Help me find someone to help me help myself?
August 15, 2015 12:58 PM Subscribe
Therapy hasn't been providing the insight or chance to make changes that I seek. How do I find someone who actually uses the practical approach that they claim?
I'm in awe of some of the amazing insight people have described reaching in therapy, some of the wise and practical things that people have related their therapists saying. Truth be told, I'm a little envious, too; I've been looking for someone with that insight and pragmatism, and I'm still looking.
I'm fairly good at finding the questions to ask - defining the problem space, if you will. I have a score of wonderful supportive friends who'll listen if I need to process aloud. I turn to therapy to help me explore myself to answer those questions, and to develop the skills and strategies to help me in future.
Therapy hasn't been doing what I needed, however. I've mostly found people who are good at listening and nodding and asking me how I feel about things (often when I've just told them that!), but not about helping me reconsider my perspective, explore the patterns underneath specific situations, or focus on how to improve my approach for next time.
I thought I had a good therapist when I asked my last question here; it turned out that I had a supportive therapist, which wasn't quite the same thing. Once the immediate emotional pressure was off and I wanted to seriously tackle some of the underlying issues, I found out that my therapist wasn't what I'd hoped at all.
My last therapist liked throwing questions at me - particularly at the very end of sessions - but they were questions I was already asking. When I asked how we explore these questions, he threw it back with a "how do you think we do it?" I'd told him initially that I was looking for a short-term relationship with an emphasis on practical problem-solving and skill development, but after several months we weren't getting anywhere.
When I expressed that concerns to him, he noted that "I'm just here to walk this path with you." As I told him, though, from where I stand there isn't a path - we're deep in the metaphorical woods, and I don't have enough wilderness skills to find my way around. There are all sorts of interesting things to see and I could explore forever, but I have a direction I'd like to go. But I've no compass or map, and I can't even see the sky, to work out which way is north from the sun or the stars.
I'm not looking for a therapist to take my hand and pull me in some direction, but someone who metaphorically knows how to tell which way is north by looking at moss on trees, or what poison oak looks like, or where to find water - so I can find my own way with their support and guidance.
And I'll be honest - as the extended metaphor possibly shows, I also need someone who'll tell me when I'm going off on a tangent or overthinking things - but can tell me how to approach things instead!
Almost every therapist I've interviewed claims that they use a practical, CBT-or-similar-based approach aimed at breaking old patterns and developing skills. I've asked the "what will you see as markers of progress" question in interviews, and it all sounded good but didn't pan out. It's pretty demoralising.
How do I find someone who actually does these things without months of trialling them? Am I looking for group therapy or a life coach or something else instead? I just want therapy to work...
I'm in awe of some of the amazing insight people have described reaching in therapy, some of the wise and practical things that people have related their therapists saying. Truth be told, I'm a little envious, too; I've been looking for someone with that insight and pragmatism, and I'm still looking.
I'm fairly good at finding the questions to ask - defining the problem space, if you will. I have a score of wonderful supportive friends who'll listen if I need to process aloud. I turn to therapy to help me explore myself to answer those questions, and to develop the skills and strategies to help me in future.
Therapy hasn't been doing what I needed, however. I've mostly found people who are good at listening and nodding and asking me how I feel about things (often when I've just told them that!), but not about helping me reconsider my perspective, explore the patterns underneath specific situations, or focus on how to improve my approach for next time.
I thought I had a good therapist when I asked my last question here; it turned out that I had a supportive therapist, which wasn't quite the same thing. Once the immediate emotional pressure was off and I wanted to seriously tackle some of the underlying issues, I found out that my therapist wasn't what I'd hoped at all.
My last therapist liked throwing questions at me - particularly at the very end of sessions - but they were questions I was already asking. When I asked how we explore these questions, he threw it back with a "how do you think we do it?" I'd told him initially that I was looking for a short-term relationship with an emphasis on practical problem-solving and skill development, but after several months we weren't getting anywhere.
