How can I get more out of therapy?
March 23, 2019 12:51 AM   Subscribe

I have been in therapy for around six months and will have a hard stop in May. I don't believe that I've gotten a lot out of it and feel frustrated. What can I do to open up to my therapist and stop wasting everyone's time with superficial chatter? What can I do to salvage this course of treatment?

I originally signed up for therapy because I wanted to be sure I wasn't sabotaging my romantic relationships (I've been a serial monogamist and want to settle down). I also have some other struggles, mostly with perfectionism, aka, crippling performance anxiety in all areas of life, and just some bad coping mechanisms that I probably should work on in order to be productive and happy.

In the past, I have had periods of time when I've had poor mental health. I had a very destructive bout of depression for a couple years (2013-2015), but managed to claw my way out with the help of medication (which I then stopped taking in 2016) and a lot of focus, willpower, and luck. For the past couple months, I have gone back on medication and am generally feeling meh but more-or-less stable in my life. Stable job, good friendships, etc.

In 2015, during the period when I was really struggling, I did attempt therapy -- but it went terribly. I had maybe four sessions total, with three different therapists. The first therapist said she wasn't taking on new patients, the second therapist got into a screaming match with me during our first session and then was suspended by her practice, and the third therapist just didn't seem to "get" me at all or take my problems seriously (I was in my late twenties, but he kept comparing me to his teenage daughter). This is my first time in therapy since.

I like this current therapist, she's nice and we get along OK. But I treat our sessions like a hang-out with a friend and just chat. I don't lie to her, but I gloss over things in ways that are kind of misrepresentative, in the same ways that you would when trying to save face with a friend. I can see I'm doing it and maybe so can she, but I have a really hard time opening up to people and she is no exception, so I keep doing it anyway. I have never cried when around her and can't imagine doing so. A friend finally got on my case for blowing off my therapist whenever she wanted to talk about my childhood, so I did talk about my past with her for one session, but then last week, I caught myself blowing her off again when she brought it up. I know this is counterproductive.

I would like to open up to her because I think that it's such a waste to just chat with her like we're acquaintances meeting for coffee. But I just can't. I feel like I'm always casting around trying to figure out where we're going with this, what I'm even supposed to be saying or thinking or feeling or how I'm supposed to be changing/growing. When I ask her directly for advice, she just says really banal things, like that I should try to live in the moment.

She seems to want me to guide these sessions, but I have no idea where or how I'm supposed to be guiding them. I brought it up at one point that I was worried about the timeline (there's going to be a hard stop in May no matter what) and she seemed to think that I was criticizing her pace and said that maybe I wanted a harsher but faster and more CBT-oriented approach? But I don't want things to be harsher in there! I already dissemble too much out of wimpiness. So I just dropped it and we moved on. It's possible that she's steering things, but in a subtle way that I'm not picking up on. And I don't want to control our sessions because I don't know what I would even do with that control and because she clearly thinks that I want to control too much in my life generally (and that's probably true). The thing is that I feel like nobody is in control of them, and that makes me feel pretty confused and frustrated.

What really shook me (and this is going to sound so ridiculous) is when I watched an episode of Brooklyn 99 and Jake said “Why learn to grow when you can fix the past? This is exactly why I don’t need therapy.” It really struck a chord because I'm plagued by a lot of regret and remorse that I can't let go of, and I am always coming up with ways to fix things or make up for things or compensate for or even just hide things. And those "hopes" mix in with all this fear of failure and performance anxiety until I'm freaking out that I'm going to screw things up again this time (except worse) and so I just freeze and/or withdraw. This happens with work, this happens with relationships, everything. So when I heard that line in Brooklyn 99, I thought, I don't want to keep trying to fix the past! I want to grow! But I don't know how on my own, and I feel like therapy isn't helping. Or even addressing any of this stuff.

Also, I think a huge hindrance in "the therapeutic relationship" is that I apparently don't know how to express myself in general, because people consistently assume that I don't feel things, even when I'm feeling things very strongly and really trying to express those feelings. This therapist makes the same assumption, that I'm cold-hearted or that problems/situations are not as serious as they are. It's very frustrating, and honestly pretty painful, but I don't know how to be more expressive than this.

