What should you expect from therapy?

So I've supposedly been in therapy for over a year now. I don't think there's been any measurable improvement. It's once every two weeks, one hour. It's supposed to be CBT, but all we do is casual talk and scheduling. I am not sure if it's me or what, but I don't feel it's working. What should I do? I ask this because therapy keeps on being mentioned when I say anything.

edited 3rd May '11 7:57:44 PM by LoveHappiness

"Had Mother Nature been a real parent, she would have been in jail for child abuse and murder." -Nick Bostrom

It is very hard to give constructive advice without knowing the details, but as a general rule, you should not be doing something if you do not feel it is worthwhile to you. Unfortunately, perceptions of effectiveness of therapy can be quite variable in their accuracy.

So...yeah, good luck. I wish I knew some right answer to give you.

edited 3rd May '11 7:54:14 PM by blueharp

I suspect there are better alternatives to CBT. Music, aroma, plain old love, exercise.

"Had Mother Nature been a real parent, she would have been in jail for child abuse and murder." -Nick Bostrom

See if there's a referral service where you live and find somebody new then.

Well ideally you should be talking about things that bother you, the really deep, painful stuff. If the conversation seems trivial, it might not be working (IMPORTANT NOTE: Not a psych-anything, except maybe fan.)

It's possible a different psy...chiatrist, chologist (?) might be of more help. I know a guy that didn't get anything out of therapy until he got a female therapist, make of that what you will...

Of course if you do switch, don't give up on the new one too fast.

edited 3rd May '11 8:34:05 PM by deathjavu

Look, you can't make me speak in a logical, coherent, intelligent bananna.

^ Very much this. If therapy is easy, it's probably not very effective. If your therapist isn't pushing you into areas you don't really want to go at least part of the time, he probably isn't helping very much.

Anecdotage: I tried three different therapists before I found one who was what I needed. It was a straight-up Goldilocks situation: the first didn't push enough. He let me dodge things I didn't want to think about. He was "Too soft." The second pushed too much; she didn't let up when I said, "I can't go there yet. I'm not ready to look at that right now." She was "Too hard". The third let me come at things at my own comfort level, until it became clear that I was circling something without ever coming any closer to looking at it. Then he pushed — "Dammit, [name], you've a dozen different synonyms for 'angry' so far today, and you won't say 'angry.' Why won't you use the word 'angry'??? Why are you afraid to say 'I'm angry'?" He was "Just right." Working with him, I accomplished far more in six months than I did with the other two in nearly a year.

edited 3rd May '11 9:02:24 PM by Madrugada

...if you don’t love you’re dead, and if you do, they’ll kill you for it.

just to give a slightly counter point of view, if therapy is dragging on, or just not working, or just going in the wrong direction, there's no reason to stick around either.

Therapists are human, they can be wrong, they can go in the wrong direction, and while ideally they would recognize that, sometimes they won't, so...don't feel ashamed to trust your judgement when you want to walk out.

It is a case of walking the edge of a knife though.

^^^ I'm actually not surprised about how your associate found a woman therapist more effective, having had similar feelings myself when going about therapy again. I think more places are catching on to how important that might be these days: I've been asked, when possible, whether I'd like to see a man or a woman quite a few times now. I don't really have an explanation for this. Personal preference is one thing, but I think putting the nature of your issues into account is also crucially important.

^^ I really like that way of going about it. I think the best therapist I ever had knew beforehand that getting me to talk about things wasn't exactly going to be easy, so she got quite creative about it. Some things she tried ended up less effective by design, but that was just the nature of those sessions, and I find it useful to remind myself that therapy is never supposed to be providing an easy way out through clenched teeth. I like to think that she had a sense of when something was inevitably less inviting to me though, so it was worked around.

I'd definitely back that "Goldilocks" method OP.

Have you raised these issues with the therapist? What did the therapist say?

For one, have you brought this up with your therapist? And for two, therapy is like medication. Just like you have to find an antidepressant that works with your body chemistry, you have to find the right counselor to fit your personality. Most people have to go through several therapists before they find one that works. Also, you have to feel comfortable talking about your problems with them. When s/he asks you questions, do you feel like you can answer honestly? Are you avoiding bringing up things that you think are "wrong"? Do you worry about the reaction you'll get?

Also, you've mentioned that scheduling takes forever (multiple times in various threads). I'm curious as to why. Do you have some sort of difficulty in making it there? Is the counselor overworked and trying to squeeze you in?

"I don't know how I do it. I'm like the Mr. Bean of sex." -Drunkscriblerian

Psychiatrists are MDs, they can proscribe medication and the like. Psychologists are PhDs, and normally more geared toward providing therapy and the like, but aren't medical doctors like psychiatrists.

