Are there any therapists who actually help you?
May 15, 2013 10:33 PM   Subscribe

I went to a couple ones and they just say “uhh huh” and “ya” and “how does that make you feel?” all the time and dont give me any advice. Are there any that actually help you and give you advice? I also want to mention that going just made me focus on my problems and feel sorry for myself instead of changing things and going just seemed to make my problems worse.
posted by john123357 to Health & Fitness (33 answers total) 9 users marked this as a favorite
I told my therapist straight out that the quiet listening approach doesn't work for me. Luckily, he agreed to take a different tool from the therapy toolbox and we work with a combination of methods that include his giving me lots of feedback and exercises and really engaging me in thinking about how to move forward, as opposed to letting it all spill out and me drawing all my own conclusions.

I'd be very up-front with a therapist if you feel you have specific needs, because not all therapists work the same way, and even the same therapist doesn't use the same techniques on every client. Say what you want the relationship to be, and hold your therapist to that.
posted by xingcat at 10:38 PM on May 15, 2013 [4 favorites]

Response by poster: is there a specific type of therapy that deals more with "fixing things" than just talking about them (CBT, EBT, psychotherapy ect) ?
posted by john123357 at 10:41 PM on May 15, 2013

Unless your problem has a physical component, such as addiction, I am unaware of any therapy that can just "fix things". To my knowledge the purpose of all therapy is to be able to raise your own awareness of your actions and the reasons behind them so that you then have the ability to fix things yourself.

We often think we know how and why we are doing something counter-productive when in reality we really have no real idea.
posted by Podkayne of Pasadena at 11:08 PM on May 15, 2013 [3 favorites]

Why do you want advice? That basically makes it seem like you want your therapist to boss you around. You're responsible for your actions -- maybe it would help if you looked at therapy as the space in which you can start to arrive at your own organic conclusions, rather than just have someone tell you what to do, problem solved. You can gain so much if you just keep going so you can start to lay out the problems you've got before you and talk through solutions and strategies with an objective outsider.
posted by These Birds of a Feather at 11:19 PM on May 15, 2013

Response by poster: I actually got to the "root" of my problem in therapy which was a childhood incident, and once I discovered that, it didnt help me at all. Nothing changed. What I am looking for is solution based therapy where I can bounce ideas off the therapist and get advice.
posted by john123357 at 11:27 PM on May 15, 2013

Depending on your reason for seeking support, Maybe coaching would suit better. It tends to be more action and future oriented. A good coach should be accredited and trained.
posted by MT at 11:28 PM on May 15, 2013

Response by poster: Is coaching a "legitimate" thing? Like a life coach you mean? I'm looking for something that will be covered by insurance.
posted by john123357 at 11:30 PM on May 15, 2013 [1 favorite]

I also want to mention that going just made me focus on my problems and feel sorry for myself instead of changing things and going just seemed to make my problems worse.

I mean this in the gentlest way possible: Things get worse before they get better. You need to stay in talk therapy.

The solution you are looking for is you. You, sitting with your problems and figuring out why and how you've come to the place you've come to. It's difficult, of course, but it's absolutely necessary. Think about that, and talk to your therapist about the thoughts generated by that introspective process. A good place to start might be telling your therapist exactly what I've italicized above. See what s/he has to say about that.

This is not to say that sometimes there isn't patient/therapist incompatibility; that is always possible. But your question and caveat suggest that you don't yet have the emotional tools to deal with your problems. A therapist can lead a horse to water, but.
posted by sevensnowflakes at 11:47 PM on May 15, 2013 [3 favorites]

Response by poster: I was in it for 5 years and I got worse every year. I have not gone for years and am much better, however I am looking to get into it again without wasting my time again.
posted by john123357 at 11:54 PM on May 15, 2013 [2 favorites]

I went to a therapist who offered what I thought was pretty concrete advice. She didn't offer advice in the sense of telling me how to live my life, or what things I needed to change. But when I came to her with a situation I was dissatisfied with (trouble communicating in a certain context, or anxious thoughts when trying to fall asleep, for example) she would talk to me about if for a while to get a sense of why it was causing me trouble, then suggest some possible tools to make it easier.

