Reflections on therapy, good and bad

[1sister]

I just want to comment on my experiences with therapy and therapists, and am curious if others have had similar experiences. I don't know how to create line spaces - sorry

Good therapist: the one I'm with now. Two sessions in, but I'm terribly impressed so far. Clinical psychologist - client-centred, solution focused. Why I like her: She has been extremely clear about the process, outlining what outcomes I can expect from the therapy, how long it will last, etc. She's even anticipated potential problems down the line, and described options in terms of dealing with it. Exchanges so far have consisted of focused conversations, anchored in a particular structure, which has also been explained to me. No going off track, waffling, or time wasting on either side (well, a bit on my end, but she took us back to the meat of things). Her questions are logical, and her contributions are insightful and, crucially, ring true - she's nailed a few things that hadn't occurred to me, at all. I feel respected, and have not experienced even a hint of condescension

Other experiences, now.
Psychiatrist, nominally CBT oriented. Preferred to tell stories and jokes and talk *at* me and ramble over doing the CBT we were supposed to be doing. Didn't seem all that interested in my life. Raged at me about a payment, once. Put me on Paxil, which made sense given the thinking of the time; but I experienced all of the side and discontinuation effects, and still resent losing a year of my life to weaning from it. (That's not his fault, I know. I did the weaning on my own, though. Not easy.)

Clinical psychologist, nominally CBT. Initially structured conversations and CBT program degenerated into just talking. Again.

Clinical psychologist, 'ecclectic'. Started off normally enough. Ended when he had to leave town for a family emergency involving serious illness. Insisted on carrying on with therapy through telephone appointments. I had to call his family's house knowing this. I could hear his family in the background

Social worker, can't remember her orientation. Used some version of therapy that involved long, uncomfortable silences, forcing me to talk. I found myself anxious about finding things to say, despite the fact that actual things were going on. Tons of time wasted on this artifice

Counsellor at a university health office (masters level, not sure of precise qualification or orientation). Said I had "just garden variety existential issues", and waved me off with an instruction to take yoga classes. (From my point of view today, I don't necessarily disagree with this at all. But her manner and presence were invalidating. She literally waved me off.)

Here's what I think. All but the university-based counsellor, and my current therapist, were private, solo practioners, who didn't have to report to anyone. No check-ins. No oversight. No handy base of colleagues to go over things with. I think this is not a good thing. I am seeing my current therapist through a program run by a hospital. I think this is important - it keeps her accountable and engaged with her peers in a more direct way than may be available to the independent therapists. She's also comparatively younger, and maybe closer to her training roots. (I didn't expect to find that comforting; I'd hoped for an older therapist with more experience.) I greatly appreciate the structure of this approach and her skill in implementing it

On CBT: I actually think it's not easy to find someone who can lead this effectively. (Conversely, it takes a lot of determination and effort on the patient side to keep at it.) Yes, it's supposed to be the 'gold standard', when done correctly. But there's a lot of work involved in doing it right, on both sides, and I think it's too easy to drop the ball. Can anyone speak to this?

 

[Retired]

I don't know how to create line spaces - sorry!

Use the "Enter" key, equivilant to the Carriage Return on a typewriter.

 

[1sister]

More general thoughts: I believe it offers potential for change, but it's excruciating to find someone competent & 'right for you'. It places the burden of having to be a critical consumer on a person who's already distressed. Confusion around different training backgrounds and methods adds to the patient/client's burden. Not to be ignored are the politics and controversies - around drug treatments, drug research and pharmaceutical companies; around even the definition of mental illness (ie, the very public problems with the DSM-V). Sometimes, I wish the whole tangle would just be dissolved, for a fresh, evidence-based start. ---------- Post added at 11:21 PM ---------- Previous post was at 11:19 PM ----------

Use the "Enter" key, equivilant to the Carriage Return on a typewriter.

Haha! Thank you - I only saw your reply once I'd finished my copy/paste/reply a million times workaround, lol. Will know for next time! edit: although, I could have sworn I'd tried that. Ok, trying it now: test. Edit 2: nope, no go for me. Oh wait! I am using various plugins to disable ad-tracking scripts, maybe one of them's inadvertently blocking html editing on this page.

 

[Daniel E.]

On CBT: I actually think it's not easy to find someone who can lead this effectively. (Conversely, it takes a lot of determination and effort on the patient side to keep at it.) Yes, it's supposed to be the 'gold standard', when done correctly. But there's a lot of work involved in doing it right, on both sides, and I think it's too easy to drop the ball. Can anyone speak to this?

Just doing one thing differently than before is all that is needed sometimes to start the slow, gradual ("baby steps") process of changing the way one relates to the world. In other words, resistance to change is less for things that seem small and gradual.

And one form of CBT that I like:

http://forum.psychlinks.ca/solution-focused-therapy/

 

[Daniel E.]