When I expressed that concerns to him, he noted that "I'm just here to walk this path with you." As I told him, though, from where I stand there isn't a path - we're deep in the metaphorical woods, and I don't have enough wilderness skills to find my way around. There are all sorts of interesting things to see and I could explore forever, but I have a direction I'd like to go. But I've no compass or map, and I can't even see the sky, to work out which way is north from the sun or the stars.
I'm not looking for a therapist to take my hand and pull me in some direction, but someone who metaphorically knows how to tell which way is north by looking at moss on trees, or what poison oak looks like, or where to find water - so I can find my own way with their support and guidance.
And I'll be honest - as the extended metaphor possibly shows, I also need someone who'll tell me when I'm going off on a tangent or overthinking things - but can tell me how to approach things instead!
Almost every therapist I've interviewed claims that they use a practical, CBT-or-similar-based approach aimed at breaking old patterns and developing skills. I've asked the "what will you see as markers of progress" question in interviews, and it all sounded good but didn't pan out. It's pretty demoralising.
How do I find someone who actually does these things without months of trialling them? Am I looking for group therapy or a life coach or something else instead? I just want therapy to work...
I have actually never experienced strict application of CBT as a method, as it's outlined by Beck (and in a lot of the research on it), in therapy. I think though that some phrases to look for in addition to "CBT" are "brief, solution-focused", and "problem solving".
(Until you find the therapist you're after, you could try self-help. And bolster reality checking and support [the compass side of things] via friends and family, if you're lucky and have some good relationships. Self-help like e.g. Feeling Good or something like this workbook [it's a direct download, can't find the source page on it's own, sorry] - there are many like it. There are some CBT-related apps, too, I think.)
The thing with it, I think, is that it's actually really hard to do all that homework, check yourself whenever you have unhelpful thoughts, etc. I suspect it's a lot of work for therapists, too. (Not that that's why they might not do it - I have no idea why that's the case - but my experience agrees with yours, that they don't, always.)
posted by cotton dress sock at 1:30 PM on August 15, 2015 [4 favorites]
(Until you find the therapist you're after, you could try self-help. And bolster reality checking and support [the compass side of things] via friends and family, if you're lucky and have some good relationships. Self-help like e.g. Feeling Good or something like this workbook [it's a direct download, can't find the source page on it's own, sorry] - there are many like it. There are some CBT-related apps, too, I think.)
The thing with it, I think, is that it's actually really hard to do all that homework, check yourself whenever you have unhelpful thoughts, etc. I suspect it's a lot of work for therapists, too. (Not that that's why they might not do it - I have no idea why that's the case - but my experience agrees with yours, that they don't, always.)
posted by cotton dress sock at 1:30 PM on August 15, 2015 [4 favorites]
i think i've said similar before and had -ve responses from people here, perhaps because roles (or options) in the us medical system are different. but my experience was much like yours and i found what worked for me was very occasional visits to a psychiatrist, rather than a psychologist or therapist. he's a medical doctor, not a nodding listener, which fits better with my physical science upbringing - someone smart to bounce a few ideas of and suggest new avenues, which is all i feel i need before i go away and read up and educate myself and mull over what next (CBT isn't exactly rocket science - you can buy a workbook from amazon and go through it yourself (*)). but, of course, it could also be that this one guy clicks with me personally in a way other people have not. or maybe i'm just lucky / unaware and haven't actually needed a therapist.
it helps in my case, also, i guess, that i earn enough and live in a country where these things are cheap enough that i can just arbitrarily do this (i have no idea why anyone would think you having one person for "drugs" and one for "feelings" is a good idea - the whole separation of roles seems driven by an attempt to lower costs, and the obvious side-effect of that is that the "feelings" people are, well, there because they didn't make the cut to charge more) (ok, so that's a slight generalization).