The work we did didn't really align with a particular therapy methodology, although she was trained in CBT, and I think it informed some of the stuff I'm talking about here. I suspect that it may be a good place for you to start looking. It's less about figuring out the "why" and more about developing concrete tools to change to way you think about certain things.

So, if bringing a specific problem to a therapist, and leaving with a few different tools to try the next time that problem comes up sounds like the kind of advice you want, there's at least one therapist out there who does that. I bet there's a lot more, too.
posted by duien at 12:04 AM on May 16, 2013 [3 favorites]

CBT is the closest thing I've seen to a psychotherapy practice that 'fixes things.' I got to the root causes of my issues and found my therapist lacking. Switched to a therapist that does CBT-based therapy and I finally got tools for living. It's not advice, it's methods of seeing destructive thought patterns as they happen and changing them.

I can't recommend it highly enough.
posted by wemayfreeze at 12:08 AM on May 16, 2013 [5 favorites]

Coaches advise; therapists facilitate you changing your own life.
posted by heyjude at 12:27 AM on May 16, 2013 [1 favorite]

I'd be interested in background information to know what sort of therapy I might ask for (some might take anyone and not really have a specialized approach). CBT is pretty standard treatment for a lot of things. I haven't looked around for a great therapist myself; I saw one for awhile and was mostly "meh" about it, as she didn't really push me to stick with CBT or anything and just seemed content collecting my copay without really giving me any feeling of interested support.

My psychiatrist is much better to talk to, though I see her infrequently (6-8 weeks at a time for ADHD med scripts and 20-30 minute talks about bipolar issues). I do feel like they don't pick up on the fact that I need some structured reinforcement and maybe they have no obligation to do so and as a rule they don't want to make people feel worse about themselves. But she's a good listener and she always has good practical advice that is really just good advice about life in general, about removing obstacles from things like getting regular exercise.

Really the kind of advice that's good for anybody, but it seems significant when you see roadblocks all around and just kind of need someone to help kill off the excuses. I'm extremely slow moving but getting on meds for two years (lamictal 200mg for bipolar, after a shit-ton of research and some experimenting) made a huge difference, and she's very encouraging and circling back to the "they don't push me enough" thing, she's done a good job of making it clear that she wants to see me regularly and keep me on a treatment course and I should not avoid seeing her due to guilt about not exercising or whatever things I really need to be doing to practically effect change...

In the past when I first pursued treatment I'd disappear for 5-6 months during rough spells and eventually come back, and she is good at making me feel like she cares about seeing me regularly not solely to collect an office visit, but to ensure that we're staying ahead of any impending doom or trainwreck.
posted by lordaych at 12:43 AM on May 16, 2013

CBT is beyond advice but unless your therapist is literally making you do it, a huge part of what they should be doing is advising you on ways to incorporate it into your day-to-day routines. But again, my therapist didn't seem on top of it and the book "Feeling Good" was much more helpful in grasping the concepts and basically creating my own weakened form of CBT that doesn't involve any paperwork, bookkeeping of emotions or whatever. The meds probably made a big difference, but reading through that book and just trying to keep the 16 destructive thought patterns in mind when self-defeating thoughts emerged was very useful and I'm pretty damn sure it's integrated into my subconscious at this point, like an immediate response to any negative thoughts.
posted by lordaych at 12:48 AM on May 16, 2013

Therapy isn't the right choice for everyone. Short of a court order, you aren't required to go back.
posted by yohko at 1:04 AM on May 16, 2013 [5 favorites]

Nthing CBT. It worked extremely well for me. You have to be willing to put the work in, though.

