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David Baxter

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Between Client and Therapist
1 February 2002
by Ellen McGrath, Psychology Today

Summary: Patients' relationships with their therapists often mirror other relationships in their lives. The path out of depression begins with a compatible therapist.

Depression can be understood in part as a disorder of connection; as a result, the fastest way out of it is through improving your skills of connection with others. One of the most helpful elements in recovery is the quality of the relationship with the therapy professional and how consistent and trustworthy the connection remains between client and therapist.

The patient-therapist relationship becomes a crucible of wellness for many reasons, but the most important may be because it is a kind of living laboratory of all relationships. In addition, the exchange of support acts as a catalyst, hastening recovery and fostering hope. How do you mobilize this most important resource for recovery?

Recognize that over and above the content of therapy, the client-therapist relationship is itself a therapeutic agent. When you feel like you are drowning in the sea of blues and someone is about to throw you a life preserver, you must be able to trust that they'll be smart and strong enough to pull you out of danger. That requires that you choose a therapist with great care. Some questions to consider in selecting a therapist:

  • Does he or she know what drowning in the blues is like?
  • Do they even have life preservers (tools for depression reduction) in the office? Or are their techniques irrelevant to depression treatment?
  • Do they know how to resuscitate you when you're pulled to shore and feel you can barely breathe from fear or pain?
  • Does the therapist aim to teach you to swim on your own?
  • A sense of rightness of patient-therapist fit comes from observations you make on a variety of dimensions you may not even be aware are entering your judgment. You cannot afford, however, to leave these to chance.
Conduct your own Relationship Inventory of a prospective healer. Consider the following questions:

  • Do the interventions offered target the problems you are struggling with? What do you judge the quality to be? How would you assess the cost/benefit ratio?
  • Does the therapist treat you with respect? How developed does his or her own mental health seem? How free of depression?
  • Does this person have wisdom? The professional discipline your therapists hails from matters far less than how much he or she has learned the lessons of depression in his or her own life.
  • How much do you genuinely like him or her? How together does this person appear in his or her own professional setting?
If there is any answer to these questions that gives you serious pause, then trust your instincts; too much is at stake.
  • Give yourself time for the project, time to identify problems, to identify patterns of reaction that are nonproductive, to learn and establish new patterns.
  • You may need to try several therapists to get the right match. Of course, if you keep switching without getting a good fit, then you may be using the search process as a technique to avoid facing your problems.
  • You should expect observable change in 12 to 14 weeks. If in that time you do not experience a significant reduction in depression symptoms, then talk to your therapist to find out why. You may need medication, or a new technique, or a second opinion from another therapist to find out why you're stuck.
Little change may be the sign of a bad match. However, bear in mind that staying put and resolving conflicts instead of moving on is often the most valuable therapeutic work you can do.

The patient-therapist relationship is generally representative of the nature of all other relationships you have, and so learning to resolve problems while maintaining connection provides skills that are widely applicable. To experience conflict with a therapist and learn to resolve it is often the path out of depression.

Learning how to connect despite difficulties is healing. Human beings wither when they are not connected with others. When you learn the skills of connecting you create the safety for exploring vulnerabilities.

A lack of significant progress by 12-14 weeks could also signal that your problem has been misdiagnosed. Or you may have another problem, perhaps an anxiety disorder, complicating the depression and its resolution. There is also the possibility that the psychotherapy will be most beneficial in tandem with a course of antidepressant medication.

  • There are several types of therapists who should be avoided from the outset, because their own nature itself inhibits healing connection with clients. Beware of therapists who are interested more in their own insights than in helping clients, who offer intellectual insights only, have a major life problem as yet unresolved, are drained of energy by their own unresolved depression, try to hold onto clients forever, or are themselves immature and take everything personally.
  • Expect a therapist to challenge your views and to make you work. Therapy is, after all, a form of re-education in a supportive partnership with someone who knows what you mean and knows how to help you solve the problems causing you the most pain.
 
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foghlaim

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Thanks Dr.B. this article has been very helpful in re-affirming my own judgement of my (old) psychiatrist.

nsa
 

AL

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Thank you very much Mr. Baxter,
All I am thinking now is how about if you had posted this article a year back! That time I was stuck with- ?why couldn?t I improve then existing relationship? instead of jumping to other therapist. Above article helps in thinking why I kept occupied with thoughts about my therapist instead of goal of therapy. Today I am out of everything except a few heartburning memories. All I can say is good therapists are 100% available if one searches, but considering therapist as an individual could have problems of his own hindering the therapy process.
I find this article and ?do they really care??, ?Good patient? very helpful. It seems like the list of questions I posted in my thread ?I am ok?.? are being answered in a gradual manner. For professionals issues elucidated in above articles could be part of routine, but for a layman client this information is nothing less than ?actual support to make critical decision?. In case of a problematic therapy an already troubled individual [client] may not be able to decide on his own. Information scattered all over this forum can definitely help him to choose the right approach.
Thanks again.
 

Lost

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After a year with my first therapist - there was only ONE CHANGE that I noticed!

My second therapist I felt understood me much more, but I felt no changes at all...

And now my wonderful, best-therapist-ever-in-the-whole-wide-world has made many many radical GOOD changes in the 9 months I've been seeing her.

So going by 'changes' seems to be an accurate way of judging whether you and the therapist match.
 

Halo

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I actually re-read this post again and the following paragraph really stuck out at me:

David Baxter said:
Between Client and Therapist
1 February 2002
by Ellen McGrath, Psychology Today
  • Expect a therapist to challenge your views and to make you work. Therapy is, after all, a form of re-education in a supportive partnership with someone who knows what you mean and knows how to help you solve the problems causing you the most pain.

This is so well explained about the process of therapy and I just love it :) Somehow it just clicked in my head after reading it.

Thanks for the post Dr. B.
 

Rosa

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thanks Doctor B for another helpful article. It really helps me see that I clearly have made the right decision when choosing my Doctor.
As always
Rosa
 

Banned

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Thanks Dr. B!

Certainly gives me food for thought...and reaffirms my decision last week to change therapists.
 

Angela

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Regarding therapists and their clients, Dr. Baxter, please can you comment on the discrepency? Being a nurse, i think of patients in terms of nsg care plans;eg: pt was abused and not nurtured in early childhood and developed an "i-am-bad" concept of self-blame. Immediate nsg goal: introduce idea to pt that child is never responsible for abuse or is bad or was a bad child. Ishort term nsg actionion to nurture patientsh this: during a neutral time such as the bath-time back-rub initiate the topic that neglected and abused kids often grow up believing they are bad and their badness caused the neglect/abusePerehaps say, "It's like this backrub. It's the philosophy of this hospital that simply by virtue of being a pt in this hospital you deserve and will receive a backrub unless you strongly prefer not. But it isn't something you have to earn or pay special for or lose if you go through
a hard time and become a pain-in-the-neck-pt. Allow time for response/reaction Longt term nsg action to accomplish pt being able to give up idea of being bad: immediat nsg action to nurture pt:Ask if pt would like her caretaker to hug her sometimes, after being asked first Long term goal for pt to replace idea of self-badness and self-blame/guilt, shame. Slowly introduce idea of psychotherapy and, as pt shows interest or does not run from it, continue educating about what therapy is and is not.

My T, i assumed therapist treatment plans were similar, but even after 5 years of teamwork, he has not written and refuses to verbalize for me what ishis plan for treating me . He's well-educated,keeps updated, has decades of experience, and perhaps has a special gift for "winging it" as he does
 

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