Therapy - is it worth doing for me? (long)

September 14, 2010 5:45 PM

Therapy - is it worth doing for me? (long)

Therapy - is it worth doing for me? (long)

I've been depressed for around 15 years and had anxiety for the last year (see my question on work anxiety). I've been on five or six different anti-depressants but haven't found they helped. I had three months of email therapy with a counsellor with a Person-Centred approach, and also had two face-to-face sessions with her; this counselling ended suddenly six months ago when the counsellor gave up her practice. I've tried CBT on my own using Feeling Good and got stuck. I have, I think, problems with wanting to help people (co-dependency) and fear of close relationships unless I can do so, and some issues about responsibility and boundaries.

Last week I saw two counsellors each for an introductory session. One describes herself as psychodynamic and the other as integrative with some CBT. Neither felt right. What I'd like to know is whether that is because those particular therapists were not right or because therapy is not right for me at the moment. The reasons I can identify for them not feeling "right" are:

- I did ask both about their therapeutic approaches but they didn't answer with much detail (and I wasn't confident enough / couldn't find the words to ask further);
- I found some of the things they said a bit clichéd or reductive (therapy is a space just for you; you are too self-critical);
- both misunderstood some things I said (though I accept that if this had not been an introductory session I'd have tried to repair these misunderstandings);
- neither tried to get a sense of me apart from my problems (my goals and interests etc);
- I couldn't get a grip on how they would help me to change how I feel, apart from identifying patterns in my behaviour - I feel like I can identify these already;
- both said I didn't seem to have a sense of myself, which feels untrue to me - I feel like I have a very strong sense of myself;
- both seemed surprised and faintly judgemental that I am not interested in getting to a place where I could look for a romantic relationship (though I accept I may have read in some of this);
- neither mentioned that they have supervision, although as we discussed confidentiality it would have been natural to do so - am I wrong to assume all therapists also have supervision?
- I tried to end both sessions by saying, effectively, "you've heard my problems and what I'd like to achieve through counselling; do you think you can help me?" I found this difficult to say and probably didn't articulate it very well, but I was disappointed not to get any real response from either counsellor. What I was hoping for was a sense that they had listened to me and made an assessment of whether we could work together to change things, rather than the decision being solely about my view of them.

I had drawn up a list beforehand of things I would like to get out of therapy:

- being able to get to work on time (I should say this is better since my previous question, but still an issue);
- feeling less anxious at work, especially around meetings and management tasks;
- to feel less lonely;
- not to feel as depressed as often as I do now;
- to be more self-disciplined (by which I mean that I know there are things that make me feel better, such as being more organised or doing things I enjoy, but find it hard to make myself do these things);
- not to go over and over things from the past (mostly relationship stuff);
- not to be so needy towards friends;
- to respond more calmly to criticism or rejection.

I read the list to one of the counsellors and mentioned some of the items from memory to the other. The email therapy I had before made me more aware of some of my issues but I'm not sure it helped me to feel any differently. That counsellor was not hugely experienced and I think this was the first time she'd done email therapy - factors which made me, this time round, look for experienced counsellors.

I talked about these introductory sessions to a friend who has a fairly good knowledge of counselling. She said that it would be difficult for me to find the right person because of my cleverness. Apologies if that sounds arrogant - obviously intelligence is not doing much good in sorting out my feelings. She said I'd need to find a counsellor who was pretty bright. I'm a bit sceptical about this as I know two women who saw couples counsellors as part of marriage breakdowns - both of their husbands used "the counsellor is not as clever as I am" as an excuse for not engaging in counselling.

