What is therapy for?

[silentmist]

Hi

I've been talking with an consultant psychotherapist in preliminary sessions. I've had a couple so far and she's arranged for another one because she isnt sure if therapy would be useful for me.

I've explained to her that i have problems socialising, self-image issues, eating problems and a general sense of anxiety/depression.

i was in therapy before but it was cut off for a reason i don't want to go into here. the therapist at the time was offering me a session a week and said that i could resume therapy once i was able to attend the clinic again.

the consultant that i have spoken to has got me thinking about what therapy actually 'brings to the table'. I feel i need therapy but find myself having difficulty explaining why in a specific way.

What have the rest of you guys feel that therapy has provided you with and what do you think therapy is there for ?

[nightfalls]

HI silentmist

Hmm, for me therapy gives me the oppertunity to talk about the untalkable, I think it is there to give support and advice in the non-judgement way. it is a chance to be real without all the pressure to be something else. It can be helpful.

take care

[Guest ASchwartz]

Hi Silentmist,

I've explained to her that i have problems socialising, self-image issues, eating problems and a general sense of anxiety/depression.

I have been a therapist for more than thirty years and if that is not a clear explanation for why a person needs therapy then I do not know what is. My suggestion: get yourself another consultant, this one is not right. My opinion, of course.

Allan:)

[silentmist]

Hello nightfalls and Allen

Thanks for responding. nightfall your explanation was helpful for me to bring out what i was feeling, thanks.

Allen i'm not sure if i can get a different consultant but i will ask her to clarify her feelings the next time i see her, and perhaps warn her that i may complain about her if the answer isn't satifactory. Could you explain why this one isn't right ?

Thank you guys

[finding my way]

I think Allan meant that your reasons were darn good ones for wanting therapy, and why the heck does she have a problem with your reasons?

[silentmist]

hey finding

i think her concern is that i've been in talk therapy before yet i still have problems. my previous therapy ran for just over two years but was stopped for reasons out of my control. i know i got 'something' out of my previous therpay but i'm having difficulty saying exactly what. i think her concern is that i am somehow 'dependant' on therapy, using therapy as a personal friend or something similar.

[Mark]

In the old days of psychoanalytic treatment (1950s or so) therapy was expected to take years. Todays therapies are far shorter and more targeted with far more focused goals. Back then the goal was to transform personality and remediate neurosis. Today the goal might be to reduce several identified symptoms of depression (such as social withdrawal, suicidal thinking, etc.). The old school therapy is still around, but nobody can afford it (!), and so the more modern stuff which is more modest all around, is what people do.

I think that it is a good thing that a therapist would question whether you will benefit from therapy if you make no progress over several years. I read that as a therapist who is looking to give you value and not to sell you something that wont' benefit you. But the problem when no progress is being made is that sometimes no goals were set in the first place. Some therapists don't like to do that sort of thing. Some do not set goals on principle, and others set goals but don't enforce them and with some patients/clients if you don't bring up the fact that goals are not being worked on, they don't get worked on.

There could be several reasons why you didn't feel you benefited from the previous therapy.

- the previous therapist may not have been all that skilled/diciplined about keeping you on track

- your problems may be very chaotic and the therapy may have been about putting out fires rather than working on progress

- you may have understood the therapy very differently than the therapist did

Some therapies for people with very chaotic lives are fairly controlling and directive. Such as Dialectial Behavioral Therapy, which gives conseqences for patients who make suicidal gestures including removing them from therapy for a time. This can seem draconian, but it is often the only way to get such patients' attention. You set a consequence and a limit and enforce that limit. Once the patient really understands that the therapist won't be gamed/manipulated by crises, the patient will sometimes get down to business. It's not that the patient doesn't want to get down to business; more like it is in the nature of the way that patient relates to others to constantly test/push, etc. In the case of DBT, the goal is clear - to reduce the amount of emotional distress and the total amount of self-harm/suicidal crises. People often feel better after working in this therapy, but that is kinda a side effect (grin!).

It might be that you need to work with someone to clarify what your therapy goals are - what it is that you want to accomplish. What success would look like in practical terms. If you can operationally define your measures of success, you and whomever you end up working with will have a much easier time working on them.

Once you have some sense of what you want to accomplish, then it will be practical to match a therapy, and a therapist to that set of goals. Some therapies are better for certain purposes than others. And then again, with therapists, it is important to feel some chemistry/rapport with your therapist or you're going to have some difficulty feeling comfortable and getting down to work.

So - what would you like to work on?

socialising, self-image issues, eating problems and a general sense of anxiety/depression.

All of these things can be operationalized (e.g., you can describe in practical terms what it would look like, how you would behave if you problems were to get better).