Considering a therapist change but unsure.

In My Humble Opinion
1

So, I’ve been seeing a therapist for depression and social anxiety for about four months now. It’s a problem I’ve had pretty much my entire adult life and this is the first time I’ve sought treatment. I’ve been seeing her weekly, and honestly I didn’t get the best first impression from her as she’s much younger than me (and I’m only in my mid 30s) and she’s entirely too ‘bubbly’ for my likes. I’m pretty sure this is her first job since she graduated too. But I figured those things didn’t mean she wasn’t a good therapist or that she couldn’t help me in some way. So I’ve been seeing her and trying to give her a chance but…I just feel something isn’t working.

Her therapy method of choice is CBT, Cognitive Behavioral Therapy. And her apparent favorite thing is called a CBT Triangle. The way she explained it is that we’re made up of three main ‘parts’ of ourselves. Our feelings, thoughts and behavior. They all affect each other and are all connected. So like if we work on changing how we think, it will in turn affect how we feel and act. Seems to make sense to me and I think the concept is sound, unfortunately I don’t agree with how she’s approaching it. Right at the get go, she told me that feelings and thoughts were just too difficult to change and that it was best to focus on changing my behavior. I found that dubious, as I know myself well enough to know that behavior’s the hardest thing for me to change. I even told her that but she dismissed it and insisted it was the easiest. So I’ve tried to go along with this but…I don’t feel like she’s DOING anything to help me.

Basically, each session starts with her asking how my week went and how I’m feeling. Then she asks about any goals I achieved or what I’ve accomplished. Then she pushes for me to make more goals for the next week, even though I am not a goal driven person. Again, something else I’ve tried telling her. I just feel like I’m not getting anywhere. Nothing’s changing and she’s really taking a laissez-faire sort of attitude with treatment. Some of the things she’s said to me in regards to my emotional health and treating it:

  • “It’s not MY life. I can’t make these changes, only you can.”
  • “You need to make these changes yourself. It’s your life.”
  • When I mentioned thinking that people in social situations were thinking bad things about me and my appearance, her response was to chuckle and say 'Of course they’re not thinking that. That’s just silly." and moved on in the conversation.
  • She sent me to a local ‘community inclusion’ group which turned out to be for people who were mentally challenged. When I explained that to her and how I didn’t want to go to that, she asked what MY ideas were then, for working on my social anxiety. “I think that inclusion group is good for you, but you don’t, so you tell me YOUR idea then.”

And really, the thing that annoyed me the most was when I was trying to explain to her (again) how it wasn’t easy for me to just FORCE myself to change a behavior. Her response was “Well you just need to do it. Even if you don’t want to. Just do it. I sometimes don’t want to get up in the morning for work but I force myself to and then I feel better about it.” If it was just that easy for me, to mentally force myself to do something, I wouldn’t be there with her. It drives me nuts. But I’m worried that maybe I’m expecting too much out of therapy.

I ran these issues past two friends and got two opposing opinions. One told me that she was clearly a terrible therapist and I needed to find another. While the other asked me what did I expect? That the therapist couldn’t do everything for me and I have to take the initiative. And the thing is, I’m not expecting her to do all the work but I was hoping for something a bit more…helpful? Like exercises I can do to stop my negative thoughts, things I can do to change my inner voice and to deal with anxiety in social situations. I’m getting none of that from her. Just ‘buckle down and force yourself to change’. More or less.

So am I expecting too much? Is this what therapy is supposed to be about? Because, if it is, I can stop seeing her and just have my mom do the same thing for me.

2

I would personally expect a CBT therapist to provide some exercises. You may just need someone who can give you a little more structure, and sure, if it’s not working for you, look for someone else.

At the very least, have you checked for some CBT workbooks (via Amazon, etc) to help guide yourself? I know they have depression and anxiety-related workbooks available on Amazon that seem to have good reviews.

3

Therapy is work. Very, very hard work. A good fit between therapist and patient is obviously important, but you need to put in a ton of effort in order to make the changes you want to make in your life. You do need to set therapy goals, and do “homework”, and be held accountable for it all, or it’s hard to make any progress.

That said, I’m confused about your therapist’s focus on actions as opposed to irrational thoughts, especially if she claims to use CBT methods. I’ve had a decent amount of success with CBT (and a ton of effort), using some techniques to identify and talk back to my irrational thoughts. It’s like walking around with Mr Spock in my head now - he tells me I’m being illogical, and I can change my thoughts.

I recommend you pick up Feeling Good: The New Mood Therapy by David Burns. It’s the book that changed my outlook and saved me from self-destruction, and I’m not at all the type to wander the self-help section at the bookstore or buy into hippy dippy shit.