(*) i'm not saying everyone can, or should. and in general i am considered a bit weird, so this may well be inadvisable in general. but, i feel, it has worked ok for me.
posted by andrewcooke at 1:39 PM on August 15, 2015
it helps in my case, also, i guess, that i earn enough and live in a country where these things are cheap enough that i can just arbitrarily do this (i have no idea why anyone would think you having one person for "drugs" and one for "feelings" is a good idea - the whole separation of roles seems driven by an attempt to lower costs, and the obvious side-effect of that is that the "feelings" people are, well, there because they didn't make the cut to charge more) (ok, so that's a slight generalization).
(*) i'm not saying everyone can, or should. and in general i am considered a bit weird, so this may well be inadvisable in general. but, i feel, it has worked ok for me.
posted by andrewcooke at 1:39 PM on August 15, 2015
Andrewcooke makes some interesting points. I agree that the separation between psychology and psychiatry is problematic. But, I have long supported an even greater separation. Today, a psychiatrist is very rarely a psychiatrist in the traditional sense. They are about drugs. A psychiatrist, in my opinion, should not hang a shingle with that term if they are truly a psychopharmacologist. There is a huge difference (traditionally) and I think most people visiting a younger psychiatrist would be very disappointed if they were wanting to talk deeply about classical approaches to the mind, analysis, etc. Many might very well know more about these things than the psychiatrist. It has become that bad. The bigger the city, the better the chances of finding a classically trained psychiatrist. Psychopharmacologists should call themselves just that. In my opinion.
Someone Else's Story (the OP) is asking a question that, while not exactly the same as the example above, is very similar. Finding a psychologist, counselor, therapist, (pick your flavor) that is practicing CBT (or variations thereof) is very difficult without asking tough questions upfront. For the OP that question must be something along the lines of, "I am looking for someone who will work with me, offer feedback, encourage when necessary, make me think twice when necessary, but not simply answer questions with more questions - can you be that person?" If you get a long and rambling answer rather than "yes" or "no" and a very short sentence or two -- you might have not found the right person.
You mentioned the possibility of a Life Coach. At one time, I was very opposed to even discuss them in the same conversation as psychiatrists or psychologists or even a competent social worker. But, I've mellowed a bit simply from feedback I have heard anecdotally. I think that, truly, some people just need someone on their side. A cheerleader. Someone who will listen and respond with thoughts of encouragement and support. There are some really good people calling themselves a Life Coach and there are people who call themselves the same and haven't a clue as to what they're doing, but because of the low entry requirements (none) it's very difficult to find a really good one and separating the wheat from the chaff. But honestly, re-reading your OP, I think this is something to possibly consider and there are ways to get referrals that might give you hope for finding the right coach. Many of the good ones will offer a free session or half session, enough to find out if they are right for you.
Many options for a person like yourself, and a lot of finding the right person - especially when dealing with clinical psychologists - is to ask the tough question I mentioned above and gauge their reaction. You know what YOU want. Don't waste your money on anything less than the right fill-in-the-blank for you.
One last thing...this post is specifically for the OP. I wouldn't say the same for someone who clearly needed intervention in a crisis, etc. But for this OP - that's my nickles worth. And the standard disclaimer - I am not your psychologist, therapist, etc.
Good Luck!
posted by Gerard Sorme at 2:50 PM on August 15, 2015
Someone Else's Story (the OP) is asking a question that, while not exactly the same as the example above, is very similar. Finding a psychologist, counselor, therapist, (pick your flavor) that is practicing CBT (or variations thereof) is very difficult without asking tough questions upfront. For the OP that question must be something along the lines of, "I am looking for someone who will work with me, offer feedback, encourage when necessary, make me think twice when necessary, but not simply answer questions with more questions - can you be that person?" If you get a long and rambling answer rather than "yes" or "no" and a very short sentence or two -- you might have not found the right person.
You mentioned the possibility of a Life Coach. At one time, I was very opposed to even discuss them in the same conversation as psychiatrists or psychologists or even a competent social worker. But, I've mellowed a bit simply from feedback I have heard anecdotally. I think that, truly, some people just need someone on their side. A cheerleader. Someone who will listen and respond with thoughts of encouragement and support. There are some really good people calling themselves a Life Coach and there are people who call themselves the same and haven't a clue as to what they're doing, but because of the low entry requirements (none) it's very difficult to find a really good one and separating the wheat from the chaff. But honestly, re-reading your OP, I think this is something to possibly consider and there are ways to get referrals that might give you hope for finding the right coach. Many of the good ones will offer a free session or half session, enough to find out if they are right for you.
