I know they talk about “their feelings”, but what exactly goes on at these sessions?
Does the doctor start with, “So what’s on your mind this week?” or does the doctor (or therapist) have a planned subject to discuss or is there some other structure to the session?
I found it immensely useful to have grief counselling when my parents both died within a month.
This was supplied by a charity called Cruse.
The counsellor would ask me each time what I wanted to talk about.
She would listen sympathetically, offer advice and give examples of how grieving often went. She also gave me insights, such as “you are now an orphan”* and “this is why you keep the curtains closed”**
After the first session, I was looking forward to future ones and would jot down topics I wanted to discuss.
It took about 10 meetings (about an hour for each one), then I felt ready to face the World by myself.
It was really helpful.
*I pictured orphans as Dickensian kids living in orphanages or being roped into crime
**because I wanted to keep the World out whilst I was grieving
There are many, many, many different kinds of therapy, each reflecting the particular school of psychology/psychiatry, plus the methodology of the individual therapist. There’s nothing even close to a single answer to this question. It’s sort of like asking, “What goes on in a religious service?”
This.
In my cognitive behavioral therapy sessions for panic attacks, we’d begin by going over my previous week, talking about any incidents of anxiety that I experienced, then analyze how I reacted mentally, what physical actions I engaged in as a result, and which errors I made in both, and how I could do them differently next time. That’d eat up a good solid hour most weeks.
I agree with the previous two posters, and I have another perspective of longer-term therapy. I was in therapy for about 2 years. I went in complaining of a general pervasive sense of unhappiness and futility, so as you can imagine the discussion topics might be pretty wide-ranging.
This particular therapist would not say much or anything at all at the beginning of a session, leaving it to me to start on the topic that was forefront for me at the time. It might have been a follow-up from the previous week, or something completely different based on something that had happened to me that week. I remember one session where I burst into tears when I was trying to describe my feelings about seeing a (seemingly) very happy baby and her parents on the bus on the way to the session.
Perhaps predictably, most of my work ended up having to to do with my parents and my very mixed feelings about them. I was very stuck between hate and forgiveness. I managed to work through pretty much all of that, so that I could stop obsessing about it and move on with my life.
Roddy
The experience I had, when I would come in to help with my ex (then-wife)'s therapy, was:
“How’s it going today?”
or
“I like your sweater. Did you make it?”
or
“You seem really tense. What’s wrong?”
Basically, it depends on the therapist’s mood and personality, how you present when you walk through the door, the therapist’s speciality (CBT, psychodynamic, eclectic, etc.), and probably a host of other things. My doctor starts off with small talk sometimes, and sometimes she dives right into serious questions. It all depends.
She has a checklist that she’ll ask questions from, like, “Are you still feeling ___”? Sometimes my answers will spur different ones, and the conversation can go into a million directions. I’ve had sessions where, if you were looking in from the outside, you’d think we were just two people chatting about trivial matters. And then I’ve had sessions that have been mostly silent while she sits there waiting for me to compose myself.
Like I said, it all depends.
I was in behavior modification for my Obsessive Compulsive disorder and we would do immersion therapy (subjecting me to my stimuli) and envisioning. It was very hands on.
I’ve also been in traditional therapy for my bipolar. The kinds of therapy I had depended a bit on the counselor’s style. Some had me spill my guts for 45 minutes and then made suggestions. Some would talk me through by using carefully planned questions and making me think about my own problems in a new way.
Same with me. My therapist would also recommend topics to think about to be discussed next week. He’d have me think about what I was thinking/feeling/doing during times when I felt anxious.
Also during therapy, we practiced relaxation techniques, although he also gave me CDs of relaxation exercises. On my own I meditated, and he also strongly encouraged me to take up tai chi.
Oh, and the first few sessions are usually dedicated to case history.
