Expecting too much from therapy?

[AmZ]

Hi all,

So by now, I'm sure you've all pretty much seen what has been going on with me in the last 5 weeks or so, so won't go in to it again

I went to my second session of therapy today (I had gone to 4 sessions before also with 2 other psychologists, but this one I have now is my permanent one).

I don't know if I am expecting too much from the sessions, or whether maybe I am just missing something here and that everything is really as 'easy' as the psychologist says? I feel that this is just simple 'life coaching' which I could just as easily get from speaking to my family and anyway, they are all the things I know myself.

He says that from "doing 'x' (i.e. going there and starting to meet people over the next few months and make friends), you then won't have anxiety, your OCD thing with your hands will calm down again, you'll stop having the intrusive/compulsive/obsessive thoughts" etc. I tried telling him, that to me, it doesn't sound as easy and clear cut than what he says it is. Maybe I am wrong, but it feels like something deeper that needs to be worked on more, but he just told me that I just need to take the medication, go and make friends, then come off the medication and then all will be 'solved'.

He doesn't want to get in to the bad thoughts I've been having and anything really at all that is going on with me psychologically - On one hand, fine, I know myself that my thoughts do me no good most of the time and are a determent to me moving forward, but on the other, it's just as simple as having them (at least for now), ignoring them and not dealing with them at all?

I guess just that in going to a psychologist I was guessing that we would have sessions about the err, psychologically what is going on with me (!!?) and delving more in to understanding why I have the thoughts, how I can stop the anxiety (or deal with it better) and generally sorting out the confusions in my head via processing the thoughts etc.

I hate to say it, but I just walked out there thinking that it was pretty much a waste of time... Maybe he's just taking the approach of keeping everything positive and keeping things simple, but in my mind, that's not what is happening, so it doesn't help me... At least up until now it hasn't helped me. I feel like, fine, if it's all just that easy, I'll just take this medication, work on things by myself which I am doing anyway with not much else input and see what happens. (But haha, even when I say that, I don't genuinely think that it is possible. Then on the other, I can't see how this life coaching approach will help).

So am I missing something or is this actually what I need to do?
Am I expecting too much from therapy?

I'd really appreciate everyones honest opinion.

Thanks in advance.

 

[Daniel E.]

Of course, you have had only two sessions so far. And at least in my part of the world, the first session is mostly just an evaluation. But, yes, generally speaking, it can take a certain amount of "shopping around" until you find a therapist/psychologist you are comfortable with or one that has more experience treating OCD symptoms.

In the interim, you may want to be more assertive with this psychologist, asking directly about CBT.

your OCD thing with your hands will calm down again

That part actually does make sense, at least in my case, since some compulsions can diminish fairly quickly relative to intrusive/obsessive/ruminative thinking.

how I can stop the anxiety (or deal with it better) and generally sorting out the confusions in my head via processing the thoughts etc.

I can't see how this life coaching approach will help...

Well, to give your psychologist the benefit of the doubt, "doing X" such as socializing is behavior therapy. (The "B" in CBT stands for behavior.)

Similarly, the hardest, most rewarding step in the Brain Lock approach is more about behavior than the other steps:

The goal of treatment is to stop responding to the OCD symptoms while acknowledging that, for the short term, these uncomfortable feelings will continue to bother you. You begin to "work around" them by doing another behaviour. You learn that even though the OCD feeling is there, it doesn't have to control what you do. You make the decision about what you're going to do, rather than respond to OCD thoughts and urges as a robot would. By Refocusing, you reclaim your decision-making power. Those biochemical glitches in your brain are no longer running the show.

http://forum.psychlinks.ca/obsessiv...r-jeffrey-schwartz-brain-lock.html#post104046

The is also true of the just-do-it, behavioral activation approach for treating depression and anxiety.

 

[AmZ]

Thanks for the reply.

I will put these two things you said together:

But, yes, it seems you may want to start looking for a psychologist with more experience treating OCD.

and

That part actually does make sense, at least in my case, since some compulsions can diminish fairly quickly relative to intrusive/obsessive/ruminative thinking.

That's why the psychologist today had said that really, the OCD thing with my hands is the 'least' of my worries or things to 'sort out' - I get that. I've had it for 10 years already, like I said before, and it never really bothered me so I'd never done anything about it.

So when you are referring to the possibility of finding someone who could better treat the OCD, you are not referring to the physical OCD? I had said to him today that maybe the OCD thing with the hands also relates to my thoughts/psychologically. He said that it's normal for a person in this situation to get 'obsessed' or think a lot about what is going on with them and said that the hand thing IS OCD, however, from making these 'simple changes' in my life, it will dull down the hand OCD thing again and then I can decide whether I want to treat the 'left-over' hand counting thing if I wish to.