So, my specific questions are (sorry, this process has sent me list-mad):

- given what I've told you about what I'm looking for in counselling and my experiences of these two sessions, is it worth me starting counselling with one of these people?
- what is the etiquette around exploring some of the concerns I have mentioned above with the counsellors by email before committing to seeing them again? I don't think I would feel comfortable going for second introductory sessions, but I realise if I ask questions by email they are working without payment.
- if your view is that it isn't a good idea to go with either of these people, is it worth looking for someone else? (There are not a great many options locally when I've ruled out less-experienced counsellors.)
- is this thing about finding a "clever" counsellor valid, and if so, is there any way I could maximise my chances of finding one?
- are there any books, techniques or resources you can recommend about how to get the best out of therapy?
- if I don't commit to therapy, is there anything else I've missed that could help me? I think I could do some more work around keeping a journal; I know exercise is good for depression but have great difficulty doing any.

I should also add that money is a factor in my current rather negative feelings about therapy - these people charge £50 and £40 for weekly sessions respectively, which is a lot to commit to if you don't feel hugely positive about it (I don't qualify for sliding scale fees). I also know from short periods of therapy years ago, when I was first depressed, that if one comes out from sessions feeling one wasn't able to communicate exactly what one means, or feeling compelled to go along with positivism from the therapist, it can make one feel worse (though I accept that ideally if these things happened one would be able to explore them with the therapist).

On the other hand, I know that for the last year or so I've been seeing the possibility of therapy as a kind of last resort, and that if I decide not to see one of these people without having another plan I will feel pretty low and hopeless. I will also feel guilty about friends to whom I have talked about the possibility of therapy and who may feel, possibly rightly, that I will behave in more needy ways towards them if I don't have outside support.

This is an account specifically to ask this question. I will check MeMail for this account and can also respond in-thread if necessary. I am particularly interested in hearing from people who have experience of counselling either as therapists or clients.

Thank you for reading this.

posted by stichomancer to Health & Fitness (9 answers total)

Obviously a therapist would say that you're hunting up reasons to dislike these people because you're afraid of digging into painful underlying emotions. That's a total cliche, but I think it might have some merit here.

I think it's perfectly appropriate to go therapist shopping. But beware of being too critical in your judgments against them. Or rather, beware of why you're being critical in your judgments against them.

To be honest, it sounds like you're coming on pretty strong. That's fine, but what you need is a therapist who can accept and work with that. I think that's a better trait to look for than "clever," which is vague (and possibly unhelpful) in this context.
posted by ErikaB at 6:10 PM on September 14, 2010 [1 favorite]

I, too, have tried many different prescription medications over the past 10 years. None of them worked well enough and all had serious side effects.

Easily the best thing I've found is St Johns Wort. Sounds hokey, I know. But there are many, many solid, double-blind, placebo-controlled studies on the efficacy and safety of St Johns Wort. A search should yield a lot to read. I highly recommend doing the research and then buying some to try it out. You'll need to take enough, though.

The only negative side effect I experience is slight constipation. A contraindication for St Johns Wort is that it will increase the activity of a specific enzyme which metabolizes certain medications, causing those drugs to be removed more quickly from the body, reducing their effectiveness. So if you're on those medications, the St Johns Wort probably isn't ideal. Check Wikipedia for a list.

I take between 6 and 10 300 mg pills per day when I run out of a liquid formulation. My 8 year old son who has a personality exactly like mine takes 1 or 2 pills per day.

Personally, I don't like therapists. It's too difficult to find a good match when you're at least as intelligent as they are and you aren't afraid to question things.

You know you're f-ed up. You just can't control yourself. Many of us are born fragile, not stout enough to cope readily with the modern, insensitive, depersonalized world. For that, we need help.
posted by muzzlecough at 6:21 PM on September 14, 2010 [1 favorite]

The impression your post leaves is that you are actively coming up with reasons for these therapists to not work for you. I'm struck by the fact that my counselor essentially ended our introductory visit with a similar question, more or less "you've seen and heard my approach, do you think it will help you?" The subtext is that the counselor can't bring the engagement and commitment to the process, only you can.

