I am very sorry but this is why CBT and DBT are enormously destructive! To tell a patient what is and is not, what you think they are feeling or to concretize it by a systematically slow or rapid fire of therapist driven descriptives unwittingly or unconsciously indivisibly silences their voice. It has the resplendent effect however productive or salubrious it may appear on the surface to unconsciously engender autonomic feelings of defensiveness and shame. To be in a position of telling the patient however insightful, well-intentioned and "productive" it may seem removes the patient from the room! The apparent "cognitive gains" are unfortunately too often at the expense of an increased hyper-aroused defensive or hypoactive withdrawal shutdown/dissociative autonomic nervous system. Simply, it is neither respectful nor therapeutic and does not reach the level of the body that is to say, beneath rational executive functioning or prefrontal cortex and the domain of subcortical implicit-procedural memory (where for example, trauma is stored). It ignores the subcortical limbic autonomic nervous system and tends to result in a quite impressive (though often unnoticeable cognitive dissonance. Descriptive analysis, rationalization and control ignores both symbolic encoding/meaning-making and individuation (the patient's story) his/her neuroanatomy and neurophysiology (autonomic nervous system, ventral and dorsal vagus complex) which, shall we say, is a much more tender, complex and nuanced story! Left brain rationalizations and accompanied visualizations while indeed can be helpful at moments actually increase levels of shame and repression. As far as, "Theory of Mind" it is neuroceptively registering, accessing and processing facial and somatic cues beneath the words (this involves the superior temporal sulcus, temporal-partial junction and insular/interoception).
I am very sorry but this is why CBT and DBT are enormously destructive! To tell a patient what is and is not, what you think they are feeling or to concretize it by a systematically slow or rapid fire of therapist driven descriptives unwittingly or unconsciously indivisibly silences their voice. It has the resplendent effect however productive or salubrious it may appear on the surface to unconsciously engender autonomic feelings of defensiveness and shame.
To be in a position of telling the patient however insightful, well-intentioned and "productive" it may seem removes the patient from the room! The apparent "cognitive gains" are unfortunately too often at the expense of an increased hyper-aroused defensive or hypoactive withdrawal shutdown/dissociative autonomic nervous system.
Simply, it is neither respectful nor therapeutic and does not reach the level of the body that is to say, beneath rational executive functioning or prefrontal cortex and the domain of subcortical implicit-procedural memory (where for example, trauma is stored). It ignores the subcortical limbic autonomic nervous system and tends to result in a quite impressive (though often unnoticeable cognitive dissonance. Descriptive analysis, rationalization and control ignores both symbolic encoding/meaning-making and individuation (the patient's story) his/her neuroanatomy and neurophysiology (autonomic nervous system, ventral and dorsal vagus complex) which, shall we say, is a much more tender, complex and nuanced story!
Left brain rationalizations and accompanied visualizations while indeed can be helpful at moments actually increase levels of shame and repression. As far as, "Theory of Mind" it is neuroceptively registering, accessing and processing facial and somatic cues beneath the words (this involves the superior temporal sulcus, temporal-partial junction and insular/interoception).