[QUOTE=AngelSoft]
When I mentioned thinking that people in social situations were thinking bad things about me and my appearance, her response was to chuckle and say 'Of course they’re not thinking that. That’s just silly." and moved on in the conversation.
[/QUOTE]

And that’s where she needs to be showing you WHY that’s irrational, and how you can respond to that thought in a way that works for you. For example, you think “everyone’s looking at me and judging me”, but first of all, not everyone is looking at you (all-or-nothing thinking), and you can’t know what’s in other people’s minds, so you don’t know that’s what they’re thinking (mind reading). If your therapist is not able to help you build a set of tools you can use to heal yourself, she’s not a very good therapist, IMO.

[QUOTE=AngelSoft]
And really, the thing that annoyed me the most was when I was trying to explain to her (again) how it wasn’t easy for me to just FORCE myself to change a behavior. Her response was “Well you just need to do it. Even if you don’t want to. Just do it. I sometimes don’t want to get up in the morning for work but I force myself to and then I feel better about it.”
[/QUOTE]

This is a good idea too, but it’s easier to venture into “faking it till you make it” territory once you’ve gained some power over your irrational thoughts.

Please pick up that book, read through the chapters on cognitive distortions and useful responses to them. This is a quick overview of some of the techniques. Take that to your therapist and tell her you need more guidance about HOW to identify and talk back to your bad thoughts. If she can’t or won’t help you, move on. You owe it to yourself to find someone who can work with you.

4

Both of your friends have good points. It’s true that your therapist can’t do anything for you and you’ll have to take the initiative to try things out. It’s also true if you don’t think you’re getting what you need out of your therapist, it’s completely fine to look for someone else, who will provide the things you’re looking for. I also would expect a therapist to provide some exercises and some tools for when you’re trying things out in the real world.

5

Se doesn’t sound like a terrible therapist, but that doesn’t mean she isn’t a terrible therapist for you. Not every therapist works well with every client. Sounds like you need someone who listens more and pushes you less.

6

Yeah, I know that it’s not easy and I really do want to change but I’m finding it very hard to get past these thoughts and emotions that have been ‘normal’ for me for the past 20-ish years. I just get very frustrated when I try to tell her it’s not so simple as ‘forcing’ myself to do something and she just brushes it off as not important.

Antigen, I have actually heard of that book but never really was sure how useful it might be. But, I think I might look into getting it. I need something because right now, what I’ve got isn’t helping. I really do want to change her and it’s good to hear that I’m not having too high of expectations with therapy. I’m just worried about actually DOING the change. I mean…I feel like I should give her a chance, explain what isn’t working for me but…at the same time I get the feeling she’s just not a good match. I worry about hurting her feelings or making her upset with me if I just ask for a new therapist without mentioning it to her :\

7

There is nothing wrong with changing therapists. It’s your money and time, and not every therapist is a good fit for every patient. Sign up for some sessions with someone else. Buying some books is a cheap way to try out some new ideas, too, though. No harm in trying that. Check the library, maybe, to see what you like.

8

There is a middle option between quitting cold and just sticking with this therapist, and it’s one that I used several years ago. You could try telling your therapist how you feel and what’s not working, and set a deadline for feeling differently – one that’s comfortable for you. I didn’t feel right just giving up on my therapist, so I told her my issues and set a date by which I would quit if nothing had changed. This made me feel like I had given her (and myself) a fair chance, and when the deadline arrived and things hadn’t changed to my satisfaction, I felt comfortable moving on, and she understood completely. Ultimately I found another therapist who was a much better fit for me. It’s just one other option to consider.

I also second the recommendation of Feeling Good, and add that you might want to check out the book that worked best for me, Martin Seligman’s Learned Optimism. Just like therapists, not every book works for every person. It sounds like you’re committed to making positive change in your life, and I’m sure you’ll find the right approach and therapist for you, it may just take a little time.

9

One thing you can be sure of, your thinking what is right for you is what got you where you are today. Don’t take the easier softer path if you really want to get better. Once you make a little progress the good stuff starts flowing and things get better quicker. Try it her way, if she sees progress she will become more vested in your case and you just might make a good team. If you don’t feel any better after an honest committed attempt then find someone new.

10

I would try a new therapist if this one doesn’t feel like a good fit still, even after four months. What do you have to lose?