At first, she was really confident that she'd be able to help me make my life better, like I'd be leaving therapy with a better job and a boyfriend and basically a great life. Of course that hasn't happened, I'm in my same boring job and still single and in altogether the same state I was in in September, except that I've gotten even lazier about pursing my goals and am slightly more mellow due to medication. It's just been such a waste and I feel like it's been a failure. I'm trying to salvage it. And like I said, I want to open up to her, I want to do my part. But how do I do that? How do I use therapy to actually grow, instead of wasting everybody's time?

Very concrete answers about things I should remind myself of or phrases/aphorisms that are helpful are great as well as more experiential or abstract answers. Whatever works.
posted by nowadays to Health & Fitness (22 answers total) 20 users marked this as a favorite
 
I think you should give her a printout of this post to read.
I have been in therapy myself , several therapist s, some good some bad. And i feel the useful sessions were those i talked about why therapy and sharing the truth is difficult.
It will depend on the therapist but give her what you wrote and see what she says.
posted by 15L06 at 4:15 AM on March 23 [12 favorites]


So, I think that there's something useful going on here and that's that you're noticing your discomfort with opening up. That's self-awareness and it's important, and it's not unusual for people to wrestle with that kind of new information when they first figure it out. It's probably not just a little habit you picked up somewhere, you learned to do it for a reason and you won't unlearn it overnight.

You could re-open the CBT discussion and say that you're interested in finding a way to hurry things up but you're concerned about the "harsh" aspect and ask her to go into detail about why it's harsh and whether it really has to be that way.

When I have had trouble bringing up things with therapists in the past I've written it out and printed or emailed it.

(I'm assuming that you have trouble opening up in general and not just with this therapist - but if it's the therapist, try someone else. Look up the sunk cost fallacy if that's relevant).
posted by bunderful at 5:15 AM on March 23 [4 favorites]


Also, you could ask her to not accommodate you when you treat sessions like a hang-out. If you start with "I saw that new movie" she doesn't have to say "how was it," she can point out what's happening.

I've also found it helpful to just sit in silence for a couple of minutes when I really want to make sure I'm being honest and not just saying the first that comes to the top of my mind.
posted by bunderful at 5:21 AM on March 23 [2 favorites]


There is a lot here, but I will throw out a few thoughts you might find helpful in resolving your question:

- Sounds like your earlier experiences of therapy were pretty bad. Good on you for being persistent. It shows growth that you are taking care of yourself this way.

- That said, why the six month deadline? Is it an insurance issue? You should be able to make some progress but overall this is a very short timeline for really deep change.

- You have correctly identified that not being open with your therapist is counterproductive, and started to take steps towards being more open. Your therapist can invite you to open up and should be asking good questions, but they can’t and shouldn’t push/force you to open up.

- It might help to have a conversation about why you decided to go to therapy, and what change you want to see in yourself (ie your actions and feelings). This helps the therapist to steer, and can also prompt deeper conversation from you.

- Your question has a lot of big assumptions about how other people (even your therapist) see you. Maybe these assumptions need to be examined. Again, therapy is a good place to do that.

Think of your therapist like a personal trainer at the gym. The can help you, but you are the person that needs to do the heavy lifting, so to speak, so that you can grow. If they just gave you advice on how to fix your life problems, you wouldn’t be able to make the progress you’re trying to achieve. Good luck!
posted by Concordia at 5:26 AM on March 23 [5 favorites]


When I ask her directly for advice, she just says really banal things, like that I should try to live in the moment.

...

I'm plagued by a lot of regret and remorse that I can't let go of, and I am always coming up with ways to fix things or make up for things or compensate for or even just hide things. And those "hopes" mix in with all this fear of failure and performance anxiety until I'm freaking out that I'm going to screw things up again this time (except worse) and so I just freeze and/or withdraw. This happens with work, this happens with relationships, everything. So when I heard that line in Brooklyn 99, I thought, I don't want to keep trying to fix the past! I want to grow! But I don't know how on my own, and I feel like therapy isn't helping. Or even addressing any of this stuff.


