What makes therapy worth it?

October 31, 2008 9:28 AM

New to Therapy: My 3rd and final free therapy session through my company's EAP program is this afternoon, is there some 3 session progress meter I should be looking for to help decide if i want to continue paying for this?

On a particularly 'blah' day i decided to look into therapy. No particular issues are bugging me, maybe a little ennui and some self-image issues, but i can't imagine anything out of the norm for a 30 something big city dwelling single person.

My employer pays for three free sessions, after that it's a $40 copay, which while it won't break the bank, is still $40 for something i'm not sure i need or am getting any benefit from.

The first session was great, i just kind of talked with no real purpose, just told her what was on my mind. It felt very cathartic to tell a complete stranger things i had been internalizing for years and years - lack of spark with my partner, eating issues, feeling that something is 'missing'. She gave probing follow-up questions, and made some sweeping generalizations ("sounds like you like being so nice to people that you get walked on" - which i don't agree with)

Second session was awkward, she just asked me to start talking again, and frankly, i had kind of gotten it all out of my system the first time. I started blathering about my thoughts on politics and my relationships with my family (all healthy)

Before she scheduled the third and final free appointment, she asked me if i felt that therapy was productive, and I honestly have no idea. She said we were 'working through some things' but has yet to tell me what they are, and I'm not sure I want to pay $40 just to talk to a complete stranger about how my week went.

Clearly something is going on enough that i made that first call, and the first session felt AWESOME, but how can I make therapy productive enough to justify both the cost and hour each week in my schedule?

How do I even know it's something i need, clearly she wants my business so isn't exactly a unbiased barometer.

posted by anonymous to human relations (10 comments total)

Therapy isn't like going to the doctor for strep throat -- there isn't a way for the doctor to physically test you to see if you are better.

The generalizations are an attempt to figure out if what you are saying is a one time thing (... i hate when my coworkers ask me to do their work! --- are you always doing things to try to please people? lets work on that) when it might just be a situational or a time time thing.

What do YOU want to get from the experience?

What scale do YOU want to use to determine progress?

No one here will be able to tell you if its going well or not -- nor will your therapist. They can have a hunch one way or the other.

You mention you have "no real purpose" .. and I imagine that isnt so dissimilar from most people -- and it sounds like the therapist is trying to help you figure out why you are there.

Yo may decide that immediately this isn't helpful; and later realize some trinket of explanation for some part of your life -- or perhaps nothing... but either way take it as a small step, not the antibiotic to your strep throat.
posted by SirStan at 9:44 AM on October 31, 2008

Sounds like you like therapy but maybe not this particular therapist.
Try out another, spend the $40, and remember that mental health or just an opportunity to talk things out costs you less than a good dinner out.

If you don't like a different therapist or you feel like you really don't have anything to talk about or work on, then you can just stop going. It's not an all or nothing thing where once you start you have to keep doing it forever.

Try a little more and see if you like someone else.
posted by rmless at 9:55 AM on October 31, 2008

You may just not be clicking with *this* therapist. I used an EAP therapist 7 years ago, post 9/11. EAP therapy is supposed to deal with a short-term or emergency or unexpected crisis, usually. I called EAP because I didn't have the fortitude to start asking friends for recommendations or shopping for therapists, but I knew I needed help sooner rather than later.

In our case it was 5 visits and by then I knew that I wanted to continue, just not with that particular therapist. She wasn't bad but she wasn't great and the location and time were inconvenient. I wanted to find someone who clicked with me more, and at that point I was stable enough to start the process of looking for my own therapist.

It is also very possible that this therapist doesn't "get" you. That happened to me once. Had nothing to do with denial on my part, she just didn't believe me and made her own judgement and it was plain old dead wrong on a factual level.

If she thinks you are working through issues she SHOULD be able to tell you what she thinks those issues are. You may or may not agree with them. But she should be able to tell you what she thinks they are, or what she's heard from you, and also how she plans to work with you moving forward. Those are reasonable questions to ask and she should be able to provide you with answers.

You're not going to know after three sessions if it's helping you. "Productive" is the wrong word to think of in therapy. Sometimes you grow in leaps, sometimes it's crawling, sometimes you slide backwards.

