Changing therapists after MANY years of treatment with the same person

March 27, 2019 5:38 AM

Is it possible to change therapists after being with the same one for so long? I’ve been seeing the same psychiatrist (“Dr. C”) for about 15 years now to treat moderate chronic depression, with a smidge of anxiety thrown in from time to time. Besides talk therapy, I’m also on meds, which he prescribes and monitors. He is the only therapist I have ever seen, so I have no baseline to determine what makes for good therapy.

My depressive episodes are far less frequent and far less intense than they were before I began treatment. So that’s good. But the depression hasn’t fully gone away -- it’s more like I know how to manage it. Dr. C. speculates there may be some forgotten childhood trauma that is the root cause, which gave rise to the things I’ve struggled with my whole life -- rampant people-pleasing, fear of conflict, feelings of judgment, shame, and sadness, desperate striving always to be the good boy, all of it culminating in -- ta da! -- depression. But we haven’t unearthed what that trauma might be.

On top of that, with the way I’m wired, I perceive Dr. C as an authority figure whose approval is important to me. Rationally I know therapists are dispassionate listeners who operate in a safe space where I can say anything without fear of being judged. But the way we interact, Dr. C sometimes responds to me in ways that feel challenging, and not in the helpful way. Accusatory, almost. I fully acknowledge that my wiring could be causing a misperception, and I’ve gotten confident enough to call him on it when it happens.

However, these two things -- first, my seeming water-treading, and second, and the way we interact, which occasionally gives rise to feelings of wariness on my part -- have me wondering if someone else might be a better fit. But then, on the OTHER hand, I have 15 years of history with this guy, and the thought of starting all. over. again. with a new therapist is daunting.

Any MeFites been in a similar situation? How did you handle it? Thanks in advance.

posted by anonymous to Health & Fitness (12 answers total)

But we haven’t unearthed what that trauma might be.

So, a thought on this in particular.

I've often been told I do things that seem really strongly like typical trauma reactions. But beyond some pretty mundane childhood bullying, I don't remember anything traumatizing.

Recently I started seeing an IFS therapist who specializes in trauma. And real early on they were like, "Look, this isn't a movie. You don't need to have a cathartic moment where you Remember What Happened. You can just work with the feelings and reactions you're having now, and either you'll get bits and pieces of memories back as we work or you won't. Either way, we can make progress." Hearing that, not just from a regular therapist who might not know shit about trauma, but from someone who specializes in trauma and its effects, was hugely reassuring.

It is totally legit to switch for other reasons, including maybe some of the other reasons you've mentioned here, or maybe even "I want to work with someone who has trauma as an area of specialization." But, at least according to this one expert, "we haven't unearthed the cause of the trauma" alone isn't necessarily a huge problem.
posted by nebulawindphone at 6:00 AM on March 27, 2019

Print out your question and take it to your next session. Discuss your questions with Dr. C.
posted by Carol Anne at 6:19 AM on March 27, 2019

Dr. C. speculates there may be some forgotten childhood trauma that is the root cause, which gave rise to the things I’ve struggled with my whole life -- rampant people-pleasing, fear of conflict, feelings of judgment, shame, and sadness, desperate striving always to be the good boy, all of it culminating in -- ta da! -- depression. But we haven’t unearthed what that trauma might be.

There are other modes of therapy. Please explore them to find what actually helps you in addition to the drugs. Your job is to do what's best for you and not what's best for the therapist.
posted by DarlingBri at 6:39 AM on March 27, 2019

This is not my area of expertise but I think it’s okay to try something new here. It may be helpful to think about what specifically you don’t like about your current doctor and what you’d prefer in a future doctor, both because it could potentially salvage your current doctor relationship and because then you’ll be able to compare more easily. Like sounding accusatory - maybe there are a few words your current doctor could add that would soften his statements.

I think you should also consider your goals with therapy before starting up with a new doctor. You said that your depression has improved but hasn’t gone away and you have learned how to manage it. For many people, that’s the goal of therapy. For example, I view my depression as a chronic condition. Maybe I’ll wake up one morning feeling like it has lifted permanently and I am cured. But I also think that’s not a reasonable expectation for me after dealing with this thing for two decades. So I don’t know if no depression should be your goal.

This phrase raised some concerns with me: “Dr. C. speculates there may be some forgotten childhood trauma that is the root cause ...” I think nebulawindphone is right on in that the trauma is less important than the impact it is having on you today.
posted by kat518 at 6:50 AM on March 27, 2019

I should also say that while not the same as switching doctors, I changed antidepressants at one point to see if something else was a better fit. It wasn’t so I switched back. That wasn’t my favorite experience ever and it took time but it wasn’t an ordeal. Good luck!
posted by kat518 at 7:00 AM on March 27, 2019

My symptoms match yours pretty much point-for-point, just add self-doubt.

Over the years I've been through talk therapy three times, with different therapists. All of them were helpful, in very different ways. I learned a lot from each one. I'm strongly of the opinion that for any given therapist, you've learned everything you're going to learn from them after the first year or so at most. There's only so much that can be seen from that single perspective; beyond that you're just a steady paycheck.

