March 31, 2010 2:49 PM   Subscribe

Thank you so much for getting me to seek therapy. You're the best. Now I need more help, because I don't know if the therapy is working.

At first, when I started going, I felt optimistic. I had a problem, I was doing something about the problem, and even if I didn't see changes right away, I was moving in the right direction.

It's been a few months, and I'm not feeling that optimism anymore. My problematic behavior (mainly procrastination/inability to get myself to do work) is not improving. My last few sessions have been extremely frustrating. The therapist (who does CBT) asks me what happened this week, I tell her (usually nothing much), and then we sit there in uncomfortable silence. Sometimes she asks me a question but they're usually not related to the problem (which I have clearly identified to her as my reason for seeking therapy). Like she'll ask how my family is. They're fine. I... don't know what else to say there. If I knew what the fuck we should talk about, I would bring it up. If I knew how to solve my own problems, I wouldn't be seeing her. Isn't she supposed to guide the conversation or contribute something? I end up feeling like there is nothing she (therefore, anyone) can do to help me. I also feel like I must be “doing it wrong.” I don’t want to believe that I will just always be this person who can’t get things done. I said so to her at our last session and she was just like, well, could you accept that if it were the case? Which is like a way of agreeing with the despair.

OK, I’m trying not to be emotional about this, sorry. In a word, is it typical for there to be so much silence? What am I supposed to be doing? How do I change things so I get more out of therapy? Or am I crazy to think I can change who I’ve been for more than twenty years?

(I do want to be fair to my therapist, she is a cool person and she has had at least one great insight about the way I react to things, though I don’t really know how I can put that to practical use.)

Thanks in advance for your advice. I do want to say that switching to another therapist is not an option for me at this time for many reasons, so right now it's pretty much her or no one.
posted by anonymous to Health & Fitness (22 answers total) 12 users marked this as a favorite
There's no "supposed" to or "typical" when it comes to therapy. In the end, if you are clicking with your therapist and feel like it's helping, then you're doing it right. If not, it doesn't mean there's anything wrong, just that maybe you might want to try a different therapist.

In my experience, therapists are like drugs - sometimes it takes trying a few before finding one that works.
posted by Lutoslawski at 3:01 PM on March 31, 2010

Therapists are there to make you think, not give you answers.

Have you talked to her about these feelings? Have you told her you don't know what to say or what you should talk about?

and I agree wholeheartedly with Lutoslawski, maybe this therapist just isn't for you.
posted by royalsong at 3:05 PM on March 31, 2010

This is normal, you should get frustrated with your therapist. She is there to challenge your assumptions about yourself. The fact that you are annoyed, is probably a good thing. I think you should print your question out and bring it to your next therapy session for your therapist to see.
posted by fifilaru at 3:12 PM on March 31, 2010

May I suggest this article, which was written by a therapist.
posted by halonine at 3:12 PM on March 31, 2010 [3 favorites]

This could just be not the right therapist for you. Have you talked with her about it? "[Name], I feel like this isn't clicking for me, and I'm not seeing the kind of results I was hoping to see. Let's talk about how you see this working and what results you think are reasonable and possible."

IMO, it's important that a therapist be willing to discuss their orientation to therapy, how they see the therapeutic process working, whether they have a "goal" for the process and what it is if they do, what their expectations are of their patients and how their patients participate in the process, and that kind of thing.

Some folks wind up "auditioning" multiple therapists before finding the one they click with. I lucked out with the first one I spoke to. Unfortunately, there doesn't seem to be any way to predict ahead of time whether a particular therapist is a good one for any particular client.
posted by Lexica at 3:14 PM on March 31, 2010 [2 favorites]

The frustration is good. Work with it, talk about it with her. Talking flows in funny ways, letting it flow takes practice. You may not have the right therapist but don't give up just yet.
posted by chairface at 3:35 PM on March 31, 2010

Therapy without goals can easily feel like it's going nowhere. Could you talk with your therapist about specific goals for your work together?

What would be a realistic goal? Can you define tangible things that you can work towards? "Be happier" is not what I'm talking about; something like "talk with 1 new person a week" or "go bowling every Thursday night". I'm not trying to suggest that these goals are right for you, but I'm trying to suggest that there should be goals that you can see, yes or no, that actually happened. Then once you're achieving these goals, consider if these goals are helping you build the life you want. If not, make some different goals. If they help, keep up the good work and add some new ones.

Is there something you want to do but are not doing? Maybe that's a goal. Determining tangible goals is something important to talk with your therapist about. Without them, you're missing a great opportunity to enable positive change as a fruit of your therapy work.
posted by buzzv at 4:06 PM on March 31, 2010

This doesn't sound like CBT to me. CBT generally has some sort of structure - worksheets or handouts, at least.
posted by needs more cowbell at 4:12 PM on March 31, 2010

To be more constructive: maybe ask her if she can outline some sort of path for you guys to follow. In other sorts of therapy this would be strange, but for CBT I think it is fair. CBT is sort of meant to be brief and directed.
posted by needs more cowbell at 4:14 PM on March 31, 2010

The frustration is good. Work with it
What would be a realistic goal?

