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Should I seek a different therapist?
August 29, 2014 7:28 AM   Subscribe

I'm going through the worst depression I've ever had, and I've started seeing a therapist (along with meds), but a few things she has said irk me. When do you look for someone else? Juicy details inside.

I've only seen this therapist three times. I'm a late-20's female and my therapist is female (I'd guess in her 50's). I've gone to counseling once before in my life but I guess I just lucked out liking that counselor.

There are three annoyances I've had:
1. She (therapist) talks a lot more than I expected, and a lot more than I remember my previous therapist talking. She tells what I perceive to be long-winded and largely irrelevant anecdotes. Sometimes they have some kind of moral related to something I've said, but more often they don't. This annoys me because right now I'm feeling desperate for relief from the depression, and these stories aren't helping me. More practically, she's eating up my time, and I'm a paying customer.
2. She says things that feel patronizing or misogynistic (or something else that makes me feel icky), though I know they are not intended that way. For example, today she told me "but you're pretty AND you do science" [I have a doctorate and work in a science-y field] in a tone that suggested that pretty + smart was some kind of rare combination. Being attractive and smart describes most of my female friends, so I felt a little like, come on lady, you're setting us back here. I know she was trying to boost my confidence and say I can be both, but her delivery was off and it turned me off.
3. Today (third session) was the first time I felt like I learned something about myself and the issues I'm currently dealing with. I don't know if this is a fair problem. Like I said, I'm desperate to feel different right now.

So my questions are, when do you get a new therapist? I'm not totally clicking with this woman, but I am not sure if my expectations are too high. Is there a way to bring up these issues with her (this feels like conflict to me, which I avoid at almost all costs, so specific scripts would be helpful)? If consensus is that I should seek someone else, is there a way to screen for this or talk about expectations at the beginning? I told her the issues I had identified that I wanted to focus on, but I didn't really ask anything about "methods"--I'm not sure what vocabulary to use.

If you've been in therapy or are a therapist, what is reasonable for feeling some kind of better? I know every session may not be a breakthrough. Is it common for some appointments to feel kind of pointless? I'd like to feel like I have something to reflect on or a task to focus on after each session.
posted by anonymous to Health & Fitness (23 answers total)
 
Talk with your therapist about these issues. If she's a "good" therapist, she'll listen to you and adjust her approach accordingly. A too-talky therapist might think that this is the type of engagement you want. I was the opposite -- my therapist tended to just listen and mirror what I said, and I told him that I need him to give his opinions and strategies for me, and he made the adjustment the next session.

As for learning something about yourself at the third session, I think that's pretty normal. Your therapist is not a magician or mind reader: You have to get to know one another before the insights can begin.
posted by xingcat at 7:31 AM on August 29 [4 favorites]


Changing therapists is remarkably like changing hair stylists. Because it's a personal relationship, when you don't like the one you're with, it feels like a thorny mess with no clear way out. We tend to muddle through getting lousy haircuts or unhelpful therapy out of a misplaced sense of obligation.

But it's not complicated. The answer in each case is the same: stop seeing the person you don't like and see some new people until you find one you do. You're a paying customer and you're entitled both to bail on a professional you don't care for and to shop around looking for someone you do like.
posted by DirtyOldTown at 7:33 AM on August 29 [4 favorites]


I think it generally takes three or four sessions for things to therapy clients to start feeling better, so the pace does not seem off. The talkiness seems annoying but potentially fixable ("I'm worried that I'm not getting enough time to speak in session" would be a decent way to open that discussion), the weird gender assumptions are likely less fixable.

If you had a long-standing relationship with this therapist and these conflicts were arising with that base in place, I'd definitely think that staying and working them out would be worthwhile. With a new therapist, however, it's completely ok to chalk it up to a bad fit and find someone new. I generally think one shouldn't be having to manage one's therapist -- if you're having to regularly filter stupid things she says by assuming she means well, then you're doing too much work. (Long term, it may be worth examining why you're doing the filtering rather than speaking up, but doing that is going to require a more trusting relationship than the one you seem to have with this therapist.)

