Am I too much for a counselor to handle?
July 24, 2012 3:25 PM   Subscribe

What is a therapist supposed to do for a client?

I have now had two visits with a licensed clinical social worker; my insurance will pay for a total of 6 visits. The visits last 45 minutes.

In the first meeting I outlined the fact that I'm an adult child of an alcoholic, that I'm kinky, and that I'm in a challenging, confusing relationship that lately I felt I needed to get out of. She listened and asked a few questions, I told her that what I'd read of cognitive behavioral therapy seemed like a good match for me, she said she could assign homework if I wanted, I laughed and told her if it was hours of written stuff I probably wouldn't do it. It was, in general, a "getting to know you" type meeting. I decided I like her.

Because of the 4th of July holiday and various other scheduling issues, the next meeting was something like 3 weeks later. In the interim I'd been diagnosed with basal cell carcinoma on my nose (see my previous question) and am scheduled for surgery in a month. I have been freaking out about that and juggling it with my relationship difficulties.

In the second meeting we talked a lot about the dynamics in my relationship, particularly in the context of this new health issue (he's arrogant, brutally honest and likes to push my buttons, sometimes even when I'm feeling vulnerable - like now. I'm insecure, oversensitive and prone to catastrophizing even at the best of times, but especially now.)

I talked at full speed for the whole 45 minutes, hardly letting her get a word in edgewise, trying to vent everything without forgetting or leaving anything out. She did say she felt like she should be seeing both of us, and I explained that due to his suspicious nature, my partner would be totally against that. At one point she mentioned his arrogance, interrupted herself, laughed and said something like, "he'd hate that I just said that about him, wouldn't he?!" She was very empathetic, but near the end of the meeting, everything just kind of petered out. I ran out of things to say and looked to her for something, anything useful or productive. she looked bewildered and said "I don't know what to tell you! I guess just keep meditating, work on your mindfulness... I definitely think I should see you every week until your surgery."

I've done a tiny bit of reading on meditation and mindfulness, but haven't discussed it at all with her - it seemed weird for her to suggest things I'm not really sure how to do. I was exhausted and out of time by that point and didn't call her on it, but I walked out feeling confused.

What exactly should I be getting out of this? Is the idea just to go vent, or should she be offering some sort of guidance?

I'm sorry if this is scattered. Please feel free to ask questions, I'm sure I've left out important details.
posted by thrasher to Health & Fitness (11 answers total) 6 users marked this as a favorite
Hopefully a therapist provides a safe context for the client to explore and make changes the client feels will enhance the quality of his/her life--the therapist may teach specific skills in better managing anxiety, depression, relationships etc. Much of therapy is helping the client gain perspective, recognize self/other destructive behaviors/thoughts, provide reality testing/feedback. Again, a therapist provides a safe environment to learn new skills in managing troubling behaviors and thoughts. However--one thing a therapist never does is do your work or you--a therapist can be a teacher, coach, guiding hand, adviser, referral agent but is your life and your work. An excellent therapist is also very aware of their limitations in knowledge, influence and relationships and should always be willing to refer a client to other resources.
posted by rmhsinc at 3:50 PM on July 24, 2012 [1 favorite]

kanata said "Getting better isn't a race. It is a long marathon. Slow down" and kanata is absolutely right--and I think a bit of your problem is right there. I have a strong hunch some CBT to help you learn to "slow down" decatastrophize and substitute more rational beliefs/thoughts for some of your existing ones will be a big help.
posted by rmhsinc at 3:56 PM on July 24, 2012

Therapy is typically goal driven. You and your therapist should identify one/some concrete goal(s) to focus on. Then your therapist should basically do as rmhsinc said. Most therapists aim to identify these during the "intake" (initial) sessions, but not a hard and fast rule. If you are paying for therapy without clear goals outlined, you are paying (rightly or wrongly) for conversation, and you're not receiving CBT.

Worth mentioning: My experience as a client and (intern) practitioner of CBT is that your appointments should be fairly regular, especially at first and probably will take more than 6 sessions. After all, you are identifying and working to reprogram habit patterns that don't change overnight.
posted by sb3 at 4:01 PM on July 24, 2012

Sorry, I wasn't clear on the homework thing (maybe not to her, either).

Her bio on her company website indicates she uses CBT techniques, insight-oriented therapies and self esteem enhancement (among other things.) I took that to mean she has a method (or a handful of methods) that she would utilize in dealing with her clients. While I don't know the details about those things, they sound like what I need. When I said to her that CBT seemed like a good fit, she said her approach to counseling does include CBT, then laughingly said assigning homework wasn't really her style, but she could do it if I wanted. She was joking around a bit, as was I when I said if it was hours of written homework I probably wouldn't do it.

I really don't know enough about CBT or any other form of therapy to know what specifically is involved or how any of it works. So next time I'll ask her.
posted by thrasher at 4:03 PM on July 24, 2012

You say you had an alcoholic parent; often that means "unpredictable". Children in that sort of situation can react in many ways, one of which is trying to predict and prepare for numerous possible futures. While my parents weren't alcoholic, last week I found out from a second cousin that, as a matter of fact, my grandparents were children of violent alcoholics. I had no idea growing up, but whooo-ee did it help explain a lot of things. Anyhow, many unhealthy and abusive dynamics were passed down to my mother, who behaved erratically as well. I mention this because I too had as one coping mechanism, this "predict and prepare for all possible outcomes", even though I realized often enough after the fact that my preparations for the worst, didn't actually prepare me for how bad it truly got.