There were also quite a few sessions where he’d break down how different people react to the same situations I’m in. For example, if I’m dealing with a particular asshole, he’d explain to me what the asshole would do and why, and how I should react. And my therapist used the word asshole. And the next time I was in that situation, I behaved like a mature, responsible adult, and it totally defused the asshole.
I’ve been twice in my life (i.e., two different therapists). The first time, the therapist made it clear we were working as fast as reasonably possible to get me out of therapy. The second time, I made this decision on my own. I didn’t want to be a terminal therapy patient.
Will I have to go back again ever? Hmm…good question. The last time (about six months ago), I had stopped eating and wanted to stay in bed 24/7, which was pretty serious. If I ever get like that again, I’d go back. Not that I’m unwilling, it’s just that I’ve been given tools to deal with anxiety, and I really want to have the upper hand.
I found it useful, when I was in therapy, to ask myself, “Quick, what do you most NOT want to talk about?” Kind of checking things off the list from the bottom up. Always felt like progress, which is half the battle.
I always went to a psychiatrist*, or a psychiatrist working with someone else who did the talk therapy. I have a lot of medical problems, and part of the mental problems are the direct result of having low thyroid function, diabetes, digestive tract issues, etc. The psychiatrists would sometimes order tests for me, or ask for copies of tests that other doctors had run on me.
The analyst always asked how I was feeling that day. While this was partly a social question, it was mostly a question of how I was feeling, and so a response of “I’m doing well, and you?” was actually not appropriate, unless I was actually feeling well. It took me a while to be able to answer this question honestly. If I had some urgent problem, this was my cue to say so. If there were no urgent problems, and I’d had some lab work done, then we’d go over that information. Occasionally, early in therapy, I was given assignments, such as to read a certain book and think about it, or to be aware of a certain behavior that I exhibited. If so, then I was asked to report on my progress in these areas. If none of the above applied, and I didn’t seem to want to talk about anything specific, then the analyst would usually refer to the notes in my chart, and ask me about how I was coping with this problem, or another problem, or how I was dealing with a life situation. We usually discussed my feelings about situations. If I was having a problem with coping with something, usually I was given some suggestions about how to deal with things.
*I’ve been told that I’m stable now, and don’t need more therapy, but I DO need to continue medication until further notice.
This is a fantastic way of putting it. There are so many different kinds of therapy that the answer will vary dramatically depending on who you ask. Probably the most common type of therapy is psychodynamic, or ‘‘talk’’ therapy, which usually focuses more on the client-therapist relationship and is normally driven by the client and what he or she chooses to discuss at that session. It involves the client talking a lot and the therapist listening a lot, maybe occasionally interjecting an insight but for the most part just being a listening, supportive force. Psychodynamic theory is influenced by the work of Sigmund Freud and notions of unconscious forces that disturb conscious functionality. It’s hard to generalize too much about the structure of ‘‘talk therapy’’ because it isn’t consistent; each person practices as they see fit using these general principles a guideline. Some therapists may be more aggressive than others, more talkative, or incorporate other methodologies at the same time.
The second most prevalent is probably Cognitive Behavioral Therapy and even that is an umbrella term for different approaches – you’ve got exposure therapy (an approach to anxiety disorders), dialectical behavioral therapy (mainly used to treat borderline or complex-PTSD, and emotional lability issues), and a kind of cousin of CBT, EMDR (for treatment of trauma, involves rapid eye movement combined with CBT ideas.) These are what we call Empirically Supported Treatments (though calling EMDR an EST is somewhat controversial), meaning the main thrust of the development of these treatments is based on scientific research, and they change and evolve according to what the evidence indicates actually helps. The sessions tend to be a lot more structured and usually assign the clients ‘‘homework.’’ A typical homework assignment might provide the client with a list of common cognitive distortions (overgeneralization, all-or-nothing thinking, etc) and have them keep track of any irrational thoughts that come up, identify the cognitive distortion and then come up with a rational response to that distortion.
