When to quit therapy? When to find a new therapist?
March 23, 2019 5:01 PM   Subscribe

Inspired by, and related to, this question previously. I've been seeing a therapist for eight months now and am frustrated at the lack of progress. Is it time to try something else?

I've been seeing a therapist for eight months now. At the start:
  • I had quit a previous job after a month due to feelings of excruciating daily humiliation and inadequacy
  • Had no friends
  • Zero sexual experience as a gay man over 40 years old
  • Consumed by feelings of loneliness
Today:
  • I'm in a new job, where every day is a painful, humiliating, anxiety-ridden struggle
  • Have no friends
  • Zero sexual experience as a gay man over 40 years old
  • Consumed by feelings of loneliness
  • Am almost a year older and poorer for it, as I'm paying out of pocket
During therapy, I am honest. I don't prevaricate. I listen. I try to be patient, hoping that this therapy is going somewhere.

I understand how treatment-resistant my condition is, so I don't necessarily blame the therapist. If I had to guess, it's rooted largely in attachment disorder and shame as an adolescent, that is beyond my capacity to unravel.

But I am very frustrated. If I went to any other professional - plumber, doctor, physical therapist, neurosurgeon - I would expect and require a treatment plan with the expected, concrete results.

But what is this expensive noodling and verbiage? Where is this going?

I don't know what other people go through at work - I know everyone has their struggles - but for me, every moment of every day is painful and humiliating. After eight months of therapy, the better part of every day is still painful and humiliating and excruciating.

Am I "cured"? Am I fixed? So is this all I can expect from therapy?
posted by beigeness to Human Relations (20 answers total) 8 users marked this as a favorite
 
Can you clarify if you are pairing therapy with meds for your anxiety?
posted by DarlingBri at 5:36 PM on March 23, 2019 [2 favorites]


There's a lot we don't know about your condition, your therapist, their modalities, etc.

But it couldn't hurt to have a conversation and ask how they see your treatment plan unfolding and on what timeline, where they think things are now and what they see as the next step. Therapy is of course not plumbing, brains are weird and people are unpredictable, it takes a long time to build trust etc, but still, it's frustrating to spend money and time in therapy and feel like you're not getting anywhere at all with it.

Another thing I have done is go to another therapist for a one-time consult (and be clear that that's what it is). Sort of like I sometimes call another mechanic after my main mechanic gives me an estimate, just to double-check that it's within the ballpark.
posted by bunderful at 6:01 PM on March 23, 2019


No, I am currently not on meds. I have been on a variety over the years previously (Prozac, Zoloft, Wellbutrin, others?) and did not see or feel any benefit to them. Without meds, things like walking, talking and sitting with other people were painful. With meds, walking, talking and sitting with other people was just as painful.

That being said - a new phase of my insurance takes effect in April, and I'm not averse to trying meds again.
posted by beigeness at 6:01 PM on March 23, 2019 [1 favorite]


I think it's time for a new therapist for you. I would say tell your next therapist that you want to work on the feelings at work, and the sense of shame. Afterwards you can delve into other things. I reccomend CBT because it is focused. It's not harsh, but it does encourage you to focus on your current thoughts and practice skills to manage your current thoughts and feelings. Be sure to tell your new therapist that you want them to point out to you when you avoid the conversation. Best of luck on your search.
posted by SyraCarol at 7:00 PM on March 23, 2019 [2 favorites]


What does your therapist say when you say "I feel like I can't unravel my problems with attachment disorder and shame"? What does he or she recommend? If you haven't addressed this really directly and really directly said, "I would like to have concrete strategies for changing how my life works", try that and see what happens. It may be that you're communicating about your feelings in a very clear and forthright way but that your therapist isn't picking up on your goals and perceptions of the therapy.

But it may also be that your therapist is a bad fit. If you haven't done so, try making a list of specific ways that you envision your ideal therapist helping you - do you envision your therapist helping you strategize how to meet people? Do you envision your therapist practicing social interactions with you? Teaching you strategies for when you get depressed or anxious? Helping you think through your memories and create a narrative about your past? When you look for another therapist, focus on one whose modalities match what you're looking for.

Also, are you seeing a gay-competent therapist whose values broadly align with yours? I'm not saying that seeing, eg, a gay therapist will magically make therapy work, but it's much easier with someone who basically gets your experiences.