If you want to get this sort of help, you first need to commit to that, and then recognize that the most you can do is find the best counselor available, who will also be an imperfect human being. I don't think there is anything at all wrong with calling them and saying "I'm not sure I got what I needed to decide to work with you out of my first session, do you mind if we schedule another where I can ask a few questions and we delve a bit deeper?" I don't think you'll get what you want out of e-mail.

I don't think "cleverness" should be part of the discussion. Put it out there if it is a concern and ask the counselor to stop you if you are using 'clever' to get around dealing with your issues. My entirely untrained guess is that clever only really comes up if you are using to evade discussing what is up for discussion. If you are being open and honest about yourself, then clever will only help you express your genuine feelings more clearly. If you do find you are able to use 'clever' to trick your counselor then you can at least recognize youa aren't getting what you paid for and either decide to stop, or try to change. Again, just putting it out there and asking the counselor for help on it is my recommendation.

tl;dr
Don't start therapy until you are ready to give it an honest shake. Then commit to it and commit to telling your therapist about any doubt, distrust or disappointment you have about the therapy. It will quickly come around to whatever it is that is setting your expectations and at least give possibility for positive outcomes.
posted by meinvt at 6:42 PM on September 14, 2010 [2 favorites]

Frankly, it sounds like you are over-analyzing this - I'm curious as to why - is it really about the money? Or are you reluctant to try therapy? It just sounds like you have picked out so many reasons as to why these experienced therapists might not be right for you. Cliches are cliches because they also happen to be true - therapy is a space for you, the fact that it's a cliche doesn't make it less true, or make the therapist less qualified for having said it.

- given what I've told you about what I'm looking for in counselling and my experiences of these two sessions, is it worth me starting counselling with one of these people? >>>Yes, most of your experiences described seem perfectly normal for an introductory session. In fact, I think it accurately describes my first session with my therapist who I successfully saw for over a year. It's natural to have a less than perfect feeling, therapy is a process, the first day is only the very tip of the iceberg. I would at least try 3 or 4 sessions to really give it a chance.

- what is the etiquette around exploring some of the concerns I have mentioned above with the counsellors by email before committing to seeing them again? I don't think I would feel comfortable going for second introductory sessions, but I realise if I ask questions by email they are working without payment.>>>The etiquette is: do what you need to do. Print out this list and show it to them, or email them if you want. If they aren't willing to answer you via email for money or other reasons, they will say so. Um, the hard part and best part about therapy is bringing up the things YOU want to talk about - so you might as well start with your list of concerns, face to face with either person.

- if your view is that it isn't a good idea to go with either of these people, is it worth looking for someone else? (There are not a great many options locally when I've ruled out less-experienced counsellors.)>>>It's worth it, whether you continue with these two or not.

- is this thing about finding a "clever" counsellor valid, and if so, is there any way I could maximise my chances of finding one?>>>I don't think it's valid. How do you define cleverness? Intelligence? Wittiness? Feeling like the other person "gets" you? There are so many variables here.

- are there any books, techniques or resources you can recommend about how to get the best out of therapy?>>>Doing it is the best way to get the best out of it, just give it a chance, be open and see what happens.

- if I don't commit to therapy, is there anything else I've missed that could help me? I think I could do some more work around keeping a journal; I know exercise is good for depression but have great difficulty doing any>>>Therapy can help you get better at doing things that you have great difficulty doing. Otherwise you'd be doing all those things and not considering therapy.
posted by Locochona at 6:52 PM on September 14, 2010 [1 favorite]