Many options for a person like yourself, and a lot of finding the right person - especially when dealing with clinical psychologists - is to ask the tough question I mentioned above and gauge their reaction. You know what YOU want. Don't waste your money on anything less than the right fill-in-the-blank for you.
One last thing...this post is specifically for the OP. I wouldn't say the same for someone who clearly needed intervention in a crisis, etc. But for this OP - that's my nickles worth. And the standard disclaimer - I am not your psychologist, therapist, etc.
Good Luck!
posted by Gerard Sorme at 2:50 PM on August 15, 2015
Maybe add a life coach in as well? Coaching is different in that it focuses on actionable steps moving forward. I do a form of coaching and one of my clients is also in therapy. We both like the combination. She can go as deep and intense as she likes/needs in therapy, and then she can take focused action in coaching.
posted by Vaike at 2:55 PM on August 15, 2015 [1 favorite]
posted by Vaike at 2:55 PM on August 15, 2015 [1 favorite]
It sorta sounds like you're getting stuck in the land of talk therapy which isn't quite what you're looking for. You really want someone to have a conversation with, who will call your bluff, point out alternative points, and be an active participant in the conversation. I would suggest being very explicit about those things when you interview new therapists. You can even literally say "I am NOT looking for someone who is just going to turn my statements and questions back around on me and make me answer them myself, nor am I looking for someone who is just here to walk the journey with me. I want someone who will actively help me figure this problem out."
If, on the off chance, you are a woman in the Seattle area I STRONGLY recommend you give the Women's Therapy Referral Service a try. If not, maybe see if your city offers something similar. This was how I found my therapist and it was such a godsend. I met with a coordinator who wasn't a therapist herself but personally knew all of the therapist in her program, and after interviewing me she recommended 3 therapists for me to try out. I met with each of them for 30-60 minutes for free to see if they were a good fit. It was very obvious in the end which one was what I was looking for.
posted by joan_holloway at 3:23 PM on August 15, 2015 [2 favorites]
If, on the off chance, you are a woman in the Seattle area I STRONGLY recommend you give the Women's Therapy Referral Service a try. If not, maybe see if your city offers something similar. This was how I found my therapist and it was such a godsend. I met with a coordinator who wasn't a therapist herself but personally knew all of the therapist in her program, and after interviewing me she recommended 3 therapists for me to try out. I met with each of them for 30-60 minutes for free to see if they were a good fit. It was very obvious in the end which one was what I was looking for.
posted by joan_holloway at 3:23 PM on August 15, 2015 [2 favorites]
I dunno, I think US culture as a whole and metafilter in particular just...refuses to acknowledge that sometimes therapy just doesn't work. Just like treatment for cancer or heart diseases just sometimes doesn't work. And it's not necessarily anyone's fault, and it definitely isn't the client's fault. When I asked a similar question here a few months ago, I got a few nice but not helpful answers commiserating with me and a lot, A LOT of victim-blamey answers, including the crazy circular logic "it's not working because you don't believe in it!"
Not everyone who undertakes therapy has a successful outcome, with somewhere around 30 - 50% of people leaving therapy with their problems largely unresolved and their feelings largely the same. Also, the majority of people who change in a positive way make somewhere between a 30% and 80% improvement in a helpful direction.
If you’ve been in therapy for the length of time that is usually recommended, and completed the therapy processes that are likely to help with your problem or situation but have not noticed any changes in a positive or helpful direction, it is possible that therapy isn’t working.
Also, CBT has some nasty ethical connections.
posted by Violet Hour at 3:38 PM on August 15, 2015 [14 favorites]
Not everyone who undertakes therapy has a successful outcome, with somewhere around 30 - 50% of people leaving therapy with their problems largely unresolved and their feelings largely the same. Also, the majority of people who change in a positive way make somewhere between a 30% and 80% improvement in a helpful direction.