[/The More You Know]

edited 4th May '11 9:08:25 AM by NativeJovian

Really from Jupiter, but not an alien.

I don't seem to benefit from therapy either. In my case I attribute it to being autistic - the therapists are assuming things about how their patient's mind will work, and mine doesn't work that way. (For example, CBT utterly fails because my verbal thoughts are simply narrating nonverbal thoughts/emotions, and have no power to actually affect them in any way.) Whereas those psychologists who are familiar with autism only know the misinterpretated results from studies (for example, thinking autism is 'weak central coherence' based on high Block Design scores) and want to fix my autism rather than helping me with my real problems (PTSD etc).

I've found self-therapy useful, using books like Courage to Heal. And art therapy, though I've never been able to find a regular art therapist. I also found a book about a kind of therapy I'd probably find helpful, but it's only done by this one therapist in England, so I doubt I'll ever receive it.

Therapy isn't essential to recovering from psychological problems, just really helpful. It's especially good if you don't have much self-awareness, but that also makes it harder to tell if you've found the right therapist for you. What is essential, I think, is having healthy, supportive relationships with at least one other person. A good therapist can provide this for someone who has no one else like this in their life. For me, I have several people (my parents and younger brother) who provide this, so I don't need therapy to heal.

If I'm asking for advice on a story idea, don't tell me it can't be done.

That depends wildly from person to person, and it depends on what disorders are present. In your example, PTSD is indeed something that doesn't always require outside help to resolve or cope with. Someone with severe depression isn't going to be able to make the first steps on their own due to their disorder. For them therapy is essential, since it's very complex and requires someone who has experience with counseling people. Same goes for a lot of disorders, where the very nature of the problem prevents the first steps towards getting better.

Since LH is on various medications, therapy would be something I consider essential. Since the point of medication is to change chemical imbalances that are a barrier to getting better, the therapist has to be there to monitor the situation, since some medications work, some don't, and some make it worse. A stable brain (chemically speaking) is needed to build the groundwork of change.

"I don't know how I do it. I'm like the Mr. Bean of sex." -Drunkscriblerian

If you don't like a single Frank Ocean song, you have no soul.

I think a lot of the benefits of therapy are from simply being able to talk about things that are considered unacceptable in mainstream society. For some of my issues, I never needed therapy—I just needed the Fetishes thread.

That's Feo . . . He's a disgusting, mysoginistic, paedophilic asshat who moonlights as a shitty writer—Something Awful

I did know that, but the OP didn't specify which they had.

Look, you can't make me speak in a logical, coherent, intelligent bananna.

I have a psychiatrist. I also have a therapist, their creds I'm unsure of. From what she's said...I don't think so...

"Had Mother Nature been a real parent, she would have been in jail for child abuse and murder." -Nick Bostrom

If you're paying for the therapy, she's got to be a licensed psychologist or psychiatrist with a degree and all that jazz. It's a legal thing.

"I don't know how I do it. I'm like the Mr. Bean of sex." -Drunkscriblerian

If it's someone separate from your psychiatrist, and any amount of your health insurance is paying for it, I'm assuming a psychologist.*

Well, if all that's happening is casual talk as you say it is, the problem may be that whatever treatment that's supposed to be happening isn't, well, actually happening. Has your psychologist outlined how the procedure is supposed to work to you? Do you know what specifically you're going to therapy for (Depression? Anxiety? PTSD? Thoughts of suicide and/or self-mutilation? All of the above?). Does the psychologist regularly try to bring up or address the issues you came to her with and, if so, do you openly talk to her about them? By casual conversation, do you mean "So, what did you think of the most recent ep of Doctor Who?" or "So, how well would you say your current situation at home is going?"*

It also simply might be the sort of therapy itself. CBT's a broad category with a lot of methods under it (clicky and clicky again). It's possible that you might need to try out a different method, a different therapist, or both.

edited 5th May '11 8:41:10 AM by Sparkysharps

^^ Nope. "Therapist" doesn't require a Ph D. An MS is enough to rate being called a therapist, and whether you're paying for it or not doesn't matter.

...if you don’t love you’re dead, and if you do, they’ll kill you for it.

Sorry, should have been clearer. I meant degree as "someone who's been through formal schooling and graduated" as opposed to "some hackney off the street".

"I don't know how I do it. I'm like the Mr. Bean of sex." -Drunkscriblerian

^ A social work degree can also qualify you to do therapy in some cases.

If I'm asking for advice on a story idea, don't tell me it can't be done.