I also just want to say that pretty much any form of therapy will involve some degree of focusing on your problems--you need to be able to understand them in order to move forward in overcoming them.
posted by tan_coul at 1:06 AM on May 16, 2013 [3 favorites]

CBT, neurofeedback, and EMDR.
posted by Jairus at 1:39 AM on May 16, 2013

There are several therapy modalities that are more structured than just "client talks about issues and therapist listens and occasionally prompts 'so how does that make you feel'?" It would be easier to answer this question if you could give more specific examples of the things you are trying to "fix." Obviously, no therapy is going to be able to "fix" anything that is external to you; the only things that are on the table is how you think about certain things and how you respond in certain situations. Cognitive behavioral therapy is certainly one of the alternatives out there that you might find more helpful. There are other behaviorally oriented therapies that you might also find beneficial, such as dialectical behavioral therapy, which is very structured and oriented toward skills and tools for dealing with real-world situations more effectively.
posted by drlith at 3:14 AM on May 16, 2013 [2 favorites]

The therapist I went to didn't do a lot of the 'yah' and 'uh huh' stuff. He designed a sort of quantifiable action plan for me, which might sound a bit weird but it worked, i.e. by X date you will X percent better about this situation. I was also given homework assignments. He listened to me cry and stuff but also offered objective, constructive criticism. Also, he had a Buddhist approach, which may or may not be for you but I was open to it since Buddhism is a system for reducing suffering.

So not all therapists are like yours - perhaps you need to find someone else or ask your current therapist to modify his/her approach.
posted by faraasha at 4:09 AM on May 16, 2013 [2 favorites]

Depending on what your particular issues are, DBT, dialectical behavior therapy, might be of interest to you. It is very structured and involved lots of different exercises and activities, making lists of goals, learning mindfulness, so it might give you that feel of actually doing something. Some programs are very intensive and time-consuming, but there may be lighter versions around. It is typically used for people with Borderline Personality Disorder, but they are not the only ones who can benefit from it, I think it teaches some skills that could be valuable to just about anybody, mental illness or no.
posted by catatethebird at 5:34 AM on May 16, 2013

I used to see a respected therapist in New York who'd been a student of the influential French analyst Jacques Lacan. Later in his career, this therapist moved away from traditional analysis and began focusing on cognitive behavioral therapy, going so far as to rebrand himself as a life coach. Why? Because, as he pointed out, "no one ever stops drinking because they finally understand why they drink. They stop drinking because they stop going into bars." In other words, you can talk all you want about why you're doing something or why you feel a certain way, but what really gets results is modifying your behavior over the long term. His philosophy was essentially this: First, you change behavior that's having a negative consequence. Second, you can delve into what caused that behavior in the first place.

This mode of therapy may not work for everyone, but it delivered results for me. I just needed someone to say, "that thing you're doing isn't good for you? Then stop doing it."
posted by bassomatic at 6:25 AM on May 16, 2013 [2 favorites]

I found my therapist searching for those who specialized in CBT, but I ended up with someone who primarily works with children. His big specialty seems to be play therapy and, as someone who, like you, used to just go to therapy and get upset and cry, I find it enormously useful. When things get tense, he's good at reading my body language and suggesting we switch to another task. I'm encouraged to grab a fidget object if I'm uncomfortable. The more that I think about it, the more I realize that his perceptiveness at reading me is what's really helpful. He is interactive, and will say things like "This seems to be a really raw spot for you. Why are you still punishing yourself?" That kind of thing. If I ask for direct advice, I'm sometimes rebuffed, but it nevertheless feels like a dialogue.

This is how he describes his services, in case it's helpful: "These services include: 'traditional' one on one humanistic therapy, dynamic play therapy with sand tray, strongly 'positive behavioral' services in work, educational and home settings and years participating in youth programs that are resources for at risk adolescents and young adults as well as less high need individuals."
posted by PhoBWanKenobi at 7:23 AM on May 16, 2013 [2 favorites]

I have this AskMe comment from several years bookmarked, and I think it offers a lot of wisdom on this question.
posted by Asparagus at 7:51 AM on May 16, 2013

My psychologist is really awesome. She doesn't give me advice, per se, but she will walk me through (or assign as homework) exercises to help me suss out what it is *I* want to do in a given situation. Or she will share with me worksheets to help me identify disordered thinking so I can get a batter handle on assessing a situation realistically rather than through my sometimes flawed/warped perspective. And I hated this at first because it feels awkward, but she also makes me role play if there's something I need to do but am anxious about what to say. I must admit, it's enormously helpful to me.

