How can I successfully complete psychotherapy?

October 19, 2007 11:17 PM

I've scrupulously screened my therapists to find talented, qualified people who are good at what they do, but my therapeutic relationships always peter out after a few months. How can I keep my psychotherapy on track? Please read the more inside!

I've been through a few therapists now, and I'm getting frustrated. The first few weeks of therapy are always great, and I come away with some valuable insights, but around the second month, once my therapists get to know me, something goes wrong; I get the sense that we're not moving forward or working on the problems that brought me into therapy in the first place. My weekly sessions turn into enjoyable, intellectually stimulating, but unproductive, one-hour chats.

After a while of this, I usually drop THE bomb on the therapist, hoping that it will get things back on track. I tell them that, between the ages of 13 and 16, I was in an abusive relationship with a 45 year old man. They express shock and concern, but by next week, even after THAT, it's as though I'd never said anything and we're back to where it was: me, kicking back in a comfortable leather chair, regaling them with funny stories about being a dog trainer and comparing notes about the art exhibit we both took in over the weekend.

During the initial appointment, I'm always completely up front about exactly what my goals are. I provide them with paperwork from doctors who have diagnosed me with ADD and a few other more esoteric neurological disorders. I tell them that my last few therapists haven't worked out, and I tell them exactly why. I reiterate that I have ADD and tend to go off on tangents unrelated to the subject at hand. They all assure me that no, they'll keep me on track. Two months later, I'm blowing a $15 copay to teach them how to house-train their new puppy.

My problems (procrastination, perfectionism) aren't as dire as most of their caseload, but I still want to be able to consult with a professional who knows how to deal with these things.

What am I doing wrong? I've tried, really tried, to be in therapy, and it hasn't worked. All I want is to solve a few problems.

posted by freshwater_pr0n to health & fitness (24 comments total)

Drop the "bomb" on the first visit and see how that goes.
These folks are trained. Use that to your advantage.

If the first visit doesn't go well, drop them and try out the next one.
posted by lilywing13 at 11:28 PM on October 19, 2007

I obviously don't have the whole story, but it seems like: you're looking for help with procrastination and perfectionism by allowing yourself to procrastinate during your therapy sessions (not giving your therapist all the relevent information, avoiding the topic, putting all the blame for this on the therapist) and to demand the perfect therapist. By doing this, you're reinforcing your perfectionism (why stick with a therapist who's not perfect?) and procrastination (if you keep dropping your therapist, you'll never really have to work on the issues).

Can you see why this might be skewing the quality of the therapy you're participating in?

It's possible you just haven't found a good therapeutic fit, and I'd certainly recommend not only trying different therapists but also experimenting with different modalities (psychodynamic, CBT, stricly behavioral, whatever) to see if there's a better fit. But I'd also strongly recommend looking at how you're simply reproducing your issues in these relationships, and seeing how you can change your own behavior -- rather than putting all the responsibility for that change on your therapist -- as you move forward.

Also, you're allowed to say, "I don't feel like this is working, what can we do to change it?" As simple and explicit as that. You don't need to "drop bombs" in an effort to secretly manipulate your therapist (or anyone else) into the behavior you want. Think of dog training -- simple, concise, clear commands are going to go a lot farther than roundabout confusing manipulations.
posted by occhiblu at 12:06 AM on October 20, 2007 [8 favorites]

You tell an Internet full of strangers about "the bomb" after two paragraphs, but you wait weeks to tell your carefully selected therapists?

Maybe think on that?
posted by Good Brain at 12:18 AM on October 20, 2007 [3 favorites]

you're looking for help with procrastination and perfectionism by allowing yourself to procrastinate during your therapy sessions (not giving your therapist all the relevent information, avoiding the topic, putting all the blame for this on the therapist) and to demand the perfect therapist. By doing this, you're reinforcing your perfectionism (why stick with a therapist who's not perfect?) and procrastination (if you keep dropping your therapist, you'll never really have to work on the issues).