If you’ve been in therapy for the length of time that is usually recommended, and completed the therapy processes that are likely to help with your problem or situation but have not noticed any changes in a positive or helpful direction, it is possible that therapy isn’t working.
Also, CBT has some nasty ethical connections.
posted by Violet Hour at 3:38 PM on August 15, 2015 [14 favorites]
@andrewcooke, I used to think the way that you do, but US trained psychiatrists are generally taught the "nod and listen" form of therapy as opposed to anything science based, although some of that seems to be changing. In fact, physicians in general are selected and trained more for memorization skills than any sort of rigorous scientific background. It's a (highly specialized) trade, not science.
If you want scientific metal health help in the US, I strongly recommend going to a PhD psych, and having him tell the MD what to prescribe.
@Violet hour is correct, talk therapy doesn't work.
Anecdotally, my brother teaches an evidence-based medicine class to mid-career physicians. These are people who have generally been practicing at or near the top of their fields for about ten years. He always starts the class off with the same exercise: they read a paper on megadoses of vitamin C causing cold symptoms to abate within about 72 hours. When asked, almost all of the physicians say that they would prescribe vitamin C to a patient who presented with a cold.
There's always a rather uncomfortable silence when he asks them how long it normally takes to recover from a cold.
Back to the original question, when was in your metaphorical shoes, I started by asking for assistance oping with very specific problematic behavior. I quickly moved on if they were unable or unwilling to provide a behavioral solution. The issues I was having were strictly associated with OCD, so I was able to be fairly focused. I think the highlight of my search was walking out of one psychiatrist's office mid-session when he asked me if I had been circumcised.
There are a lot of bad or just incompetent shrinks out there. You just need to keep looking.
posted by builderofscience at 4:04 PM on August 15, 2015 [4 favorites]
If you want scientific metal health help in the US, I strongly recommend going to a PhD psych, and having him tell the MD what to prescribe.
@Violet hour is correct, talk therapy doesn't work.
Anecdotally, my brother teaches an evidence-based medicine class to mid-career physicians. These are people who have generally been practicing at or near the top of their fields for about ten years. He always starts the class off with the same exercise: they read a paper on megadoses of vitamin C causing cold symptoms to abate within about 72 hours. When asked, almost all of the physicians say that they would prescribe vitamin C to a patient who presented with a cold.
There's always a rather uncomfortable silence when he asks them how long it normally takes to recover from a cold.
Back to the original question, when was in your metaphorical shoes, I started by asking for assistance oping with very specific problematic behavior. I quickly moved on if they were unable or unwilling to provide a behavioral solution. The issues I was having were strictly associated with OCD, so I was able to be fairly focused. I think the highlight of my search was walking out of one psychiatrist's office mid-session when he asked me if I had been circumcised.
There are a lot of bad or just incompetent shrinks out there. You just need to keep looking.
posted by builderofscience at 4:04 PM on August 15, 2015 [4 favorites]
The Academy of Cognitive Therapy (founded by the father of CT, Aaron Beck) maintains a list of therapists who have been credentialed by their organization. The American Board of Professional Psychology has a directory of therapists who have received Board Certification in different fields (which is different than boards in somatic medicine; think fancy postdoctoral letters you can get after you've been practicing for quite a bit, and it's also elective and not all great therapists get ABPP certified). One of these is Cognitive and Behavioral Psychology, so you may have some luck, though apparently there are only some 160-odd ABPP CBP folks in the country.
The Association of Behavioral and Cognitive Therapies has a less screened directory as well.
If by chance you live in the Philadelphia area, feel free to PM me for specific recommendations. Good luck!
posted by Keter at 8:12 PM on August 15, 2015 [1 favorite]
The Association of Behavioral and Cognitive Therapies has a less screened directory as well.
