My ongoing therapy dilemma

[Daniel E.]

And I wonder whether I'd just encounter the same problem with a different therapist... by being so guarded that it makes a connection impossible, while simultaneously really wanting a connection, and hating myself for wanting something disgusting and impossible. :facepalm:

Of course, it is human nature to prefer a well-defined problem -- one you are already comfortable with (the devil you know) as opposed to free-floating anxiety/uncertainty/vulnerability.

e.g. I consider my OCD as a bad coping mechanism for the underlying anxiety -- a way of trying to rationalize the irrational.

 

[Daniel E.]

"And I wonder whether" reminds me of "what if" as in what-if thinking. (On the positive side, what-if thinking seems good for fostering creativity/design.)

 

[gooblax]

This just seems too sad and impossible. I want to prepare something for the session but I don't know what. I want to raise the topic in an email so I don't chicken out and pretend everything's fine but I don't even know what to say there.

 

[David Baxter PhD]

Instead of thinking about it as "preparing for the session", try making a list in point form of questions you would like answered and things you would like to change.

Don't worry for now about whether he will ever see the list. Just make it.

 

[Daniel E.]

Say Anything

 

[David Baxter PhD]

From that Ryan Howes article in the link @Daniel posted:

Therapy is one place you can talk about anything you want. There's no need to censor yourself, be overly polite or avoid conflict. Still, many clients have a lot to say and don't. Why?

I've heard a ton of complaints about therapy. Friends, acquaintances and strangers upon learning I'm a shrink spill their guts about the misunderstandings and miscommunications they've experienced in their own therapy. Things like "I don't see her point" and "why would he say that?" and "what does she think about me?" and "I hate the way he clears his throat." I always respond with the same question: "Did you mention this to your therapist?" Unfortunately, the typical answer is no.

Throughout this blog I've done a lot of talking about client empowerment and helping people get the most out of their therapy. One key point is this: if a problem arises in therapy - talk about it. Unspoken questions/gripes/concerns result in wasted time and money, unnecessary frustration, and may even draw therapy to a premature end.

What kinds of roadblocks am I talking about? How about when your therapist:

• says something that makes no sense to you
• tends to be late for sessions
• made a face, gesture, or comment that brought up a strong emotion for you
• has an annoying quirk
• is taking therapy in a direction you don't want to go, or don't understand why
• seems too chatty, or says too little
• reminds you of someone you love or hate
• didn't seem to get your point
• looks like he's got something else on his mind
• etc.

The list could go on and on. Basically, any time something occurs and you feel like talking about it, you should feel free to do so. This is easier said than done.

For example: my client Jane was upset with how the last session ended. She gave me a compliment as she walked to the door and I didn't seem to acknowledge it. My "stoicism" is frustrating for Jane, and she has been thinking about this all week. In fact, she's frustrated with a lot of things about me: I don't make small talk with her, I don't offer up a lot of details about my life, and when she asked me a direct question about her boyfriend I didn't give a direct answer. She's been talking a lot with her friends, griping about me and therapy. But when she shows up for our session, I hear nothing. She's ten minutes late and seems a bit reserved, but when I ask if there's anything wrong she says no and launches into a recap of her week. When we end this session, I have a vague feeling something isn't clicking between us, but I have no idea what the problem is.

There's so much great material for us to dive into. We could explore why she feels frustrated and how she copes with disappointment, find other places in her life where she feels similarly, examine how she tends to react and when she learned to respond that way. We might discover that what she is feeling in therapy is similar to how she feels in many relationships - frustrated with others for not giving enough, frustrated with herself for needing too much. We could see how her past contributes to this frustration, and how some of her thoughts and behaviors perpetuate it. We could crack this case wide open.

But not if Jane doesn't talk about her frustration, we won't. Not today, anyway.

Many clients do feel free to vocalize their questions and concerns, but certainly not everyone. Why not? Here are some possible reasons:

Confrontation is scary: Telling your therapist his interpretation makes no sense, or you think he charges too much, or you're afraid he's falling asleep is a confrontation. I'm not surprised if it raises your heart rate a little. But keep in mind a few things. By telling the therapist how you feel, you're giving him more information about you, helping him to understand you better. Also, facing conflict may be a part of your problem, and therapy can be an ideal laboratory to learn to practice confrontation in a healthy way. Finally, you're the customer, and if you're not getting the service you want you have every right to speak up. Most therapists know how to handle confrontation in a non-reactive, non-defensive manner. And if they don't, you can always take your business elsewhere.

