What is therapy for?
May 9, 2014 6:56 PM   Subscribe

I'm not understanding how it's supposed to work. How much is the therapist supposed to drive the conversation, and how much are you supposed to do so yourself? How do you know if it's going well? What are you even supposed to get out of it? What are you supposed to do to get the most out of it?

When I talked to a psychiatrist last week she asked if the therapy appointment I'd had previously had been helpful. It blew my mind that the previous therapy appointment was even supposed to be helpful, I had thought it was like a test so that I could get my prescription. Now I see that was the wrong way to conceptualize it.

During that therapy appointment, the therapist asked a bunch of questions about my family, which felt invasive, and echoed back to me what she thought I was saying. She's probably a fine therapist, but I was confused as to what she was trying to do and it was overall more aggravating than anything else. Now I'm supposed to go to therapy regularly (though I have to pick another therapist -- how?), and also have to go to another place to get more evaluation/documentation done (and maybe therapy also? not sure at this point), and I'm not exactly looking forward to any of it.

How is this *supposed* to work? What am I *supposed* to be doing so that it works well? What's my mindset *supposed* to be? I'm confused. How do I even know what to talk about? Which kinds of problems can therapy be used to fix anyway? What kinds of problems is it not useful for? I want to work with the therapist(s) and have things go well but I don't know how to do that right now.

If you can, please spell out everything for me? Don't worry about being condescending, I've been having a hard time thinking clearly and am pretty dense at the moment. The idea of making or going to these appointments is daunting, but the psychiatrist is insistent and I need to do it for documentation reasons so I'm going to have to try. Please tell me what to do so that these appointments can go alright, I can do a good job, and things can turn out OK.
posted by rue72 to Health & Fitness (33 answers total) 26 users marked this as a favorite
Best answer: Here's a useful comment from OmieWise about what to look for, to get effective therapy.

One question that is useful to think about is, what do you want to get out of it? What problems are you looking to solve, or what patterns/feelings/behaviors would you like to change?
posted by LobsterMitten at 7:00 PM on May 9, 2014 [4 favorites]

Therapy is supposed to help you solve problems or effect change.

Do you mind expanding on what type of evaluation the psychiatrist wants and why? What's being documented and for what purpose? Knowing this may help get you better responses.
posted by kinetic at 7:02 PM on May 9, 2014

In an ideal setting, you and the therapist will take some time to decide and outline what success looks like and how you will get there. This gets shaped into a treatment plan.

Success looks different for people who have a phobia than it does for people who want to become more skilled at managing their anger or other emotions.

If you and the therapist do not have a picture of success, then it will be hard to work toward that together.
posted by bilabial at 7:06 PM on May 9, 2014 [2 favorites]

Maybe try thinking of therapy as a way of talking to yourself, only the part of yourself that you're talking to is a little smarter.

A therapist isn't necessarily supposed to prescribe anything, or proclaim that you're depressed or whatever. They are supposed to be a safe person with whom you can discuss the complicated personal issues you may be facing, and who is also supposed to ask the questions that get you to realize the deeper causes of those issues yourself - and once you've done so, they can offer advice that is best suited to you. For instance, if you spend five sessions in a row coming close to talking about your ex-boyfriend but then every time you do you fall all over yourself saying that you're over him, really, you're fine, they point out that "you know, you always seem to try awfully hard to convince me that you're over your boyfriend, why do you think that is?" It's their job to notice these things about you that you either haven't noticed yourself, or seem to be avoiding, and encourage you to think about them and sort them out. Maybe then if you figure out that you aren't over your boyfriend, say, they may encourage you to figure out why, and how to act on that.
posted by EmpressCallipygos at 7:08 PM on May 9, 2014 [3 favorites]

These are all really good things to ask your therapist!
posted by crunchtopmuffin at 7:21 PM on May 9, 2014 [1 favorite]

Response by poster: What's being documented and for what purpose? Knowing this may help get you better responses.