If by chance you live in the Philadelphia area, feel free to PM me for specific recommendations. Good luck!
posted by Keter at 8:12 PM on August 15, 2015 [1 favorite]
I'm a therapist, so take whatever I'm saying with a grain of salt.
The thing about mental wellness, when one is not dealing with a severe mental illness (and, often, even then), is that it's actually very simple: Feel your feelings. Take ownership of your thoughts. Be honest with yourself. Be honest with others. Accept responsibility for yourself and assert your rights with others, and look for other people who accept responsibility for themselves while asserting their rights with you. Spend time in nature. Pay attention. Figure out goals that align with your values and work toward them. Laugh.
So what can happen with intellectual people (and I count myself among them) is that we get caught up in some huge manufactured story of why X and Y and maybe Z, and we stay up in our heads about untangling all of that -- or sometimes embellishing that with a lot of metaphor -- rather than actually recognizing that all the handwringing is bullshit and yes, I do actually need to slow down, acknowledge I feel sad or glad or angry or anxious and then give myself the space to feel that. Not just say that I feel it, and spend the next 50 minutes spinning various stories about why I might feel it or what I should feel instead or how it reminds me of this other time I think I felt it, but actually feel it.
For myself as a client, I found that I actually made the most progress with therapists who initially struck me as annoyingly non-intellectual, even stupid. Because we're taught that people who concentrate on their feelings are dumb (and probably girls), and that feelings are dumb, and that evolved people spend all their time in their heads and none in their hearts, because that's Harlequin Romance-land (also girly). As a therapist -- and one's who's both intellectual and smart -- I had to learn to get out of my head (it's seriously fun to sit with a client for 50 minutes and spin all sorts of philosophical bullshit), especially with clients who were already too much in theirs, because if weekly 50-minute philosophical BS sessions fixed everyone's life, no one who graduated from college would ever struggle with anything, ever.
And the thing with CBT is that it's all about staying up in one's head. It also (though individual therapists may find ways to compensate for it) puts all the blame for a client's difficulties on the client, which is completely inappropriate in a lot of contexts, if a client is dealing with racism, sexism, homophobia, transphobia, etc., and I have a gut feeling (as a therapist who was trained in CBT but finds it often useless) that therapists who use it exclusively are therapists not thoughtful enough to understand that taking personal responsibility doesn't fix every problem. It's also going to attract therapists who want to stay up in their heads. Which is totally appropriate for clients who are over-the-top emotional, but, in my opinion, is a huge disservice to clients who are already up in their heads.
If I were you, I'd try to find a therapist with training in a style completely opposite my usual intellectual approach. If I were dealing with trauma, Somatic Experiencing. If family-of-origin issues, psychodynamic. My most helpful therapist, before I really got the feeling thing, was a guy who did some sort of somatic therapy (talking about feelings in the body, not touching!) and had a previous career as a massage therapist. You absolutely do not have to go into any sort of full-on "woo," but do be aware that the main reason CBT is shown to be effective is because it's a cookie-cutter approach that's easy to study, and that the creators have made a huge effort to get it studied so that it can be marketed as "the one way." Other forms of therapy can be just as effective, and in my experience, are even more effective with people who stay up in their heads.
I do use CBT, and I've found it gets more effective the lower-functioning the client is. My clients who are homeless, unemployed, high-school drop-outs need, and thrive with, that level of structure and explicit instruction. With higher-achieving clients, I think an exclusively CBT approach turns into a trap that keeps them stuck in the exact same patterns, but with an increased ability to justify them.
posted by jaguar at 8:34 PM on August 15, 2015 [38 favorites]
The thing about mental wellness, when one is not dealing with a severe mental illness (and, often, even then), is that it's actually very simple: Feel your feelings. Take ownership of your thoughts. Be honest with yourself. Be honest with others. Accept responsibility for yourself and assert your rights with others, and look for other people who accept responsibility for themselves while asserting their rights with you. Spend time in nature. Pay attention. Figure out goals that align with your values and work toward them. Laugh.