Exactly.
posted by Ironmouth at 12:52 AM on October 20, 2007

In other words, the therapist can't make you talk about what's bothering you.
posted by Ironmouth at 12:52 AM on October 20, 2007

Seconding that you need to drop "the bomb" on the first visit. A therapist needs to have the emotional and professional fortitude to be able to explore that with you.
posted by amyms at 1:03 AM on October 20, 2007

going against the grain here, your relationship with the therapist peters out because you're sufficiently well-adjusted, capable of taking care of yourself, that you don't actually need a therapist. you complain of perfectionism and procrastination. these are minor league complaints, i'm the same way but i don't let it bother me. it would be a lot harder on the people around me if i were perfect as opposed to perfectionist.
posted by bruce at 2:51 AM on October 20, 2007

freshwater_pr0n,

I suggest you drop the meta-bomb: show your next therapist this Metafilter discussion, ask them if (and how) they think they can help you knowing what they know now. Get to the point fast, rather than taking the long way around.

As a fellow perfectionist-procrastinator, I can relate to the difficulty of focusing the therapy. I don't have such a bomb to drop, but rather more mundane and banal aches of the soul, and I also tend to skirt issues a lot while I ponder on how one thing may be related to another (also taking painstaking efforts to explain everything just right, assigning blames and causes in the most precise manner possible. For this reason I am inclined to think that the bomb itself is a bit of a red herring, and your therapy doesn't go forward for what would come after the bomb, not for the bomb itself.

So drop the bomb the first day, and point out that your other therapies didn't really survive the bomb, and then plan together with your therapist a course of action that will allow you to get yourself in gear.

Just saying, playing by ear, I am not a therapist, just done some therapy.

Finally, good luck with your therapy and with the rest of your life. Also, stop reading metafilter, don't you have stuff to do?
posted by kandinski at 3:45 AM on October 20, 2007 [1 favorite]

going against the grain here, your relationship with the therapist peters out because you're sufficiently well-adjusted, capable of taking care of yourself, that you don't actually need a therapist.

I agree. It sounds like you might benefit more from a life coach. Alternatively, you could through psychoanalysis as distinct from generic psychotherapy, or you could try cognitive therapy.

If you go to a generic talk therapist, you'll get generic talk. It sounds like you have specific goals in mind and so a goal-oriented process designed for people who are not mentally ill could be more successful.
posted by alms at 4:29 AM on October 20, 2007

Maybe I'm missing something, but it seems to me that you're going in and stating explicitly that you want to work on your perfectionism and procrastination. Then a few weeks later you mention this abuse in one isolated session. You've already told them that you go off on tangents. So maybe they think that you're going off on a tangent and mentioning something that you don't care to work on, or that you've already dealt with. If it's an issue that bothers you, say so up-front and on your first visit.

Also, maybe you can tell your therapists that you'd like to be more of a participant in your therapy by knowing the rationale of what they're doing. Maybe knowing that they have goals for each session and a reason for your conversations will make you feel like you're moving ahead.

Good luck!
posted by christinetheslp at 4:51 AM on October 20, 2007

There's a lot of variables that go into a "good" therapist, one thing to remember is that there is some part of every therapist that sees you as income. When you combine that with a therapist who is trained to gather as much information as possible and to diagnose your problems, you can run into problems. Traditional psychoanalysts and cognitive therapists judge change over periods of months.

Perhaps explore STDP (Short Term Dynamic Psychotherapy), these therapists are trained to bring the most serious issues to the forefront and work on them. You just have to be prepared to do the work . . .
posted by jeremias at 5:06 AM on October 20, 2007

Regaling them with funny stories? Sounds like you're dodging. Which is a waste of your time, and theirs.

If you are in therapy to talk about your problems, then TALK ABOUT THEM. The fact that you continually avoid talking about your actual problems in favor of relating in a more jovial way with your therapist is not, in the end, anyone's fault but your own.

They're not there to drag you through therapy, kicking and screaming, until you resolve your issues. The theory behind therapy is you're going there BECAUSE you're ready to work on your own problems and do the work required to get there. That means talking about what's really bothering you.