Has it occurred to you that all of the stuff you list as troublesome is to do with either your past or your future, from which it follows that your therapist's suggestion about trying to live in the moment is not in fact the slightest bit banal but is in fact genuinely good advice well worth acting upon, and deserves not the dismissive snort but a bunch of followup questions along the lines of well OK, what are some techniques I can use to go about doing that?

Everybody sucks at taking advice, especially good advice. Therapists know this, which is why they so rarely offer it; best practice is just to sit back in the weeds and wait for the patient to perceive the need to do whatever it is the therapist is screaming on the inside to take them by the shoulders and shake them into doing.

Spending more of our in-head time in our past or future than we do on paying attention to what's happening in and around us right this instant is a super common pattern in our excessively mediated culture and causes terrible trouble for loads of people. This is exactly why "try to live in the moment" is heard often enough to sound banal. It really, really isn't.

I feel like I'm always casting around trying to figure out where we're going with this, what I'm even supposed to be saying or thinking or feeling or how I'm supposed to be changing/growing.

There you go again, avoiding being present in the moment by deflecting yourself onto worrying about where you think you ought to be in the future.

Next time you meet with your therapist, take her advice. Just drop the worry and regret filters and tell her what's in your head right now regardless of how banal your inner critic tells you it is. This will feel weird and threatening and risky, but remind yourself that you've done the work of evaluating this therapist's trustworthiness and right here right now it's time to put the results of that work into play.
posted by flabdablet at 6:44 AM on March 23 [18 favorites]


Your therapist is not your friend and they cannot be your friend. They are your coach or your trainer. They're there to assist you but ultimately they can't help you, only you can. If you let them, by telling them all-the-things, then they can point out where you're going wrong and they make suggestions for solutions but you are the one who has to make the changes.

Stop chatting with your therapist and tell them all the deep dark things that hurt you in the past or scare you about the future. This is the only way they'll have the information they need to do their job.

The other thing you should do is meditate. A nice simple secular mindfulness meditation with no mystic energy or chakras or other BS. Just you and your brain. Because how can you learn what's going on inside your skull if you don't pay attention to it. And the lovely part is, you learn to pay attention and that pays dividends in the rest of life because all of your problems are because of stories you're telling yourself. When you learn to pay attention you start noticing the stories and when you notice the stories that gives you the option to stop listening, and stop being miserable.

It's not a quick fix. It takes time to learn new skills but it's life changing.
posted by Awfki at 7:12 AM on March 23 [3 favorites]


Your therapist wants you to take charge of the sessions exactly for the reason you are having a problem doing so. Therapy is about you taking charge of your life and you are experiencing in the session what happens when you don't and it's not pleasant. If this experience isn't enough to allow you to do so, then that's what you should talk about. E.g. "I come in here and chat with you because I don't feel safe enough to open up. Can you help me to open up more?"
posted by Obscure Reference at 7:20 AM on March 23 [3 favorites]


When I ask her directly for advice, she just says really banal things

This is exactly why I found therapy to be largely useless. I spent years going to various therapists, but none of them really made much of a difference in my life, except for the last one I saw (who actually had the least amount of academic credentials). I was mostly a shut-in at the time, and he advised me to do some volunteer work. I resisted for a while and came up with lots of rationalizations why it would be a bad idea. But eventually I tried it. Doing the volunteer work initiated a cascade of positive events that lifted me out of my depression, got me a new job, and led to marriage with someone I met through volunteering.

When I look back on it now, I saw that a lot of my problems could have been addressed with practical, concrete changes. I had terrible sleeping habits and watched TV late into the night. I ate unhealthy foods and never exercised. The antidepressants I was taking made me fat and tired (I never did lose the weight after I quit them), and I should have ditched them much earlier than I did. I mismanged my money, didn't pay bills on time, didn't clean my apartment regularly, etc. The therapists had little to say about this stuff.