This may sound flip but if I were your prospective therapist and you asked me if you thought I could help you (based on the info you posted) I would be very tempted to say: "Since you know exercise is good for you, and there is no physical reason why you cannot exercise, come back after you have exercised 1/2 hour 3 days out of 5 and we will discuss it." "I will do my very best to be helpful but I need to know if you are going to make an equal effort". I would guess you are clever, very good with words and treatment savvy. Words however, are only words, and they can be quite a refuge from action. BTW, a therapist is very likely to take your goals and ask you to transform the negative goals (less, not etc) and ask you to work with them to transform them into what you want instead of what you do not want. I would also hope that since this is a long standing pattern you and your therapist take a very serious look at past experiences with medication and look at your compliance, ability to work through side effects, experience with drugs to augment primary drug, etc. Just given the nature of your post it suggests that you do "think a lot". That has to be tiring, confusing, frustrating and really not all that helpful. I wish you the best and hope you find the right combination. Until you decide what to do I would also encourage you to think about some support group that utilizes components of the 12 Step program--particularly the issues looking at "accepting the things you can not change, changing the things you can and learning the difference". This may sound trite and overused but it can make a huge difference in managing uncertainty and anxiety.
posted by rmhsinc at 7:02 PM on September 14, 2010

Therapy's never going to work as long as you approach it like a battle of wits. You need to realize that you and your therapist are on the same side; needing to have one be smart enough to out-wit you is just setting yourself up for frustration and wasted time, energy, and money. All you need is to have someone who's smart enough to realize when you're trying to out-wit YOURSELF, and call you on it. (And then, of course, to have enough trust in the relationship and the process that you believe them.)
posted by KathrynT at 10:18 PM on September 14, 2010 [1 favorite]

The impression your post leaves is that you are actively coming up with reasons for these therapists to not work for you

I got a similar impression, specifically that you are seeking to define certain areas as off-limits or seek to control how the process will go. There is a well known phenomenon in psychotherapy called Resistance. Therapists are well used to this and aim to work with it, rather than against it, but any therapist worth there salt will want explore what you resistances are and why you have them. In therapy what we don't want to say, often says more than what we do (see the second paragraph of this recent comment for an interesting take on this). Ultimately shutting areas off prematurely will only hurt you but it's not a reason not to do therapy.

Note: This is not the same as having specific issues you wish to explore. The last time I did therapy I had a very, very specific question that I wanted to answer and I wanted to tackle this specifically, rather than go for more general stuff. Nobody I talked to had a
problem with this, quite the opposite, but the caveat is I also made it clear I was aware other issues might arise as a consequence of what I wanted, I was willing to tackle them if they did, and nothing was off-limits.

is this thing about finding a "clever" counsellor valid, and if so, is there any way I could maximise my chances of finding one?

As you might have guessed "I'm too clever for therapy/my therapist" is a text book case of resistance and as you also pointed out being clever has not been of much help thus far. That said the (quality of the) relationship between you and your therapist is the single most important thing in therapy and what you should be look for. But perhaps you need to consider that the relationship you need is precisely the one with someone you perceive as less clever than yourself. What might you learn about what this says about how you view other people and yourself? Why should it matter? Might there be something to learn form people you see as less clever than yourself yet appear more skilled in how they handle the world and the pressures it produces?

There is nothing wrong with therapist shopping but don't be fooled into thinking you will find the perfect therapist out. There is no more the therapist out there who will relieve of the burden of all your problems and the responsibility for them, than there is a lover who will do so.


what is the etiquette around exploring some of the concerns I have mentioned...

As Locochona says, do what ever it takes. There are naturally areas therapists will want to explore in therapy, but if they aren't prepared to start addressing your concerns up front then they are not for you.
posted by tallus at 8:24 AM on September 15, 2010

You see your arriving late at work as sufficiently outside your control as to require a therapist but you imagine your therapist can control how successful your work together will be. Based on your post, it sounds like control and communication with others are issues for you. Controlling your therapy to the extent you seem to imagine necessary will only work against you. Dealing with imperfect communication in therapy (as opposed to deciding you can't work with someone unless you're always perfectly attuned) will be an important part of the work.
posted by Obscure Reference at 9:42 AM on September 15, 2010

Response by poster: Thank you for your answers.
posted by stichomancer at 12:22 PM on September 28, 2010