So what can happen with intellectual people (and I count myself among them) is that we get caught up in some huge manufactured story of why X and Y and maybe Z, and we stay up in our heads about untangling all of that -- or sometimes embellishing that with a lot of metaphor -- rather than actually recognizing that all the handwringing is bullshit and yes, I do actually need to slow down, acknowledge I feel sad or glad or angry or anxious and then give myself the space to feel that. Not just say that I feel it, and spend the next 50 minutes spinning various stories about why I might feel it or what I should feel instead or how it reminds me of this other time I think I felt it, but actually feel it.
For myself as a client, I found that I actually made the most progress with therapists who initially struck me as annoyingly non-intellectual, even stupid. Because we're taught that people who concentrate on their feelings are dumb (and probably girls), and that feelings are dumb, and that evolved people spend all their time in their heads and none in their hearts, because that's Harlequin Romance-land (also girly). As a therapist -- and one's who's both intellectual and smart -- I had to learn to get out of my head (it's seriously fun to sit with a client for 50 minutes and spin all sorts of philosophical bullshit), especially with clients who were already too much in theirs, because if weekly 50-minute philosophical BS sessions fixed everyone's life, no one who graduated from college would ever struggle with anything, ever.
And the thing with CBT is that it's all about staying up in one's head. It also (though individual therapists may find ways to compensate for it) puts all the blame for a client's difficulties on the client, which is completely inappropriate in a lot of contexts, if a client is dealing with racism, sexism, homophobia, transphobia, etc., and I have a gut feeling (as a therapist who was trained in CBT but finds it often useless) that therapists who use it exclusively are therapists not thoughtful enough to understand that taking personal responsibility doesn't fix every problem. It's also going to attract therapists who want to stay up in their heads. Which is totally appropriate for clients who are over-the-top emotional, but, in my opinion, is a huge disservice to clients who are already up in their heads.
If I were you, I'd try to find a therapist with training in a style completely opposite my usual intellectual approach. If I were dealing with trauma, Somatic Experiencing. If family-of-origin issues, psychodynamic. My most helpful therapist, before I really got the feeling thing, was a guy who did some sort of somatic therapy (talking about feelings in the body, not touching!) and had a previous career as a massage therapist. You absolutely do not have to go into any sort of full-on "woo," but do be aware that the main reason CBT is shown to be effective is because it's a cookie-cutter approach that's easy to study, and that the creators have made a huge effort to get it studied so that it can be marketed as "the one way." Other forms of therapy can be just as effective, and in my experience, are even more effective with people who stay up in their heads.
I do use CBT, and I've found it gets more effective the lower-functioning the client is. My clients who are homeless, unemployed, high-school drop-outs need, and thrive with, that level of structure and explicit instruction. With higher-achieving clients, I think an exclusively CBT approach turns into a trap that keeps them stuck in the exact same patterns, but with an increased ability to justify them.
posted by jaguar at 8:34 PM on August 15, 2015 [38 favorites]
I've been very impressed by what I've read of Dr. David Burn's work in CBT (and his further developent of the model called TEAM). You might check his organization, the Feeling Good Institute - they have some short term intensive programs for out of town folks plus lists of people trained in this approach. I would pick someone who had higher levels of training and then ask them how closely they keep to the approach - therapists tend to use a blend of styles and you want to make sure you are getting what you are expecting.
posted by metahawk at 8:37 PM on August 15, 2015 [2 favorites]
posted by metahawk at 8:37 PM on August 15, 2015 [2 favorites]
I have not been in therapy for years and I was a difficult teenager at the time, but I found the kind of serious, no-bullshit, challenge-me therapy you sound like you may be looking for with a psychiatrist (not a psychologist, therapist, or coach.) It may seem counterintuitive, but it worked for me. I can only speculate that perhaps his medical school/scientific training made him a bit more practical and outcome oriented as a general rule. He was also very experienced and older, and had an intellectual personality which helped. Unfortunately he was pretty expensive, always booked, and I take it it is rare to fine psychiatrists who mostly do extended talk therapy.
posted by quincunx at 11:51 PM on August 15, 2015
posted by quincunx at 11:51 PM on August 15, 2015
Also, on perhaps a more practical note:
I'd told him initially that I was looking for a short-term relationship with an emphasis on practical problem-solving and skill development, but after several months we weren't getting anywhere.