What I should have done is hired a good life coach, instead of spinning my wheels with a stream of over-educated therapists who had MD and PhD degrees but didn't really have anything practical to offer.
posted by akk2014 at 7:23 AM on March 23 [7 favorites]


In general, therapists shouldn't be giving advice (for all the reasons flabdablet listed). It's a common misconception, though. This article, The Best Advice a Therapist Could Get? Stop Giving Advice, talks more about why it's not helpful and often actively hurtful.

My advice (ha!) in this situation would be to talk to your therapist specifically about your difficulty opening up, rather than trying to force yourself to open up or ask her to force you to open up. It's kind of meta-discussion about the problem, and those meta-discussions can be really helpful to the therapeutic process; they can also serve as test-runs for opening up more (i.e., you're opening up about your difficulty opening up, which may be slightly less scary than opening up about your childhood). Those sorts of test-runs in therapy can help build your confidence in opening up about slightly more difficult or in-the-moment subjects.

It is, of course, possible that your therapist just doesn't have the skill to help you through this, but it's hard to know unless you try. And it may feel like jumping across a giant chasm and hoping that she puts out a hand to catch you -- emotional risks often do -- but it can also be helpful to realize that maybe that chasm isn't nearly as deep as you feared it was and that opening up a little bit isn't going to make you as vulnerable as you imagined.
posted by lazuli at 8:35 AM on March 23 [3 favorites]


It sounds like this therapist understands you a great deal and is spending time building trust with you so you can eventually choose to open up and connect with her on a non-superficial level. Are you ready to make that leap? She can’t and won’t force you.

So maybe try to say one honest thing per session. Slow down and challenge yourself to go deeper instead of skimming the surface. Tell her honestly “I think I’m being shallow with you, and with myself, and I’m afraid to connect and open up and I don’t know why.” Or say “this week I’ve been feeling X” and then let some silence sit in. And then see what happens.
posted by St. Peepsburg at 11:27 AM on March 23 [1 favorite]


And, accept you’re skimming the surface for a reason. This shit ain’t easy. You want to face something, and are afraid of facing it in the same measure. Your mind is dancing around trying not to feel a mountain of Big feelings. Don’t be surprised that you oscillate between opening up and then totally avoiding it next session, like you mentioned about talking about your childhood. A “useful” session and then a “useless” session so to speak. This is all part of learning to trust someone and face whatever you’re avoiding. Keep your eye on the prize - the end goal of the person you want to be. Good luck and a warm hug from me.
posted by St. Peepsburg at 11:33 AM on March 23 [1 favorite]


tl;dr If you've been hoping for more guidance, advice and even instructions from your therapist, and they've been all Freudian and not said much, now is the time to ask for it.
That worked for me the last time I ended therapy.
If this answer doesn't apply to you, sorry, and please disregard.
posted by JimN2TAW at 1:01 PM on March 23


I dunno sounds like you might be better off switching to someone willing to call you on dodging the hard questions rather than this person who's content to waste your time playing softball. How much time do you really want to spend doing meta-therapy on how the therapy itself is going?
posted by sockymcpuppeterson at 2:19 PM on March 23 [1 favorite]


I find therapy only really works if you have a specific issue that you need help with, and focus on that. It doesn't sound like you've crystalized a single issue. Maybe a religious or philosophical practicr would be more in line with what you need?
posted by schwinggg! at 2:25 PM on March 23


As mentioned above, sending this post to your therapist could be a great place to start. I find that talking *about* therapy with my therapist is meta enough that I don’t feel like I’m exposing myself too much. There’s no dark secrets, just the nuts and bolts of how communication works.

If not the whole post then just send "I don't lie to her, but I gloss over things in ways that are kind of misrepresentative, in the same ways that you would when trying to save face with a friend." I’m sure there are reasons for glossing things over, but just the process you use in making that decision could make good grist for the mill.