All therapies generally involve some level of psychoeducation, for example telling a traumatized person they aren’t crazy but are in fact reacting in a normal way to a horrific circumstance. Obviously this is going to vary widely depending on what is being treated.
There are still others types of therapy, many of which I’m not familiar with at all, so I guess the main thing to keep in mind is that not all therapies are created equal. Just because one methodology is widely accepted doesn’t mean it works. In fact, one widely practiced method of treatment intended to prevent PTSD, debriefing, has been shown to increase the incidence and severity of PTSD in the affected population yet it continues to be presented to mental health practitioners, businesses, and schools as a viable treatment method.
I know you didn’t ask about treatment efficacy and evaluation but I feel a moral obligation to mention it. Anyone seeking treatment for a mental health problem should do their research before jumping in.
I’ve had sessions with roughly 10-12 mental health professionals over the years, and each experience was completely different.
First, it depends on the therapist/psychologist/counselor/psychiatrist as a person, and the way they have been trained.
Secondly it depends on you as a person, and your situation.
In my case I was trying to solve a particular problem (depression/anxiety) and deal with a bad family situation, so most sessions focused on immediate events and what strategies I could use in the following week to cope. There was never much if any focus on my childhood for instance.
I’ve learned I prefer a more hands-on style - some therapists just say ‘and how did that make you feel?’ and sit there and nod. Not helpful for me. I need someone who will ask probing, detailed questions, offer analysis, and push me to come up with my own solutions.
I think everyone can benefit greatly from therapy (you don’t need to have a mental illness, but on medication, or have lots of problems - even a happy person can get insight from therapy), but you have to find the right therapist for you - which is a combination of both personalities, and their style/training as a professional. It isn’t easy.
This is an example from my own experience
I know for me, I have been to two different kinds of group therapy and I have had personal one on one therapy.
In the therapy, the goal was to build enough rapport and safety so that a person can talk about traumatic events that they normally cannot bear to discuss or acknowledge in a less safe environment.
That is different from what you’d do in CBT therapy, or EMDR therapy for PTSD.
Supposedly there are 3 main ingredients to a strong sense of rapport:
Actually listening to each other (not waiting for your turn to talk or just to express your opinion, but trying to understand someone else’s situation) and devoting your attention to someone else (not multitasking)
Mutual positive affect for each other
Physical synchronicity
http://www.ijourney.org/index.php?tid=615
A decent therapy session, or conversation, in my experience involves those things and makes you comfortable and safe enough to discuss important issues.
Sometimes other people give advice in those situations (what to do different in the future), but usually just having someone empathize is enough to help a person feel better.
One time, my therapist just asked me how to fix his computer. I hope the point was just to distract me from my own problems, because that’s what it did, and it still helped.
For me, a lot of therapy wasn’t about talk. It was about getting me used to intense sensation, like loud sounds and strong tastes and intense emotions. It was about getting the physical touch I didn’t know I missed. It was about getting me accustomed to being around people. This was actually the more important and low-level learning… but I only got into it after several years of more conventional talk therapy.
I’d seriously started with talk therapy after my sister got ill with cancer in '89, and it went on after her death. Afterwards, there was a gap while I tried out a new career direction, but that ended and I went back to the old. Then my mother and my stepmother and my aunt got ill and it was back to the talk therapy.
But even then, after I’d rebuilt myself after the deaths (with the therapist’s help), the basic problem in my life remained. I knew there was something wrong but I had no idea how to fix it. I was socially disconnected and unable to form real emotional or romantic relationships.
I’d known something of this since senior public school (grade 7 or so), but then of course only knew that I wasn’t able to find a girlfriend. I had no idea why; I simply thought I was ugly and unworthy. I knew nothing of the need to, say, learn body language; I thought surface changes like a new haircut would fix things. But they didn’t. Even in university, my friends were finding love and getting married, and I couldn’t tell if anyone was interested in me!
