should I continue with CBT?
October 9, 2014 6:31 AM   Subscribe

I recently began seeing a Cognitive Behavioral Therapist for the first time. Sometimes she also refers to what we are doing as "coaching." I have a lot of resistance to her suggestions, and I'm wondering if this resistance is something I should try to work through, or if I should try to stop seeing her.

I am a 35 yr old PhD student at a very "high-achieving" school who is having difficulty writing my dissertation, to the extent that it threw me into depression that made it feel impossible to write. I have been in psychoanalytic psychotherapy for seven years which has been tremendously helpful to me. (Crazy parents). I still see my analyst and feel very good about our relationship, the work that I do there, and the insight that I have gained.

However, feeling very frustrated with my dissertation process, and like I was rather stuck in therapy on this issue (I could tell you all the things I should be doing, all the reasons why I wasn't doing them, how my thoughts didn't match reality, but I still could not change), and due to worsening depression during a stint overseas during which I wasn't seeing my therapist, I went to my university's mental health department to inquire about medication. I am working with a great psychiatrist there and medication has been tremendously helpful in terms of me righting (and writing) my dissertation. Part of his "prescription," however, was that I see a CBT therapist who specializes in dissertation issues within my school's mental health department.

I have seen her now four or five times, at first at a stage when my medication was just starting to work, and I was just able to get back into my dissertation. I found her advice that a dissertation is not just writing, but all of the other work that surrounds the writing, very helpful, as I had been beating myself up for not being able to write, despite doing a lot of research and reading in the meantime. I changed my work habits after our second meeting or so, got way more organized (medication was starting to work), and started keeping track of all of the work I was doing on my dissertation rather than harping on page counts.

At our next meeting, I reported this progress to her, and then I felt like she repeated the same things to me that she had already said. Additionally, I had invented a system of time keeping that she liked so much that she took a photo of it and told me she was going to use it with her children. In our sessions, she typically talks 85% of the time. All of this makes me feel infantilized, and I sit there with knowledge from the regular analysis sessions of why I am not doing things -- and also why I might be prone to projecting the infantilizing behavior onto her -- thinking to myself, "yeah, I KNOW. You've already told me these things five times." It is also very difficult to interrupt her to tell her that I am already doing the things that she is suggesting. I now have a relatively bad attitude about seeing her, not helped by the fact that in our last session, her suggestions were things like, "if you are stressed you should watch TV at the end of the day," and that I should write it down on a list of things to do when I am stressed, alongside "listen to a podcast, listen to music, go to the grocery store, cook," all of which are things I do everyday anyway. She also asked where my bike helmet was when I mentioned that I rode a bike, then told me that I had to get one, where to get one, and that she was going to continue to "nag me" until I did. This to me felt totally outside the context of what we are trying to work on, and, when put in contrast with the standard boundaries that my regular therapist has as a psychoanalyst, borderline unprofessional?

In any case, as you can probably tell from my writing, I am not thrilled to have been prescribed to continue seeing her, yet on the other hand, I feel like maybe I need to be more open and find a way to benefit from her. I discussed my resistance with her after the first time I felt infantilized, and she was open to hearing that, but now, frankly, I'm afraid that that is all I'm going to talk about with her, when I can get a word in edgewise.

My question is whether this sounds like a situation that I should perhaps ask to terminate (she is the "dissertation specialist" in the mental health group, so I assume there is no one else I could see there) or whether my resistance is founded more in my own issues that I should try harder to work through than in her methods/CBT really not being right for me. Otherwise put, should I bother trying to overcome my resistance here, or is it well founded?
posted by anonymous to Human Relations (23 answers total) 4 users marked this as a favorite
In my experience, a therapist (in any capacity, CBT or otherwise) who is doing the majority of the talking in session is not an effective therapist. That sounds frustrating and unhelpful.

You might consider that your problem is not resistance to CBT but to the therapist. I say that because you seem to have started out with some success with CBT. If you can, find another therapist (even one who is not a "dissertation specialist"--which is not even a real thing, I don't think) and give it a few sessions before giving up on CBT.