Also, can you see some kind of psychiatrist-specialist? I know that a lot of people get prescribed meds by a GP or by someone who takes a fairly general approach, and this can work - but it sounds like you really need someone who knows all the potential meds and can manage your dosages, try something different, etc. Meds might not work, but on the other hand it might be that you haven't seen someone who is skilled enough to get you on the right one and the right dose.

Also, in my experience you can hit a wall in therapy when you've got your narrative. For me, part of therapy was to tell my experiences to a listener I could trust and feel validated by, and just doing that was a big, big relief and solved some problems in itself. But then there needs to be a move from "I understand a lot more" to "I have a doable plan to make my life better", and changing modes can be really hard. A therapist who can help you with the narrative might not be the therapist who can help you with, for instance, becoming someone who can date.
posted by Frowner at 7:07 PM on March 23, 2019 [6 favorites]


I disagree with SyraCarol. If you think that there's an attachment and shame-component to your issues, psychodynamic psychotherapy is the way to go, UNLESS you are actively suffering from behaviors that are getting in the way of your basic activities of life / daily functioning (think something like compulsive behaviors, agoraphobia, an eating disorder). I also think that eight months in therapy is barely any time in the grand scheme of things, especially for an issue as life-long and entrenched as attachment issues. I am not trying to say that you need to sign up for five years or a decade of therapy, and I hear that you are working hard in therapy and trying to be patient, but instead of contemplating throwing in the towel now, why not examine your feelings of frustration and anxiety surrounding your feelings that nothing has changed? A major premise of psychotherapy is that the patient will invariably re-enact patterns of relationships within the therapeutic relationship, and exploring how that takes place is where growth occurs.

You could also ask for a consultation by another therapist -- sometimes therapists can bring in a second clinician for one or two sessions and help provide another clinical perspective to guide the treatment. And, if you're not opposed to medications for anxiety, I do think that they can sometimes help.
posted by gemutlichkeit at 7:14 PM on March 23, 2019 [5 favorites]


Are you just unraveling the past in your therapy, or is your therapist giving you tools to move forward towards your goals? Wading endlessly in the past is something some therapists do and it can feel Iike Groundhog Day. There are many different modalities and there is nothing wrong with shopping around for a better fit. Also, combining something like life coaching, which can support you in doing the therapist’s homework and the practical aspects of what the therapist is moving you forward with can be helpful. Good luck. You can do this.
posted by MountainDaisy at 7:18 PM on March 23, 2019


I'd move onto another therapist, one who is less entrenched in helping you rehash the past and more interested in helping you develop coping mechanisms for the present. I'd also give CBD a try.
posted by DarlingBri at 7:56 PM on March 23, 2019


are you seeing a gay-competent therapist whose values broadly align with yours?
Yes, I specifically sought out a gay-friendly therapist, and given how nothing seems to work, a therapist with a Phd.

None of the succession of therapists and counselors I've seen in the past have known what to do with me.
Wading endlessly in the past is something some therapists do and it can feel Iike Groundhog Day.
Right, I've spent twenty years rehashing and dissecting the past, with and without therapists, and have little interest in exhuming the past yet again. Thankfully, that's a small part of this therapy.
Are you just unraveling the past in your therapy, or is your therapist giving you tools to move forward towards your goals?
I think the therapist is trying to. So for example, I am to repeat a set of mantras during the day:
  • "I feel that my life is only getting better." (no it is f---ing not getting better. I am lonely, tired and humiliated.)
  • "I enjoy facing and overcoming challenges and take pride in myself when I do." (like hell I do. I am in f---ing pain. get me out of here!)

posted by beigeness at 8:12 PM on March 23, 2019 [1 favorite]


It's perfectly okay to see another therapist, or a few. You can see them as few or as many times as you like, You don't need to make any decisions first as to whether you're going to switch. You can tell the new therapists that you're there for a one-time consultation, that you need perspective, or even that you're shopping around.
posted by wryly at 9:00 PM on March 23, 2019 [1 favorite]


There is a lot of research that says that therapeutic alliance is a really, really important predictor of success.
Scott Miller, who does research on how to measure this has developed a four question survey. These questions might be a good way to think about how you feel about the actual therapy that is happening. Miller recommends that therapists ask these questions every week.