She does CBT but will use a variety of therapeutic techniques depending on the situation. Like PhoBWanKenobi, I think my therapist's best attribute is her ability to read me and adjust her approach accordingly. Especially now that we've established a year-long relationship, our sessions are enormously productive; enough that we've reduced frequency of visits to every other week just because she's helped me "solve" so many things. (And this includes making very major, very difficult life-altering decisions - so although she never said "you should do this", her techniques helped me assess situations; make decisions and be relatively confident in those decisions; and execute them even when it was very hard/scary to do so.)

Good luck!
posted by misskaz at 7:57 AM on May 16, 2013

Many people's main problem is that their primary mode of action in the world consists of following what others say or opposing what others say. A therapist who tells such people what to do will not help them since they will become just another outside influence. Asking how you feel may be just directing your attention away from what others think you should do and allowing you to have your own independent evaluation of a circumstance.

Since you don't say what kind of change you're looking for, there's not much specific I could add, but if you do fall into the category I describe above, I'd be wary of finding someone who is giving you too much "help."
posted by Obscure Reference at 8:13 AM on May 16, 2013 [1 favorite]

Sometimes they ask you how you feel so that you can actually get in touch with your feelings. You think you are but from an outsider's perspective it's painfully obvious that you have no clue what you're feeling. FEELING. Physically feeling. So it seems useless because you think you know, but it's not about thinking it's about feeling, and integrating into a whole mind/body person.
posted by St. Peepsburg at 9:02 AM on May 16, 2013 [1 favorite]

Interview potential therapists. Ask what type of approach they use. State that you are looking for interaction and coaching. Ask if they have experience with coaching and interactive therapy. Ask about their degree, where is it from, when did you get it? Ask a wild card question(s) - come up with 1 or 2 questions that will get the potential therapist talking, like Do you believe in ghosts? or Are you a feminist? or whatever. It helps if the questions are connected to things you care about. It gives you a sense of the therapist as a person.

In therapy, it's okay to ask questions, like What would you recommend? What do you think? What's your assessment of this situation?
posted by theora55 at 9:16 AM on May 16, 2013 [1 favorite]

If you use a resource like Therapist Finder, you probably want to look for descriptions like "focus on the present" or "use the past to find solutions to your present problems." Avoid things like "Delve into the past" or anyone who just talks about feelings. You'll definitely want to avoid anyone doing psychoanalysis, and you should probably be wary of therapists doing psychodynamic work (there's nothing wrong or bad about either, but they're very past-focused).

There's not really any one therapeutic school that is more present-focused than past-focused, but it might be helpful to look for therapists working on a brief therapy model (which generally means six months or less), because they're a bit more likely to push harder to solve the solvable stuff. If you can find anyone doing or incorporating Solution-Focused therapy or Narrative therapy, those might be a good fit for you.

No good therapist is going to tell you what to do, and you're still going to have to talk about your problems, because you can't solve things without understanding them. But there are plenty of therapists who will keep the focus on the present rather than staying exclusively in the past. You just need to "interview" them a bit, whether that's reading their Therapist Finder profile, their website, or having a phone conversation with them.
posted by jaguar at 9:21 AM on May 16, 2013 [1 favorite]

I don't know that there's a particular label to look for, but I definitely know what you mean, and have had a similar experience. My recommendation would really just be to try different therapists. You can make it clear, when you first meet with them, that you are looking for a new therapist (not already pre-committed to them before even starting!) and that you want to see if they would be a good fit; and explain that your prior therapist(s) had a bit more of a laissez-faire approach and you are at the point in life where you want something a bit more directive.

I've been to three different therapists in the past two years (with my partner, with pretty specific goals and expectations), and frankly the current one is the only one who I feel has been really helpful. The first one was very much the soft, lean-back-in-the-chair and say "oh really? how does that make you FEEL?" and it frankly drove me nuts. Someone above said that it may be obvious you are not in touch with your feelings, but I am far far OVER in touch with my feelings, I am extremely self-reflective and overthink everything, and she would make simplistic useless statements like "I think you are angry now. You seem angry." And say it in a really patronizing voice with a nod and eyebrow wiggle. And I'd be mentally like "f***ing right, lady, obviously I'm angry, I just was talking about how my boyfriend cheated on me when I was pregnant with his kid, yes I am angry... How f***ing profound."

