I like my therapist but I don't know if they are the right one
April 20, 2018 7:11 AM   Subscribe

How did you decide if a therapist was good for you when you really liked them as a person, but they maybe weren't serving you as well as a therapist?

I like my current therapist a lot, as a person. After years of abusive, incompetent, fearful, cruel, etc interactions with the mental health system, I have finally found someone who not only treats me like a human being but is incredibly intelligent, informed and up-to-date about psychiatry, gentle, and not afraid of someone with intermittent suicidal ideation. Within my two months of seeing this therapist I've gotten a few diagnoses I've waited years to get, and some validation I've never before received. There's no question they know what they're doing, and I'm very scared to lose that after searching for it for so, so long.

That said, I don't know if the therapy itself is working for me, and because of my deep respect for this therapist I am fearful of bringing it up to them. They seem very much psychoanalytic/talking focus (although also trained in CBT), a lot of time is spent with me sharing my feelings, to which they will occasionally interject insightfully, but it feels like it's 70% just me talking and them nodding. I need more feedback and validation than that given my specific traumas, and I also really want to learn coping skills to deal with it, and with suicidality/depression, and anxiety. As I finally have an antidepressant that's working, for the first time in my life I feel ready to implement those skills as they're taught to me in a safe place, where I can put down a lot of the weight I've been carrying. But I'm not sure this is that place. I come out of many sessions feeling we ended so suddenly I'm in shock, and that I have zero coping skills that I have learned. I don't know that my therapist is equipped to deal with the level of trauma I have experienced, despite treating people with PTSD. It is very important for me to form an emotional connection with any kind of doctor where I feel a strong alliance, and while I respect them a lot I don't know that it's happening here. I have brought up some of these concerns.

I worry about losing the first person who was ever nice to me in therapy if I switch therapists, despite this therapist assuring me I can speak up if it's not a good fit. I worry I will never find someone who is kind to me again. But I also feel very much at a loss in terms of dealing with my illnesses on a day-to-day basis, which is what I'm in therapy for. It's not that I don't want to tell my story, in fact I do - but I want to know how to deal with it too, and I want perhaps more of a warm environment than this very intellectual therapist provides. Have you ever been in this situation, and if so what did you choose?
posted by anonymous to Health & Fitness (3 answers total) 2 users marked this as a favorite
First, you should definitely bring this up with your therapist. It could be that you need what they offer more than you know, it could be that they can modify their approach if they find out it's not working for you, or they could help you find someone more appropriate — if they're good themselves, the chances are good that they also know good people. By not bringing it up, you are clouding an important issue, and may be depriving them of the opportunity to help you even more.

Second, it sounds like you probably need a social worker. Psychologists and psychoanalysts tend to focus on your interior ("just [you] talking and them nodding"), while SWs focus on coping skills and making things work for you. It might be even better if you could see both, though maybe not so often — say, three times a month for the SW and once a month for the shrink. Again, something to discuss with your current therapist, but it sounds like you shouldn't lose them entirely.
posted by ubiquity at 7:25 AM on April 20, 2018

IANAPsych, but IAAPatient.

There are more than a few really good skills workbooks available for purchase for around $30 each that have a sort of course-approach to CBT, DBT, and others as well, I'm sure. My suggestion is that you discuss this with your awesome, intelligent therapist and maybe propose you guys work through one or more of these books.

The way it has (really) worked for me, I have identified concrete experiences out of my own life that gave me trouble, read up (and: brainstormed with my therapist) on strategies I felt comfortable with/were practicable/were appropriate, then went out into the world and APPLIED them, and then came back into their office and discussed the results.

Treat therapy as independent study seminar, where most of the learning happens outside of class.
posted by ipsative at 8:48 AM on April 20, 2018 [2 favorites]

I am a psychologist specializing in trauma but IANYPST. My standard recommendations for PTSD are either Cognitive Processing Therapy or Prolonged Exposure, assuming that's what you're seeking treatment for, because they have the strongest evidence for their ability to treat PTSD. Both are about 12 weeks long, and they are a lot more structured, directive, and skills-focused than what you're describing- which sounds like what you're looking for. One option might be to ask your therapist if they would be open to you taking a 12-week break to try this treatment, and restarting again afterward if that's helpful.

To address the comments above, social workers will probably not offer this (and a good psychologist should be focused on coping skills), and DBT is not a standard trauma treatment for patients without other difficulties.
posted by quiet coyote at 9:08 AM on April 20, 2018 [3 favorites]

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