctorate level, just don't deal with transference very well until they've had experience with it or it's the nature of their personality.

Agreed. With my psychodynamic T, I'm able to do a lot more deeper work BECAUSE of the coping skills I've learned with CBT T. So...I am not discrediting anything I've learned. Yes, it's a bit more "cold," in the sense that he doesn't seem to care as much about my past.

Well there are certain things T2 hasn't touched upon yet. (CBT T= T1, psychodynamic T= T2) Mostly because the things we've talked about haven't exactly required CBT. I came to him for "deeper" work, and in that sense it has been very very helpful.

The post by Grimtopaz actually helped me understand CBT more than I ever have...which is weird. Reading it just clicked. And I realize that T1 has actually been conducting this therapy exactly how he SHOULD. I was just expecting different things. I mean, he has mentioned that he borrows from a few other approaches, so he's not ENTIRELY CBT, but that seems to be his main area of focus. I guess I thought that's why I could get a little wiggle room, and the more I think about it, I have. He's taken liberties with me that he didn't even have to. We've talked about my feelings probably more than he's even required to as a CBT T. And, he's tried to help me through them the best way he knows how. All this time I've been getting resentful because I thought he didn't care to talk about it in depth. He's kept me in super long sessions, and is always honest. We only go as far as I want to. (as in, we only talk about what I bring up). He's never really dismissed a subject before, but rather tries to lead me ultimately to stop processing so much and look at facts.

So...looking back, it's all fine. I just have to ask myself if it's what I want. And truthfully, I want both. Now that I've realized that's how he operates, I feel a million times better. It's weird, cause T2 has super strict boundaries, where as T1, basically anything goes.

It's hard to do both. Finances are hard (getting insurance soon, however) and then just remembering to operate in a slightly different manner with them. That's tough too. But nobody interacts with any one person the same. Everyone's different. It's helpful though. I like gaining different perspectives. It probably doesn't help that they're both older men. T2 has asked me if I have any transference feelings for him...and I said, "Will you be offended if I said I don't?" Cause we talk a lot about my feelings for T1. Therapy aside, I do enjoy having intelligent conversations with older men. It sucks that I have to pay for it, but eh.