Should I reschedule my therapist appointment with a therapist of a different modality?

October 24, 2010 1:33 PM

Should I reschedule my therapist appointment with a therapist of a different modality?

I’d like to avoid using AskMeFi as therapy, but I need to give some of the relevant background to allow the question to make sense.

I’d also like to apologize, because there’s a certain amount of . . . the therapist equivalent of iatrophobia going on in this question. I’m sure you’re all lovely people.

I’m a graduate student in my 30’s. I’ve recently made an appointment with the university’s counseling services (they schedule a good three weeks out for intake appts.) I’m really facing, for the first time, the probability that the sexual abuse I underwent as a child (by my substantially older brother) has had lasting repercussions, both on my sex life with my partner and my career performance. I have some specific goals for therapy, such as resolving the problems in our sex life, reducing my professional anxiety to nonpathological levels, and, possibly, talking to my parents about my sexual abuse history.

When the abuse was going on, I disclosed to a friend, who told her mother, who told the school, which talked to my parents. My brother was taken to a therapist; he then told me that we were both in big, big trouble because I’d talked, and that after our upcoming family vacation, I would be taken to her too (I honestly at this point cannot tell you if we were actually taken to the same counselor or not.) The vacation was a nightmare, as was the theraputic experience; my only memory of it is being asked about what I had done to initiate this, and what my sexual feelings were. The abuse didn’t stop; it got worse, and I knew that I couldn’t talk to anyone about it.

I saw two other therapists when I became a teenager. I was brought to one, a personal friend of my mother’s, after a suicidal effort. One was the high school counselor, who I went to voluntarily. Both were slightly worse than useless. I saw a counselor in college, much, much too late for what was going on with me in college, but she was extremely effective for solving my immediate issues in a problem-focused modality. So I’m batting about 0.25 here with therapists; I expect I must just be unlucky. But I recognize that an effective therapist can be really great.

I have pretty strong feelings about that counselor and how that “intervention” went (though I’ve recently been experimenting with feeling compassion for her). Because of that experience, the entire concept of “childhood sexuality” is a trigger for me, liable to send me into icy shock or foaming-at-the-mouth rage.

The counselor I was scheduled with for my upcoming appointment (based on availability) lists psychodynamic theory among her specialties, and that takes me straight to Freud and sexualized seductive children, and I start to get nauseated and icy. I’ve considered the possibility that working through this fear of Freudians would be productive, but, as my partner points out, that’s not actually what I’ve scheduled an appointment for. I’m also anticipating this might really require medium term counseling, not just a couple of visits. But I don’t want to medicate my fear of being told that I deserved it by therapist shopping, either. And on the other other hand, I do have this fear that any therapist is going to identify closely with the therapist in my story, and not with the terrified eight year old girl. So I don’t know whether I should reschedule with, e.g., a CBT therapist specializing in sexual abuse issues, or if I should leave the appointment as it stands.

I don’t even know what an intake appointment is likely to be like, or if she’s likely to take my history and schedule me with another counselor, or if she’s going to say, “no, no, you’re fine, imposter syndrome is utterly normal and no one really talks to their parents.”

I appreciate any advice, though I’d also appreciate as little derailment from the actual question as possible. I recognize that that’s hard; I just really do want to save my therapy for therapy. Throwaway email: [e-mail]

posted by anonymous to Human Relations (15 answers total)

Freud is the worst possible place to start when addressing issues of childhood sexual abuse, in my personal, not-a-therapist-just-a-patient opinion.

If I were choosing a therapist for the first time, I'd strongly recommend someone who does a combination of dynamic (talk) therapy and cognitive behavioral therapy. And I'd look for someone with experience dealing with childhood trauma survivors. In fact, if you're in NYC, please MeMail me because I can recommend several people who would be fantastic.

I recommend this book a lot, but I think it would be especially helpful in your situation: Trauma and Recovery by Judith Herman.

Finally, I understand the fear that a therapist might not be sympathetic. There are a few unsympathetic therapists out there, and I'm sorry you've met some of them previously. My advice to you would be to schedule consultations with multiple therapists before you choose one you gel with.

