I do not like thee, Doctor Fell

January 25, 2011 6:59 AM

How do you know when it is time to change counsellors?

I have been seeing a counsellor, Ada, once a fortnight for approximately six months for a variety of issues, including social anxiety, my relationship, and coping with a recently-diagnosed chronic physical illness.

Ada was extremely highly recommended to me by a couples counsellor.

The first two sessions with Ada, I felt very positive about her.

Over the last few months, however, I am finding myself feeling more and more exasperated / frustrated / angry with Ada, and I am thinking about switching to a new counsellor... but I am not sure if I should.

Reasons that I want to switch counsellors:

1) Her sessions go on for unpredictable lengths of time - between 1hr 30 and 2 hours. This is too long for me, and I frequently start off optimistic/energetic but am exhausted and despairing by the sessions end.

The most recent session went for 2 hours, 49 minutes, and by the end I was so mentally/emotionally exhausted that I almost could not drive the 30 minute drive home.

I seriously contemplated calling my boyfriend to come and drive me home, even though that would have meant coming back later (1 hour round trip) to pick up my car.

2) I feel like I am not making any progress on my issues.

3) I'm wondering if the level of irritation that I feel towards her is a sign that we are not compatible as counsellor/patient. On two separate occasions I have found myself feeling so annoyed with her that I wanted to throw my glass of water at her. Obviously I would never do such a thing, but it shows how I feel.

4) She is not a psychologist, and I am increasingly concerned about what her qualifications are.

Reasons not to switch:

a) I am on a very low income (disability), and her fees are very affordable compared to most counsellors.

b) I am unsure about how to go about finding/choosing a new counsellor.

c) What if the problem is with me, not with her? Maybe I should just stick with her and hope things will improve?

d) I worry that maybe the real reason that I want to change counsellors is because subconsciously I want to 'run away' from issues that she is raising. If this is the case, I'm guessing that I would be better off sticking with her?

d) I have given her a very detailed and complex personal / family history, which took lots of mental/emotional energy and time, and I would have to do that all over again.

e) What if the next counsellor is no good?

posted by anonymous to Human Relations (13 answers total)

You switch when you feel you aren't getting out of it what you want to get out of it, and after you have discussed that issue with the counselor. The very long sessions are obviously a big issue for you. Have you raised that with the woman, what was her response?

4) She is not a psychologist, and I am increasingly concerned about what her qualifications are.

Most licensed mental health professionals are not psychologists, and there is no evidence that seeing a psychologist produces better outcomes. The evidence tends to show that some individual clinicians do better than others, but this is not correlated with their training in any meaningful way. What this means is that this variation is as great among psychologists as it is between psychologists and counselors. On the other hand, different professions tend to have different overall philosophies and focuses, so it might make sense to change to a different type of mental health provider for that reason.
posted by OmieWise at 7:12 AM on January 25, 2011 [1 favorite]

You should try discussing the time issue with her. It seems like a long time for a therapy session to me too, fwiw. Is it possible she's making the sessions that long because you are only seeing her every 2 weeks? Perhaps if you went weekly the sessions would be shorter. At any rate though, even if you can only go to see her fortnightly, she should still listen to any concerns you have about the amount of time spent in a therapy session. If 60 minutes in you are completely wrung out emotionally, anything after that is probably pointless and maybe even counter-productive.
posted by katyggls at 7:33 AM on January 25, 2011 [2 favorites]

On 1), that actually seems like a positive to me, that it sounds like she keeps going for as long as she feels that it takes. All of the therapists I've seen (in the U.S.) abruptly end the session at the end of the scheduled time, no matter where you're "at". (Possibly because their schedules are more thoroughly booked, of course, but it can be annoying.)

It seems okay to me that you don't want the sessions to be so long but I think you should simply ask her to end them sooner, rather than counting it as a negative against her.

However, feeling as though you don't get along with her or aren't making progress are valid reasons to try out other counsellors.
posted by XMLicious at 7:34 AM on January 25, 2011

I've never heard of a counseling session going on for longer than 50 minutes, unless it's a group therapy session. It seems that going on for that long of a time period is counterproductive - you start feeling tired, overwhelmed, emotionally exhausted....I would also feel that way if my sessions were to drag on for that long.

You say she's not a pyschologist - do you know what her credentials are? Is she a Clinical social worker, a Licensed mental health counselor, or does she just hang up a shingle and call herself a "psychotherapist"? I would find out exactly what her educational background is, and discuss the fact that you don't like the sessions going on for hours. BTW, does she charge a flat rate, or does it depend upon how long the session runs?
posted by Sal and Richard at 8:03 AM on January 25, 2011

Talk to her about your concerns (specifically 1, 2, and 3). Although I wouldn't directly say, "You annoy me so much I want to fling things at you." If she is a good therapist, she will listen.
posted by joeyjoejoejr at 8:40 AM on January 25, 2011

You mention having to hash thorough the same stuff with a new person -- that part kept me from changing counselors for a long time. I could not handle the idea of going through it all. over. again. But it's worth it to get to the person you trust. I also think long sessions are too exhausting. Just say you don't have the energy for more than an hour. If she doesn't look at her watch, then you should. You can also ask for treatment goals. You want to be able to do X to show progress for handling anxiety. You want to be at Y in your relationship (and how will you get there). In the meantime, keep researching other options. It's a miserable process, but the alternative -- not getting treated properly -- is worse.
posted by bluemoonegg at 8:44 AM on January 25, 2011

You should talk with her about your concerns and see if she changes.