At the moment, I'm pretty much not able to function at all. It's been a struggle just to eat and sleep every day, and some days I don't even get that done. I'm having a lot of trouble thinking clearly (can't read, can't focus, can't organize my thoughts, no memory). Maybe 85% of my time is spent zoning out or doing I don't even know what. This past therapy appointment was an evaluation for my insurance. I need a medical withdrawal from school, which is why I need evaluation/documentation beyond that.

I've started medication, but one (for depression) is not expected to have an effect for another month or two, and the other one is not working out (that one is just for sleep). I asked if I could wait until the medication had taken effect before starting with a therapist, but the psychiatrist said no.

To be honest, I don't even know where to *start* with a therapist. I have no desire for more insight into myself or anything that I particularly want to talk about, I just want to be able to live like a person again instead of like a sloth or an indoor cat.
posted by rue72 at 7:23 PM on May 9, 2014

Have you had a full medical work up?
If not, you really should.
posted by bleep at 7:27 PM on May 9, 2014 [2 favorites]

I have no desire for more insight into myself or anything that I particularly want to talk about

Then you're the kind of patient Cognitive Behavioral Therapy is made for! Look for a therapist who practices this approach, or can.


At the moment, I'm pretty much not able to function at all. It's been a struggle just to eat and sleep every day, and some days I don't even get that done. I'm having a lot of trouble thinking clearly (can't read, can't focus, can't organize my thoughts, no memory). Maybe 85% of my time is spent zoning out or doing I don't even know what.

Seconding getting a thorough medical evaluation: thyroid, vitamin B12, vitamin D3, iron panel, assessment for sleep disorder, etc. A good primary care doc (maybe even at your student health center) will know what to do.
posted by blue suede stockings at 7:34 PM on May 9, 2014 [2 favorites]

Response by poster: I hear you on the medical workup and being critical about therapy, but right now I *have* to go to therapy (and I *have* to go through these particular groups of therapists) in order to get the medical withdrawal from school and in order to keep getting medication through my insurance. I don't have a lot of choices right now. My goal at the moment is just for the therapy not to be frightening or frustrating, and for it to be as helpful as possible, so I want to know what I can do to make that happen.
posted by rue72 at 7:41 PM on May 9, 2014

Mod note: One comment deleted; if your advice is that therapy is pointless, maybe give the question a pass.
posted by LobsterMitten (staff) at 7:43 PM on May 9, 2014 [3 favorites]

It's a complicated question, but when I was going I thought of my (CBT) therapist as something like a sports coach. Coaches exist to teach techniques, hold you accountable, to help you do your best, and to point out things that you can't see yourself because you're too close.

For me this took away a lot of fretting about if I had "real problems." I didn't think of her job as "fixing" me or giving me some grand insight, but just helping me do my best at everyday life.

(And for the record it made a huge difference for me. I feel so so much better, happier, more confident and like I "know what I'm doing" then I did a few years ago.)
posted by drjimmy11 at 7:43 PM on May 9, 2014 [3 favorites]

Just to clarify: the medical workup isn't in lieu of therapy, but to be pursued simultaneously. In fact, many psychiatrists will run basic blood tests for first-time patients as part of their own screening process.

And really: CBT for you! Goal oriented, shorter term, not psychoanalysis, and evidence based. (This is not to denigrate the usefulness of insight or psychodynamic based forms of therapy, but those aren't the kind you seem to be interested in.)
posted by blue suede stockings at 7:50 PM on May 9, 2014

Best answer: Ah jeez, I'm sorry you're going through this. IANAT, but that sounds a lot like what I went through when I was depressed.

The better therapists I've had have explained the whole process to me, including why they were asking various background questions. Most have asked me why I was there and what I hoped to achieve, and then explained what their approach and methods were, and what could realistically be hoped for within a given time-frame (also discussed). That is often called the 'intake session', which it sounds like you had (but weren't told about?).