Relationship: did you feel heard, understood and respected?
Goals and Topics: did you work on and talk about what you wanted to work on and talk about
Approach or Method: is the therapist's approach a good fit for me
Overall: For any given session, did it feel like something is missing or was it right for you?

Given that you are eight months into the relationship, If your answers are consistently on the low side, I recommend first talking to your therapist and then, if nothing changes, look for a new one. Real observable change might be slow but there should be a sense that therapy is moving (or at least will move you in the right direction. On the other hand, sometimes pushing yourself to talk about what is wrong about the realtionship and being able work through it with your current therapist (assuming that they are a good therapist and can handle this well - some are and some aren't) could be one of the most healing things you could do. So don't just run away to avoid a hard conversation.
posted by metahawk at 11:17 PM on March 23, 2019 [6 favorites]


If I went to any other professional - plumber, doctor, physical therapist, neurosurgeon - I would expect and require a treatment plan with the expected, concrete results.


Yup. I had the same problem. This has happened to me with every. single. therapist I've seen for going on twenty years now (although for a completely different issue than you). I quit therapy. It's time we actually TREATED mental illness just like other illnesses instead of taking sick people for a ride. People seeking treatment for an illness don't want to "feel heard and understood," we want relief from our illness or injury, just like someone seeking help for any other disease.

I don't think you're going to find therapy to be helpful, because, frankly, our framework for mental health is victim-blamey and gross and needs to be discarded for something that actually helps people.
posted by Violet Hour at 12:26 AM on March 24, 2019 [6 favorites]


The mantras you describe do make it sound like you could use a better therapist (not sure how repeating untrue things about yourself is meant to help you?) and they reminded me of a recent post about someone who only made progress in therapy once she found a therapist who didn't try to convince her her life was wonderful.

Since you list sex as one of the areas you'd like to improve, maybe searching out a sex therapist or therapist who specializes in issues around sex might help - but as always your mileage and therapist quality may vary.

Anyway, as someone who has spent years trying to make progress on a badly-understood physical health issue with no success - it's hard, isn't it? I'm sorry you're dealing with this.
posted by trig at 1:39 AM on March 24, 2019 [6 favorites]


'You need to make an Ingratitude List. You should be PISSED. Your life's honestly kind of sh*tty right now. I'm not saying there's no bright spots, but you need to stop trying to pretend you're not in pain. You need to make a "This Sucks Ass" list.'
That article and the accompanying post and comments are amazing. Good god.
There is a lot of research that says that therapeutic alliance is a really, really important predictor of success.
Yes, I think after eight months, I am still an incomprehensible alien to my therapist, and they are still an alien to me. At this point it's probably a demoralizing experience for the both of us. The appointments keep getting pushed to weird times, which is a probably a sign.
Anyway, as someone who has spent years trying to make progress on a badly-understood physical health issue with no success - it's hard, isn't it? I'm sorry you're dealing with this.
Thank you, you too. Time to blast some Hole/Courtney Love.
posted by beigeness at 2:20 AM on March 24, 2019 [1 favorite]


If some of what you want to work on is relationships/sex, it might help to seek out a therapist who is gay rather than just gay-friendly. I know that for me it's helpful that my therapist is familiar with the peculiarities of the queer world and queer dating world and what it's like growing up a little different (I think this is more true for those of us in our mid 30s and up - growing up gay in the US was a different experience 20+ years ago than ten years ago.)
posted by needs more cowbell at 6:41 AM on March 24, 2019 [2 favorites]


I think the therapist is trying to. So for example, I am to repeat a set of mantras during the day:
"I feel that my life is only getting better." (no it is f---ing not getting better. I am lonely, tired and humiliated.)
"I enjoy facing and overcoming challenges and take pride in myself when I do." (like hell I do. I am in f---ing pain. get me out of here!)


This sounds very CBT-ish. A lot of people on Ask like to recommend CBT therapy because it is "evidence-based" (it is, but that's because tons of studies have been done on it because it's manualized and easy to study). However, a criticism of CBT is that there's too much of a focus on changing "negative" and "incorrect" thinking without looking into the reasons for those thoughts. CBT is present-focused and works on changing thoughts and accompanying behaviors. It works for some people and some situations- especially for changing specific behaviors.