Depression doesn't have to have a root cause, and personality characteristics aren't necessarily based in childhood trauma. Sometimes these things just are. And even if there is one, knowing the cause of something doesn't necessarily have anything to do with coping with its effects, if the cause is unchangeable and in the past. I spent a long time hunting for a This Is Why I Am Like This. I think that was... not wasted time, exactly, it was necessary to get to where I am now; let's just say a wrong path. It was a real relief to accept that I Am Like This is the starting point, and switch to And This Is How I Make That Work as the goal. Still working on that part but it feels a lot more manageable than the existential questioning I was stuck in before.

So, yes, I'd say by all means switch to another therapist asap. Don't think of it as starting all over, just as seeking a different point of view. (And also don't think that it means your current work was wrong or wasted either; if you're mostly able to manage your symptoms that's huge, seriously, congratulations on that.)

That's a highly opinionated answer, I know; and I don't mean to dispute the experience of anyone who feels differently: I have friends who've been with the same therapist for decades and seem content with that arrangement. But if you don't feel like you're getting the results you want from what you're doing, it's ok to -- and may be better to -- try doing something else.
posted by ook at 8:09 AM on March 27, 2019

I saw a psychiatrist for probably that long and felt vaguely dissatisfied. I started seeing a specialist in trauma, specifically somatic experiencing, in addition to the psychiatrist (I still needed the psychiatrist for meds). After a few years with the somatic experiencing specialist, I just didn't need the meds or the psychiatrist anymore, so I stopped seeing him. It was no big deal at that point.

So if you want to experiment with a different therapist, you really don't have to drop the psychiatrist altogether.

Also, I happen to know about a specific trauma I experienced as an infant because I was told about it, but if I hadn't been, I would never have remembered it, and I really don't think I would have needed to. There's a version of therapy in popular culture that involves remembering a specific incident and then being cured. It's possible that happens in real life, but I really don't think it's necessary to remember childhood trauma to be helped by therapy.
posted by FencingGal at 8:14 AM on March 27, 2019

I am ...concerned... that this therapist has seen you for 15 years and is ok with the fact that you’re mostly treading water. That is actually not great. A good therapist recognizes when you need someone else, or a different specialist, or a different treatment modality, and they help you get that, because the point is that you get better.

You should absolutely see someone who specializes in trauma. There have been a lot of advances in the last fifteen years of which your therapist does not seem to be aware. Which...also concerns me.

I would suggest finding a somatic therapist or another trauma specialist. You need to see someone who can help you.
posted by schadenfrau at 1:01 PM on March 27, 2019

Breaking in a new therapist isn’t as hard as you might think. This time around you’ll have a much clearer (albeit not perfect) idea of what you want and don’t want and the experience to judge whether it feels like a step in the right direction. And your ability to hold authority figures to account will open all sorts of possibilities.

In your shoes I would say yes, if it’s been fifteen years and I’m starting to get antsy, it’s time to try someone new. Returning to your current therapist is always an option if things go poorly.
posted by Tell Me No Lies at 4:29 PM on March 27, 2019

I highly doubt that some forgotten childhood trauma is causing you problems. This is not really a thing. It does sound like your current thinking and behaviours could use more help. Switching to a new therapist could be just the thing you need. If it doesn't work out, you can always go back.
It sounds like your most worried about disappointing the doctor by saying you want to leave and go work with someone else. Think of what a great personal success it would be for you to do that. Why I bet the good doctor would be so proud of you for risking rejection and disapproval! This might be your most important task yet, to learn that you can risk disapproval and still survive.
posted by SyraCarol at 9:02 PM on March 27, 2019

... the things I’ve struggled with my whole life -- rampant people-pleasing, fear of conflict, feelings of judgment, shame, and sadness, desperate striving always to be the good boy...

This basically describes me -- and I had no trauma. Unless you could label as 'trauma' the constant unspoken lessons from my family that my feelings were unimportant, and that being obedient and self-denying was my purpose in life.

Many therapists spend less time exploring the past, and instead concentrate on how to cope in the present. It's okay to meet with one or more other therapists just to see how you feel in those sessions and whether they give you more hope for improvement. You don't have to stop seeing your current doctor while you investigate. On the other hand, you can take a break from Dr. C any time you want. He's not going to think less of you for leaving, or for wanting to come back if you decide that's the right thing.

I've accepted that my depression isn't going to go away. I'm satisfied to have medications with manageable side effects, and that I can enjoy some things. As a person gets better, they are able to tolerate more things...but there will always be a threshold beyond which they'll feel overwhelmed or anxious. My psychiatrist calls it "trading up." It took me many years to to accept that it's inevitable.

Hope is very important to the success of therapy. If a different therapist can make you feel more positive about your chances of doing better, that's worth a lot.
posted by wryly at 10:07 AM on March 28, 2019

This is definitely a conversation you need to be able to have with your therapist. Having a separate pdoc to do the meds has been important for me, fwiw, because my therapist can go into the processing without worrying about whether she needs to also tweak meds to keep me stable.

In my limited experience: I got to that same kind of point, but a) my therapist saw that something didn't fit and needed to at least rule out baseline trauma to figure out what else might be happening b) she was right about there being trauma c) I think "forgotten childhood trauma" is a blunt and imprecise way of looking for something that is probably hard to call trauma, but is nevertheless Weird Shit that manifests in ways that mess up all your future relationship patterns. So I don't call it trauma, but it is something that predisposed me to react to future events in a way that made them traumatizing.

MeMail me if you want.
posted by ahundredjarsofsky at 12:42 PM on March 28, 2019