The stuff you're talking about isn't necessarily the type of thing you're going to learn about a therapist until you've had a few sessions with them; I'm not sure there's a good way to screen for it. It's always ok to just go with your gut in selecting a new therapist.
posted by jaguar at 7:54 AM on August 29 [2 favorites]


My rule of thumb is to give therapist 6 sessions. That's enough time to be in a routine. Do comment on what your are feeling about her. A good therapist will be able to adjust.
Finding a therapist is a process. You are not doing this wrong and it is okay to try someone else.
posted by AlexiaSky at 7:55 AM on August 29


Find a new therapist. I second DirtyOldTown that it's a very personal relationship,and if you are having these feelings, this is most likely not going to work.

Also, look into cognitive behavioral therapy (CBT) rather than talk therapy-- it sounds like you might enjoy that more.
posted by atetrachordofthree at 7:56 AM on August 29


To your third point, therapy takes time, so I wouldn't consider that anything out of the ordinary.

To your first point, that is something you can address with her.

To your second point, however, that would probably make me walk. And I would explain why.

A therapeutic relationship needs to be built on trust for it to be effective. If you can't trust her (and trust isn't one of the issues you're dealing with, because that complicates things), you won't be able to trust therapy from her.

I would say, however, find a new therapist before leaving the current one. I have severe depression too, and it's always a good idea to make sure there's a safety net available. Also, ensure that she will turn over your files to the new therapist so you don't have to start over from square one.

When interviewing new therapists, bring up the two issues you have had with this one and be direct about asking how they would approach similar situations.
posted by feckless fecal fear mongering at 7:58 AM on August 29


Just so that you don't get confused in your search: CBT is a type of talk therapy.
posted by jaguar at 8:01 AM on August 29


You can waste a lot of time visiting different therapists trying to luck out and find a great fit. Of course, if you want to privilege the conflict avoidance, that would be the way to go. Do you think that desire to avoid conflict plays a role in your depression? If so, then addressing it will be part of getting depression out of your life.

Three sessions is not unreasonable for a therapist to start getting to know a client well enough to make useful suggestions. Therapists tend to be much more effective when clients give them information about what they want, direction on how they want to work together, and feedback each and every session on how that session helped, and how it missed the mark. Scary? Sure! But the right therapist will show willingness to hear this and adjust. The better therapist will initiate seeking out this info. Sadly, most therapists fall down in this area.

That said, you have to do what feels right to you. Your points 1 and 2 are somewhat red flags. I believe you will make the best choice for you, for right now.

Best wishes and good luck to you.

BTW, I'm a therapist. (And I always ask clients for feedback! :-)

PS: Check out the book "What's Right With You" -- I think the author (not me but someone I know and admire) has some excerpts online. Also, look for a client who uses the ORS/SRS rating scales to inform effective therapy.

PPS: One script: (at the beginning of the session) "I'd like to tell you what I'm seeking from therapy, and from you. I have some ideas on what would be helpful to me." If she doesn't respond helpfully or you can't bring yourself to say some version of this, then you probably do have to look for a therapist who already does this so you don't have to ask for it. (Yet. ;-)
posted by dancing leaves at 8:13 AM on August 29 [1 favorite]


1. She (therapist) talks a lot more than I expected, and a lot more than I remember my previous therapist talking. She tells what I perceive to be long-winded and largely irrelevant anecdotes. Sometimes they have some kind of moral related to something I've said, but more often they don't. This annoys me because right now I'm feeling desperate for relief from the depression, and these stories aren't helping me. More practically, she's eating up my time, and I'm a paying customer.

This irritates me to no end, too. Especially because the irrelevant anecdotes would make me feel like the therapist is *really* not getting me or understanding what I need. You can bring this up with the therapist, but don't be surprised if this is just the therapist's style/personality and not something that she can or will change. I mean, give your therapist a shot to adjust to your needs/personality, but if this is just how she does things and she doesn't quickly change (as in, within another session or two after you bring it up), then imo you guys are probably just a bad match and it's better to move on ASAP rather than waste more of your time (and money) trying to make it work with her.

To be honest, I've dumped a therapist over this (basically just stopped going to him because going to him never seemed to worthwhile). As time has passed and as I've addressed the (health/physiological) problems causing/exacerbating my depression and have gotten into a much healthier frame of mind, I *still* find the anecdotes he told me to be unhelpful and irrelevant. So don't second-guess yourself too much about that, your take on the stories she's telling you being unhelpful is likely to prove correct.