As someone who felt the same way in therapy, and stopped going because of that, I get the feeling that OP wouldn't be asking this question if they knew how to "work with it" or what kind of goal to set.
posted by ArgentCorvid at 4:20 PM on March 31, 2010 [3 favorites]

I think your frustration sounds reasonable. And I don't think frustration is always a good sign-- sometimes it means the therapist really *isn't* giving you what you need. I just fired my therapist (who was more traditional and psychodynamic) after 2.5 years. I spent the last several months complaining that I didn't know how to use our time effectively and wishing we had a clear plan and some goals. The therapist said his view of therapy was different from mine, and would only elaborate that he didn't think in terms of goals, and that it's a long process. Once I realized he would never change for me, I quit.

Passive silence is a common complaint about therapists, and they're not all like that. I'm especially surprised you're getting this from a CBT therapist-- I saw one years ago, and she had me buy a copy of Feeling Good and gave me worksheets like these to do between sessions-- we definitely talked about concrete behavioral goals as being the point of our work together.

I do think it's a good idea to print this question and discuss it in your next session. It's going to be tough for you to get past your frustration if you feel that you and your therapist aren't on the same page about how to work together. And if you don't at least have the sense that she's trying to get on the same page with you, she may not be a good fit for you.
posted by Dixon Ticonderoga at 4:31 PM on March 31, 2010 [1 favorite]

I have felt the same way. I really think the only way to feel better about this and hopefully improve the experience for you is to be honest with your therapist. It was hard for me to psych myself up to do this myself, but after a number of sessions where I just felt like it was a waste of time, I finally said something along the lines of, "You know, I'm not really sure if this sounds funny, but I feel like I'm not 'doing therapy right'. I'm not sure how this is supposed to work, or what I should be talking about, and I'm frustrated that I just come in every week and whine about the same shit happening week after week. What do you think? Are we doing this wrong? Is there a way to make this feel more constructive?"

It's not guaranteed to fix the issue, but it's possible that it will open up a new dialogue with your therapist or get him/her to come up with some suggestions as to how better use your time together.
posted by tastybrains at 4:37 PM on March 31, 2010

You're not alone, lots of people suffer from procrastination. I've thought and read about it a lot, and here's what I think are two of the roots of it (in my experience):

Self-doubt: This is when you feel you are not good enough to do it, or that you don't know enough, or you just don't think that you can. Self-doubt is crippling, because you know nobody is holding you back... it's all you, and you can't understand why you never feel good enough. When you have self-doubt, it's easy to want to curl up in a little hole and wait for someone stronger than you to pull you up. Don't do that, fight the temptation. The solution to this one, I think, is nothing else but learning to pull yourself up. Open your mouth and admit to anyone who will listen when you want something or when you have a problem. Pump yourself up and get going -- go to the gym, take a run, drink a cup of coffee. After a certain point, you realize that you must either brush self-doubt aside, or you can continue to sit there while life moves on and opportunities pass by.

Perfectionism: This is a fairly good problem to have. It means you have good taste and high ideals and so forth. Unfortunately, we don't live in a perfect world. You aren't perfect, I'm not perfect, and the work you do will never be perfect. If you find you can't get any work done for this reason, it would be a good opportunity to work on any perfectionistic tendencies you may have by learning to accept the realities of life. Be practical. Remember the big picture of why you are doing something, and remember that life is dirtier, uglier, and shittier than you think. Otherwise, you will keep playing a losing game, because you will never be able to get it just right. Take that weight off your shoulders and have more fun with your work if you can. There's lots of stuff worth doing in life, even if you can't do it perfectly.

Hope that helps. You can change! It takes time and commitment, but every effort counts. It's not an overnight thing or a "couple of months of therapy" thing.

If you want, I'll give you an example from me when I was in college. I used to procrastinate a lot, which is fairly common, except it got problematic sometimes. I would spontaneously worry that there'd be no way I could pass certain classes, so I might as well not even try to do the work. It was a kind of self-doubt that had no basis, no real explanation. However, when I actually showed up to class, and showed up every day, and did all the projects and homeworks and so on (even though I didn't feel like it), I discovered that I could manage it, and that I could pass. I ended up realizing that sometimes you just need to show up to life, and then you discover that you are capable of more than you imagined.

Furthermore, when faced with nasty or stupid assignments or projects, I had to learn to remember to seriously look at the Big Picture of why I had to go through them (to get my degree), instead of procrastinating out of boredom or because I couldn't see the point.
posted by Theloupgarou at 4:46 PM on March 31, 2010

I had the same feelings about the first therapist I went to. I stuck with it for several months, but I just got more and more depressed - in fact the most depressed I've been in my life - and I finally quit. Several years later I got up the nerve to seek therapy again, and I found a therapist I really "clicked with," who really worked hard to help me figure out my issues and make progress. It was only then that I realized how wrong the first therapist was for me.
posted by pitseleh at 5:54 PM on March 31, 2010

One of my first therapists was like this. I suspect this approach was very patient-centered in her mind, but it didn't work for me, because my main problem was that I was pretty cut off from my feelings, bottled them up, and didn't really reveal them to anyone. Including, you know, the therapist. I had no idea what I was supposed to talk about, and thought that therapy was something someone else would "do" to me while I just sat there responding. I didn't realize I would have to be a participant, and I didn't do anything to prepare for the meetings.