Until you're willing to face these issues head-on, it's unlikely any therapist will be able to help you.
posted by twiki at 6:00 AM on October 20, 2007

In my experience, having some chatty sesssions is part of the overall relationship/process. The chatty sessions can help center a person, develop the relationship, connect back to your issues. Sometimes getting from point A to point B is not what one expects. So staying with a therapist to see what happens next, beyond the chatty sessions, might be interesting.
posted by ClaudiaCenter at 6:30 AM on October 20, 2007

I get the sense that we're not moving forward or working on the problems that brought me into therapy in the first place.

How do you know if you are moving forward or not? Is it because of the number of insights or aha moments you experience? Is it because your symptoms have decreased in a perceptible way? What is your evidence?

My weekly sessions turn into enjoyable, intellectually stimulating, but unproductive, one-hour chats.

Again, how would you know if they were productive? What specifically would happen and change?

Some people play the "no one can help me game", in which they get to feel bad and a victim, and they also get to make others wrong for not being able to help them. Its a fun game, that you are asking us to play along too. Therapists by their profession are paid to play that game, and they don't care if you make them wrong. They win because even if you make them wrong they know they are right, and they get your money.

Read
Napkin Notes on the Art of Living.
posted by blueyellow at 6:38 AM on October 20, 2007

Heh. I get this. I started out like you. I walked into my therapist's office fully convinced that I was there to improve my work performance, find a boyfriend who wasn't a complete jerk, and to sleep better at night. So, I told my therapist all that and she said fine and we chit-chatted for 50 minutes once a month. A couple of sessions in I happened to mention that I grew up in absolute utter fucking chaos, "ha ha ha, you know, who doesn't, doesn't mean I'm totally messed up, doesn't mean I'm wretchedly hard on myself, doesn't mean I'm terrified of intimacy and can't tolerate frustration or rejection. Ha. Ha ha ha. So what about you, Ms. Therapist? How are you?"

Also, you've framed your question exactly the way you frame your issues for your therapists. You've rather blithely slipped this sentence in mid-paragraph, bookending it with your ostensible major complaints of procrastination and perfectionism and your problem of finding a therapist worth the $15 co-pay:

I tell them that, between the ages of 13 and 16, I was in an abusive relationship with a 45 year old man.

Well, let's back up. Let's re-read that again:

between the ages of 13 and 16, I was in an abusive relationship with a 45 year old man.

That's major. That is not a minor problem. That is not passe or boring or small or insignificant or easy or casual. Mentioning it says to me that you know, on some level, that your perfectionism and procrastination are linked to this major trauma you've survived. And let me say it again - this is a major trauma no matter how you've naturally coped with it, either by using humor to deflect vulnerability, or doing everything right to avoid criticism, or putting off doing things so you don't have to risk failing and feeling worthless because of it. It's possible the enormity of the feelings you have surrounding this terrible thing that happened to you scares the shit out of you and you aren't ready to risk allowing a therapist to help you deal with it. Yet. Because, yeah, it's major and difficult and all that, but you're still here. You have a life to lead without being dragged down any further by something that was done to you without your consent.

When you're ready to get serious about your therapy, you will. You'll finally get sick and tired of how your behaviors (perfectionism/procrastination) stand in the way of living your life enough to deal with the feelings underneath those behaviors. Until then, you're just going to keep putting off dealing with the feelings you have about being sexually molested by a scumbag who used you for his own personal sexual gratification without regard for how it might render you unable to trust people, or how it might make you feel dirty and ashamed and damaged for your whole adult life. And you're not going to be able to tolerate feeling vulnerable or out of control for periods of time, and you will quit. Procrastination. Perfectionism. And so on.