2. She says things that feel patronizing or misogynistic (or something else that makes me feel icky), though I know they are not intended that way. For example, today she told me "but you're pretty AND you do science" [I have a doctorate and work in a science-y field] in a tone that suggested that pretty + smart was some kind of rare combination. Being attractive and smart describes most of my female friends, so I felt a little like, come on lady, you're setting us back here. I know she was trying to boost my confidence and say I can be both, but her delivery was off and it turned me off.

I agree that your example of the "you're pretty AND do science!" is obnoxious and it would bother me, too. This might be more of a "once you hate someone, everything they do is offensive. 'Look at this bitch eating those fucking crackers like she owns the place'" thing than an intractable therapy-work incompatibility, though. You and your therapist don't have to have the same values to have a good/helpful work relationship, and I would assume that you're more irritable and uptight than usual right now because you're depressed and feeling horrible. So I'd personally give her some slack on that and not worry about it for now. What would turn this from a red flag into a signal to leave would be if she starts trying to steer you toward doing things or taking up perspectives that you don't think are in line with your values (for example, if she pressures you to take a very ~traditional~ gender role with your SO and that's something you think is archaic and misogynistic, etc).

3. Today (third session) was the first time I felt like I learned something about myself and the issues I'm currently dealing with. I don't know if this is a fair problem. Like I said, I'm desperate to feel different right now.

Honestly, I don't know if therapy is going to make you *feel* differently. It's good for figuring out/adopting coping strategies, but it's not going to change your brain chemistry or fix any physiological problems. How long have you been taking the medication? If you're still at the end of your rope and you've been taking it for longer than four weeks, I would start asking about trying a higher dose or a different medication. It takes a while to work, but if it's the right medication and the right dose, it will work -- if it seems like you've given it a fair shake but it's just not going to, it's not the medication (or possibly dose) for you.

To be honest, for me, the most helpful therapy sessions I've had were when the therapist straight up told me to do a certain thing -- maybe to complete a certain task, maybe act on a certain feeling, things like that. The fuzzy "let's talk about how you feel" thing really doesn't work for me (it's pleasant most of the time, albeit a bit dull, but is pretty much useless/pointless), and maybe that's not your bag, either. That doesn't mean that therapy won't be helpful altogether, but maybe *this* kind of talk therapy isn't helpful. If there are really specific things you want to work on (like for me, I had a lot of trouble with insomnia that I needed help with), CBT can be great. It's pretty fast and straightforward, and can help you make the behavioral/conceptual changes that will help you make your life easier, so if you need relief *now,* it might be a good thing to try.

I'll be watching the thread to see ways I might screen therapists, too, because I honestly don't know how to do that without just going for a few sessions and seeing how things go. For what it's worth, I do look for therapists who are comfortable making specific suggestions about behavioral changes I can/should make, and who are pretty businesslike in how they talk with me. Something that puts me on alert is if I find myself "making conversation" and "being friendly" with the therapist in the way that I would with an acquaintance at a cocktail party or a bar. Therapy sessions where you're "chatting" are relatively easy and pleasant, but they're not very helpful, in my experience, and don't really become more so over time. You're mostly looking for someone who can advise you on specific ways of improving your coping skills and your perspective/assumptions. Of course you want to feel comfortable with your therapist, but she doesn't have to be someone you'd pick as a friend, and you don't want the appointments to be so laid back or superficial/easy that they're useless.
posted by rue72 at 8:34 AM on August 29 [3 favorites]


Honestly, I don't know if therapy is going to make you *feel* differently. It's good for figuring out/adopting coping strategies, but it's not going to change your brain chemistry or fix any physiological problems.

Good therapy should make you feel differently, yes, and any type of learning to look at your problems in new ways does physically change your brain, yes.
posted by jaguar at 8:51 AM on August 29 [3 favorites]


I think therapy is a great place to practice having conflicts. It's supposed to be a safe space to explore things that are hard for you, including having conflict. So yes, bring up the questions you have about her approach but also let her know that bringing this up triggers your conflict avoidance response. With my therapist, I do discuss how the therapy is going and this often makes me uncomfortable if I am struggling with feelings of frustration about my own progress, but one of the reasons I am in therapy is to learn to cope with the things that make me uncomfortable. So, I guess I'm saying it's normal within therapy to talk about the process of therapy itself.
posted by megancita at 9:08 AM on August 29


I think it's not a good fit. I used to have these kinds of issues with therapists until I found someone I liked. It's like dating. She's long winded and has weird gender role issues. DTMFA.
posted by 3491again at 9:14 AM on August 29 [2 favorites]


I'd like to feel like I have something to reflect on or a task to focus on after each session.