A lot of therapy amounts to cognitive behavioural therapy, i.e. aims to change your thoughts and behaviour. There are certain patterns of thinking (attributional styles) that are common in e.g. depression, such as attributing failures to permanent causes internal to the self ("I failed at x because I'm basically a terrible person"). A therapist should pull these beliefs out of you, hold them to the light, and challenge them with reality-based statements. S/he might also give you tasks to do in life, that are not too much of a reach for where you are, but push you a little out of your comfort zone. Those are the skills they have, and what they're trained to do.

But really though, you have to like the person, and in the end it's two people in a room trying to help you make sense of the problem. A good therapist should spend the first few sessions (after the first) just kind of feeling things out and getting a sense of what the main issues are. They're only people, so there will be miscommunications and hiccups, but the deal is that when those happen you can talk about them. And the whole commitment, the focus, is about and on you. Sometimes, even with great therapists, I've found that sessions can feel a little unnatural, just for this reason. But I usually came away with something useful or affirming. Even if it's a metaphor, or a story, something.

Sometimes a therapist has an idea about you or your problem, and you're like, what, no that's not it at all. But you can say that, and talk about it.

I think there's something to this placebo idea, actually - part of what I found helpful when I was depressed, whatever the actual content of the conversation turned out to be, was just the fact of having this appointment that was about getting better, that I had this weekly appointment that I had to plan and get dressed for. Just that made me more conscious of the fog I was in, and I think helped to wake me from it, and gear me up to thinking about other things I could do to help myself.
posted by cotton dress sock at 7:55 PM on May 9, 2014 [1 favorite]

Best answer: The first session is always rough, because it's more of a getting-to-know-you thing than an actual session. She was probably just trying to get an idea of who you are and what makes you tick, so she would know how to move on from there.

If you feel uncomfortable answering a question, or even if you're just curious about why it's being asked, it's perfectly appropriate for you to say, "Why do you ask that?"
posted by The Underpants Monster at 8:18 PM on May 9, 2014 [3 favorites]

One of several things therapy has been for, for me, is having a professional pair of eyes on me before and after going on psych meds, so someone a little more objective than me knew what my baseline was like and had some idea of how well the meds were working. If therapy's a pre-req for meds, it might help you to think of it that way too.
posted by clavicle at 9:23 PM on May 9, 2014

My therapist would sometimes give me 'homework' type things - so I should try doing X for a week, and see how it goes (where X related to whatever issue it was that I was talking about - could be going to bed at 9pm, could be noticing and engaging with an emotional response). So your therapist might want you to note, in some way, what it is you do for that 85% of the day. What time you go to bed, or what you eat. That sort of awareness thing. Then, once you're aware, you start working on it.

By the 'end' that awareness is entrenched and you start the work yourself. Or that's how it's gone for me.
posted by geek anachronism at 9:36 PM on May 9, 2014

My goal at the moment is just for the therapy not to be frightening or frustrating, and for it to be as helpful as possible, so I want to know what I can do to make that happen.

The best way to do this is to keep an open mind about therapy. I was kind of pushed into seeing a therapist by my boyfriend who thought that I might benefit from it as I was going through some heavy stages of grief at the time. I was very reluctant, but I did it, and it's been extremely beneficial to me to not only work through that particular issue that I was struggling with, but also some reactions that I hadn't noticed about myself and why I feel about certain things the way I do. But it took at least 4-5 sessions before I started really opening up. It took at least 15 sessions before I could bring up the grief-causing thing.

My therapist is very pro-awareness and she will also give me "homework" in that if I feel xx emotions, I am supposed to become aware of my physical response and note that. I don't always do this but I'm trying. Sometimes my therapist and I will be talking about something and it will click in my head and I'm like, oh, THAT'S why I feel that way sometimes. And sometimes we'll spend our 45 minutes together listening to me vent about something that irked me that week.