Concerning this psychologist, I actually saw that he has published a book on OCD, so I'd hope he knows what he's talking about. 1. I don't know about OCD asides from the very basics of physical symptoms, but don't know how it is diagnosed and/or treated. Therefore I can't (and anyway, shouldn't) diagnose myself. 2. He said the hand thing is OCD but can be treated at a later date. I'm OK with that, as long as there is nothing else I am missing here that may not be being treated.

The only advice he gave about the current OCD situation, he said that I should first of all not drive myself crazy about it and also within that to try to limit myself in how much I do it (Ideally, yes, thank you, good idea!) - He said to tell myself it's fine to do it for 1 minute here and there but to control how much I do it in general.

In the interim, though, you may want to be more assertive with this psychologist, asking directly about CBT.

I'm going to have to clue myself up more on this so that I can ask him. I was being quite persistent in telling him the things that are bothering me mentally, and in doing so, giving a rather large hint that I'd like to perhaps talk about them and understand more why I have certain thoughts and perhaps get some tips on how to control them etc, but like I say, he was just doing the mega-only-positive-thing in saying that these thoughts will stop via medication/positive changes. I gave him a couple of examples about the intrusive thoughts and he just said 'OK'.

He's just at least for now adamant to not go in to anything more than to just mention it i.e. "I have intrusive thoughts", then giving him an example and then him saying "OK, the medication and changes in your life will fix that".

That's all?

PS.

OTOH:

Behavioral Activation: How To Be More Active in Your Life!

Thanks for the link! This article gave me more than the one hour session of private therapy gave me!!!!!!!

---------- Post added at 05:34 PM ---------- Previous post was at 05:19 PM ----------

How about instead of rambling on... I just sum this up in one paragraph:

I do not want to be on medication to just cover up the problems/feelings - The idea of being on the medication (I had and do hope for just a matter of months) is that I go to therapy at the same time and fix those problems and then come off of the medication so that hopefully this will never happen again in my life!!! (Even take the hand-OCD thing out of it. I'm just talking about the rest of the things!).

---------- Post added at 06:19 PM ---------- Previous post was at 05:34 PM ----------

You know what? For now.. I'm done. I'm shutting up now.
I'm just going to blindly go ahead with this and see what happens.

All I want to do is understand everything and myself better and not to do things blindly - I don't want to feel and come across as this mightily negative person or at least one that questions each and every single thing along the way. At least if I do do that, then I only do it for the right reasons. I'm not trying to make things more difficult for myself, just some things don't feel good/right to me and I'm just confused as to what the right path is to take in fixing these horrible few weeks so that it goes and never comes back.

I don't want to over analyze everything or under analyze everything, so I guess it's just best to not think or say anything and hope that it won't do me worse again like how this whole episode started in the beginning.

 

[Daniel E.]

Regarding the issue of simplicity, especially at the outset, one possibility of where your psychologist may be coming from:

It is possible to combine cognitive therapy with behavioral activation...

You should be careful about a couple of things when you combine techniques from different treatment approaches. First, you don't want to overcomplicate things by trying several different techniques at once. If you do this, you may find it difficult to use any of the techniques to their full potential. Second, as discussed above, you don't want to get stuck trying to figure out which approach is the correct approach...both can be helpful to you. (pg. 171)

Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back

But, certainly, your psychologist should be able to easily address your concerns, and part of having a good relationship with a therapist/psychologist is feeling free to address such concerns. For example, even before meeting with a therapist for the first time, it's more than acceptable to ask therapists which approaches/frameworks they are most familiar with, such as cognitive behavior therapy (CBT).

 

[Daniel E.]

I don't know about OCD asides from the very basics of physical symptoms, but don't know how it is diagnosed and/or treated...

All I want to do is understand everything and myself better and not to do things blindly...

BTW, some info in the "sticky" threads in the OCD forum:

Diagnostic criteria for 300.3 Obsessive-Compulsive Disorder

A. Either obsessions or compulsions:

Obsessions as defined by (1), (2), (3), and (4):

(1) recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
(2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
(3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
(4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)

Compulsions as defined by (1) and (2):

(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
(2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive

B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.

C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships.

D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorders; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).

E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

http://forum.psychlinks.ca/obsessiv...iteria-for-obsessive-compulsive-disorder.html

Important initial steps in facilitating recovery include correct diagnosis and educating the patient concerning the nature of OCD. Treatment is indicated when OCD symptoms cause impaired function or significant distress for the patient. Although treatment rarely cures the patient with OCD, significant symptomatic relief is achievable. Reasonable goals for treatment would be to spend less than 1 hour per day on obsessive-compulsive behaviors, causing minimal interference with daily activities.

