Too good to leave, too bad to stay - therapist edition
May 16, 2013 2:41 AM   Subscribe

Should I find a new therapist when I'm only in town for 6 more months?

I have been in therapy for about 2.5 years, twice a week for most of that time but in the last couple of months, only once a week. I originally sought treatment for anxiety related to my parents, who disapprove of my partner because he is of a different ethnicity. My therapist describes what she does as psychoanalysis. She never speaks before I do at the start of a session. She gently asks me questions about my feelings and experiences. She suggests ways of looking at things, but she never tells me what she thinks is the solution. If I ask her direct questions, like "What do you think I should do?" or "Was this out of line?" she won't give me her opinion, she will try to help me understand how I feel about the situation by asking more questions.

I do feel I have gotten a lot out of therapy. I do understand myself better, and I can see very clearly how my childhood has shaped who I am. I have better boundaries with my parents, though our relationship is still more distant and strained than I would like, and I still find it very tough to enforce my boundaries or create new ones.

The trouble is, though I understand myself much better, I don't feel I have the tools or skills or whatever I need to actually enforce changes in my life. I feel like I need more direct, straightforward advice or some kind of action plan to follow, and therapy is not giving me that. I still feel anxious most of the time, my gut is usually cramped up with it. I'm not sure of the next step with my parents, my relationship of almost 7 years is going really badly - we're about to break up, partly because my boyfriend thinks I'm not direct enough with my feelings. I'm such a mess.

In addition, though I don't wish to self-diagnose, I think I may have Obsessive Compulsive Disorder, and this has never really been addressed by my therapist. For as long as I can remember, I have suffered anxiety over silly things like whether or not my teddies are touching the edges of the bed (as a child) or how the door mat lies in our hallway (as an adult). I also check things a lot - the lights, the oven, the sink - multiple times every time I leave a room. This got better for a bit, but right now it's worse than it has ever been and I'm worried people in the office are going to notice. My therapist knows all of this, but she has never said much about it other than to tell me it's a manifestation of my anxiety.

Typically, a full course of analysis takes four years to complete, says my therapist. I only plan to remain in this country (not my home country) for another 6 months, so I will not reach the end of the course. Is there any point to switching therapists now? It might take me several weeks to find a new therapist anyway - there are not that many native-English speakers here, and they are often fully booked. But on the other hand, after I move it will be a while before I can afford therapy again. Should I try a different approach to therapy while I still have the chance? Will I still get something out of it even if it's just a few months? Or am I unjustly dissatisfied with my current treatment - do I just need patience?

Bonus question: is there anything self-directed I can do to supplement my therapy which might bring about the changes I'm looking for?

Datapoint: I have never been in therapy before. At university (UK) I was prescribed antidepressants (Prozac) following an incident of self-harm after a bad break-up. I filled out a form, had a 15 minute chat with the doctor and left the office with a prescription - I can't really remember if the Prozac did much except make me nauseous, and I am angry at the experience of being fobbed off with drugs without being given other options. So I am hesitant and a bit mistrustful of the antidepressant option, but at this point so miserable that I would be open to it.

Thanks so much in advance for any thoughts you may have.
posted by guessthis to Human Relations (6 answers total) 1 user marked this as a favorite
(IAAT, IANYT) I would suggest that it may well be worth your while to locate a therapist that uses some form of Cognitive Behavioral Therapy (CBT). It sounds like your current therapist is using a more non-directive, Rogerian approach which can be a fairly slow process, it depends heavily on the client to determine the course of the sessions and the treatment.

CBT focuses on the "now', is more specifically guided by the therapist, and, if done correctly, includes some pretty concrete goals and objects around behaviors and change. 6 months can often be a sort of standard length of treatment when dealing with some clearly identified issues. CBT has also been shown to be an effective modality.
posted by HuronBob at 3:05 AM on May 16, 2013

Psychoanalysis and Rogerian therapy are actually quite different. Psychoanalysis can focus a lot on childhood, transference, the subconscious etc. Rogerian therapy is more about working with relationship, in that the model of unconditional acceptance and empathy offered by the therapist allows the client to begin to offer those qualities to themselves, so they can begin to trust their own judgement and experiences.

It is true that CBT can be effective, and if you have specific behaviours you wish to work on such as the OCD it may be useful to you. But it won't really address the underlying reason for your anxiety. The OCD is a way of trying to bring control into your life when you feel you don't have much - but it wont really address why you feel you don't have any control.

However studies have also shown that it really is the relationship with the therapist that is the most important aspect, regardless of modality. So I generally would apply the same principles as any other relationship: are you getting what you need? If not I would firstly address it with the therapist (bring it into the room) and let them know what you would like, or what you feel you are not getting at present. If it doesn't change it is your right to find someone else who may be more suited to you. You don't need to worry about deadlines - don't worry about 'sticking it out' until you leave. If it doesn't work for you any longer you have the right to move on. And congratulations for being so pro-active about your mental health.
posted by billiebee at 4:23 AM on May 16, 2013 [2 favorites]

My therapist describes what she does as psychoanalysis.

A psychoanalysist is never going to provide the specific kind of help you seem to be looking for. If the next six months is your window of opportunity to get that help, yes you should change to a CBT therapist. It can still be very effective in short courses.
posted by DarlingBri at 5:27 AM on May 16, 2013 [1 favorite]

Here's the problem with some therapy- it can get you overly focused on yourself and your problems to the point where it is all you think about. You don't seem to be enjoying life much right now.

'Bonus question: is there anything self-directed I can do to supplement my therapy which might bring about the changes I'm looking for? '

Commit to doing one new thing a day. Something that scares you a little bit. Stretch your boundaries, which seem to be a little too tight for your personality.

Commit to making at least one person's day better, every day, even something simple like smiling at people until they smile back is a help.

If I were you, I would take a therapy vacation. Take some time to find your voice. You don't need anyone else's feedback or decision making skills to know what is inside you, you just need you. Find your voice and then speak it loud. It might save your relationship. It will certainly save you.
posted by myselfasme at 5:27 AM on May 16, 2013 [1 favorite]

For a self-guided intro to cognetive behavioral therapy (CBT), the Feeling Good Handbook by David Burns is a good place to start.
It has lots of excises that help you frame and deal with "now", similar to what I've used in CBT.
posted by natasha_k at 1:23 PM on May 16, 2013

It certainly sounds like this therapy isn't what you're currently looking for. That doesn't mean either you or the therapy is necessarily "wrong," just that it's a bad fit for your needs.

You say you won't be able to complete the four years your therapist requires one way or the other; do you believe that you'll get anything out of this last six months that you haven't seen so far? Is it of benefit to give your therapist a firm deadline, say four weeks from now, and ask her to bring her analysis to a close and give you her thoughts in that time?

If language issues are a barrier where you currently are, it might be worth looking into therapists who see clients over Skype or similar. A quick Google shows plenty of CBT practitioners who work this way, for example, so it would expand your options greatly.
posted by Someone Else's Story at 12:26 PM on May 17, 2013

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