I sincerely wish you the very best of luck. I also encourage you to get really pissed off at the bastard who molested you. Until then, feel free to MeFi mail me if you'd like to chat more.
posted by TryTheTilapia at 6:48 AM on October 20, 2007 [4 favorites]

I think you said this is psychotherapy? Maybe psychotherapy isn't for you. There's lots of other schools of thought out there. Try something more cognitive or behavioral, etc. Maybe a therapist from a different school of psychological thought would meet your needs better.
posted by bobdylanforever at 9:59 AM on October 20, 2007

This dynamic that keeps cropping up is as important to deal with in therapy as anything else. In other words, this recurrent problem is something that takes place within therapy (as a reaction to it?) and needs to be explored as such. Rather than as, say, the byproduct of a crappy therapist or bad fit between therapist and patient. You drive the direction of your therapy as much as (more than?) the therapist. So, when you are ready to get serious and get to the bottom of stuff, it will be on you to make that happen. If you don't feel like regaling, don't regale. If you feel like entering into a real exploration where you're serious and committed to figure it all out, jump in. You also might consider analysis, rather than therapy.
posted by sneakin at 10:11 AM on October 20, 2007

I think you said this is psychotherapy? Maybe psychotherapy isn't for you. There's lots of other schools of thought out there. Try something more cognitive or behavioral, etc. Maybe a therapist from a different school of psychological thought would meet your needs better.

In general, all those modalities are considered "psychotherapy." There are psychodynamic modalities that tend to rely mostly on exploration of feelings and gaining insight; I think this is what the traditional idea of "therapy" is; humanistic and psychoanalytic modalites would both fit in the psychodynamic category. Then there are more behavioral models, like CBT, which focus less (or not at all) on emotions and more on behaviors and/or thought patterns.
posted by occhiblu at 10:50 AM on October 20, 2007

Your work with dogs, as I've been able to glimpse it through your posts here and your livejournal pages, is truly fascinating, freshwater_pr0n; I'm not at all surprised your therapists have been beguiled by it. Wouldn't it be wonderful if you could find a therapist who could engage with you in the transformative way you have engaged the dogs you work with? I am not convinced that's impossible, but it is surely rare.

I think your case is not at all simple and straight forward for a therapist. In fact, it looks more like a kind of trail by fire to me, and is scaring your therapists off, although it might not have occurred to them that's what's happening.

You have scrupulously left the sex of your therapists unspecified, but I think you present very different difficulties to a man as a therapist than you do to a woman.

A male therapist who chooses to try to help you disarm 'THE bomb,' as you put it, must confront the probability that you will identify him by turns, over and over again, perhaps in rapid succession, with the older man who raped and exploited you, or the father who failed to protect you from that, for whatever reason. Most male therapists would find themselves feeling at some level, by the force of such a projection, as if they had actually done these awful things to you, in my opinion, and that is a daunting prospect. Add to it the fact they might have to cope with sexual attraction to you on their own parts, and I think many would wholeheartedly agree that you had dropped 'THE bomb' in their quiet and well-appointed offices.

I guess you would identify a woman therapist, on the other hand, with the mother who was absent, incapacitated in some way, or who should have known from an abundance of clues what was happening to you, but willfully and unforgivably turned her face away from the abuse of her child for selfish reasons. How terrible, and how terrible even to allow yourself to be seen that way-- and to feel it, even for therapeutic reasons, when you never would have done such a thing in a million years.

I think you would do best with a therapist who could go through such an ordeal with you, and has already been tempered in those fires. I know there are men out there who could do it, but I believe you are most likely to find what you need in the person of a very experienced, loving woman therapist who specializes in survivors of sexual abuse and domestic violence.
posted by jamjam at 11:30 AM on October 20, 2007

Not all male therapists are attracted to their female clients, and all competent therapists have been trained in dealing with transference and counter-transference issues.

Something to clarify for yourself: It seems like you are, in some way, still psychologically caught up enough in the abusive relationship that you're holding on to it for a reason. It may very well be a good reason, but it still holds enough power for you that you consider it a good test or tool to wield in your therapeutic relationships. I think TryTheTilapia's point is really good, that we tend to find therapy effective only when we're really ready to deal with whatever issues we're working through. Maybe, rather than just the procrastination and perfectionism, this abusive relationship -- in whatever form it still exists for you -- is really what you feel like you should be working on now? Maybe that means delving into it and finding insight; maybe that means finally closing it off and letting it go; maybe it means something else entirely for you right now.

One of my professors said that therapy tends to "break open" right around the sixth session, that something just shifts and that's when the real work starts. I'm sure that's not true for all therapeutic relationships, but it did pop into my mind when you said you tend to "drop the bomb" right at about the six- to eight-week mark.