My psychiatrist is different, and our first session was essentially an hour of "tell me all the shitty things that have happened to you" - I see her only for medication management so when we meet, it's basically just questions about shitty things and then we talk about medication levels.

When I first met my therapist, I was concerned because we didn't click immediately and she was very quiet, and I was like, well, there's no way I'll be able to tell this COMPLETE STRANGER all my secret secrets, look at her, she's wearing grandma boots come on. But I stuck with it and we went through an awkward month of my skirting around issues or just talking about things that had no impact on my life. Sometimes it takes awhile. And sometimes, it won't work out, and then you'll find a new therapist that you work better with.

It's not an overnight cure, it's not something you can just work really hard at and in a month, you're fixed. It takes time and effort, and the best thing you can do make this happen is to just keep going.
posted by kerning at 10:03 PM on May 9, 2014 [1 favorite]

And really: CBT for you! Goal oriented, shorter term, not psychoanalysis, and evidence based.

Ehhh...CBT is really only applicable if your problem is caused by negative self-talk or thought patterns. ("I'm so worthless" "everyone hates me" "I'll never be good at anything," etc.) I don't see any evidence of that from the OP, although of course we don't know. Also, someone who is unable to function at all is probably not able to do CBT even if it's appropriate.
posted by Violet Hour at 11:26 PM on May 9, 2014 [2 favorites]

I suggest you ask about solutions focused therapy. This is where you start with where you are and you try to get to where you want to be. Ask when you are making the appointment if the therapist uses this approach (after you read about it yourself and decide if it might work for you).

You will spend a lot less time talking about your past and a lot more time talking about what you want your life to look like, and how you might get there - one step at a time.

If you have therapists to choose from, don't be afraid to try a few out before picking one to stick with for a bit. The last thing you want to do is be stuck with someone you don't trust or don't like.
posted by AllieTessKipp at 11:53 PM on May 9, 2014

A part of it can be about being 're-parented' (forming a positive attachment relationship that can later, hopefully, be replicated) and some of it can be about discharging (lovely word eh? hope you're not too visual ;) emotion. It's up to you how long and deeply you commit (I have no idea about how it works in the US)... It's a mixed bag I think.. it can be really painful, a release, the basic satisfaction of human connection, a space for you, frustrating and so on and so on.

I've been in it for a few years :-0 for me it works slowly.. if there is a horrible, lying voice in your head about your worth etc (put there often by a caregiver, like a caregiver did to them) therapy can also bring in a voice of reason.. become the good 'inner' parent. So when I personally have this hellish mantra in my head.. that better voice occasionally pops in, generated by this developing bit of me and says 'that's crap' or 'ofcourse you can do it' etc. It's a long road and one thing that I found helpful afterwards used to be to go for a nice meal afterwards and reflect on it all. Hope it starts to make sense for you.
posted by tanktop at 6:37 AM on May 10, 2014

Best answer: How much is the therapist supposed to drive the conversation, and how much are you supposed to do so yourself?

Sometimes one of you drives it and sometimes the other. In the first few sessions, usually, a therapist is trying to get to know who you are, what your difficulty/situation/issue is, and what you're hoping to get out therapy. This means a lot of questions on their side, usually, about who you are and what you're all about and questions about what's going on in your life.

How do you know if it's going well?

On a per-session basis, I've always found it hard to know if something is going well. Cumulatively, though, I find things start to shift in my life. Depending on why I'm seeing the therapist, I may feel a sense of relief, I may feel like I've got more to think about (when previously I was feeling stuck on something), or symptoms may start to disappear (anxiety, insomnia, etc.)

What are you even supposed to get out of it? What are you supposed to do to get the most out of it?

In time, you should get some relief and some clarity about things. For example, if you're going in because you're struggling to deal with X, you should start to feel better about X and your ability to deal with it. Or you should feel some acceptance of X or gain some insight into why you feel the way you do.

