Therapy checklist

May 14, 2012 7:31 PM

Psychotherapy starter kit

I'm trying to figure out what I should ask my new therapist to determine if we're a good fit. This'll be my third therapist, but it's been about eight years since I've been in therapy.

My previous attempts were unsuccessful. I'm not a big fan of rehashing or dredging up my issues. I've found therapy extremely painful, and I feel my previous CBT-oriented therapists have been too rigid and combative.

I'm seeing a psychiatrist concurrently and have recently started the medicine merry-go-round again. Medication has also been unhelpful in the past. I'm giving it another try, though, because I'm at a point where I can't manage the basic duties of being an adult, and I'm unhappy all of the time.

I'm not sure my diagnosis is relevant, but I do have depression and anxiety issues that need to be dealt with outside of pharmaceuticals.

My main concern is that my previous psychiatrists (for whatever reason) set me up with strong, confrontational female therapists, which is about the exact opposite of what I need. I'm afraid that's what I'm walking into this time, too, but I'm basing that feeling on the therapist's website, so who knows.

I think I'm looking for someone kind and empathetic who can give me coping mechanisms for some current work and relationship issues and help me come to terms with what is likely a life-long condition. I'm not interested in having the flaws in my thinking pointed out constantly or being forced to journal.

So, what I need is some sort of list of questions or checklists to get me through the first session. Thoughts?

posted by lunalaguna to health & fitness (8 answers total)

Personally, from the sounds of it, this one isn't going to work either - you can't really go into a situation where your needs are the direct opposite to what the therapist is capable of offering - it defeats the purpose of therapy.

If you are able to I would look into narrative therapy - the onus is on externalizing the problem (the depression, anxiety) rather than internalizing it (having your flaws pointed out) and without being rigid like CBT.
posted by mleigh at 8:22 PM on May 14, 2012 [1 favorite]

I think the first thing you need to know is what the therapist's primary methodologic approach is, and how it fits with your goals. You might need to do a little homework first to figure out what kind of therapy you want (website website website). I am not surprised that CBT didn't work out for you, since it's all about addressing flaws in thinking. I think you will probably be uncomfortable with most analytic therapy, since you don't want to go spelunking in your past. You might be more comfortable with something more solution-oriented.

Do listen to your instincts in the first meeting - if you don't feel reasonably safe and at-home with the person (apart from first-meeting jitters), you are not going to be able to do the work. It's fine to set limits about characteristics (gender, age, ethnicity, affect) of a therapist that make you feel more or less safe, because no matter the type of therapy, you have to make yourself at least a little vulnerable.

You can basically guarantee that you'll be asked "what brings you here today" and "what do you hope to accomplish in our time together" - you are already on your way to sorting those, but you can and should use your answers to ask whether the therapist thinks this is a good match, and if not, where s/he would refer you.
posted by gingerest at 8:48 PM on May 14, 2012 [1 favorite]

I've had CBT that wasn't "flaw"-focused. It was all about empathetic recognition of my need to gain better coping skills and feel joy in the world again.

There's nothing wrong with openly stating that you need coping skills AND gentleness in your therapy and going by the response you get.

My first attempts with therapy were like yours (or weirder), and it almost completely turned me off from the process, which I knew I desperately needed. It took over a decade, two states, and five total tries to get one that fit well enough to help me build a better framework for dealing with past events, present stressors, and future challenges. It didn't solve everything, but she proved that hunting for the right fit was absolutely the best thing I could have done for myself. That's all a testimony to not lose hope just because this part sucks. Good caregiving can be yours, I'm certain of it.
posted by batmonkey at 9:12 PM on May 14, 2012

I'm not sure this advice will work in your context, but what I did was try three and then listen to my gut.
posted by salvia at 11:15 PM on May 14, 2012

Have you have only seen female psychologists? If so, I suggest you make an appointment with a recommended male therapist. You expressed that confrontational females haven't successfully helped you, so it's worth it to try. I've had similar feelings in the past, and though I didn't seek out a male therapist, I have been working with one for over ten years. He has been a kind and insightful figure for me. Therapy sessions are often difficult because life can be be very sad. They should not be difficult because you dislike your therapist or the way he or she treats you.

You may also want to try acupuncture. I've found it to be extremely helpful in managing depression and anxiety (and it also doesn't interact with any medications).
posted by lrrosa at 2:03 AM on May 15, 2012

I had a psychologist like that (I actually prefer the kind you don't like!) so they're definitely out there. I'd recommend talking out with her everything you said here. Feel free to challenge her and express and skepticism and doubts you have. If it doesn't seem like she's going to be a good fit, just keep looking.

(I commend you on giving this all another try, btw -- I've seen medication&therapy work after different medication&therapy had already failed. Good luck!)
posted by callmejay at 9:41 AM on May 15, 2012

Here's another answer I wrote about how to get the most out of therapy, which might be helpful.
posted by OmieWise at 9:52 AM on May 15, 2012 [1 favorite]

I would go into the first session thinking of it as an "interview" and you are the "consumer" considering whether you want to "hire" this person to provide "services" for you. (Geez...sorry for the overuse of quotations there.) It can be really difficult to get your brain to think this way if you are feeling depressed or anxious (I know from experience) when you are trying to be your own advocate and you don't really have the strength...but try. It may feel that the first session makes no progress but if you find out that you are (or are not) on the same page, it is worth it.

Think of a list of characteristics you would want to find evidence of to move forward, make a list and take it with you:

It sounds like you are looking for strength-based perspective. Ask the therapist to describe her personal style in a few sentences. How she motivates her clients. AFTER she answers to get a true response, let her know you respond more to a supportive relationship than a combative one and this had been an issue with past therapists.

It sounds like you need immediate assistance with developing coping skills for daily life rather than focusing on your history. Therapists do look at history to unravel pattern among other things. But if it feels judgmental to you, just say it and let her know what you need.

Will this therapist generally support a client not staying on meds for a long period? Right now you need them but you are hoping that this is not a long term situation. Is she on board with that attitude if it is what you want and you are safe?

And so on. I would let the therapist know when you first sit down that you also have a few questions for her so that there is time during that first session for you to both talk before you get into your specific reasons for being there.

I wish you the best and I hope you find your strength again soon.
posted by Kitty Cornered at 12:36 PM on May 15, 2012