First-line therapy should consist of cognitive behavioral therapy with exposure and response prevention, or pharmacotherapy with an SSRI, such as citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, or sertraline. Physicians should be aware that medication dosages required in OCD often exceed those needed for other indications, and there is also usually a longer duration of treatment needed before response becomes apparent.

For patients with OCD who are resistant to treatment, feasible options for therapy may include augmentation of an SSRI with an atypical antipsychotic. Because OCD is a chronic condition with a high rate of relapse, treatment should be discontinued only with caution. Patients with OCD should be carefully monitored to detect possible comorbid depression and suicidal ideation.

http://forum.psychlinks.ca/obsessiv...r-treating-obsessive-compulsive-disorder.html

At UCLA, we call this approach "cognitive-biobehavioral self-treatment." The word cognitive is from the Latin word "to know"; knowledge plays an important role in this approach to teaching basic behaviour therapy techniques...The basic principle is that by understanding what these thoughts and urges really are, you can learn to manage the fear and anxiety that OCD causes. Managing your fear, in turn, will allow you to control your behavioural responses much more effectively...

During a normal day, we make many rapid shifts of behaviour, smoothly and easily and usually without thinking about them. It is the functioning of the caudate nucleus and the putamen that makes this possible. In OCD, the problem seems to be that the smooth, efficient filtering and the shifting of thoughts and behaviour are disrupted by a glitch in the caudate nucleus.

It's like having your car stuck in a ditch. You spin and spin and spin your wheels, but without traction you can't get out of that ditch. With OCD, too much energy is being used in a frontal part of the brain called the orbital cortex. It's as if the orbital cortex, which has an error-detection circuit, becomes stuck in gear. This is probably why OCD causes people to get a "something is wrong" feeling that won't go away. You have to do the work to get it out of gear--to shift the gears. You have a manual, rather than an automatic, transmission. In fact, the person with OCD has a sticky manual transmission; he or she must shift the gears. This takes great effort because the brain tends to get "stuck in gear." But, whereas an automobile transmission is made of metal and can't fix itself people with OCD can teach themselves how to shift gears through self-directed behaviour therapy. In doing so, they can actually fix this broken gearshift in the brain. We now know that you can change your own brain biochemistry.

The key to the Reattribute step is to realise that the awful intrusiveness and ferocious intensity of OCD thoughts are due to a medical condition. Underlying problems in brain biochemistry are causing these thoughts and urges to be so intrusive. That is why they won't go away. By doing this Four-Step Method of self-directed behaviour therapy, you can change the brain's biochemistry. This takes weeks or even months of hard work. In the meantime, understanding the role the brain plays in OCD thoughts and urges will help you to avoid one of the most demoralising and destructive things people with OCD almost invariably do: the frustrating attempt to "get rid of" the thoughts and urges. There is nothing you can do to make them go away immediately. But remember: You don't have to act on them. Don't take them at face value. Don't listen to them. You know what they are. They are false messages from the brain that are due to a medical condition called OCD. Use this knowledge to avoid acting on them. The most effective thing you can do--something that will help you change your brain for the better in the long run--is to learn to put these thoughts and feelings aside and go on to the next behaviour. This is what we mean by shifting gears: Do another behaviour. Trying to make them go away will only pile stress on stress--and stress just makes OCD thoughts and urges worse.

http://forum.psychlinks.ca/obsessiv...our-steps-dr-jeffrey-schwartz-brain-lock.html

Also:

OCD, for all the suffering it inflicts, is nothing more than the brain doing something it's supposed to do--warning you of danger--but doing it very badly. Living in the world means living with risks: real ones, imagined ones, exaggerated ones. That's not an easy lesson, but it's a powerful lesson--one that, once learned, can offer a paradoxical state of peace.

http://forum.psychlinks.ca/obsessive-compulsive-disorder-ocd/8629-when-worry-hijacks-the-brain.html

 

[Daniel E.]

He's just at least for now adamant to not go in to anything more than to just mention it i.e. "I have intrusive thoughts", then giving him an example and then him saying "OK, the medication and changes in your life will fix that".

That's all?

One way of addressing this concern is asking what the "treatment plan" will be:

At the end of your first session (which should include a diagnostic evaluation), ask the therapist what the treatment plan will be. Make sure the plan makes sense to you. If the therapist doesn't provide you with a cogent, sensible plan, it's probably a signal that you should look for treatment elsewhere.

http://www.huffingtonpost.com/judith-s-beck-phd/the-how-and-why-of-cognit_b_628131.html

 

[AmZ]

Many thanks for your reply and sorry for my negativity.

Regarding the issue of simplicity, especially at the outset, one possibility of where your psychologist may be coming from:... But, certainly, your psychologist should be able to easily address your concerns, and part of having a good relationship with a therapist/psychologist is feeling free to address such concerns.