To get the most out of therapy, you have to do the work. There is almost no point in going to therapy if you're not at least somewhat invested. The therapist isn't there to solve all your problems for you - they're there to help you figure out the right path, the way you want to deal with things, recognize patterns, help you navigate difficult emotions.. You need to take gentle, manageable steps toward whatever goal you need to reach. It often means allowing yourself to be vulnerable, to talk about things you haven't discussed before, to be honest and open about things that may not be pretty.. which is part of why the first few appointments are important for building a professional, trusting relationship.

During that therapy appointment, the therapist asked a bunch of questions about my family, which felt invasive, and echoed back to me what she thought I was saying.

You do not have to answer anything that you are not comfortable answering - but it can be really helpful for a therapist to understand who you are in the context of your bigger life. Your past, your present, your family relationships, your friends, your experiences, ALL shape who you are today to varying degrees. You, as a person, don't exist in a vacuum.

The therapist is echoing things back to you, probably using slightly different wording, to try to make sure they're understanding you correctly. While we don't often notice it, we all use different language to explain how we feel about things - a good therapist wants to make sure they're actually getting the meaning behind what you're saying. As well, sometimes hearing your words echoed back can give you some insight into things. If I say, "It was THE WORST DAY EVER!" a therapist might respond with, "You've never had a worse day in your life than today!" which, as I hear it said, would cause me to say, "Well, okay, that was a bit of hyperbole. Today did suck though!" Again, this is about trying to understand your thoughts, feeling, and how you express yourself.

How do I even know what to talk about?

Start with what you've already posted here - that you just want to be functional again. The therapist will ask questions. You'll answer them as best you can. Back and forth. The nice thing about therapy is that it isn't like making small talk at a party with a bunch of strangers.

Which kinds of problems can therapy be used to fix anyway? What kinds of problems is it not useful for?

Most therapists have areas of specialty - mood disorders, say, or family therapy or addictions or abuse or trauma or.. whatever. A lot of things can be worked on in therapy if you're also willing to do some work outside of the office. If the therapist suggests you try (for example) keeping a journal, give it a shot. If it doesn't work for you, come to the next appointment and talk about why it didn't work ("I felt really awkward and self-conscious" "I didn't have time at night" whatever!) Therapy is an active process - going to the appointment, sitting and saying nothing, and doing nothing again until the next appointment won't help anything.
posted by VioletU at 11:33 AM on May 10, 2014 [1 favorite]

Response by poster: Thanks everybody. I'm finally going to my first therapy appointment today and they just switched the therapist on me, and I'm sort of freaking out. Which doesn't make sense because I haven't met any of the therapists at this practice yet so there's no practical difference in which therapist I see. Plus, it's probably just going to be another "intake" appointment and not a "real" therapy appointment anyway. But when I say "sort of freaking out" I mean *really* freaking out. Any last minute advice? I asked my psychiatrist what I should talk to the therapist about and she said whatever I want because it's my time. BUT WHAT DOES THAT MEAN.

Ironically, I don't have anxiety as like, a diagnosis. I'm just really anxious about *this.* PLEASE TELL ME IT WILL BE OK AND I'LL GO AND SHE'LL BE NICE. (How do I make sure that she's nice? And that it goes well? I want to know exactly what's going to happen and want to have infinite contingency plans to make sure it happens correctly. Please give those things to me if you can AT ALL. I know this isn't rational and nobody is probably reading this thread anymore but I'm really freaking out here.)
posted by rue72 at 8:19 AM on June 2, 2014

You may want to print out this thread and give it to her, and tell her precisely what you've just asked us - that you don't know what it MEANS when people say "talk about whatever you want", and you just haven't done therapy before and don't know how any of this works. That will also help you get a sense of whether this particular therapist is right for you, because hopefully she'll tell you how she thinks therapy works, and if that sounds like that works for you, then great.