None of this really changes the core advice: This abusive relationship seems important enough to you that you should try to mention it sooner, and given that you're aware of your tendencies toward procrastination and perfectionism, you may need to force yourself to stick with therapy for a bit even when it doesn't seem perfect and to force yourself into self-disclosure even when it seems like you could do it later. (Though, if any of that feels totally wrong, as opposed to simply a bit weird, then you may either need a new therapist or, as others have suggested, maybe this is just not the right time for you to be working on these issues.)
posted by occhiblu at 12:26 PM on October 20, 2007

Jeez, this EXACT thing happens to me, minus the bomb part. I tell them anything and everything I can think of up front. But eventually we get to that 50-minute useless chat stage. I go there to get work done, to understand underlying issues, to make specific progress, to get better. I state my goals and tell them I want to focus and connect the dots and work. I get answers like "it doesn't work that way" which just seems like bullshit.

I don't want to be in therapy for a decade. And people always say, "If you're not getting what you need from your therapist, leave. Keep trying others until you get it." But ugh, it can take a year of bi-weekly appointments to just to communicate your basic backstory. What a waste of time. But I don't see another option, so that's my only advice to you - - keep trying. Once I'm to the point of arguing over technique, it's time to go. Maybe do like someone upthread suggested and try a different subspecies of therapist.

I've kind of given up on it for a while and I just go home and stew in my crazy and try to figure it out myself. Good luck to you.
posted by Bravely Anonymous at 12:09 AM on October 21, 2007

I ran into this too. I think some therapists use these chat sessions when they think you are stuck or about to stumble on a breakthrough. While talking about the intricacies of fly fishing for 50 minutes may not seem like it will directly lead to you being a more whole person, the process may give your doctor opportunity to probe things you didn't even think significant and to get a sense of your general approach to stress, your family, etc. Your therapist may have a purpose in mind during these sessions even if it's not obvious on the face of matters.

That being said, if you're frustrated with the direction things are going and want to take a more active hand in your therapy, a good therapist should help you do that. S/he can talk to you in general terms about the style of therapy s/he practices and how you currently fit into the progression. If you don't like some aspects, you can ask about how they can be changed. S/he may even tell you about other major schools of therapy in the event that your investigations lead you to decide that a different path and therapist would be more productive for you.

It took me a really long time to change my mindset around therapy from one of "obedient patient on surgical table" to one of a curious, informed, equal part in the process. If that resonates with you, perhaps spend a session or two just exploring that idea with your doc and then you can think about how you want to move forward.
posted by rhiannon at 1:44 PM on October 21, 2007

One more thing... your post's title ("How can I successfully complete psychotherapy?") caught my eye. Though this is not a journey that is ever necessarily completed, most people do have goals for psychological growith in the short and long term. It sounds like you present your short term goals as relating to ADD and staying on track. Your therapists may be viewing your seemingly inconsequential conversations as great tools to practice staying on track and interacting with others in ways that don't "look" ADD.

However, it sounds like your real goal is to explore deeper issues based on events that have happened in your past, such as this sexual relationship that still clearly has some impact on your life. Your therapist perhaps does not "get" that your revelation means you have now established enough trust to explore your highest priorities.
posted by rhiannon at 2:04 PM on October 21, 2007

Wow. There's some great input in this thread!

Jamjam nails it. As a dog trainer, I don't delve into Fluffy's early puppyhood to determine *why* she's humping the mail carrier's leg; I just come up with concrete ways to solve the problem. I see my own problems as behavior issues rather than emotional issues, too.

Maybe I'm frustrated that they're seeing the whole freshwater_pr0n package, while I'm coming from a pragmatic, dog trainer's perspective. I want to break my problems down and work on them one by one. Talking about how I feel when I procrastinate doesn't help me - hearing concrete ways I can be more proactive does.

I'll do some research into the specific schools of therapy some of you have mentioned, and also look into life coaching.

Thanks, everyone. I feel a bit sunnier about the whole process now.
posted by freshwater_pr0n at 7:52 PM on October 23, 2007