This is something you can ask for directly. I'd tell the therapist this, and keep going to her for another couple of sessions, or however long it takes to get an appointment with someone new.

When you find a new therapist, you can use this as one of your screening techniques. Ask them if they can give you "homework" after each session.
posted by Bentobox Humperdinck at 9:30 AM on August 29


I think you have to feel safe for therapy to be really useful to you. I would ask your friends if they know a good therapist and then change.

I do think that if something strikes you as off, it's perfectly okay to confront it in therapy, "Gosh, that statement strikes me as anti-feminist. A lot of women I know are pretty and smart."
posted by Ruthless Bunny at 10:15 AM on August 29


I can only speak to my experience as both a long time client and current psychotherapist. I have found wonderful therapists throughout my life and some were at the right time. If Depression is showing up in a major way now is not the time to do analysis or learn about yourself. I've been successful when I just get all the gross stuff out, get a bit more stable, and then and only then start looking at reasons and patterns.

Not every therapist is good at focusing on the short term goal of getting you out of this funk first. Often they only have one goal - dive deep. That said, at my darkest I have found not all - or even most - therapists get it. They might be fine but not for my current state of mind.

When I practice, I want to know the client's immediate goal and in the first sessions help them see some movement. "Small wins." This means I do a lot of question asking but rarely much talking. I need to support the person where they are.

I suggest you find someone who can support you. It might be this person. Using your dislike for the therapist's style is an excellent growing opportunity later. Right now IMO is not the time.
posted by Lil Bit of Pepper at 10:43 AM on August 29


I would absolutely be finding a new therapist due to point 1 only. But I've been to three therapists over the past couple years and only the third helped me whatsoever (these were couples' therapists but still). The first was too "oh, you sound ANGRY, let me ramble on about anger" and the second was too into traditional gender roles. The third was more pragmatic and had actual insight and suggestions and was a good listener and struck me as the most intelligent of the three. So I definitely believe there are helpful and unhelpful therapists and I would not waste any time with the unhelpful ones as soon as I realized we were not clicking.
posted by celtalitha at 10:50 AM on August 29 [1 favorite]


I'm new here and not sure of the protocol but if you want to discuss the different types of therapies and how they look in a session, send me a note. Having a science mind can be a great tool in therapy - I had a high science career before becoming a therapist. Yet, I've found it can be intimidating to my own therapist. (Her issue, not mine yet I learned to work with it.)
posted by Lil Bit of Pepper at 10:51 AM on August 29


I am a woman working toward her PhD, and the best therapist I've had was a woman who had a Ph.D (someone with a PsyD might also work), instead of 'just' a Masters degree or license. I probably liked this therapist so much because we communicated with a familiar academic style of targeted questions and thoughtful answers, so there wasn't a "learning curve" of me figuring out whether I need more or less talk or questioning from my therapist. It felt very natural. I'm also inclined to think that a woman who has earned a PhD will be less intimated by your degree, and will be fully cognizant of well-meaning but misogynist comments about looks versus intelligence. That this therapist also comfortably discussed research findings with appropriate scope was a helpful bonus.

Of course, I could just be terribly biased...but regardless of whether the root cause of my sessions being so good was bias or communication style or whatever, maybe try this as a first-pass filter if you decide to find a new therapist.
posted by nicodine at 10:54 AM on August 29 [1 favorite]


She just sounds like a bullshitter to me.

Don't waste more time and money, just end it now. Six sessions is way too many to wait, imo, three is enough. The first session is always weird; the second a little less so; by the third you have a sense of their style and how you feel about them. If it's this bad this early on, it's not going to work.

Also, leaving would not be "privileging your conflict avoidance". It would be smart. The waste would be sticking with this person and losing time you could be spending finding something who can actually help you. The kind of attitude displayed by dancing leaves is what that keeps people in bad therapy, unhelped, for too long (or just not helped at all), blames the client while asserting the - in this case - undeserved authority of "experts", and is pretty terrible overall, imo.

I don't think you'd be feeling better three sessions in even with a good therapist (which it doesn't sound like yours is, she should be listening to you, three sesstions in especially!), but you should feel that they are competent, and you should be starting to feel some kind of rapport and sense of trust.