Your expectations for the work involved to fix things may be off. In my experience, three to six months of weekly sessions is generally sufficient to make significant progress on one recent well-defined discrete issue, like "I'm newly feeling very stuck in my current relationship and I don't know what to do" or "My mother just died and I need help dealing with my grief." Six to twelve months of weekly sessions is generally required for current-but-not-recent discrete issues like "I've been feeling very stuck in my current relationship for the past few years" or past non-recurring discrete issues like "I need to work on childhood trauma or abuse." Issues that are not at all well-defined like "I'm depressed and don't know why," longstanding patterns like "All of my relationships have sucked for my entire life," and/or multiple issues like "I hate my job and my relationship sucks and my family of origin is a mess and I need more friends" are going to require time to untangle, to identify the patterns, to practice identify the pattern when it's happening in real time, to learn how to do things differently, and to practice doing things differently in real time.
I don't think everyone needs to be in therapy for years and years, but I do think insurance companies have created unrealistic expectations for what can be accomplished in short-term therapy. "Short-term" used to mean six months of weekly sessions; many insurance companies now start wanting justification for why a client is "still" in therapy after eight or twelve sessions. There should absolutely be some sort of improvement for clients after a few sessions, but longstanding problems take time to work through. And while many short-term therapies claim to fix these problems quickly, studies I've seen have shown that longer, less-superficial therapy often fixes the problems for longer.
posted by jaguar at 8:55 AM on August 16, 2015 [6 favorites]
I'd told him initially that I was looking for a short-term relationship with an emphasis on practical problem-solving and skill development, but after several months we weren't getting anywhere.
Your expectations for the work involved to fix things may be off. In my experience, three to six months of weekly sessions is generally sufficient to make significant progress on one recent well-defined discrete issue, like "I'm newly feeling very stuck in my current relationship and I don't know what to do" or "My mother just died and I need help dealing with my grief." Six to twelve months of weekly sessions is generally required for current-but-not-recent discrete issues like "I've been feeling very stuck in my current relationship for the past few years" or past non-recurring discrete issues like "I need to work on childhood trauma or abuse." Issues that are not at all well-defined like "I'm depressed and don't know why," longstanding patterns like "All of my relationships have sucked for my entire life," and/or multiple issues like "I hate my job and my relationship sucks and my family of origin is a mess and I need more friends" are going to require time to untangle, to identify the patterns, to practice identify the pattern when it's happening in real time, to learn how to do things differently, and to practice doing things differently in real time.
I don't think everyone needs to be in therapy for years and years, but I do think insurance companies have created unrealistic expectations for what can be accomplished in short-term therapy. "Short-term" used to mean six months of weekly sessions; many insurance companies now start wanting justification for why a client is "still" in therapy after eight or twelve sessions. There should absolutely be some sort of improvement for clients after a few sessions, but longstanding problems take time to work through. And while many short-term therapies claim to fix these problems quickly, studies I've seen have shown that longer, less-superficial therapy often fixes the problems for longer.
posted by jaguar at 8:55 AM on August 16, 2015 [6 favorites]
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I also was part of a therapy group that she facilitated and that might be another avenue you look into. I actually got one of my most powerful insights in group therapy after a session where I left feeling the worst. Individual therapy was a great place for me to stretch out and discuss new ideas I had, but group therapy was a grab bag of personalities, some of whom I found made me angry, or disappointed, or confused in ways that were the same as I would be with people in my day to day life. And then we could unpack that reaction. Like, what did they say that hurt my feelings? Did they know they hurt my feelings? What did they mean when they said what they said? It helped me understand possible intents of others and my own reactions to them in an uncontrolled (but not too uncontrolled!) way that I just never could have achieved in one on one conversation.
posted by MsMolly at 1:21 PM on August 15, 2015 [1 favorite]