If you want to continue but maybe with someone else, see if there is a therapy referral service in your area. There you pay a set fee - about the cost of one session - to meet with an intake counselor who will recommend three therapists you then get to go sit and talk with. ideally you click with one and work with them. (If you really don't click, they'll send you to one or two more, but three is usually it.)
posted by micawber at 10:09 AM on October 31, 2008

It is also very possible that this therapist doesn't "get" you.

That sounds like the key issue to me. I knew I was going to the right therapist after the first session--I talked and talked, then she made some sweeping generalizations that totally made sense to me, really synthesizing all the various things I talked about. I walked in there feeling like a jumbled mess of contradictions, but she was able, in one session, to make me feel not crazy.
posted by MrMoonPie at 10:14 AM on October 31, 2008 [1 favorite]

You might want a therapist with a different orientation. A cognitive-behavioral therapist will generally help you identify your problems, set goals and make a plan. Psychoanalytic therapy is often much less structured, with the therapist letting the client lead the session. From the sound of your second session, you have a psychoanalytic therapist and want a cognitive one.
posted by futility closet at 11:03 AM on October 31, 2008

Just to play devil's advocate here, but... maybe you don't need more therapy. Maybe all you needed was a couple of sessions to talk through some stuff. You said you got some things off your chest, and that's great. I've been to therapy at a few times in my life for various reasons, and I agree with you in that after a while it can tend to drag on to you talking about your week, or some minor thing. Some people need that, and I'm not knocking that, but if you don't think you do, and you don't want to pay the $40, then I would call it a day.

Therapy can be fantastic, but it's a waste of everyone's time and money if it's not helping you. You said there's nothing particularly bugging you - maybe you should leave it be for now. If in the future you feel more therapy would be helpful, then great, you can go back to her or find a new therapist.
posted by badmoonrising at 11:15 AM on October 31, 2008

I tried therapy a few years ago for similar reasons as you. I kept it up for a few months even though I wasn't sure it was helping and ultimately I stopped going. I didn't feel much different after quitting.

Reflecting on that experience, I would have achieved more if I'd clicked better with my therapist. But the biggest thing I realized is that I needed to apply much more effort in directing the therapy than I did. I went into it assuming it would work like at my GP where I say what's bothering me and the medical professional takes the reins from there. I think that's what would happen for a therapy patient in a crisis situation. But someone who is mostly healthy but trying to catalyze some life change needs to provide the motive force for that change. There's no clear right "answer" a therapist can give you (though a therapist you click with will have better intuition about how to nudge you along). So you have to observe yourself and give a lot of feedback on what's working and what isn't or your therapist won't have much to work with.

If you try therapy again, in addition to looking for a therapist and an approach you like, you could spend the first couple of sessions defining the result you're looking for. Do you want to change or foster specific behaviors? Are there elements of your life that you want to alter but you don't know how to do it? Also, fairly early in the process you should talk about how you'll know you're done. You might agree to checkpoint in two months, for example, and decide whether it makes sense to continue therapy, alter your strategy, or take a break. Or your stopping point might be internally directed, such as when you feel you've explored a set of issues sufficiently well and won't have anything new to discover until you've lived some more of your life.
posted by rhiannon at 11:50 AM on October 31, 2008 [1 favorite]

If nothing's bugging you and you feel better after 3 sessions, why do more?
posted by sondrialiac at 12:04 PM on October 31, 2008

I'm with badmoonrising and sondrialiac: doesn't sound like you feel a need to continue here.
posted by jenfullmoon at 1:10 PM on October 31, 2008

I'd second most of what others are saying about therapist-client fit. I'd also add that it is fairly-common practice to ask the therapist to leave your file open for the next month, and that if you feel the need, you'll be in touch. Then, give it a few weeks on your own, and if you decide that your time with this therapist was more productive than you originally thought, you can return.

As a therapist intern myself (but not your therapist; there's my disclaimer) I have some clients who come every week like clockwork, and some who are on more of an as-they-need-it approach, and they might come twice in one month, and then once the next month. Some therapists get a little funny about keeping client files open too long (due to liability concerns), but many don't mind a few weeks or a month.
posted by cheeken at 6:38 PM on October 31, 2008 [1 favorite]