I’ve seen a number of therapists or counselors for a mental disorder (OCD) and other issues over the years. And unfortunately, they almost always had nothing to offer but trite, shallow stuff like “Close your eyes, take deep breaths and think good thoughts.” Either that, or they sounded like they were just reciting things verbatim from a pamphlet; stuff anyone already knows.
“Closing one’s eyes and thinking good thoughts” is not bad advice, but it’s certainly not worth 80 dollars an hour - not even 80 cents. I could have just Googled that for free on the Internet. And if I’m going to the trouble of seeing a professional counselor, I need lifechanging advice. I need stuff that I haven’t heard before, serious stuff that is worth paying serious money for, something that will really change my perspective or direction.
Is this what modern counseling is these days, or did I just happen to hit a string of bad apples?
Are therapists and counselors the same thing? When I went to a therapist it wasn’t for advice, it was for help understanding (and working through) the reasons I was so unhappy. The therapist almost never made a declarative statement, unless it was to mirror something back to me that I had said; generally he listened a lot and asked the occasional question. That’s what people (not me) used to complain about with therapists, that they wouldn’t tell their clients what to do.
So what is it you actually want from your therapist or counsellor? Are you trying to work through issues, or do you want them to tell you what you should do?
IANAD and my advice on the subject is worth exactly zero, but AFAICT it seems that OCD is generally treated with Cognitive Behavior Therapy (CBT), with prescription medication if needed.
The part of that that a therapist or counselor can do is the CBT. Which IME (geez, all the three-letter acronyms (TLAs)!) does mostly consist of behavioral routines and exercises.
Do you, though? It’s your life and your brain, and IANAD, but if I understand anything at all about disorders like OCD, it’s that you typically can’t just “understand” or “perspective” or “lifechange” your way out of them.
You’re already, AFAICT, a smart and articulate guy who can think and reason and figure stuff out. If that was what your brain needed in order to break you out of OCD loops, wouldn’t you already have managed to do that?
CBT AIUI is basically about wiring up some new neural pathways in the brain to work around the existing pathways that aren’t operating productively. And the way you do that is mostly not by consciously understanding your reactions and feelings, but by going through repetitive cognitive exercises to train your brain basically like a goddamn puppy.
It may feel “trite” and “shallow”, but that’s not the point? This is a behavioral/cognitive problem, not a deep-understanding perspective-changing problem.
Now, I don’t know what you’re dealing with besides OCD, and even about OCD my advice is medically worthless anyway, as I said. But that’s what occurred to me on reading your OP.
General knowledge of CBT alone is not enough for most OCD patients. Specifically, the kind of CBT that is most likely to work is called exposure and response prevention (ERP). When used together with ACT (acceptance and commitment therapy), it has a pretty high success rate. Still, that approach does NOT work for everyone. IANAD, this comes from “Al,” the one person I know with severe OCD.
Medication can also be very helpful, especially in conjunction with therapy. However, some people with moderate-to-severe OCD simply cannot force themselves to take medication. That’s Al’s case.
@Velocity, I think what you’re really saying is that you need more effective, targeted help than you’ve been getting. I agree. Just because OCD is a form of anxiety disorder doesn’t mean calming techniques alone are effective. I think the key is finding someone who has had a lot of experience and training in working with OCD patients specifically (and not just experience with CBT).
Can you ask therapists you know to recommend someone who has broad experience working with OCD patients?
Maybe I should put it this way - my frustration isn’t so much whether I’m getting CBT, ACT or not, but rather, that I get the impression from most counselors/therapists that they’re just mentally reading off of a script. They talk with an attitude and tone that comes across as “I’m just reciting a pre-rehearsed mental book to burn off the time until your time is up on the clock”. When I leave their office, I don’t get the impression that I “got” anything from them I couldn’t have just gotten by Googling on the Internet for free or just talking to a friend.
I don’t feel like I got 80 dollars’ and my commute and time’s worth, is what I’m saying, I guess. I feel like I have deep problems and all these ‘professionals’ do is scratch the surface and call it a day. The things they talk about are just…only inch deep. I feel like Charlie Brown sitting at Psychiatrist Lucy’s booth, except that he’s paying big money instead of a few dimes.
I’ve been seeing Shrinks since I was 7. I’m 40 now. I think some people, (not the OP,) expect top much from them. YOU have to be the change, a shrink can only make suggestions. But there are bad Shrinks too. One Shrink I had was a believer in 'The Secret", that’s how bad she was.
It’s tough to find a fit, and that’s a problem because we are limited in the US due to insurance…, but there are good therapists out there.