I agree with your psychiatrist that medication without therapy is not as effective as both together, so why not give therapy another try?
posted by GoLikeHellMachine at 6:52 AM on October 9, 2014 [10 favorites]

You're allowed to say something to her about how she addresses you.

"Jean, I appreciate your advice, I found Foo very helpful, but you've told me bah and blah already. May I speak for a bit and perhaps we can uncover some other insights together?"

My Dad is a behavioral therapist and he usually limits his stuff to: "What keeps you from doing X?" Although in real life, he's one of those guys, if you ask him what time it is, he tells you how to build a maybe it's just a hazard of the profession.
posted by Ruthless Bunny at 6:54 AM on October 9, 2014 [5 favorites]

CBT totally got my anthropology dissertation done. But this woman sounds ... like you have already derived all the benefit from her that you are going to get.

Find a better CBT person. Mine wasn't school-sponsored and didn't specialize in dissertation writing, but like many therapists she had written a PhD dissertation herself, offered a sliding scale, and actually paid attention to what I said.
posted by feral_goldfish at 6:58 AM on October 9, 2014 [8 favorites]

As a Coach, but not a therapist, I can tell you that I was trained to ask questions and let you do at least 80% of the talking. I do very little suggesting or telling you what to do, rather, by asking questions, I allow you to come up with the answers that serve you best. I also allow you to set goals for yourself for the upcoming week (before our next call), because you're more apt to do THEM rather than ones I tell you to do.

I would give it one more appointment, maybe sharing your misgivings, and see what happens after that.
posted by John Kennedy Toole Box at 7:01 AM on October 9, 2014 [5 favorites]

If you feel comfortable doing so, I would be very blunt and in your next session say something to the effect of: "The tips you gave me in our first meeting were really great and have helped me improve my work flow a lot, but I feel like the progress has stalled in the past few meetings. I am still struggling with X, Y, and Z and would really appreciate spending this session discussing those issues." Be clear on whatever it is you still feel you need help with. If she veers off into inappropriate areas (your bike helmet is not really her business, especially if she's not a general therapist but supposed to be helping with the diss), you can be blunt there too: "I appreciate your concern, but I'm here for help with finishing my dissertation, not bicycle tips. Could we please get back to topics X, Y, and Z which are the reasons I am paying you."

On the other hand, if the issue is that your dissertation work is now going amazing and you feel like you've got your system figured out, then I don't think you should see her anymore. Perhaps you can talk to the psychiatrist and lay it out to him/her, saying "Look, the combination of the meds + the talk therapy that I'm still going to + some basic CBT tips really seem to be doing the job! I can't afford the additional CBT sessions when it seems like the dissertation is going swimmingly and the CBT therapist has little more to add."
posted by rainbowbrite at 7:01 AM on October 9, 2014 [2 favorites]

Also YES she sounds hella infantilizing, to a point where she probably rationalizes it as her job to be nurturing, or something. This was also my experience the one time I tried a school-sponsored therapist (at the University of Chicago).

Since she was recommended by your psychiatrist, who is otherwise great, you might report your experience to him -- if you feel comfortable doing this, it would be a good deed.
posted by feral_goldfish at 7:08 AM on October 9, 2014 [2 favorites]

This sounds less like cbt and more like bog-standard one-size-fits-all grad school personal effectiveness coaching (we all have to sit through 20hrs of it during our PhDs and it is execrable). I bet this woman also runs a writing workshop doesn't she? And maybe does the in-house teamwork or assertiveness training.

CBT ought to involve YOU examining YOUR thought patterns and trying to re-frame the unproductive ones. I would give up on her if she's not helping any more, but don't write off cbt, that isn't what she's doing.
posted by tinkletown at 7:14 AM on October 9, 2014 [6 favorites]

This therapy isn't helping you.