Confusion around different training backgrounds and methods adds to the patient/client's burden

On the positive side, each therapist or framework provides a different perspective -- a different way of framing one's situation so that it is seen in a larger, expansive context as opposed to the overly self-focused or problem-focused (ruminative) perspective of many people with mental disorders.

In other words, each therapist has a different personality, perspective, and way of interacting but most of them are good at promoting "cognitive flexibility" such as being more open to experience.

 

[1sister]

On the positive side, each therapist or framework provides a different perspective -- a different way of framing one's situation so that it is seen in a larger, expansive context as opposed to the overly self-focused or problem-focused (ruminative) perspective of many people with mental disorders.

That is a virtue of the current landscape, agreed. I just think it takes some familiarity with different approaches to make sense of the options, and that not all clients - including perhaps those who need help the most - necessarily have the background knowledge to make fully informed choices. Or, given any mental illness, the ability to balance trust/engagement with (an unfortunately necessary) critical sensibility. Throw transference issues in there, and the inevitable discomfort around change, and things can get very muddy. Plus, the reality is that as with every profession, therapists may be more or less skilled, experienced, naturally talented...

I kind of think that therapists of all stripes should be mandated to at least offer some kind of informational pamphlet, or something, around the rights and responsibilities of both clients and therapists.

 

[Daniel E.]

not all clients - including perhaps those who need help the most - necessarily have the background knowledge to make fully informed choices.

In the UK, for example, the libraries offer extended book loans for mental health books:

In the U.K., where the wait for professional treatment can stretch six months, the national health system has embraced bibliotherapy as the first line of treatment for non-emergency cases. The program varies but in most parts of the country, health officials have approved a list of about 35 books that have been stocked at local libraries. Seekers of non-emergency mental-health services receive a prescription enabling them to check out a book without a library card and for 12 weeks, four times longer than other books.

http://forum.psychlinks.ca/therapy-...herapy-reading-your-way-to-mental-health.html

A classic self-help book on CBT that is still a bestseller is The Feeling Good Handbook.

 

[David Baxter PhD]

Oh wait! I am using various plugins to disable ad-tracking scripts, maybe one of them's inadvertently blocking html editing on this page.

That is quite possible. This site relies on JavaScript and Ajax and ad-blocking may well disable those features, with the result that you cannot use many features of the forum.

 

[1sister]

@Daniel - I'm positive you're right that baby steps are key to change. I can see how solution focused therapy is a kind of cognitive behavioural therapy.

I suppose I was thinking of the sheer laboriousness of (especially written) CBT homework; it's hard work countering very specific, idiosyncratic core beliefs, as they occur in real time, with appropriate attributions and realistically hopeful affirmations. And investing this process with genuine emotions (particularly the affirmation part), vs intellectualizing things, or just glossing over them...

I feel that in real life situations outside the therapist's office, things happen too quickly to do this effectively (or convincingly, if in the grip of a really foul mood). Maybe this says more about me than the technique, but I can't imagine going through 12 weeks of full compliance. (Though apparently there are now IPhone apps that are meant to expedite the process...)

I have found that reading about attribution and explanatory style in a more general way has helped to recognize my unhelpful patterns, though imperfectly. (Though of course I could be wrong - it might be that my previous therapists were more effective than I now think.)

With regard to the UK bibiotherapy program: I really like that idea. I wonder though whether it might be most attractive to people already on a search, who may be inclined that way (perhaps ruminative types, already possessing a fair degree of insight, etc)...

Re just general background knowledge, I can think of a number of people who are open to 'therapy', but may not be inclined or have time to read (not just about CBT, but all the others listed in the forum) in a way that would prepare them for the kind of critical evaluation I suspect is important in avoiding bad or even just ineffective (and costly) therapy.

Thank you for the recommendations; the Feeling Good Handbook in particular seems to enjoy wide support.

---------- Post added at 02:54 AM ---------- Previous post was at 01:56 AM ----------

Would like to add that I think I often benefitted from, at the very least, optimism about my general capacity for change, and validation at points in my life when it wasn't coming from other places. That's definitely worth something.

But as far as helping with eg anxiety and depression, in an enduring way, across a range of situations... I feel I got the most lasting results from real world events outside the therapist's office, none of which had much if anything to do with the explicit content of sessions. And, just being frank here, as far as those kinds of outcomes go, I cannot say that the specific therapeutic experiences I had worked all that well. For a range of reasons, probably.

FWIW, though, I have read convincing studies that suggest that therapy can be a very effective treatment for many mental health issues, at least as good as drugs, in the short to mid term (not to say longer term effects mighn't be effective; just can't think of many studies that look at outcomes eg 3-5-10 years out). Also that the actual mode of therapy appears not to matter all that much (for depression).