What's not great imo about how therapy's usually delivered is that they're left to their own devices to operate in isolated offices with limited collegial input, and there's usually no non-pressured way for clients to give honest feedback. I think they can often drift away from evidence based techniques with time (even though they tell you they'll use them in that initial screen). It sucks because I know therapy can help (I've experienced it; there's evidence to that effect) but these crappy therapists make the whole thing feel like a crock.

And what's the worst is that it's people having a really hard time who have to engage in critical evaluation of this kind of bullshit.

But, all you can do is try :/ Try someone earlier in their career, maybe in a group practice affiliated with a university or hospital.

Do the initial screen -- ask what their approach is. CBT is the best evidenced treatment for depression; it's a technique. "Person-centered" means they are supposed to make an effort to listen to you and accept your definition of problems; a kind of technique but also a sort of philosophy; that's what I'd be looking for, myself. It does come down to gut in the end.

Good luck.
posted by cotton dress sock at 10:56 AM on August 29 [5 favorites]


(Sorry I wrote quickly above, not sure I was as clear as I could be: a therapist can have a person-centred approach, and use CBT techniques.)
posted by cotton dress sock at 12:08 PM on August 29


For example, today she told me "but you're pretty AND you do science" [I have a doctorate and work in a science-y field] in a tone that suggested that pretty + smart was some kind of rare combination.

It is. At least, it is in my experience and, apparently, your therapist's, too. Unless you misinterpreted her tone.

If you feel like you're starting to make progress, I think you should stick it out for a while. A therapist can be helpful without necessarily being someone whose company you would enjoy outside of therapy.

Progress on the third visit is actually a good sign. I know you're eager to feel better, but you may be starting over or even from behind with a new therapist.
posted by jingzuo at 2:40 PM on August 29


Anecdata: I'm also a lady in my twenties, currently also having the worst depressive episode of my life and four sessions into working with a new therapist.

She's the best therapist I've ever seen - she's expressed sentiments that suggest she's strongly feminist, often based on feminist stuff I've said; she makes sure I challenge the stuff she throws at me (in terms of frameworks, metaphors, picking up on something I've said, etc.) to ensure we're working together and I'm not just agreeing with her because it's easier than arguing/asserting myself/actually thinking about how I feel (which, hey, is one of the reasons I'm there); she makes me feel extremely validated and believed, welcomed and inherently worthy as a person - she shows compassion when I talk about a really sad experience, but also calls me out on my bullshit when it needs calling out.

During the assessment process (which we're still kinda in, seeing as it's only been four sessions and we have a whole quarter century of repressed emotion to plough through together), she's been asking me all the questions I need to be asked in order to address the stuff I've really struggled to bring up of my own volition in therapy in the past (eating disorder stuff, body stuff, sex stuff, etc.).

Basically, it's been a stroll through a lush field of green flags so far, and I'm feeling much more confident about the process (and my own chances of not bailing on it out of frustration at not feeling understood) than I ever have before. I actually look forward to sessions - it's a little beacon of "I am doing something that is good for me now and will be good for me in the long run" in the middle of what have been some very grim weeks. Maybe a tiny fleck of hope.

That's not to say it's going easily - it's been really raw and really painful so far, but I'm not surprised that that's the case, seeing as I've been Not Dealing With a really big pile of stuff for a very long time. But I feel like I can actually get some good work done with this person. My previous therapist was sort of fine, in that I got the small benefit you get from talking about your problems with more or less anyone once a week, but we (I) avoided a lot of stuff. And the previous two were useless and frustrating.

Sorry - this has been kind of a rambling memoir of a comment. I guess the point I'm trying to make is that, having had "I guess this is fine but I have a couple of concerns that I'm either too scared or apathetic to address" therapists, and now having met a "damn, you get me" therapist, I would run far far away from the former, because in retrospect it feels less like paying someone to help me get my shit together and more like paying someone to vaguely be my friend for an hour a week.

I sort of didn't believe therapy really worked (or really worked for me) before, but now I can see how it might.
posted by terretu at 2:43 PM on August 29 [2 favorites]


Get a new one. She should not be talking much at all. She should be establishing rapport by listening, not telling anecdotes. If you don't like her, she's not right for you. Therapy is as effective as the therapeutic alliance you feel with your therapist. Don't waste your time & money. (I'm studying clinical psychology and she sounds like rubbish.)
posted by saturn~jupiter at 11:53 PM on August 29


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