Good luck, and please do feel free to MeMail me if you want to chat with someone who has dealt with similar difficulties. It's hard, and it doesn't get easier just because you get older or farther away from the trauma. ::hugs::
posted by brina at 1:46 PM on October 24, 2010 [2 favorites]

In my experience, a good therapist is someone who, before even walking into a session, has divested themselves of all personal agendas and pride and is therefore ready to take on the needs and agenda (if one exists) of the patient they are about to see. From the get-go, explain exactly what it is you're looking for from the therapist you are about to meet with; my therapist's specialty is one modality, but I came to her and continue to go to her for assistance in another format, and damn, does she know what she's doing, even if it is low on her list of specialties. It is quite possible that the counselor you are going to see will be glad to provide you with a nuts and bolts consultation, especially if you acknowledge your discomfort and bad track record with other therapists in the past, and if you ask about their experience with sexual abuse therapy.

Therapists are there to help you, and they want to be of service. They will not side with other therapists; instead, they may play devil's advocate for a while to give you another perspective on a problem, but in the end it is YOU who they are worried about, not the rep of their from-far-away-colleague.

And for what it's worth, if I were your counselor, I would want to hear (or read) exactly what you've written above because it would give me a very good baseline from which to tailor our meetings together. You deserve to be with a therapist who will put you and your needs first (which is really what all therapists should do), and you will do well to assert your needs from the get-go. It may take a bit of pendulum swinging to get you to a person who truly is the right match, but that's okay. You will find that person.
posted by patronuscharms at 1:54 PM on October 24, 2010 [1 favorite]

Definitely reschedule.

Psychodynamic therapy is inappropriate for your specific needs and has a hard time getting anything done before most insurance plans run out of covered sessions.

So I’m batting about 0.25 here with therapists; I expect I must just be unlucky.

I've seen four therapists so far; two were ineffective (but not harmful) and the other two were great. I would guess then that your experience so far has unusually negative, and would encourage you to keep trying to find someone that works for you.

I have heard many stories of people having horrible therapy experiences as children- much more than people having horrible therapy experiences as adults. My guess is that adults have much more control over what happens in therapy and can change therapists if they need to. Don't be afraid to exert that control- you will likely have a much more positive experience now than you did then.

Good luck.
posted by a snickering nuthatch at 2:04 PM on October 24, 2010

Here's what I'd do, based on my understanding of most college counseling centers: go to the appointment, but without any expectation about whether the person you see that day will be the person you continue to see. University counseling centers are usually designed, as you allude to, for short-term interventions. However, their staff are usually also in a good position to help you find a longer-term therapist who can help you if you need intensive, long-term therapy. So don't cancel this appointment, especially given how challenging it can be to get an appointment with a new doctor when you need one. But don't think of it as "if I go to this appointment, this person is my therapist." Instead, think of it as, "I'm going to this appointment to get access to the resources I need. It may be that the person I see first can help me, and it may not be. If I don't like her or her style isn't right for me or I need someone whose expertise is more tailored to my specific experiences, I don't have to go anymore, and I can use the resources I've gained to find someone better able to help me."

On a side note, the fact that she's been trained in psychodynamic therapy doesn't mean that she buys into Freud's ideas about sexuality. She could very well agree with you about sexualized children. You won't know whether she's right for you until you meet her and discuss what you need and what she has to offer. And if she doesn't meet your needs, there is absolutely nothing wrong with shopping around to find a therapist who can give you what you need. That's not "medicating your fear," that's sticking up for yourself and asking for what you need. It's not a sign of failure on your part (nor, I should add, on the therapist's part) if you don't click with a particular therapist and choose to see someone else instead.

Good luck to you!
posted by decathecting at 2:04 PM on October 24, 2010 [5 favorites]

My feeling (with no more expertise than some generally successful therapy experience) is that one word can't tell you much about what a therapeutic relationship is going to be like. Lacking more meaningful data about your alternatives (and the one thing I'd guess would seem obvious to look into is if there is anyone where you have access to services with expertise in childhood sexual abuse, if so it seems like that would be worth the wait), going to the appointment you can get the soonest and working from the much better knowledge that will afford seems like the most sensible course. You don't need to work through your fear of Freudians or whatever, you need to find a particular professional individual you can get work done with, and my anecdotal experience is that basically involves trying whatever is accessible, moving on if it doesn't work, continue until it is helping.

Leaving a therapist who does not immediately, given a similar precis of your situation as you offered above, affirm the basic interpretation that you were subjected to a profound trauma as a child and subsequently profoundly failed by the adults whose responsibility it was to protect you does not constitute therapist "shopping," it is abandoning a pointless continuation of a relationship with an incompetent professional. Keep trying until you find someone who you can work with. It is a long term process, I mean years long term. You don't have easy problems.
posted by nanojath at 2:28 PM on October 24, 2010

You'd go to a dentist for a problem with your teeth. You'd go to a cardiologist for a problem with your heart. If I had your problem, I'd only go to a therapist with a proven track record in treating childhood sexual abuse survivors, and who specialized in it.
posted by yarly at 2:39 PM on October 24, 2010 [2 favorites]

The mental health field has gotten much better informed about childhood sexual abuse in the last ~20 years, so it's extremely unlikely that any new therapist will hold you responsible for your abuse in any way. I agree with the other posters that if you can identify and access a therapist who specializes in childhood sexual abuse, that would be ideal - but if not, I'd keep the appointment and give yourself permission to decide whether this therapist is the right fit for you or not.
posted by synchronia at 3:09 PM on October 24, 2010

I think you might be overthinking this plate of beans, but then again you might not.

On the one hand: I really don't think that most therapists who self-describe as "psychodynamic" are actually adherents of Freud's theories to the letter, particularly not the spectacularly crap bullshit of the seduction theory.

On the other hand: What if your bad luck holds, and you get another shitty therapist?

So I am on Team Find A Specialist, and if that doesn't pan out, I would basically run down the points you made in this very cogent post in your first meeting with the therapist you're scheduled to see. And then listen to her response.

Kudos to you for being a good self-advocate, which is hard for everyone, and in particular for those of us who experienced abuse as children. I am sorry for the pain in your past, and wish you all the best in building a better present and future for yourself.
posted by Sidhedevil at 3:25 PM on October 24, 2010

My experience is that psychodynamic doesn't translate into "liking Freud". On the other hand, my first therapy session (with a CBT therapist) Decidedly didn't work for me, so I asked for a different therapist (psychodynamic) for my next session. We're wrapping up after about 5 years, and it's been hugely helpful. So reschedule if the anxiety will impede your ability to ask questions of this therapist about their approach, but know that others are right above: this person isn't your only option.
posted by ldthomps at 3:26 PM on October 24, 2010

I don't think psychodynamic means what you think it means. Freud used psychoanalysis which is what psychodynamic theory grew out of but they are very different. The only real relevant concept that would highly correlate with Freud is the idea of the subconscious and how it affects our conscious/decision making. And it's worth to note that most major theories used today would not disagree with said concept.

So I would encourage you to go. Someone that uses psychodynamic will likely be interested in what you’re feeling in the moment. A lot of what’s called, "here and now"…meaning your feelings at that moment in the session.

I think it's more important to find a therapist that has had extensive experience with trauma and abuse. Working through that is challenging no matter what your theoretical perspective. I would highly suggest finding someone that is trained with EMDR. It's unlikely you will find that at a university counseling center though.

Good luck!
posted by WhiteWhale at 3:39 PM on October 24, 2010 [1 favorite]

I'm just gonna fifth (?) that a psychodynamic orientation is not the same as psychoanalytic. Generally the psychodynamic perspective tends to take up that childhood experience is important to adulthood experience, and that a lot of childhood stuff gets repeated unconsciously. Psychodynamic therapists tend to take their cues from the different neofreudians thinkers (Adler, Jung, Winnicott, Klein, Horney, etc.) who had their own issues with Freud and therefore split off from him and created their own theories. You could ask who specifically your therapist has been influenced by, or how s/he interprets "psychodynamic" to get a better sense of where s/he is coming from. I actually think a psychodynamic therapist would probably be good for your situation, because it seems like you actually want to explore how this childhood abuse experience is affecting your present life. I'm not sure CBT, or another more problem-focused modality would be all that helpful in that respect. (I don't quite get why that seems to be the only true therapy for Metafites? IMHO it all depends what you're trying to get out of therapy.) I currently see a psychodynamic therapist influenced by Jung who I have found to be extremely helpful. That therapy has made it clear to me how childhood issues with my parents have sensitized me to feeling invalidated in other relationships in my life, and made sense out of some professional struggles I was having. But that's my two cents. Anyway, good luck with whatever therapy you do. Self-knowledge is arduous work, but priceless! ;)
posted by amileighs at 4:33 PM on October 24, 2010

Most therapists of a certain generation were trained in psychodynamic theory. Some of them specialize in it, maybe even becoming psychoanalysts. Most, however, become eclectic and use bits and pieces of techniques they've learned over the years. Psychodynamic thinking mostly rests on the idea that there are unconscious motivations for much of what we do, and that intrapsychic conflict (opposing wishes, desires) accounts for a lot of the problems we have. People can have psychodynamic training and still be highly sensitive and responsive to issues of childhood trauma.

The whole notion of abused children being responsible for their own abuse belongs in the dust heap of psychological thinking and I can't imagine a therapist (of any theoretical orientation) in this day and age holding it to be a fundamental truth. If you get a hint that the counseling center therapist believes that, feel free to discontinue the session. Your upbringing was filled with multiple chronic trauma from family members and from people who were supposed to be helpful to you. You have special vulnerabilities in this area and certainly don't need to have your early experiences retriggered by some therapist who doesn't know what she is doing.

I'd encourage you to explain some of what you're hoping to get out of therapy with the counselor. Indicate that you believe that some of your current problems may be rooted in some very difficult childhood experiences that included abuse, and that you're reluctant to get into these issues without knowing whether the therapist has expertise in that area. Ask her about her experiences treating people who were abused as children, and listen carefully to her words and her emotional tone when she's responding. Be mindful of the fact that college counseling centers can be staffed by student interns who are supervised by more senior people. The counselor's status at the center and their philosophy about maximum time in treatment should be disclosed to you. Such centers tend to emphasize short term, problem-focused work, though they can sometimes work for longer periods of time under certain circumstances.

Also be aware that the therapist may have a duty to report abuse if children might be currently at risk. The therapist may need to ask you questions about the current status of the abuser, as therapists have a role in protecting vulnerable people from being victimized.

Don't feel you need to commit to being that person's client - at the end of the session you can certainly say that you'll think about how you want to proceed and get back to her. It often does take some shopping to find the right therapist for you. If you think you've found someone good, try working with him or her for a month or two, and then re-evaluate - are you talking about things that are important to you? Are you feeling relief or, if not, do you feel good about the plan you and the therapist are pursuing? Don't hesitate to bring up your concerns and questions, and feel free to move on from any therapist who isn't working well for you.
posted by jasper411 at 4:35 PM on October 24, 2010

In my own university grad student intake at counseling services involved a pretty clinical person that referred me to someone else.

They want you to be with a good match. Don't stress and know that they probably have a dozen people for you to cycle through if you must.
posted by k8t at 7:37 PM on October 24, 2010

The research says that all modalities of therapy are about as likely to provide relief with mental problems to people who need help. Which is not to say that all modalities are right for all people at all times. Since the most important constituent of successful therapy is a good relationship with your therapist, if your current feelings would preclude you from developing a good relationship (where good is defined, in part, as trusting, and hopeful that they can help you), then I would suggest considering a change.

Here is an answer I once wrote to someone asking how to get the most out of starting therapy. It addresses some of your concerns.
posted by OmieWise at 7:33 AM on October 25, 2010 [1 favorite]

I'm late to the thread, but since OP's three weeks aren't up, I'll reiterate what k8t said: in my (admittedly anecdotal) experience with university counseling centers, the person they have doing the intake is just whoever's available at that time. The idea is to get down some basic information and match you with someone for ongoing sessions.

Another thing to consider is that the intake form (or the person conducting the intake) will probably ask if there's any special considerations they should take into account when matching you with a regular therapist. Even if they doesn't, it would be perfectly appropriate to bring up your concerns during the intake.

Good luck.
posted by kagredon at 8:56 PM on November 9, 2010