Your sensation of being "erratic" may be an instance of this very same coping mechanism. At its best, it's being open to possibilities – you see the value of therapy and you like your therapist. But its downside is that you tend to hold back from committal until the other party acts. My own therapist was pretty up-front with me after the first few sessions, so yours may be as well. She said I decided what my therapy would be. That whatever came from it, would be from my engagement and choices. Later on, as I gained confidence in that, she helped me understand the context I'd brought into sessions over time and, in a sense, taught me through my own background, how to forgive myself and grow (guilt trips from parents having been a big thing, for instance).

You also said: he's arrogant, brutally honest and likes to push my buttons, sometimes even when I'm feeling vulnerable - like now. I'm insecure, oversensitive and prone to catastrophizing even at the best of times, but especially now.

Go easy on yourself. Health issues such as cancer are inevitably linked with death, one of mankind's biggest questions, so it's hard to call that unnecessary "catastrophizing", especially if you're with someone who's goading you rather than supporting you. I do understand how catastrophizing can be taken too far, but your therapist's suggestion of meditation and mindfulness are great in this case: often, just sitting with the uncomfortable void of potential catastrophy and accepting that life has tragedies – you may well be fine in the end, but we all know people who aren't, and our own health scares tend to link us with others' – can, as paradoxically as it seems when told this way, bring a sense of deep peace. Rather than running with the catastrophic thoughts, just sit with and acknowledge them. I know how hard that can be at first; it's not pleasant, very little in our happiness-addicted society prepares us for sorrowful thoughts. Sometimes reading books about it helps, or Greek tragedies, whatever you're drawn to. Then realize it is indeed you being drawn and making those choices. If you can bring up associations in therapy, and sit with them there too, leaving silences if/when you feel the need, as kanata wisely suggests, your therapist will be able to help give insight.

Eventually, with a good therapist, you end up weaving a story of healing. Your own story. It does take time.
posted by fraula at 4:09 PM on July 24, 2012 [8 favorites]

I just want to thank you for introducing me to the verb "catastrophize." It was missing in my life, and now that hole has been filled. Most appreciated.
posted by Capri at 4:53 PM on July 24, 2012

I came up with it on my own, Capri, then found that it is actually a term used for a specific kind of cognitive distortion that I'm very prone to!

Thanks all for the input. I have found I am not clear enough about things I want and need, often because I myself don't know what I want and need, and the interactions with the therapist seem to be like that too, so far. I appreciate the push in the right direction.
posted by thrasher at 5:12 PM on July 24, 2012

Am I too much for a counselor to handle?

It doesn't sound like you're too much to handle. But I wonder if you're too much to handle in a hurry like this. Six visits is really not that many! And that's especially true when you've got a lot of deep interconnected issues to work out.

It's one thing to be like "Okay, I just want advice on how to communicate with my partner better" or "Okay, I just want to figure out how to cope with my health fears" or whatever. A single issue like that is something you could work on over six visits and get something out of it. But to try to address everything in six visits is.... a pretty daunting prospect.

If I were you I'd either try to get insurance approval for more than six sessions, or look for a way to keep seeing this counselor after your insurance gives out, or pick a single goal to focus on for the next few visits and see what progress you can make.
posted by nebulawindphone at 6:27 PM on July 24, 2012 [1 favorite]

hardly letting her get a word in edgewise

This. This is the first problem. Let her guide you a little and ask questions. Not everything that happens to you has equal relevance - it's up to your therapist to gently guide you into figuring out what is relevant and what isn't.

What is a therapist supposed to do for a client?

This is the second problem - you have no clear goal. In therapy, and especially in cognitive behavioral therapy, you need to outline exactly what you are trying to achieve. For example: "I want to be more empathetic." "I want to trust my partner more." "I want to be less sad all the time." If you don't know what you want, how can you possibly expect your therapist to give it to you?
posted by wolfdreams01 at 6:48 PM on July 24, 2012 [1 favorite]

You might start by asking your therapist what her role is meant to be. She should be able to articulate this and help to build a sense of long-term direction in your sessions. Did you tell her why you were interested in CBT? Evidence-based practice is trendy right now, and CBT is supposed by EBT, but it's possible that she won't strictly adhere to a CBT approach unless you express that this is important to you.

Also, evidence has continued to support the hypothesis that it is the therapeutic relationship, independent of the theoretical orientation, that tends to produce positive outcomes. So there is something to your instinct that you 'like your therapist'.
posted by sb3 at 9:07 PM on July 24, 2012 [2 favorites]

My therapists have been helpful in two ways:

One, by asking exploratory questions that resulted in my re-evaluating a narrative or point of view or seeing a pattern. Very useful. Two, by giving me specific tools in response to a particular stated need. A reasonable goal for the next for sessions is to use CBT to lower your anxiety about surgery, for example.
posted by DarlingBri at 7:22 AM on July 25, 2012 [2 favorites]

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