After the deaths, I continued with therapy that brought me touch and also accustomed me to intense stimulus. I also started group therapy. In controlled conditions, I was able to experience emotional intensity from others, and survive it, when I’d previously believed it would destroy me. I learned about body language. I learned about getting outside my own brain and really working to perceive the people around me.
I had a few unpleasant surprises, like discovering that I had some degree of face blindness. (“What do you mean, you don’t have to consciously figure out who everyone is all the time?”) But all in all, I’ve learned a lot of the things that most people lick up on their own. And these days I even have a relationship with a woman going!
It’s like The Pit we have here at this wonderful message board. If some annoying shit has been building up in your life and you need someone to rant to, BAM! Talk therapy.
Or more specifically, your mom that you live with, frequently talks and acts like a fucking ten year old then gets all pissy at you because you just want some peace and fucking quiet while trying to relax after a hard day’s work dealing with bitch customers that think they own the world. Then during the times your mom actually speaks like an adult, it’s as if you are the 10 year old that can’t speak for yourself even though you just celebrated 20somethingth birthday, in which she was present. I mean doc, I have to fucking cut her off midsentence to answer a question someone else specifically asked me, yet she wants to go and answer for me as though I’m gonna fuck it up somehow. I mean, come on! They asked me the question you bitch, not you, let me speak for myself.
And speaking of a hard day’s work, you know what happened to me on the way home? Before I had the luxury of dealing with my beloved mother. I’m driving along, about seven miles faster than the speed limit and some little princess bitch in a convertible comes up behind me, switches lanes and passes me and glares at me like I’m 80 doing 25 while driving a land yacht and I’m like “Bitch don’t look at me like that! Seven over isn’t fast enough for your precious fat ass?”
And then some asshole in a BMW comes up behind me and starts riding my ass and so I’m just like “Fuck!” So I speed up to 10 over the limit and guess who’s still behind me. Mr. I’m A Middle Aged Yuppie Fag That Thinks I Own The Road Because Finally I Can Afford An Expensive Yet Still Shitty Car. Of course at this point I can’t even do the tap the brakes trick because he’ll be further up my ass than is comfortable.
deep breath
You know what I’m talking about doc? I mean, fuck, why can’t people just be normal? Can you maybe prescribe something for anxiety? Dealing with all these crazy asses is making me all wound up ya know?
The above was not at all serious and should not be moved into The Pit. It was strictly for humorous purposes.
Really? I appreciate that everyone’s needs are different, but if a counsellor came out with that kind of talk to me, I’d tell them to stop patronising me and walk out.
I’m afraid you’re missing the point (partly because I gave a brief response).
I simplified the many hours of counselling because:
I can assure you that my counsellor was sympathetic, attentive, patient, courteous, reliable and helpful throughout. There was absolutely no patronising but only a genuine desire to help someone in pain.
I have recommended grief counselling (and that charity in particular) to several people since.
I merely mentioned those two comments because they were interesting and gave me an real insight into my situation.
Both arose after long friendly discussions and specifically when I asked my counsellor to explain why I had certain feelings and took certain actions.
In the first case, the ‘orphan’ comment was a real revelation to me. Part of my grief-stricken brain was refusing to accept that either of my parents was dead, let alone both. Apparently this is a common sympton of grief.
In particular, the counsellor knew by then that I was a scientific type, who preferred to work through my problems intellectually (i.e. using facts).
The second ‘curtain’ comment came as a real surprise, but immediately made sense to me. I had been asking how I would know when I was coping better with the grief.
The response made me realise that I had unconsciously drawn my curtains after the funeral and that they had literally stayed shut for weeks (continuously day and night). I had grown used to this and not given it a second thought. (Again, this sort of compulsive behaviour often occurs in this situation.)
After the counsellor explained the significance, I spent a couple of days bearing it in mind. Then I walked over and opened them. This was a real ‘eye-opener’ for me and I immediately felt happier and more confident.