Also, I have social anxiety and (what a psychiatrist called a “slight”) depression. As I mentioned in other threads, I had a round of sessions with a psychologist on my campus (he was going for his doctorate) and he was absolutely wonderful. He recommended the book “The Happiness Trap” for me and I recommend it to anyone who has a social anxiety disorder. It just has some useful tips and tricks to help remind myself that what I am fearing is all inside my head and also has tips with how to dismiss it, become calm, lessen the fear/anxiety, etc. Can never recommend it enough.

11

It may be that your therapist would welcome some form of confrontation. You come across, to me in this thread, as someone who isn’t willing to take on any uncomfortable challenges or really be proactive about instgating any changes. Under those circumstances I would feel OK with goading you into opening up and getting stuck in.

12

Mind you, 'Of course they’re not thinking that. That’s just silly," with no further comment is next door to useless, so I do concede she is probably a very poor therapist.

13

I would change therapists to someone who’s listening to you. From what I’m reading, she’s inexperienced and sticking to what she’s just learned no matter what. CBT can be really helpful but may not be what you need right now. There are other paths to change and often one path leads to another one.

14

Permit me to remark something totally snarky but serious too. Well, at least semi-serious.

Years ago, it was common for patients of the HMO I belonged to, to complain that they “never saw the same [primary care] doctor twice.” Actually, I came to believe it was better that way, because all the doctors did very superficial and perfunctory examinations, and each doctor looked at something different, according to his own personal idiosyncrasies. I felt that, if I were examined by a different doctor every year, I’d end up getting more comprehensive treatment than I could ever get from any one of them.

My experience with mental health practitioners over the years has led me to wonder, sometimes, if the same might be true within that specialty too.

15

My advice is to move on to someone else. It is true that just a few months is not a lot of time, but it sounds like you have no chemistry. I think chemistry must be there for therapy to work.

In my experience, CBT practitioners tend to be more “no frills” than others. Mine specializes in CBT, and sometimes she isn’t as empathetic as I’d like. I think she is like this because she is big on being a problem- solver, though. She is attentive and has lots of good advice, but she doesn’t spend a lot time on feelings. She would say that thoughts and behavior are under one’s control, but feelings just are.

16

Thanks for all the advice and suggestions everyone. It looks like my local library has Feeling Good in stock so I think I’m going to check it out if they’re open tomorrow. I’ll also see about the other books that were suggested, though since money’s a bit tight and they’re not at the library, they might have to wait.

I’ve got an appointment with my therapist on Friday so I think I might say something about my concerns. In the end, I think I’ll probably find someone else but at least this way I’ll feel a bit less guilty about leaving her. I’ve just been feeling like things are getting worse and worse and I’m afraid I’m not going to be able to get myself out of this hole. So I’ve got to try something different.

17

On Friday fire her ass. She’s working for you, and she ain’t workin’. No apologies, no guilt. Whose life are you trying to save anyway?

  1. Get an appointment with a psychiatrist. They write prescriptions. Legal drug dealers. You might could use some.
  2. Inter-Library Loans. Whatever your local library doesn’t have, they can get hold of, even if it’s from a different state. Flash your library card like a homie and get some.
18

CBT is one of the more effective therapies for social anxiety, and behavioural practise is considered one of the more effective ways to improve. One of the biggest problems with practise though is that its gradual change, and you don’t notice improvement until the change is quite large - a bit like dieting where a person doesn’t feel any weight or body change has happened even though the scales and tape can show them an actual weight loss or body change has occurred. So it can be very easy to feel like ‘nothing’s happening’ when it actually is, particularly with depression which tends to increase pessimism and discount actual progress.

Which is why your therapist should be able to show you some kind of evidence of progress, as a big part of cbt usually involves measuring progress with charts and the like to address that ‘nothing’s happening’ feeling. If they can’t do that, then it’s definitely worth trying another therapist, given you’ve been trying for 4 months. If nothing else, it will give you something to compare against, given this is the first time you’ve tried therapy.

Otara

19

There is no real drawback to trying out a new therapist. There is only what works or doesn’t work, after all.

That said, based on what little I see here, I would guess that the therapist is working to get you to make a pretty specific breakthrough.

I’d guess that breakthrough is somewhere along the lines of “Therapy is going to be a lot of work, and will probably take me uncomfortable place. Nobody else can do this work for me. If I want to get better, I will need to hold myself accountable for the very difficult, somewhat boring, and often unpleasant work I need to do.”

If you are not really ready to confront that. there are limits on what a therapist can do.

20

I’m curious as to what will happen. Please keep us updated!

Also, half.com has the book I recommended for $9. After shipping it’ll be a little more, it’s some money but worth the $12 or so imo. Love half.com, never get my books new if I can avoid it! :smiley: