Should I change therapists? Do you know a good one in Portland, OR?

July 4, 2016 12:15 PM

Is therapy burnout a thing? I think I has it, but I don't know if the problem is me (uncomfortable, withholding, sometimes worried that a lifetime of therapy has made me immune to it) or my therapist (lovely but non-challenging; it feels like we're treading water.) I'd like to talk to someone super-smart who can shake up my previous notion of sit-and-talk-and-nothing-changes therapy. Can you recommend a counselor in the Portland area (or, alternately, tell me if I'm approaching this the wrong way)? Much snowflake below.

I'm a cis woman in my mid-thirties with lifelong depression and anxiety. I was in therapy at my parents' urging/expense for big chunks of my childhood, teenage years, and the tail end of college. I briefly took Wellbutrin and Prozac post-college but stopped because, as I recall, it made me feel overly numb (this was over 10 years ago, and I don't really remember anymore, just that I was uncomfortable with the combination I was on). I then stayed out of therapy for about ~8 years until four years ago when I sought out a practitioner on my own for the first time (without parental input/financial support).

When I made the decision to see a talk therapist as an adult, my goal was to "do the work" in a way I hadn't before. I specifically chose someone who doesn't really mess with meds because I wanted to focus on identifying and changing thought patterns, and making lifestyle changes and choices that would support better mental health. I understand how vital medication is to a lot of people, but my own experience with it left me cold (I am now more open to the idea than I was before). FWIW: I exercise 4x/week, meditate semi-regularly, and generally try to make brain-healthy choices (little/no alcohol, interrupting unhelpful thoughts, etc.).

My therapist is an LPC/LMFT with a strong focus on naturopathic and alternative treatments. I've seen them regularly for almost 4 years, at certain points bi-weekly, currently weekly. I've taken a few multi-month breaks here and there, including last summer, but came back after a devastating breakup that triggered the worst depression of my life (so far! ha). My therapist is an excellent listener, and I quite like them as a person, in the sense that I think we would be friends outside of the office. But I suspect that isn't quite the "right" relationship. My friends talk about being challenged by their therapists, getting homework, having big breakthroughs, and I get a little envious. I feel like I'm just treading water with mine. In recent months, I've started to dread sessions, and leave feeling more frustrated than anything else. My therapist does a lot of talking, and I do a lot of trying to listen, nodding, and responding halfheartedly. It doesn't feel productive or helpful, just habitual, and I get the sense that we're both sick of it.

I suspect that it's my fault for not being more engaged and forthcoming. I don't open up to them as much as I want to, I think out of a combination of personality (I'm very guarded, which is something I've made progress on in therapy and in my personal relationships, but I still tend to shut down when I'm uncomfortable) and habit ("I've done therapy for so long and I always end up feeling this way, what's the point"). I worry that maybe I'm just an unhappy person and nothing will ever fix that. Four year of therapy with this person, many years with many other therapists when I was younger, and I always seem to come back to this place. Frankly, I'm tired.

I know that no therapist will be able to wave a magic wand and fix me. I know I will likely be working on this stuff for the rest of my life. But I don't have a clear picture of what "the work" should be, and after my most recent, severe depressive spell, I feel like it might be time to try something new. Medication? A more structured/goal-oriented form of therapy? Quitting?! I'm extremely nervous about bringing this up with my therapist. As I said, I like them a lot, and after four years it would be very hard to sever that relationship. But I've reached a point of utter frustration.

Would love suggestions for how to approach therapy to get more out of it, or new types of therapy to consider, and/or specific, excellent, Portland-based practitioners. I'm currently uninsured so a sliding scale option would be ideal, but I can get some help if I need it.

posted by adastra to Health & Fitness (16 answers total)

Tell her that you're thinking about leaving the relationship. Tell her you're bored! Tell her you dread it! See where that conversation goes. It COULD help you figure out what's keeping you from getting more out of the therapy now, OR she could agree it's time for you to move on, OR her response will make clear that it is. And be prepared to HAVE that conversation. Give it a couple of sessions, not a "talk about it right now and immediately decide" timeframe. This is THE first step to figuring out which other solutions might be necessary.
posted by listen, lady at 12:22 PM on July 4, 2016 [5 favorites]

p.s.: My therapist is an excellent listener, and I quite like them as a person, in the sense that I think we would be friends outside of the office.

LOTS of people think this about their therapists; it's transference. She's presenting a particular version of herself to you. You might not actually like her as a person. This might truly be a different situation, but also it might help if you leave her likability as a person out of it entirely.
posted by listen, lady at 12:28 PM on July 4, 2016 [3 favorites]

I'd start with rethinking the goals of therapy. "Do the work" doesn't describe a functional benefit to your life. Therapy should be a means to an end, not an end in and of itself.

Therapists are there to help you change thought patterns and behaviours. They provide a safe space, teach tools, and can act as an accountability partner. You can use these concepts to help you define what benefits you hope to achieve and what role you want your therapist to play.

Have this conversation with your existing therapist. If you like, screen others, but have the same conversation with each. Observe the results.
posted by crazycanuck at 1:49 PM on July 4, 2016 [3 favorites]

What listen, lady said.
Your therapist needs feedback about what is or isn't working. Walls are common. It is what motivates you to take a risk and put things on the table about how it is all working for you. A good therapist will be able to help you move forward again if you have such a conversation.

If you try and continue to feel stymied, try seeking someone who uses a totally different modality. Somatic or body psychotherapy, EMDR, emotion focused, gestalt. Read about the styles and pick one. Sometimes the reason you hit a wall is because you can only talk about the problem so much. Sometimes you need to chip away at it from another angle.
posted by crunchy potato at 1:51 PM on July 4, 2016 [1 favorite]

Check your MeMail for therapist recommendations.
posted by linettasky at 2:29 PM on July 4, 2016

Sometimes we reach the end of what a relationship (any relationship!) can do for us. It's normal natural and right to change. It's not your fault for not getting enough out of it, it might just be time to move on.