As for how you tell whether someone is nice - well, that's the same way you tell if anyone is nice, by spending time with them and seeing what they do and seeing how you feel around them. The best therapist I've ever had, I didn't even start seeing her AS a therapist; she moonlight as a gift shop owner, and I just ended up going to her shop so much and talking about all these crazy issues I had for some reason, that when I decided I needed to see a therapist and found out she was one I realized "well, hell, I've been telling her all my troubles already anyway, clearly I feel comfortable doing that" and started using her as a therapist.
posted by EmpressCallipygos at 8:30 AM on June 2, 2014 [1 favorite]

Here's a thing to try: sit down with a pen and paper, and think about a short list of things you would like to have change in your life. Things that cause problems for you, things that make you unhappy, things you find yourself avoiding dealing with, etc. It could be wishing that you felt more calm about social situations, or it could be wishing that your personal space were more organized, or that you could get better sleep, whatever. Make a short list, say maybe 3-5 things.

Your comment here is a good example, and that would be a fine starting place if you're still having those same problems.

Then you bring your list to the appointment, and when the therapist asks you what you have come to talk about or what your goals are for this, you have a good starting point. Then you and the therapist can talk over those things that are bothering you, and you can ask them to explain how they think therapy can help improve things for you on these things. You can ask them if they have had other patients/clients who had similar problems, and ask them to tell you in general terms how things go when therapy is successful for these problems - what kinds of things do they do in the appointments, and what does the person's life look like in two months, or four months, etc?
posted by LobsterMitten at 10:26 AM on June 2, 2014 [1 favorite]

Response by poster: Guys, it was an absolute shitshow. Lots of (literal) yelling at each other, just horrible. Thanks for all your help. Evidently, therapy is just something I fundamentally don't get, at this point I just fucking give up.
posted by rue72 at 12:07 PM on June 2, 2014

rue72: "Guys, it was an absolute shitshow. Lots of (literal) yelling at each other, just horrible. Thanks for all your help. Evidently, therapy is just something I fundamentally don't get, at this point I just fucking give up."

That sounds beyond awful. I am sorry that happened and that doesn't sound at like how therapy should go. Under no circumstance should they yell at you. I cannot imagine how that must have felt.

Are you able to possibly lodge a complaint or something? Because that' incredibly poor behaviour on the part of the therapist.
posted by geek anachronism at 5:32 PM on June 2, 2014

Yelling at each other? I agree that is way, way outside what would happen in a normal therapy session. Is there some story about what happened that explains the yelling?

Can you try to see a different person? If your psychiatrist recommended therapy, I think it would be a good idea to give it another try if you can.
posted by LobsterMitten at 1:29 PM on June 3, 2014

Response by poster: My throat was literally raw afterward, so I'm sure it didn't just feel like we were yelling at each other, we were actually straight up yelling. We weren't discussing anything "deep," she wants me to do my taxes and we talked about the rental market, stuff like that. It felt like she wasn't listening to me and didn't believe anything I was telling her, to the point that it felt like she was putting me down or dismissing me, and I'm sure I came off as arrogant or obnoxious because I started getting frustrated during the session because of that. I cried in my car as soon as I left the appointment, because I was so frustrated, and I've been upset since.

She seemed disrespectful, to me, but I don't know if this was some sort of...technique? She signed me up for another appointment next week before I left the room. This is at a health clinic run by my insurance, and she's a full-time employee there, so I don't think that she gets any more money or anything if I have more sessions with her, and so I don't understand her motivation for immediately making another appointment with me when this one went so badly? Unless somehow she doesn't think it went so badly? How could she not? She was cold and pissy when she directed me out, too.

I don't know how to approach this. She tended to interrupt and I didn't get a chance to respond to everything I wanted to in this past session, so I don't think that she'll be especially amenable if, next time, I try to bring up how I felt that things went wrong. I'd rather adjust my approach so that she adjusts hers. But I don't understand what approach I should have nor do I have a coherent idea of what her approach is (and based on her explanation, I don't think that she necessarily does, either? But I'm not a psychologist, so I'm not completely confident in my take on that for now).