Versus my current therapist, who has a lot more energy and comes from a holistic approach and is more likely to talk through things with you, ask questions, present models of thought and tools that might help me think about something better, even get out a white-board and scribble a little diagram of a destructive communication pattern I'm trying to work on or something. While obviously no (decent) therapist is going to tell you WHAT TO DO exactly per se, there is a broad range in styles and I don't think there is anything wrong with wanting a more proactive style for a particular need. You're the client, ask for what you want and find it.
posted by celtalitha at 9:22 AM on May 16, 2013 [1 favorite]

Is there a specific reason you want to go back? I too did not feel therapy was productive for me. I felt like i got more understanding by talking to myself and my dog and more solutions by just physically doing something, no matter how small, rather than mentally stewing on the problem. For example, If I was worried about money, I'd go online and transfer 3$ into my savings account. IT felt like a much more concrete way to address the problem and at the same time got rid of the big emotional/ mental block about actionlessness in teh face of something thath seemed unscalable. Just doing something was the mental equivalent of just throwing the bad thought in the trash.

Also, stress reduction things help me more than therapy. I like massages and other such spa pampering, good tunes, and every now and then, like once a year or so tripping on mushrooms or acid is like pushing the reset button on your pessimism cache. I realize that isn't for everybody, but I thought I'd throw it out there.
posted by WeekendJen at 2:32 PM on May 16, 2013 [2 favorites]

Response by poster: Wouldn't mushrooms cause more mental instability?
posted by john123357 at 2:41 PM on May 16, 2013

I have had a good experience with CBT. I've had other therapists that I was ok with but sessions often felt like "just talking." CBT has given me the tools I need to address internal negativity and distorted thinking in order to live the way I want, which has given me a lot of relief from depression and anxiety. As the depression lifted I was able to improve both my physical fitness and my nutrition in a way I was never able to stick to before; this has had a snowball effect contributing to a much better mood and general outlook. I took meds before, I don't now, but I have been feeling much better, like "normal" again. Mentally I am much more productive, my work performance and my relationships are the best they've been since I was a kid.

It was hard to get used to "actual feelings" for a while. Instead of feeling depression numb I have learned how to use CBT techniques to address emotions, thoughts and feelings in the moment. That's not a comfortable thing, but now that I am more used to it I'm glad I went through the process.

Clear communication about my goals and priorities has helped a lot ("I want help stopping rumination," or "I don't want to go back on medication unless the situation is truly dire.") My therapist does integrate other techniques. We had a 30-minute intake phone conversation before our first appointment - sort of a neutral way to determine "fit."

You actually have to do the worksheets though, if you're given them. I felt silly doing some of the homework but I wind up using it all the time.
posted by ProtoStar at 4:09 PM on May 16, 2013

CBT is the closest thing I've seen to a psychotherapy practice that 'fixes things.'

i don't know what the right answer is, but to answer your question a little, i have to say i disagree with that comment. i don't think CBT is a way that 'fixes things.' my experience with it is that it's about 'rationally' arguing about things. but it's really just unreasonably harsh on 'negative' thinking, and charitable to 'positive' thinking.

CBT is about how your feelings are a reaction to your thoughts. you only have problems to the extent that you think about them as problems. so, CBT is about manipulating your thoughts so they don't make you sad. the thoughts that don't make you sad may not be factually correct or logical, and neither is the manipulating to get you there guaranteed to be factually correct or logical.

so, CBT is about changing your thinking, not necessarily changing your behavior or the world around you. sometimes they coincide, but sometimes they don't. often we are powerless and have little control of our situation. it's also hard to distinguish between what we do have power over and what we don't. i've often found that it's easier for practicers of CBT to err on the side of things you can't change rather than the things you can because working to change things and failing will make you very sad. so, the bias is towards just changing what you think rather than fixing your problems.
posted by cupcake1337 at 6:45 PM on May 16, 2013 [1 favorite]

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