Also, it can take some people a very long time to trust. Case in point: I’ve had weekly sessions with a really good therapist for eighteen months now. Last week for the first time, with great trepidation, I touched on the topic of sex. Some things you can’t rush.
posted by Tell Me No Lies at 3:14 PM on March 23 [1 favorite]


When I look back on it now, I saw that a lot of my problems could have been addressed with practical, concrete changes. I had terrible sleeping habits and watched TV late into the night. I ate unhealthy foods and never exercised. The antidepressants I was taking made me fat and tired (I never did lose the weight after I quit them), and I should have ditched them much earlier than I did. I mismanged my money, didn't pay bills on time, didn't clean my apartment regularly, etc. The therapists had little to say about this stuff.

FWIW this is exactly the opposite of my experience: these are examples of things I actively work on in therapy and my therapists have all brought up practical things like exercise, money management, healthy self-care, etc. My therapist right now has been particularly good about digging into questions like, "what are you doing when you're not going these healthy things and why?" and "how are you actually spending your time and how do you actually feel about it?" Most of the time, when I am doing something unhelpful like procrastinating or ruminating instead of exercising or working or contacting someone I care about, it's not for no reason at all. It's often an ineffective way of coping with feelings that I don't like, and within that category there are a lot of "greatest hits" that repeat over and over that I am now better at recognizing. I have also gotten a lot of practical info about habit formation that has been helpful.

Also, a more active approach does not have to be harsh, or some heavy burden. Therapy does require work on your part, but the belief that your only options are ineffective pleasantries or some kind of punitive boot camp/struggle session is maybe worth interrogating.

That said, I have also had one or two therapists where I felt exactly like OP did and in retrospect those cases were really bad therapeutic fits. I know from reading other people's stories on MeFi that some people really do just need to talk about their story with someone sympathetic and end up feeling really helped by that. But I think a lot of people are probably better served by something where the therapist takes a more active role in providing structure and assessing progress.

It sounds like you've been particularly unlucky with therapists here and I totally sympathize, the whole process can be pretty awful; I also think that in six weeks or so I think you basically know whether someone is going to be helpful, so my advice would be to shop for another therapist. I do think bringing these thoughts up with your current therapist is a good short-term step that would probably be good practice for you having this type of conversation, totally; but I also wouldn't feel obligated to stick it out with this person for that reason alone.
posted by en forme de poire at 5:24 PM on March 23 [4 favorites]


If you want to stay with this therapist, you could tell her you’d like to directly address perfectionism and anxiety (possibly also avoidance?) in a more goal-directed way. (Ie your therapeutic goals are to reduce perfectionism, etc.) Tell her you’d like some benchmarks to work towards so you’ll both agree when you’ve achieved them.

I think more than likely, you’ll need to work with someone else.
posted by cotton dress sock at 5:58 PM on March 23 [2 favorites]


best practice is just to sit back in the weeds and wait for the patient to perceive the need to do whatever it is the therapist is screaming on the inside to take them by the shoulders and shake them into doing.

Ugh this is exactly the dynamic that has kept me out of therapy before and why I explicitly ask my therapist for advice and for clarifications of that advice and for techniques for how to try following it, and then write it down as soon as I leave her office so that I won't forget it, and all that stuff. If this woman wants to shake me because she's so sure how I should be handling things, then she should just TELL ME what her opinions are and I will try doing things her way for at least a bit. It makes me feel so paranoid to think that she's sitting there in silent judgement, secretly wanting to shake me or hit me upside the head or whatever because, in her mind, I'm (unwittingly?) screwing up so badly. I know this is way out of proportion, but it makes me feel like I've got a sword hanging over my head and one day she's going to have enough and cut the rope holding it there. Like any minute, she's going to say, "enough is enough! I'm done!"

I am used to walking on eggshells for other reasons and I guess it's hard to train myself out of that even when it comes to therapy. Besides, I feel like I barely know this woman and won't know her at all in a couple months, and it's the same for her regarding me. Like, who am I to her? So it's hard for me to trust her or open up to her about anything. I've tried bringing it up before that having this hard end date looming over us is making me feel like we're on borrowed time (and it is a hard date -- she's in LSW training, and that's when her training will end, so that's when the therapy has to end) but when I brought it up, she misread me and thought I was criticizing the therapy's pace. That's when she said that she could use "harsher" (her words) but faster methods. I was like, oh, no, never mind! The last thing I want is "harsh."

