Should I continue with my current therapist, or switch to someone new?
January 10, 2023 10:12 AM   Subscribe

I’m on my second therapist and wonder if I need to try a third one. Seeking advice on whether I should jump ship now, or stay with my current provider.

I started therapy about six months ago, mainly due to stressful situations in my home life and my professional life – but also to address some long-standing problems with procrastination and with recurring, intrusive thoughts. I had five sessions with the first therapist, who holds a license in clinical social work. I found his style to be grating. He was a bit abrupt and was too insistent with his opinions. He kept recommending that I look for a new job, even after I explained my reasons why I needed to stay in my current position. He also hinted that I should divorce my spouse, which is something that’s completely off the table (and I told him so several times). Even if in some broader sense he was right, he wasn’t respecting my decisions.

My second therapist has both an MD degree and a PhD in psychology. Despite his medical background, he is practicing as a clinical psychologist, not a psychiatrist. He is more pleasant and less forceful in his views, but I don’t feel like I’m getting a lot of benefit from him, either. What I mainly get from him is a sympathetic ear. He also offers a small amount of pragmatic advice, which I haven’t found to be very useful.

I’ve had six sessions with the new therapist. I told him during the first session that I was interested in cognitive-behavioral therapy (CBT) that would hopefully give me some peace of mind with regard to situations in my life that are basically unchangeable. I’ve reminded him at least two other times that I’m looking for CBT or related, which is an approach that I used successfully many years ago for depression. He hasn’t offered any CBT exercises at all. Instead, our sessions consist of me describing the distressing aspects of my life, while he listens supportively and offers practical suggestions to address the specific situations (as opposed to helping me change the way that I react to those situations emotionally). His advice is just commonsensical, basic stuff – and even if it worked, it wouldn’t lead to any dramatic changes. He hasn’t said anything at all about the procrastination or intrusive thoughts (in fairness, I haven’t emphasized those areas in our sessions).

I do find the current therapist to be pleasant and empathetic. He’s partially retired, and his cost per session is very reasonable, about a third of what I was paying the earlier therapist. Money is tight right now, so I’m really reluctant to switch again to someone else because I’m unlikely to find someone with comparable rates.

Not sure what to do in this situation. I’m not in any kind of crisis mode, and I’m willing to continue seeing the current therapist, but I’m losing confidence that his approach is going to work.
posted by anonymous to Health & Fitness (15 answers total) 1 user marked this as a favorite
> I told him during the first session that I was interested in cognitive-behavioral therapy (CBT) ... I’ve reminded him at least two other times that I’m looking for CBT

Maybe try asking him directly: "Do you provide CBT?" and "Do you think CBT is the best suited modality for my needs?" Asking these questions directly is probably the only way you're going to get his thoughts and opinions on this matter.

Most therapists consider themselves 'eclectic' i.e. not wedded to a single modality. And most of them believe that they are in the best position to decide what type of treatment will work best for each patient, because after all they are the expert in prescribing and providing treatment. If you go in there saying "I like CBT," many therapists are likely to react the same way that a primary care physician would react to a patient announcing "I like antibiotics." If they don't agree with you, they'll just kind of nod and ignore you and go on providing whatever they think is the best treatment for you, determined based on their own training and expertise. It's not wrong for doctors and therapists to do this, generally. Deciding the most suitable treatment plan for you is well within their purview.

If you as a patient are indeed more knowledgeable about your personal treatment needs or if you have strong preferences, then you need to ask directly for what you want so that your therapist (or doctor) is forced to tell you yes or no. If they say yes, great. If they say no, then you find someone else. If they say no and give you their reasoning as to why, decide based on whether their reasoning makes sense.
posted by MiraK at 10:48 AM on January 10 [3 favorites]

He hasn’t offered any CBT exercises at all.

For what it's worth, I've done a fair bit of CBT-type therapy over the years, and there were never "exercises."

We talked about what I was doing, and what I was thinking about, and how I might look at things differently. (In my case, that often meant figuring out ways to cut myself slack instead of beating myself up. For you it might mean something different.) But there wasn't, I dunno, homework or training or specific mental practices or anything like that.