I'd asked yesterday about pretty much what I have written here and what you said above. I guess he is just taking the simple approach to things and not delving in to my thoughts and when they happen and all of those things. To me, it just sounds like all of these things are being 'swept under the carpet' - To simplify this so much to say that all I need to do is take the medication and go out and make some friends I think is simplifying things a but too much and for me, it doesn't feel good. I don't want to make things more complicated than they are of course, but on the other, I've still had a lot going on in the last 5 weeks (all of the mental things going around in my head and the physical symptoms) - I don't want to rely just on the medication to cover over these things and think that I'm feeling better because of that.

For example, even before meeting with a therapist for the first time, it's more than acceptable to ask therapists which approaches/frameworks they are most familiar with, such as cognitive behavior therapy (CBT).

I don't really know what I 'need' so I don't know what I should/should have been looking for. This is the third psychologist and I'd hate to have to switch again. It's been frustrating already.

About the OCD thing - Thanks for the info. Like I say, the psychologist had said that it was (mild) OCD... No coincidence that the hand thing started when I was 15, at a time when all of the issues I have now had started then. He said that it's no surprise that it's gotten worse now because the heightened anxiety (I see and understand that also), but again, has taken the simple approach by saying that if I've had it for 10 years and it hasn't bothered me, plus once my anxiety dulls down, it will go back to being 'normal' again. (Or what was 'normal' for it before anyway). I'll see how things go in the next week or two and then see about getting it dealt with. It's been worse and in other ways the last couple of days... Doing the counting thing in other ways also, like with tapping my feet and stuff - And it only happens when I'm not doing something, like sitting on the bus for example - Just like when all of this had started, I was on the bus and having the intrusive thoughts... I guess I'd better stop taking bus journeys Whatever, it's do-able for now, there are more serious/important things to sort out for now.

One way of addressing this concern is asking what the "treatment plan" will be

I can ask him this, but he's pretty much, at least up until now given his standpoint already.

He had said that even though that I have OCD, it can be worked on via therapy at a later date if it stays bad or if I decide to work on stopping it - I'm fine with that.
Regarding other stuff, he says that he doesn't see me as having any kinds of 'disorders' and that I'm a 'normal person that has just been affected by their circumstances' - I see that. It's a long story, but I was always in a place in my life where it wasn't where I needed to be, and in being there, I then didn't have any friends really (since the age of 20 probably and since 15 and being in high school things weren't easy also) - So now I am where I want to be, living in a new country and not wanting to be anywhere else (at least that I know), this is why he's just said that I need to build on my life as a whole and go out and make friends and connections.

This is what I've been trying to do up until now (for the last year now since my sister got married and can no longer 'rely' on each other for everything including social-wise) - And now has just built up to this point of being alone basically. Plus losing the other only few close people I had in the past also.

When I say it all like this, it's simple. I think on one hand (no pun about OCD intended) maybe he is right in saying that of course, these 'simple' things can be changed over a matter of a few months if I really work on them (was putting in an effort before but I know not 100%) - But I just don't know, like I say, if all of the psychological things (not the OCD, but the rest of the things) should be felt like they are not being addressed and just ignored.

If I do go along with his approach and keep things simple, I go out over the next few months and make some friends and find my direction in life. I also take the medication which will enable me to do this better/easier as it will calm the anxiety/mild-depression I may still have along the way. Then, once I feel like I am 'happier' in life and have less reason to be anxious, I come off of the medication - My concern would be that maybe this could come back again in my lifetime (whether it be for the same reasons, or for other reasons) and maybe it should have been dealt with more thoroughly in the first place. Maybe I have the type of personality/chemical make-up that could make me more sensitive to this, so I don't know that if in this example of just 'making the life changes necessary' is enough. For now, it could be, but for the future?

Maybe I'll stop calling it mild-depression also and admit the other side of the problem asides anxiety... Reading the articles in the depression section just sums everything up that I am feeling, (plus some):

* Decreased energy
* Trouble concentrating
* Feelings of guilt and hopelessness
* Loss of interest in activities once enjoyed
* Change in appetite and sleep patterns

 

[Into The Light]

it sounds like you feel he's not giving you what you want, which is to look at certain issues more closely. if you have discussed this with him and he seems to not take those needs seriously, then maybe you do need to switch again, as much as you don't want to do that. i had a therapist who didn't seem to want to work with me on issues that i needed to, so i found someone else who did. it is well worth the shopping around.

 

[AmZ]

Thank you for the advice.

I just feel that this is how all of this started, by suppressing my thoughts and keeping them inside of me, so how can I be in 'therapy' now by doing the same thing.