Something fundamental that I don't understand is that both she and the other therapist would ask factual, concrete questions that I'd relay the answers to -- am I supposed to be actually trying to communicate the answers to the therapist or am I supposed to be "rethinking" the answers for myself and communicating with myself "through" the therapist? Because these are pretty basic, factual questions that I know inside and out, so I would assume I'm supposed to be communicating the answers to the therapist, rather than myself. But what's the point in making sure that the therapist has a good grasp of my financial/familial/whatever situation, considering that the therapist is just some joe schmo who doesn't actually need that information? This didn't actually feel like a "getting to know you" type thing, she said she'd read the previous therapist and the psychiatrist's notes about me and acted like she already had all the answers...?

Also, during this appointment, the therapist would often respond with "is that realistic?" when I answered some of the questions (like about transferring schools or turning in bureaucratic documentation -- again, these were concrete questions/scenarios we were discussing), and I would say yes, my answer was realistic, based on what I'd found out by previously researching the questions or by what had happened in similar instances in the past (I would be specific about where I'd gotten my information, etc). She kept assuming that I was pulling my answers out of my ass, when they weren't really based on what I wanted or didn't want to happen, they actually were already based on the facts as I know them, and it was really frustrating (and honestly, I found it disrespectful/offensive) to be called out constantly to cite my sources, as though my information or thoughts were untrustworthy on the face of it. What was *supposed* to be going on there? I feel like something was lost in translation, because to me, it just felt like she was implying that I'm untrustworthy even when it comes to quite basic topics that I've researched and thought about extensively (again, concrete things, like the use of transfer credits). But why would she sit there and try to imply to me that I was untrustworthy for half an hour, what would even be the point of that from her perspective?

She said that her goal was to change my way of perceiving things so that I wasn't preoccupied with mulling over negative thoughts, but I don't really have that problem. My problem w/r/t "negativity" is more about lack of motivation and follow-through, not really rumination. Mainly, I've been having *cognitive* issues, like poor memory, lack of focus, relatively disorganized thinking, etc. Her response was that I must be unconsciously ruminating on negative thoughts (?) so I had to start consciously ruminating on them (?!) and then should vent about them to her in order to stop thinking them. But if I'm not preoccupied with negative thoughts now, I don't see how thinking and talking about negative thoughts *more* would be helpful? It seems to me that that's just her hammer and she's trying to make all my problems into nails. But again, I don't know anything about psychology, so I'm open to being corrected.

She also would make pronouncements that I don't personally believe, like that the future and long-term is more important than the present and short-term, and when I said I disagreed, she would just frown, say I was wrong, and not explain why. She also gave me "assignments" to do over the week without explaining why I should do them (the assignments are to do my taxes, make an appointment at a career center, and write out the negatives about my current living situation. None of which seems especially relevant to problems I'm having now?). I guess I'll try to do what she says in order to be cooperative, but another part of me wonders why I even owe her that or why her ideas of what I should do are any more valid than mine or why I should make doing those things a priority? What the point of doing those things is, I guess? It's not that I'm set on the assignments *definitely* being irrelevant, I just need some justification or explanation for why they are relevant or should be my priorities. Is it just supposed to be taken on faith that the therapist's perspective is "correct" and the patient's is "incorrect"? How would I find that faith, when I don't see any reason to trust this random woman I don't know anything about and who I find disrespectful?