However, a psychodynamic therapist will look at the past, childhood, and family relationships to figure out how these affect the present. Most therapists use a little bit of technique from lots of theoretical orientations but some are more married to CBT style. Personally, as someone in training to be a therapist, I think CBT has some good tools but it leaves out a lot. Lots of other therapists I know feel that way too.

And as stated above, therapeutic alliance has been shown to be more important than theoretical orientation of the therapist when it comes to a successful therapy relationship. This is key!
posted by bearette at 7:50 AM on March 24, 2019 [4 favorites]


But I am very frustrated. If I went to any other professional - plumber, doctor, physical therapist, neurosurgeon - I would expect and require a treatment plan with the expected, concrete results.

Out of all of these, I think seeing a psychotherapist is most similar to seeing a physical therapist. That is to say, the client needs to do the majority of the "work", But in physical therapy, the "work" is much more concrete and the progress faster.

There are certain times therapy can work "faster"- for example if you are trying to change or become innured to a behavior, things like systematic desensitization can work relatively quickly. That's great, but changing a behavior doesn't mean that you have addressed the deep-rooted issue; therefore it can pop up again in another realm. This is why behavior therapies are criticized.

I think psychotherapy is more about becoming aware of patterns and issues that are blocking you from leading the kind of life you desire. That really takes time. I've been seeing a therapist for years. Just now I am starting to become aware of patterns of attachment and anxiety in relationships; through awareness, I have been able to change my behavior to move more towards the life I want. But it's not a fast process. There aren't any "quick fixes". Having a strong alliance with a trusted therapist that you feel "gets you" and with whom you can process issues and talk honestly is a start in the right direction. If you don't have that with your current therapist, I'd suggest finding another one. And also realizing that it can take a while to really feel or see change.
posted by bearette at 8:00 AM on March 24, 2019 [3 favorites]


Yes, I think after eight months, I am still an incomprehensible alien to my therapist, and they are still an alien to me. At this point it's probably a demoralizing experience for the both of us. The appointments keep getting pushed to weird times, which is a probably a sign.

Yes, definitely don't just keep doing the same thing!

But I would encourage you to bring this up to the therapist. There is a chance that you might get a really helpful response that could open up something new in your relationship with the therapist.
For example, they might say, "No, you don't seem alien to me. I meet a lot of people who share your trauma history who have these features" and then they go on to describe (or you ask them to describe) what they see in you and feel seen and understood in a way that is new.

Or they could say, "What is like, feeling like an alien?" and the answer leads you to connect to new material that relates to other people as well as your therapist and all of a sudden you have a new insight into yourself.

Or, unfortunately, they could respond in a way that denies your own experience or shuts you down and then you will know for sure that it is time to find a new therapist. Definitely a risk, but I think you might learn something either way.
posted by metahawk at 9:27 PM on March 24, 2019 [1 favorite]


I am a person who quit talk therapy after a year with a “smart” Dr. of psychology who came very highly recommended to me by an old friend who really grasped the issues, and is herself a therapist. So I had high hopes. Spent about $3k out-of-pocket after I experienced abuse as an adult, and an overwhelming life trauma. The psychotherapist was kind and meant well, but I eventually figured out she just could not relate on a deep enough level to the sheer craziness of what I was sharing, because she had never personally experienced anything like it, which rendered her unconsciously incompetent in a few critical areas. She also was not up on the current research. I finally pressed her to give me some actual advice, and her advice was straight up bad, and then repetitive.

The sessions soon went nowhere, and she started being late starting them (a sign she wasn’t feeling it either.) In hindsight, I really regret spending that money and time on therapy, and I am kicking myself for not quitting sooner, like the moment I knew it was a waste of my scarce resources. Oh the amazing things I could have done with that cash! Ugh. Anyway, in your shoes I’d give up on talk therapy for now in favor of trying to find a really good psychiatrist (not a GP etc) to prescribe some outstanding meds, and then really work with you over time on getting the exact right type and dosage to manage your symptoms.
posted by edithkeeler at 8:46 AM on March 25, 2019 [1 favorite]


As a neurotic queer with a lifelong history of mental illness, my number one piece of advice when it comes to therapy is never be afraid to fire your therapist and move on to the next person if you're not feeling it and not seeing results. Even if you are only seeing, for example, CBTs, there is a huge range of variety in terms of approach, personality and insight. DTMFA!
posted by zeusianfog at 4:22 PM on March 25, 2019 [1 favorite]


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