FWIW I got to a very similar place with a talk therapist after a few years of productive work. I found a CBT-based therapist (who also does mindfulness and ACT) and was able to make some major strides. I had hit a wall with talk and needed something more actionable to work with; CBT was totally the right move for me.
posted by wemayfreeze at 3:14 PM on July 4, 2016 [2 favorites]

I had an analogous experience with a therapist and it just turned out to be a suboptimal fit. Mine was almost the opposite of yours: instead of doing a lot of talking himself, he was so reserved it eventually started to feel like I was paying him so I could ruminate out loud. But the result was the same. Despite my liking him as a person, I routinely felt worse after sessions, not better. After way too long, I finally raised my concerns to him, he asked if I saw a way forward with the relationship and I said "not really, I just think it's a bad fit" and he basically said "that's fair" and he gave me some references for other therapists. I found a new therapist who was much more interactive and things got better.

You don't have to end the relationship, but I do think you should voice your concerns to your therapist, and switching to a new therapist is not an unreasonable option. I actually wish I'd had that conversation much sooner, instead of dutifully trucking into weekly sessions that I felt weren't getting me anywhere. Honestly, I think part of the problem was that I was fond of him as a person and so I was too delicate about having a conversation that he might find hurtful, even when it was clear the relationship wasn't working. Maybe something similar's going on for you?
posted by en forme de poire at 3:16 PM on July 4, 2016 [1 favorite]

Also, there are a lot of medication options out there, so your only options probably aren't "feel exactly like you do now" and "feel exactly like you did on Wellbutrin + Prozac." I had a horrible experience with an SSRI in college, but a pretty good one after grad school. Plus, if you're also doing therapy (and exercising and meditating), you may not need as high a dosage as before to see benefits.
posted by en forme de poire at 3:25 PM on July 4, 2016

I suspect that it's my fault for not being more engaged and forthcoming. I don't open up to them as much as I want to

That's "the work." Work on telling your therapist that you're doing it, explore why you're doing it, explore what techniques you can use to stop doing it, and then work on not doing it. That may be a multi-month process. But a therapist can't go deep if you're not going deep.
posted by lazuli at 3:55 PM on July 4, 2016

Have you talked about this in therapy? This is very common and there are things that can be done to shake it up. It's okay to use your therapy sessions to talk about your therapy. I'd try that before starting a new therapy relationship from scratch.
posted by peanut_mcgillicuty at 5:02 PM on July 4, 2016

I love my therapist - will MeMail you some details. She's helped me more in the last year than my previous therapist did in eight years.
posted by bendy at 8:58 PM on July 4, 2016

A more structured/goal-oriented form of therapy?

I think so.
posted by cotton dress sock at 9:38 PM on July 4, 2016 [2 favorites]

I left a therapist that I described in almost exactly the same way as you describe yours. My next therapist, I went in for a first appointment with a list of questions about two pages long, the most important of which was "I want someone who will really engage with me and push me to do real hard work; can you tell me how you'd do that?" And he did, and I clicked with him, and I do not get the feeling of "oh, we would be great friends"-- I mean, he seems like a nice guy, who knows, but that is just totally not the therapeutic relationship. That is challenging and sometimes cranky, and respectful, and as I told him just a couple of weeks ago, "look, we can disagree and it's not stressful to me, and I can pay attention to what you're saying, and evaluate it and feel around for whether there's a grain of truth there." He gives active homework, and points out when I am using the same maladaptive coping strategies that didn't work before, and therapy is fucking hard work, but it's working, and I think that's so much more useful than chatting with someone who is kind and friendly and nothing ever changes.
posted by instamatic at 4:51 AM on July 5, 2016 [6 favorites]

Therapists are there to help you change thought patterns and behaviours. They provide a safe space, teach tools, and can act as an accountability partner. You can use these concepts to help you define what benefits you hope to achieve and what role you want your therapist to play.

There are different types of therapists and therapies, though. My initial thought is that you are in a psychodynamic style talk therapy, which can be incredibly useful for gaining insight into your behaviors and thought patterns. Actually changing those patterns and behaviors can often be attained through cognitive behavioral therapy, which often includes homework and specific goals, etc. It may be useful for you to start reading up on the different types of therapy and trying to find a better fit for the next phase of therapy you want to move into.

I do agree it will be helpful for you also to discuss these issues with your current therapist. She may be knowledgeable about CBT, or have a recommendation, and if nothing else it is a good skill for you to build on of bringing up your discomfort and working to improve your situation.
posted by JenMarie at 9:37 AM on July 5, 2016

Actually changing those patterns and behaviors can often be attained through cognitive behavioral therapy, which often includes homework and specific goals, etc. It may be useful for you to start reading up on the different types of therapy and trying to find a better fit for the next phase of therapy you want to move into.


Yeah, maybe. It's also the case that THE most efficacious therapy, across styles, happens in relationships with what's called a "strong therapeutic alliance," which looks a lot like what instamatic describes. So it's also possible that if you're not any more candid with a new therapist, you won't get very far, even if it's a different methodology.
posted by listen, lady at 6:01 PM on July 5, 2016 [1 favorite]

sounds like you have been doing talk therapy for awhile. have you considered other kinds of healing? if i was bored with talk therapy in general i would do a few sessions of somato-emotional release. sorry i can't give suggestions for particular practitioners where you are.
posted by andreapandrea at 9:36 PM on July 5, 2016