I do think it's worth explicitly spelling out what isn't working with the counselor - it could be very useful feedback for her - but in my experience if a therapist is really not working for you then they're really not working for you. This isn't about it being CBT, it's about being a bad fit. Find someone else.
posted by latkes at 7:16 AM on October 9, 2014 [1 favorite]

I don't think you should continue. A therapist who repeats herself endlessly and does most of the talking just isn't very good; it's not even a compatibility issue! You shouldn't be expected to slog uphill to fix this therapist.

Question: you say you were prescribed to see *her* in particular? I'm not familiar with that way of doing things. Maybe it depends on the state, but where I've lived, you'd receive a prescription for therapy and then you get to choose whom you see...
posted by mysterious_stranger at 7:21 AM on October 9, 2014

 I have a lot of resistance to her suggestions....

Why? Which ones? The bike helmet is the only example you give that comes close. The rest of your question says you are already doing what she suggests and find those suggestions helpful and wish she would stop repeating them.

She could be a blowhard with a one-size-fits-all program that doesn't quite fit you. But there's room for this to be a case where you don't want to work, you want to continue with your analyst.
posted by Lesser Shrew at 7:22 AM on October 9, 2014 [1 favorite]

I have a lot of resistance to her suggestions....

But with your negative energy focused on her, and no longer on yourself, are you making progress with your dissertation?

If yes, then keep seeing her, as she may be helping you reach your goals in spite of herself.
posted by headnsouth at 7:25 AM on October 9, 2014 [3 favorites]

In any case, as you can probably tell from my writing, I am not thrilled to have been prescribed to continue seeing her

My doctor prescribed some drug or other that I took religiously because of fears of being tagged treatment resistant. I finally had enough of the near fainting spells every time I stood up and stopped the medication. At the next appointment my doc says, "so, how's that green pill working?" I tell him and he said back, "why didn't you stop sooner?"
posted by redindiaink at 7:32 AM on October 9, 2014 [4 favorites]

Terminate. Behavioral, or cognitive-behavioral, therapists should be helping you generate a list of behaviors you can adopt (which means: You talk, they offer a suggestion or two if you're stuck) and helping you troubleshoot obstacles (which means: You talk, they offer a suggestion or two if you're stuck), not telling you what to do.
posted by jaguar at 7:36 AM on October 9, 2014 [4 favorites]

Because, as you're finding, telling other people what to do is infantilizing, condescending, and counterproductive. Your resistance to it is very healthy.
posted by jaguar at 7:37 AM on October 9, 2014 [5 favorites]

(Sorry for the serial posting!) A therapist telling you what to do is also not teaching you how to problem-solve for yourself. It's bad bad bad therapy. Please don't subject yourself to it, and please give this feedback to your regular therapist -- they may not know that the CBT person is doing this sort of thing.
posted by jaguar at 7:39 AM on October 9, 2014 [2 favorites]

The therapist-client client relationship is one of the most important factors (and perhaps the most important factor) in the success of therapy. People can improve using a variety of approaches, but not if they don't respect and like their therapist. For that reason alone, the answer to "should I seek another therapist?" is almost always "yes."

Even though she's the "dissertation specialist," most good counselors will be able to help you work through this. A dissertation is a large, time-consuming project that requires focus and steady attention, and lots of people have those in one form or another. It's not something so unique that only one person in your university can offer assistance.
posted by Pater Aletheias at 9:16 AM on October 9, 2014 [1 favorite]

Why would you assume she is the only person you can see?
That can only be answered by inquiring, not guessing.

Additionally, not clear you need a dissertation specialist. I would say more likely you need a CBT practitioner that you can work with comfortably than one that you are not comfortably with who is a "dissertation specialist"/

I would not assume that CBT is not helpful based on your experience with one practitioner with whom you do not click. Ask for a different practitioner. You can ask for anything in this life if you can take no for an answer. And you would be amazed what people will say yes to if you ask.
posted by jcworth at 9:44 AM on October 9, 2014

I'd talk to your analyst about this decision!
posted by shivohum at 12:21 PM on October 9, 2014

"She also asked where my bike helmet was when I mentioned that I rode a bike, then told me that I had to get one, where to get one, and that she was going to continue to "nag me" until I did. This to me felt totally outside the context of what we are trying to work on, and, when put in contrast with the standard boundaries that my regular therapist has as a psychoanalyst, borderline unprofessional?"