"She's the expert:" Some clients keep quiet because they figure the therapist must know what she's talking about. Who are they to question someone with a doctorate and years of experience? So the therapist continues to use jargon and miss the point and the client feels increasingly lost. Yes, therapists have a certain amount of clinical expertise, but if you're not tracking with her, then she has yet to attain expertise in communicating with you. By speaking up, you're teaching your particular owner's manual - the ways in which you learn, communicate and relate the best.

It's impolite: You may be going against the etiquette you use at dinner parties, church or the courtroom - but therapy doesn't play by those rules. The purpose of this time is better understanding your thoughts, feelings and behaviors, which occasionally means talking about issues you would overlook in other social situations, particularly the ones that create a visceral reaction in you. I'm not suggesting you mock or act blatantly rude to your therapist, just say what's on your mind.
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Vented already: Jane had plenty of gripes about me, but after venting to her friends for a week the issues didn't seem as pressing. Sure, she was still upset, but by blowing off steam the issues weren't urgent enough for her to confront me. Sometimes it's best to keep the energy of these minor frustrations between you and the therapist, rather than dissipating them by running them by the committee. Certainly, for major conflict (to be discussed in a future blog) a second opinion would be warranted; but the minor frustrations mentioned here are best handled directly with your therapist.

Ignore it, it'll go away: They say the little things that bother you early in a relationship tend to grow into big things later on. This is true for all relationships. Whether it's your second session or 200th, if there's something bothering you I encourage you to bring it up.

I already did: You've already told your therapist you need to end on time because you have to return to work, but he keeps letting the session run over. You're afraid to bring it up again because it feels futile. If it's a problem that is getting in the way of your work together, I suggest you bring it up again. Therapists are human, with as much fallibility and forgetfulness as the next person. There's a chance this reminder might help you get the desired outcome, or perhaps you can find another solution together (set an alarm?). Either way, you've taken care of yourself by talking about it, as uncomfortable as that may be.

Need help getting started? Try this:

"I'm a little uncomfortable bringing this up, but when you _____, I felt _____."

Hopefully you'll see it's not so bad. At the very least, you've spoken up, faced a fear and gotten something off your chest. At best, you've taught the therapist something about you, initiated a change in the therapy, and created an opportunity to learn more about yourself.

 

[gooblax]

Ok, I've got somewhat of a list now.

It's not that I'm unprepared to share uncomfortable stuff with him like that article. It's just that there's so much stuff and not enough time and I don't know if he understands any of it.

 

[gooblax]

Depending on how this week's session goes, I've picked out one new therapist I could try. It would take over an hour to get there so I'd have to pay the after hours surcharge or just video with them too.

 

[gooblax]

Back in "maybe just quit altogether" headspace.
I practised saying the stuff out loud (looking in the mirror) a couple of days ago. I just don't know what will be the least-worst option, or what I'll even end up saying tomorrow afternoon.

 

[gooblax]

OK, so...
I had the session and quickly got to the topic. I asked if he had a plan to help with the stuff, he described his plan, and it didn't include stuff for the current main problem... So I mentioned that it was missing something and gave some hard specifics of the missing problem (# times I think about him, how sometimes that makes me sad now especially since the careless sentence, sometimes look at photos, how the "therapeutic relationship" is a near constant source of angst for me etc.).

He actually seemed to understand and have some ideas (although he started suggesting an idea which I had literally just told him that I'd tried... But I told him that I'd already said that and we moved on).

I mentored that I'd been wondering to myself if he can actually help with what I need, if someone else would be able to give me what he can't, if no one can. That I think that he would think my feelings to be disgusting, that I don't feel like my feelings (about anything) are really welcome in the session. That he'd prefer for my session slot to go to a client he likes better.
He said if I want to stop seeing him, he'd like to help me choose a different therapist, but doesn't want me to make that decision based on what I think he thinks without asking if he does think that. That my thoughts/feelings are welcome, and he doesn't "think of it that way" regarding it being pathetic and disgusting.

I asked him why it took 2 weeks for his office to get back to me when I first asked if he was taking Skype clients, and explained how it affected me (and totally derailed my intentional step by step decision making process), again with specifics. He apologised, said it wasn't very professional, and said he was going to look into what happened around that time cause he didn't remember why it would've happened other than being busy up to Xmas.