Like I said, I don't understand therapy. This session was an awful experience, has really upset me, and I don't know how to reconceptualize it to make it better or more useful. What really upset me is that she literally told me to "just suck it up," and when I said that I would *like* to do that but am apparently unable to do that based on pretty much having a breakdown in the midst of trying to do that, I am *unable* to actually "just suck it up," to which she responded by literally shrugging. I mean, what do I do with that? How do I proceed with her from there? I also am too ignorant to know what's awful or based on my own misunderstanding of this therapist/experience *specifically,* and what's awful or based on my own misunderstanding of therapy *generally.* Sorry for such a long ramble, I'm just even more confused about how therapy works or the value of it after this session than I was before, and at this point I'm feeling like I'm not ever going to actually understand (though I would like to, especially since I have to go back!).
posted by rue72 at 5:20 PM on June 3, 2014

You should call and try to make an appointment to meet with her supervisor to talk about this and get assigned to someone else. And get a full medical work up.
posted by bleep at 5:28 PM on June 3, 2014

Like I said, I don't understand therapy. This session was an awful experience, has really upset me, and I don't know how to reconceptualize it to make it better or more useful.

The reason this particular therapy appointment didn't work was not because of you not "getting" therapy or because you didn't "conceptualize" it properly. This particular appointment didn't work because the therapist you met with was completely horrible.

Seconding trying to change your appointment to her supervisor, or to a different counselor, because clearly she's not a good fit for you.

Don't worry so much about whether you're "doing therapy right", because there is no one right answer for everyone. There is only what is right for you specifically, and so that means that even if what she was doing was a "technique", it's a technique that doesn't work for you because you don't know what the hell you're bothering for and so clearly this isn't the approach she should be taking, and if she were a good therapist she would know that.

I wouldn't necessarily give up on therapy, but I would certainly give up on that one therapist.
posted by EmpressCallipygos at 5:58 PM on June 3, 2014

Holy shit. Seriously, your understanding of what therapy is and is good for just shouldn't include this particular therapist, because this is really bananas. If I were you, I would not consent to see the same therapist again. The way to reconceptualize this experience to make it more useful is that now you know a bunch of things you shouldn't accept from a therapist, like yelling, telling you you're wrong, withholding explanations, and the words "suck it up." Therapy's not fun, but it is reasonable to expect your therapist to be transparently supportive and helpful, not puzzling and hostile.

Is it just supposed to be taken on faith that the therapist's perspective is "correct" and the patient's is "incorrect"?

No, definitely not. A reasonable therapist would not expect you to have that faith on day one, and will recognize that in certain respects you're the expert on your own mind and what you need.
posted by clavicle at 8:10 PM on June 3, 2014

Response by poster: As an update: since people here on the thread were saying that my experience in that session wasn't normal, the night after that nightmare of a therapy session, I emailed the therapist to say that I thought things had gone badly and to ask her how she thought they'd gone. The next day, I got a reply from another member of the practice saying that the therapist I'd seen was now on leave with no return date.

Today (a couple weeks later) I had my first follow-up appointment, with another therapist. It wasn't fantastic, in that it didn't feel like we got a whole lot done. But it wasn't horrifying and I didn't need to cry after, I just felt tired and drained. His advice has already been helpful in some practical respects, which I guess is nothing to sneeze at since it's only been a matter of hours since I met him!

Thanks to everybody for helping me through this. If you have anything to add to this thread, I'm still all ears, because I'm still having trouble understanding the give and take between therapist and patient and what my expectations/hopes for therapy should be. The worst of the crisis is over, though (fingers crossed).
posted by rue72 at 6:54 PM on June 18, 2014 [2 favorites]

I wondered how this panned out for you and I'm glad to hear you got good results! You're right, nothing to sneeze at. It would be fine to tell the new guy that you're wondering what your expectations should be. His answer should tell you something helpful regardless of what it is. One of my past therapists would have said something like "you shouldn't expect a lot of direct advice from me about how to run your life, but I will make observations about patterns in all your assorted life events and relationships that should give you ideas we can talk about." Another would say something like "I don't want to talk about your past in depth unless you want to go there, I do want to hear about things that are hard for you lately, and if you want advice about how to deal, I can give it." Either way can be good and there are others that are good too -- that's probably annoyingly vague but it really really depends on the therapist and the client.
posted by clavicle at 7:29 PM on June 22, 2014 [1 favorite]

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