Thanks for the post, Ken.

I often remind clients that one of the biggest strengths of about doing this
therapy is this very simplicity you speak of. Only having to focus on what
is most likely true circumvents a tremendous amount of speculative and
theoretical red-herrings and miscommunications. Here are a couple
anecdotes:

A new acute anxiety disorder client, a middle-aged psychiatrist, kept
referring to his problem with father-figures . I told him that from a CBT
perspective our primate heritage has left us prone to feel intimidated and
submissive in the presence of alpha males, and that one's early experience
with alpha males (such as fathers) can either desensitize that anxiety or
reinforce it and lead to a phobic response such as his. The look on his
face was a simultaneous combination of sudden understanding, hopefulness
and, even more significantly, grateful relief from what had been a
long-time shame.

On the other hand, a 60 year old woman came in last week for her first
session, complaining of OCD with a number of cognitive and behavioral
rituals and compulsions to keep her loved ones safe. These began after the
death of her father at a young age, when she wanted to protect her mother
from the same fate. She told me "I'm a long time student of metaphysics",
and as we explored the nature of her OCD, it became apparent that she still
believes that her rituals reduce the likelihood of bad things happening.
To make significant progress she'd have to re-examine her whole supernatural
self-world view, which makes her prognosis pretty poor.

In my experience, the most rapid therapy responders are physicians,
attorneys, and professional scientists, because they appreciate the value of
logic and evidence and quickly engage in the process of exploring 1) what is
true, and 2) what strategy/tactic works best to deal with it. Some of the
saddest cases are very religious OCD clients with blasphemous or othewise
"sinful" intrusive thoughts. They believe these thoughts are offensive to
God, so they try to suppress them, which keeps all the associated neural
networks constantly primed, leading to more easily evoked intrusive thoughts
of the same nature. They can logically understand the cognitive
explanation, but they can rarely get past their terror of annoying the
uber-alpha male in the sky. "Ignorance is bliss"? I don't think so.

Bob