All in all, it was the most emotional session I've had and it ended up OK. I'm still going to keep seeing him but I think I'll identify to him what I've learned from this:
- that if I develop a more intellectual explanation of something, he doesn't understand it as well as he does if I have a cry over specific details in front of him (even if he maybe thinks he understands the first one, it never seems to be in a way that prompts him to respond as helpfully)
- that sometimes he either forgets stuff or doesn't absorb it properly, and I don't mind reminding him sometimes (because forgetting stuff is normal) but it's hard to know what he's forgotten/not-absorbed (eg. somehow he didn't realise I played guitar, despite me mentioning it once and then a separate instance where we had a discussion about me playing guitar and piano. It also took 3 mentions across 3 sessions to sink in that I played piano.) and sometimes that's probably a factor of how I explain things (especially if I intellectualise it instead of having a sook as above) so if it's an important topic/statement for me I might sometimes ask him to summarise what he thinks he understood and we can confirm if it's right and absorbed and he can write it down if needed

Plus I have some things to clarify, but at this stage they don't seem all-consuming like they sometimes do.

 

[David Baxter PhD]

Well done @gooblax

Very well done.

I know that must have been very difficult. But you did it! Excellent!

 

[gooblax]

Thanks @David Baxter. Having the list that you suggested was really helpful.

 

[gooblax]

I've been thinking about last session and I think the thing that was the most reassuring was that he didn't just say something like "OK whatever you want to do, up to you" as if he had no interest whatsoever in being my therapist or how I experience things with him. That's been how it's seemed to me a lot of the time and I'd been having trouble holding onto evidence to the contrary so it was good to experience something different. I guess I have to try and relax about things and bring it up with him when I get stuck on something like this again.

 

[gooblax]

I'm so sick of feeling sad about "stuff" with my therapist. I started out this morning just feeling sad in general, transformed it into sad about therapist stuff, but am feeling better after making some progress at work while the office is quiet.

Part of my therapy homework to try and stop getting sad about it is to try and define what role I want my therapist to have in my life. But that's a hard one when my automatic response is "for him to realise how much of a **** I am and hire an assassin to take me out" or similar. The only way to approach the question, without rejecting the question itself due to it being disgusting, seems to be:
- Think of "therapist" in a generic sense, and not the specific person.
- Think of myself as someone else, rather than me, i.e. what would I want someone else's therapist to be for them?

 

[Daniel E.]

Think of myself as someone else, rather than me, i.e. what would I want someone else's therapist to be for them?

Of course, we all have different needs, including different needs over time. There was one guy (a therapist himself) who wanted his therapist to read to him since he wasn't nurtured much as a child. Some people need to vent -- like taking out the garbage And some people need a different perspective, etc., as an alternative to their negative/constricted thinking.

In any case, arguably what people need the most is a client-centered approach:

The primary technique of client-centered counselling is to actively listen and reflect the client's statements in a non-directive, nonjudgmental manner, thereby providing a safe environment for the client's self-exploration. Client-centered counseling hinges on the development of a counselor-client relationship based on unconditional regard, often over multiple hour-long sessions. This relationship enables the counselor to clarify the client's feelings without imposing external assessments or values. (Sheon, 2004)

What is Client-Centered Therapy?

 

[gooblax]

Thanks @Daniel, yeah I get that different people want/need different things but I'm hoping if I can at least start with something positive (rather than a bunch of negatives or "well I shouldn't want anything from anyone, I'll just be disappointed and hurt")... Then maybe I'll at least have half a list of things applicable to me. Some things might not be applicable but if I start crossing things off I think I'd end up back at the start.

 

[Daniel E.]

something positive

 

[Daniel E.]

Ideally, the therapist models all that good stuff (the various aspects of being a fully functioning/growing person) and so is a mentor or role model in that respect, as in social learning theory.

 

[gooblax]

I'm definitely back to the self-initiated therapy/therapist angst. I was listening to a podcast where they typically link these sorts of feelings with "relational trauma" and while I may not relate to that term I do relate to their descriptions of the daily pain of therapy ruptures etc.

I hate that I like talking to him and wish I could just turn it off so I wouldn't think about him anymore.

 

[Daniel E.]

and wish I could just turn it off

One of my OCD symptoms was relationship OCD. A basic formula for anxiety anyway is something you care about + low tolerance for uncertainty (as in uncertainty avoidance and ambiguity aversion).