Apologies if I'm jumping too hard on a single word, but it seemed like it might be helpful context. I think if you want the sort of exercises you did a long time ago, you need to really specifically ask for them, because they're not default.
posted by nebulawindphone at 10:52 AM on January 10 [3 favorites]

It sounds like this therapist is not suiting your needs. In my experience, practical advice on situations is not the dominant support provided by therapists and helping with your emotional reactions is more typical. You're entitled to ask for what you need. I think you should ask these questions to them very directly and see how they respond. You could even send a version of this question - I did something similar with my current therapist outlining what I was looking for in writing and it helped a lot in guiding our sessions to what I need.
posted by lookoutbelow at 11:39 AM on January 10 [2 favorites]

I would bring up the question of how, specifically CBT therapy would be done. He may have different an expectation of the process than you do.
posted by Tell Me No Lies at 11:43 AM on January 10

It can take a few tries to find a therapist that works for you. Since things to note, do ensure that your are communicating your needs. If you are, a skilled therapist should be able to tailor their own approaches to you, and if that's not happening it is a reflection of skill.

Many therapists have very different approaches even when providing very similar services, even with similar education. I wouldn't take their educational background to reflect on how they actually do therapy.

It is also perfectly acceptable to ask for a referral from your current therapist at this point, six weeks is about the time when you should really know if this is working or not. I'd say something similar to what you said above, and ask if they know anyone doing more of what you are looking for. It's also can give the opportunity for the clinician to give you some feedback, especially if they don't think a particular approach would be helpful and why, which is a nice conversation to have especially if your trying to figure out what might be best for you.

Good luck!
posted by AlexiaSky at 12:03 PM on January 10 [1 favorite]

Through my HMO, CBT was offered as a group therapy class. They had weekly homework. It was a 4 week course. Similar format to DBT (but that was 6 months). Perhaps there might be a group therapy option, which might get you the exercises you want in a cost effective way... This would likely work best as a supplement, not a replacement, for individual therapy.

Your first therapist sounds terrible... Glad you switched. Your second therapist doesn't really sound all that helpful. I stuck with an OK therapist, because it was free to me, but a lot of times I felt I could've gotten the same benefit talking to a friend. That never changed... It was somewhat helpful, but I would recommend to continue looking for someone who is a better fit.

At the same time, I paid out of pocket for 4 sessions with another therapist. I got more out of those four expensive sessions than I did with a whole year of the free ones... So, it might be worth paying more, and managing the cost a different way (e.g. meeting less frequently)
posted by skunk pig at 12:52 PM on January 10 [1 favorite]

I've only done CBT to address specific problems and I did indeed have "homework" for those issues, mostly around exposure to anxiety provoking situations and practicing coping skills discussed in therapy. In your position I would discuss with your therapist what your specific, measurable goals in doing therapy are, and what treatment modalities he will use to address those specific issues. If CBT is not mentioned, ask for further explanation. If the results of this treatment planning session are not in line with what you expect, find a new therapist.
posted by MagnificentVacuum at 1:36 PM on January 10 [2 favorites]

I am a therapist trained in CBT, but I'm not a CBT therapist. I think it's possible your current therapist believes he is bringing in a more cognitive behavioral approach to your sessions than he ordinarily would. (It's also possible he hasn't remembered or understood your request, and is just doing his normal thing.) Generally, when a client tells me they've done well with CBT in the past, I try to get more information about what they've liked and proceed accordingly, but since I'm not a strict CBT therapist, I don't generally give exercises or homework unless the client explicitly requests it. Usually, I try to explore skills the client is already using and build onto them. However, I could imagine a client getting frustrated because I spend more time than they'd like exploring the distressing experiences they're having that might warrant the use of their CBT skills. For instance, a thought replacement skill ("My boss hates me" to "I don't know my boss very well, and he seems like a really serious guy, which makes it hard to read his emotions") might be super useful in daily life, AND as a non-CBT therapist I really want to explore where the thought pattern is coming from. For me, it doesn't feel complete to acknowledge a thought pattern of "authority figures don't like me," without trying to go deeper into where that's coming from, how it impacts relationships and self-esteem, and how ready my client is to try out new beliefs (i.e., what might they lose if they adopted a belief that they are worthy of approval? or, what might they miss if they focus on being worthy of approval without reexamining their relationship with external approval?). All of this is to say, it's totally ok to ask your therapist explicitly to work on CBT skills and exercises with you, but it sounds like you might be better served finding a CBT skills group or seeing a therapist whose primary approach is very formal CBT.

It's absolutely fine to discontinue therapy with someone who is pleasant and helpful if their style isn't a good fit for you. It's also absolutely fine to see someone whose approach isn't exactly what you're looking for, but who meets a need, and to supplement that with a workbook, therapy group, etc.
posted by theotherdurassister at 4:25 PM on January 10 [1 favorite]

I am on my fourth therapist, and have been seeing her for over four years, in which time she's helped me immensely. Never would have found her if I hadn't let three go - one of whom was perfectly good but not... quite right. (Another was terrible - much like your progression!)