Though sensible advice in general, her comments crossed a boundary for you. Yes, it was unprofessional of her.

Tell her this reason exactly when you call her to cancel your next appointment.

Please share with your referring psychiatrist how she behaved unprofessionally, and you had to stop going to her.
posted by hush at 12:52 PM on October 9, 2014 [1 favorite]

If you think it's therapist specific, certainly try another one, because patient-therapist fit is a real concern. However, CBT has sort of gained a panacea reputation, and that's simply false. When I was trained as a therapist, they made it very clear that CBT doesn't work for everyone, and that message doesn't seem to have reached the general population. If CBT with another therapist greatly helps you, fantastic. If it doesn't, it may just not be for you.
posted by namesarehard at 1:29 PM on October 9, 2014 [2 favorites]

A therapist's job is not to tell you what to do, except perhaps in small doses. A therapist's job is to help you figure out what to do for yourself. What you're getting sounds way more like "life coaching" than CBT to me - CBT is all about identifying distorted thought patterns and working to replace them with less distorted ones.
posted by zug at 4:55 PM on October 9, 2014

Followup from the anon OP:
Thanks for the helpful responses. The most important points I've gleaned from this are: 1. this therapist is not working for me, 2. this isn't CBT, it's coaching, and probably bad coaching at that, 3. given that my psychiatrist prescribed this and thinks that I am getting CBT, I should broach the subject with him*, 4. I should be very blunt in telling her (coach/CBT person) what is not working, what I'd like to work on,** and when her suggestions have nothing to do with the topic at hand.

*I actually did this yesterday, and had briefly mentioned before some issues that I had with it. He did suggest that I could see someone else. He was also taken aback by how much she is talking in our sessions. (Even if I'm exaggerating, it's still at a minimum 70 her/30 me.)

**Part of the problem here is that I don't know what CBT therapy is like, and what it can achieve, so I am not sure what is possible to work on. In my analysis, I talk often about the various fears I have surrounding the writing of my dissertation, and connect them to my parents narratives I was exposed to growing up that created my out-of-touch with reality thinking surrounding my dissertation. I keep imagining that if a CBT person asks me why I can't write, I am simply going to talk about fears (possibly including this fear), and that that will just repeat my analysis. On the other hand, I get that a good CBT therapist should be able to guide me into more behavioral responses to my fears.
posted by LobsterMitten at 8:45 AM on October 10, 2014

Part of the problem here is that I don't know what CBT therapy is like, and what it can achieve, so I am not sure what is possible to work on.

It's therapy, at its core, and it's generally appropriate (when done well) for all the same things all the other kinds of therapy address. Quick and dirty: The general idea is that emotions, cognitions, and behaviors all influence each other, and that by focusing on changing our behaviors and cognitions, we can get to a better emotional state. So if you were talking about fears, for example, a (good) CBT therapist would help identify what faulty thinking and unhealthy behaviors were reinforcing the fear and how you could shift your thinking and behaviors toward more healthy and helpful ends.

I do want to say, though, that while it's admirable to try to tell this particular therapist how to better meet your needs, please don't beat yourself up if it doesn't work (and please do change therapists). This sort of therapist behavior generally comes from fairly deep-seated misconceptions about how therapy functions and what the therapist's role is, and it's something that should have been trained out of her by professors, supervisors, and consultation groups. I'm not sure one client making a request is going to be enough motivation for her to make the fundamental changes she would need to make. (Which is why I think it would also be perfectly appropriate to change therapists (or just work with your pyschodynamic therapist) without trying to fix it with this one.)
posted by jaguar at 10:09 AM on October 10, 2014

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