I also am maybe oversensitive about some stuff, and have felt put out by some things she's said. When that happens (every other session or so), I just change the subject and "lighten the mood." I know that's counterproductive, and I'll try to respond to her more directly going forward. Hahaha I literally just grimaced while I typed that. But I'll try.

Like for example, I am in therapy explicitly to try and improve how I handle intimate relationships (I began therapy as a response to my last breakup), and I am a woman who dates men -- so eventually, of course my therapist asked me about my father. I told her about him and my relationship with him, and she didn't especially like what she heard, so I told her it really wasn't/isn't that bad, and she said that it sounded "damaging" regardless. In my head, I was like, gee, thanks for calling me "damaged." So I changed the subject and shot down attempts to talk about my family for weeks (until I vented to my friend about my therapist always trying to talk about my childhood, which I thought was totally unnecessary, and my friend took the therapist's side, so I decided to try talking to her about it again). If my therapist was saying that the random stuff that I happened to mention was "damaging," though, I damn sure wasn't going to get MORE real with her. But any attempt to defend myself would have just made me seem weirder, too, so I left it. Even in retrospect, I'm really not sure how to respond to something like that directly?

And then conversely, in another session, I was like, I guess I'm surprised and embarrassed to even discuss my childhood because I'm an adult now, and besides, I always figured my childhood was pretty happy. First, my therapist was like, well maybe it's worse or more confusing for you now because your childhood wasn't really obviously horrible at the time -- and I gave her a look, like, please don't continue down this train of thought. And then she was like, well it's not that bad, you're not going to be in in-patient therapy for years for it or something. Like what was she even trying to say? I doubt that it's what she meant, but what I heard was, "why are you coming to me with this bullshit?" and felt hurt. So again, I just changed the subject to lighter things. I still don't really know how to respond to something like that directly, either? I mean, I'm happy that she doesn't think that my past is a life-ruining disaster, but I also felt like she was saying she didn't want to hear it, and that made me feel really uncomfortable bringing anything about it up again.

Anyway, I think this problem is on me, because I don't think she's necessarily doing anything to make me feel that I can't trust her enough to be vulnerable with her, but I still can't bring myself to. I will try to be more direct with her and not just change the subject or crack jokes or whatever whenever she says something that feels a little too private or close to the bone, because I guess that's really all I can do for now.
posted by nowadays at 10:41 AM on March 26


If she’s an LSW in training you’ll have to cut her some slack. Maybe think about how _you_ would approach yourself in her shoes and give her a hint or two.

In the long run the success of therapy is always going to rely on you a lot more than the therapist, but the there does have to be some basic trust and understanding between you. From what you’re saying it seems like the restricted time period isn’t giving you the time to build up the relationship you’d like to have.

(P.S. The fact that we all have unresolved crap from our family of origin and are all in complete denial of it is an in-joke among professional therapists. You would be very weird if you didn’t.)
posted by Tell Me No Lies at 10:58 AM on March 26


I explicitly ask my therapist for advice and for clarifications of that advice and for techniques for how to try following it, and then write it down as soon as I leave her office so that I won't forget it, and all that stuff.

So how did she respond when asked for a clarification of how you should try to live in the moment, and what techniques did you write down as soon as you left her office, and what's been the outcome from applying those?
posted by flabdablet at 10:49 PM on March 26


I'm plagued by a lot of regret and remorse that I can't let go of, and I am always coming up with ways to fix things or make up for things or compensate for or even just hide things. And those "hopes" mix in with all this fear of failure and performance anxiety until I'm freaking out that I'm going to screw things up again this time (except worse) and so I just freeze and/or withdraw.

That's what damage feels like.
posted by flabdablet at 10:52 PM on March 26 [2 favorites]


That's what damage feels like.

Quoted For Truth.
posted by Tell Me No Lies at 2:53 AM on March 27


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