You are her employer, she is *your* employee. She has not been doing a good job lately, so you need to giev her a performance review, just as you would with any employee. Explain how she's missing the mark, and give her the opportunity to improve. If she doesn't, you should definitely move on.

The therapeutic alliance is a big predictor of therapist effectiveness. If you're not feeling that you and she are working together well, it doesn't matter how highly recommended she is - she's not the right person for you.
posted by jasper411 at 8:49 AM on January 25, 2011

Print out your question, take it to your next session, and discuss your issues with her.
posted by Carol Anne at 8:52 AM on January 25, 2011

I highly recommend that you talk about these issues with your counselor. As joeyjoejoejr says, a good therapist will listen to your concerns.

With regard to this:

I am unsure about how to go about finding/choosing a new counsellor.

If you want to find a new counselor (and there's nothing wrong with that, by the way), MetaFilter just added a new wiki all about how to find help. Some information about how to find therapists is here, and it might be helpful.


With regard to this:

I have given her a very detailed and complex personal / family history, which took lots of mental/emotional energy and time, and I would have to do that all over again.

It's not necessarily a bad thing to have to recount your history to someone else. Each time you tell your story, you may gain different insights into it. Don't see it as a mountain you have to climb, but as a useful and interesting therapeutic process even if you have to do it more than once.
posted by Tin Man at 9:39 AM on January 25, 2011 [1 favorite]

With regards to switching to a new counselor: it's not like getting married. You can try out a new counselor and see if you're having the same issues, and go back to your current counselor if you like the new one less. The only thing you'll be out is the time it takes to relate your history. (And as came up in a recent question, maybe type that up--which can be a good exercise in itself.)
posted by fuzzygerdes at 10:11 AM on January 25, 2011

I went into my counselor's office one day, fed up with talking about the same things and basically hearing the same things from him. I was "done with all the psychology", and I wanted to start looking at the same old things from a different perspective. I was kind of ranty about it, but it wasn't an attack on the counselor -- it was just an expression of my frustration. Things started changing from that day on. We no longer talked about where this or that feeling came from in my youth, nor restated the oft-repeated interpretations and suggestions. It became more about action: what did I want my next step to be?

Talking to your counselor can help by letting her know how you think things are going. If the counselor isn't the one you need, you'll find out in the process of discussing what you're not happy with. If you say, "I get tired when the session goes on more than an hour," and get a defensive or argumentative response wouldn't help at all. If my counselor had said to me, "Yes, it can be tedious, but this is how counseling works and I truly believe it's the best way," I would have tried someone new.

Issues you have in "real life" show themselves in your relationship with your therapist. If you don't like confrontation, for example, then a civil confrontation with the counselor would be a major step forward.
posted by wryly at 10:54 AM on January 25, 2011 [4 favorites]

It sounds like you've lost faith in Ada and her ability to help you, in which case you should change counsellors, absolutely, and soon. I spent eighteen months with the wrong counsellor—like yours he was a strong recommendation from someone I trusted, and at first I was just grateful that anyone would listen to me, but I slowly grew more frustrated with lack of progress and lack of communication, and lack of acknowledgement that there was a problem. Finally I told him I was going, I found someone else, the new guy got me sorted out, and I haven't missed the old guy and his methods once, at all.

I realise you're anonymous, but you spell 'counsellor' with two Ls and use the word 'fortnight' which isn't often heard outside the UK and the Commonwealth. If you're in the UK, specifically if you're in London, I recommend the Centre for Counselling and Psychotherapy Education (CCPE). They run a common-sense system: your first session is with someone who won't be your counsellor, but who assesses you (and your ability to pay) and recommends one of the Centre's team to you, based on your needs and their skills.

Don't get discouraged; even if you ditch Ada, do stick with counselling. It does work.
posted by Hogshead at 5:53 PM on January 25, 2011

Two hours and forty-five minutes?! Ada may have trouble with boundaries and consistency. There is no way a session should take that long, nor should session lengths vary from week to week. You ought to tell her so.

The larger issue is not with you or with Ada, but the quality of your relationship. It sounds like a poor one, but it's hard to know whether it can be improved without knowing exactly what it is that you find irritating about Ada in session. If you think you can address it with Ada (for instance, maybe you can't stand that she guesses how you felt about a situation before you get a chance to tell her), try doing so. But if it's something ineffable or that you can't see being fixed through discussion (for instance, just the way she nods her head makes you want to punch her lights out), find a new counselor. Based on her boundary issues, I'm leaning toward the assumption that your difficulties with her are based on some lack of professionalism on her part, and not something illogical, but either way: if you don't have a real alliance with her for whatever reason--logical or not--you won't be able to do any work together at all. Use your instincts here.
posted by pineappleheart at 10:19 PM on January 25, 2011