Do talk about it with your therapist. It's OK to say things like "I don't feel like I'm getting a lot out of this. I don't know what to say."

The "How was your week" opener is still a non-starter for me. I like it when the therapist reviews their notes prior to the meeting and picks up where we left off after checking in with a little welcome 'how are you' that's more of a mood-read than a conversation starter. "So last week we were talking about conflict...." etc. The open-ended approach might be just what some people need, but it's not what I needed. It might not be what you need either.

There's always a chance you're resisting a method that's working because it's getting more difficult, and you know at some level you're going to have to come around to dealing with something you'd rather not think about. If you bring up your questions about how therapy is going for you, you might be able to get a better idea about that.

So switching therapists ended up being good for me, but also, I started to take a more active role. Like, as the week was going by and I was experiencing something, I would flag it to remember and talk about in therapy. If I tried something she recommended and it worked, or didn't work, or sort of worked, I'd revisit that with her in therapy. If I read something that caused me to wonder or have an insight, I would bring that up. I started using it as a way to understand experience.

So the first thing to do is bring it up with the therapist, and give whatever solutions you discuss a chance. If that still feels unproductive, it's okay to say 'the style isn't working for me' and switch.
posted by Miko at 6:31 PM on March 31, 2010 [2 favorites]

The therapist is your employee - you're paying her salary, right? You've hired her, but it sounds like she's not giving you what you need. It's nice you want to be fair with her - so treat your next session as a performance evaluation - this is what I like about the way you work, but this is what I don't.

Have a discussion, which may lead to you being more clear about what kind of help you want. Or it may lead to an impasse, in which you thank her for her time with you so far, but indicate that you're going to be looking for a new therapist/employee.

Silence by the therapist is most often a way to not intrude - to let the client lead the way, and not have the therapist impose an order on the sessions. She definitely doesn't sound like she's doing CBT with you, as CBT is focused and directed.
posted by jasper411 at 6:38 PM on March 31, 2010

Wow, I can't believe all of the comments that frustration is productive. I say, find someone new. If your frustration was "she keeps saying these things that make me so mad!" I'd say "ah, you are getting somewhere." This feeling of "WTF, why are we sitting here, where is this going, what are we supposed to be doing?" makes me think that this just isn't a good therapist for you.
posted by salvia at 8:07 PM on March 31, 2010

1. Find a new therapist, but be aware that 2. therapy can take a long time. I didn't feel like I was making any progress until like 2 years into my therapy. Now, years later, I am seeing a new therapist temporarily for some problems, and I sometimes have insights into myself on my own.
posted by IndigoRain at 10:04 PM on March 31, 2010

Therapy depends on the chemistry between the client and therapist. This person might experienced and work wonders with others but it sounds like it is not a good fit for you, at least the way things are going now. In general, if therapy is going to be successful, there will be at least some sense of movement after a couple of months. (More than just one insight that you don't know what to do with). That said, I strongly suggest that you find a way to talk to her about what is bothering you. After that session you can decide if you want try a few more session or if you want to look for someone else. It is very common for someone's first try at therapy to not quite work.

Also, from your description, it does not sound like your therapist is doing CBT so don't assume that CBT wouldn't work for you just because this isn't working.

Finally, YES, you can absolutely change the habits of the past twenty years to become the person that you want to be. You just need someone to help you find your path to change.
posted by metahawk at 11:05 PM on March 31, 2010

I experience that relatively regularly with my current therapist, whom I like. What happens is that when it bugs me, I call him out on it and then we talk about it and then things generally get more helpful again for a while. I think he's just focused more on the deep-seated emotions that cause the unhelpful behaviors rather than on addressing the behaviors directly with CBT.

As a result, my behaviors haven't in fact changed a huge deal, but the way I feel in general has changed significantly -- I kind of feel like I've grown up a lot in therapy, if that makes sense. And the truth is, CBT is simple. I can do exercises from the books Feeling Good and Thoughts & Feelings whenever I want to if that's what I want. What I can't do by myself is figure out all these emotional things that I'm not even consciously aware of half the time and really start addressing them at a deep level.

I recommend confronting your therapist and saying, hey, my procrastination's not getting better and I don't understand why you're doing what you're doing instead of attacking the procrastination directly.

In my experience, therapists fucking love talking about the therapist-patient relationship.
posted by callmejay at 7:51 AM on April 1, 2010

Print out your question and take two copies to your next session. Give your therapist one copy and discuss your concerns.
posted by Carol Anne at 10:24 AM on April 1, 2010

Whether your therapist is CBT or not, she certainly doesn't sound relational. There are some models that are more interactive than others. Would help to bring up the important observations you've shared here with her?
posted by ChicagoTherapyConnection at 2:58 PM on May 17, 2010

« Older Babies and Bathwater   |   Ow; stop that. No wait; please don't. Newer »
This thread is closed to new comments.