EVERYBODY feels like they have deep problems that require unique solutions but unfortunately we’re fairly simple creatures and most of our mental tics and problems actually can be addressed with simple solutions BUT they require us to commit fully to them to make them work. If you’re expecting a therapist to have some amazing button to push that fixes YOUR brain, well, you might as well get used to being disappointed. Therapy is also a process and deciding you aren’t getting your money’s worth is just another form of dismissive deflection along with being contemptuous of modalities you are patently unfamiliar with.
Find a therapist who specializes in treating OCD, preferably one who can also prescribe appropriate medications then actually apply YOURSELF to the treatment plan because as long as you’re holding yourself aloof from the process and expecting another person to fix how your mind functions you will not improve, not even if you find the most expensive therapist in the world who’s the acknowledged #1 authority on the treatment of OCD. YOU fix your brain, the therapist just helps you find methods that work for you.
Right, I understand - I’m not trying to shirk any part of my burden, not at all. But I want counselors to not act like they’re merely reading a script to burn off the clock. I got the impression from one that she wasn’t even listening at all, she was just counting down to the next client and the end of the workday.
It is not rude and it won’t offend a therapist - if they’re a reasonable person anyway - if you ask to be referred out. Some therapists practice different styles and the rapport between the therapist and client is a key ingredient in successful treatment. It’s much more of a specific compatibility match than, say, finding the right GP doctor.
I would suggest asking to be referred out to someone who specializes in OCD, or maybe your health insurance or other resources can help you find the right person in that regard. If your problem is very specific like that, you will likely get the most help out of a specialist.
But unfortunately sometimes it just takes trying multiple people - there are lots of stories of people who got no help from therapy until they found the right therapist at which point things became massively more productive.
Totally reasonable, and in that case, as others have said, your only recourse is to get a better counselor. Many therapists will let you have a trial session, especially online these days. Do you have a support group or contacts among other OCD sufferers to get recommendations for somebody who’s more engaged?
I’ve done a bit of this, a bit of that. I’ve got zero sympathy with shrinks that think they can ‘only make suggestions’, and that they can’t change people. They’ve chosen the job because they couldn’t cut it in sales or teaching, where changing people is the whole point. Like ‘managers’ who manage because they can’t do anything else.
They can’t all be Erickson, but they’re taking the easy way out.
I very much doubt people got into counselling, which requires a master’s degree and 2-3 years of supervised internship, because they couldn’t cut it at sales or teaching. It’s not a job you just fall into because it’s easy and you aren’t cut out for other things.
I think you’re probably misinterpreting the principles of what’s happening. People have to change themselves. You can guide them, you can help them to discover why they do certain things or what methods they could try to improve, but it’s important that the client know that they’re playing an active role in changing their own lives, they aren’t being passively healed as they would with, say, surgery. Putting too much expectation that the therapist is going to do something that fixes the client is going to lead to them being too passive about their own changes and thus make the therapy ineffective.
No, I’m not misinterpreting: I’m disagreeing. (Or, if you like, I’m agreeing with Erickson rather than Freud). “People have to change themselves” is not a luxury teachers or dog trainers or armies are afforded: it’s an excuse therapists use for ineffective therapy.
Which also (relevant to this thread) is an excuse for lazy lack of engagement.
I’m always fascinated by the fervent, quasi-religious belief so many people have in therapy. Like therapy itself is God, and therapists are mere ministers who might sometimes misinterpret or twist His holy words, but that doesn’t invalidate God himself. You just need to keep trying until you find the right minister-therapist. Or really, the right one for you, since everyone is different and the one who worked for someone else may not work for you. The neat thing about that belief is that it’s unfalsifiable; no one can ever try every therapist on earth, so no one can definitively disprove that the right one for them is still out there. Oh, and as a backup, we can always blame the individual for worshipping the wrong way and therefore denying himself grace. The important thing is that we never criticize or acknowledge the limitations of Therapy-God. Even medicine, which requires so much more training of its practitioners, is but a humble earthly practice that we all acknowledge can’t save everyone no matter how good the doctors or how cooperative the patients. In fact, no other profession on earth is inherently infallible, with all the mistakes resting at the feet of those who are not worthy of its promise. It’s really something.
You’re getting that from me saying that you should be referred out to a specialist in OCD or find a therapist that you have a good rapport with?
I’ve actually read quite a lot of people’s experience with therapy and therapists and I’ve literally never come across anything like what you described, nor has anything in this thread been anything like what you just described. It sounds like you have a weird chip on your shoulder.