I'd say try someone else. It truly can't hurt!
posted by Isingthebodyelectric at 4:31 PM on January 10

If you want to try someone else without cutting ties with your current therapist, you could "take a break from therapy" for a couple of months while you do 4-6 sessions with another therapist.
posted by heatherlogan at 5:20 PM on January 10

Certainly, there's nothing wrong with switching therapists. But before you go to that effort, it might be worth providing the feedback you've provided here directly to your therapist. You could even send an email with some of the information in this post, and let him know you'd like to discuss it at your next session.

I have a therapist I love, but there are times when what he's doing just isn't working for me, and I'm able to say to him, "I'm finding these sessions frustrating and unhelpful, to the point where I'm considering quitting therapy over it, because I'm not getting what I'm paying for, and spending time in therapy that isn't helping me is an added frustration I don't need in my life at a time when I'm already dealing with a lot of other frustrations." And then we talk about why that is, and what I'm hoping to get out of it, and what we each need to change to keep the relationship productive.

Obviously your relationship with your therapist is newer, but you can still provide that feedback, and let him know that your comments about CBT aren't just idle remarks, they're you telling him that you need something different out of therapy, or else you're going to quit. That's a perfectly reasonable and acceptable thing to say.
posted by decathecting at 8:03 AM on January 11

I'm also a therapist who is trained in CBT, but I only use certain concepts from it in some sessions where appropriate. THe CBT course I had presented CBT sessions as very regimented and structured, with "homework". Most therapists don't do that, but they may take concepts from CBT to apply to session as appropriate. He may be doing that.

If you find CBT exercises helpful and you like your therapist, it may be helpful to ask them for a suggestion/pick out a book of CBT exercises, and do them in session and on your own. It might also be helpful to identify what has been helpful about CBT in the past, because it may not be about CBT itself, but related to the structure, the intentionality of doing the exercises, or the personality of the therapist you had at the time. Maybe think about what aspects were helpful, and discuss with your therapist. Some people really respond to the structure and approach of CBT, but in my opinion and experience it has advantages and disadvantages like any other modality. It's also practiced in different ways (see, structured vs. just using some ideas from it)

What research shows is that therapeutic rapport, not therapy technique or modality, is most important in terms of therapeutic "success".
posted by bearette at 9:24 AM on January 11 [1 favorite]

and, because of the importance of therapeutic rapport, if you're not feeling it with your current therapist after talking to them about this, it's totally reasonable and even recommended to seek out another. They sound like an sympathetic person whose approach may not be ideal for you, and maybe talking to them will help, or it might not change things much.
posted by bearette at 9:28 AM on January 11

I'm not sure what you want from CBT and from your current therapist. You say that the therapist seems to be suggesting you get a new job and a new partner. And, while you say that neither of those changes is possible, you don't seem horrified at the therapist's attitude about them -- as if you sort of agree with the therapist's (and your) assessments of your situations, but can't act on them.

You say you want CBT to achieve some "peace of mind" about the situations you can't change, but that may be running contrary to how the therapist sees your situations. Maybe he doesn't think you can achieve this peace of mind you seek, and would like to work more actively on supporting you in making real changes in your life that might actually results in those changes that seem impossible to you (NOW -- maybe not forever) -- but, since that's not what you want, the therapist is now as STUCK as you are.

If this is the case, your therapist may only be able to eek out some support and suggestions for coping -- but he might be as frustrated as you are.

So you now put the problem into the "I am being denied CBT" -- the same basket as "I am being denied in my marriage" and "I am being denied at my job." (maybe I'm wildly stretching here. These are just my impressions of a stranger's post.)

Anyway, rather than bailing because you're now seeing therapy as yet another situation that is failing you (but one out of which you can bail at will -- unlike your marriage and your job) -- you could talk about your relationship with the therapist directly rather than ask for a therapist to change how you construe your situations outside the therapy room.

I'd try to stay IN the room with this particular person and say how you feel and see if he can be with that with you, and you can have a deeper interaction that might help you.

I'm not your therapist.
posted by DMelanogaster at 2:33 PM on January 12 [1 favorite]

If you're not feeling it, I'd try to find a new one. I started with someone and she served me what I thought was adequately over 18 months but within a couple months after starting with a new person, I wished I'd moved on faster. Granted I switched modalities and that may be a part of it, but switching modalities (or actually getting a CBT-trained person!) may be helpful too.
posted by emkelley at 10:19 AM on January 13

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