I genuinely don't understand how therapy is helpful for some people

[mango-meridian]

So recently, despite my intuitions and life experiences telling me I should do otherwise, I started talk therapy again.

I'm in awe once again at the fact that it is actually helpful for some people. To be clear - I believe people when they say this; I just don't get how it actually happens. I reached out to two friends not too long ago asking them about their experiences with therapy and they were both enthusiastically in support of it. They said it had helped them a lot. But how?

I do the things I'm supposed to do (and always have). I do the "homework". I come to each session with an intention. I make sure that we are on the same page about what my goals are. I try to always have an open mind. I do everything I can to be willing to change. I try to respect that this is a professional whose job it is to help people like me, and I'm aware they probably know a lot more than me. (In my case, she went to school for this - for six years! And she's been practicing for over ten years!)

There are a several reasons why it feels like it isn't working:

1. Finding solutions to any problem in my life requires a lot of context. I need to explain the people involved, important events, the patterns I have, the way I react, my emotional states, etc. This takes a lot of time, and I estimate that if I do a session once every week or two, it will take many months, if not years, to establish proper context. And that's if my therapist remembers even a quarter of the things I say, which they usually don't.
2. The only things I get suggested to me are things I already thought of and tried a long time ago. I'm an adult and most of my issues are things I've been dealing with since I was a teenager. I feel like the advice and suggestions don't go deep enough.
3. A lot of the issues I deal with seem to happen on a subconscious/unconscious level, and are therefore hard to communicate about. Trying to take what is ethereal, emotional or somatic and convey it in words to another person (who views the world differently and uses a different vocabulary) and then translate what they say back to my own way of seeing, then converting THAT back into the language of the subconscious/unconscious, is extremely tedious, difficult and time-consuming. And it's hard to do on the fly - for both of us.
4. A lot of the issues I deal with don't seem to be known or have clear diagnoses associated with them. I try to explain what I go through, and I get a confused stare. At that point, they usually just ask an unhelpful question about it, brush past it, or try to tell me that what I deal with is perfectly normal and nothing to worry about even though I've just told them it's a huge disruption in my life.
5. It isn't enough to just "talk through" my problems. I get that a lot of people benefit from talking through what is happening to them with a professional on a regular basis, but I don't get much from that. I'm looking for actual solutions and concrete ways I can grow/change. I want to be less alone. I want my life to be less hellish. If I just wanted someone to talk to, I would seek that out in friends/acquaintances (the few I have) or I would just journal.
6. Therapists in general (but especially my therapist) cannot take a chill pill when it comes to CTB ideation. Before each session, I have to take a survey on an ipad that asks me whether I have been having thoughts of CTB lately. I answer "no". Then, my therapist asks me at the beginning of the session if I have been having thoughts of CTB. I answer "no" again. Then, she asks me MORE about it throughout the session, even though I answer "no" every time. She seems to take every opportunity to steer the conversation toward CTB even when it doesn't flow with the conversation at all. Maybe she's paranoid about being held responsible for a client who might CTB? Regardless, I hate having to mask this part of myself. And the fact that we can be locked up, traumatized and forced to pay thousands of dollars for wanting to CTB makes therapy adversarial and everybody knows it.

To be honest, every time I have tried to do therapy (I am on round 4 now), it has felt basic, insufficient, lacking in depth, and just not helpful. Almost like a placeholder for actual treatment. I feel like there have to be better things out there. But part of the reason I like doing it is it shields me from the criticism that I am not doing The Responsible Thing. I am doing The Responsible Thing. Again. For the fourth time. (Fifth if you count group therapy.) And I'm doing all the things you're supposed to do as a client, too.

I've heard people say that you just need to find a Good One. But I think four times should be enough. If only 10-20% of therapists are the Good Ones then we need to stop recommending it.

I've made a lot more breakthroughs trying to address my own problems just by careful pondering and journaling and then researching what I'm dealing with. It's slow and takes a long time, and it's vulnerable to my own biases, but it's worked better for me. What can I say.

 

[Praestat_Mori]

Your issues seem to be very complex.

If you don't know what's causing the issues then a therapist has to find out the issues and then come up with a comprehensive solution to it. To achieve that you must tell your therapist everything regardless of how much time it takes.

Due to the obvious complexity of your case one session a week may not be enough, as you already say in 1.

Therapy isn't a cure for everything - it may or may not help. Depending on whether the problems that are causing you MH issues can be solved or not. I'm sorry you have to go through this.

 

[reallysleepy]

I think that maybe DBT or ACT therapy could work better for you (if you are not already doing those).

DBT has some abilities (interpersonal abilities, abilities to regulate your emotions, abilities to get out of emotional crisis and mindfulness abilities) that are really practical and give you actual tools to have a better life.

I'm doing ACT and my therapist told me that DBT and ACT are equal on the following: they don't try to find the root of the issue in your past and fix it like in psychoanalysis but try to accept the recurring harmful thoughts and understand where the emotional deregulation comes from for then to try to find ways for you to, deeply and honestly, get better. And the two ACT therapists I've had accepted my suicidal ideation as one of those harmful thoughts (they do ask me if I think on actually doing it or if I'm planning or things like that but they don't fixate on that unless you are fixating on it). Also, they are supposed to create a crisis plan with you (you are part of the planning) in case you are felling like ctb or sh.

 

[-Link-]

What are your goals with therapy?

In therapy, you want to look at SMART goals...

• Specific -- detailed rather than generalized
• Measurable -- you want to be able to track progress
• Achievable -- they need to be realistic
• Relevant -- you want them to align with your values and needs and what you view as worthwhile
• Time-based -- start date, end date

As @Praestat_Mori said, your issues sound very complex, in which case talk therapy would ideally only be part of a larger, intensive treatment program. But this is only an ideal rather than a reality. We need to stay grounded in what's realistic.

So, when looking at goals with therapy, you want to keep in mind the complexity of your situation and the type of therapy you're doing. This goes towards the 'A' in 'SMART' -- what's going to be realistically achievable doing weekly sessions of talk therapy.

But part of the reason I like doing it is it shields me from the criticism that I am not doing The Responsible Thing. I am doing The Responsible Thing. Again. For the fourth time. (Fifth if you count group therapy.) And I'm doing all the things you're supposed to do as a client, too.

If you're primarily attending therapy to satisfy other people, then I would keep expectations relatively minimal. (There is absolutely nothing wrong with this. It's just that outcomes in therapy are highly dependent on the patient's mindset going into it.)

I've made a lot more breakthroughs trying to address my own problems just by careful pondering and journaling and then researching what I'm dealing with. It's slow and takes a long time, and it's vulnerable to my own biases, but it's worked better for me. What can I say.

This is very good for gaining an understanding about yourself and the issues you're dealing with.

With treatment, though, you really want as much structure to it as possible, and this is where the therapist comes in. (Again accounting for the fact that talk therapy as a standalone treatment will have limitations in complex cases.) There may be some high-quality self-guided programs online as well that could help keep a structure to it.

I think that maybe DBT or ACT therapy could work better for you (if you are not already doing those).

Echoing this, yes, absolutely, if these are accessible to you, even if you've already done these in the past.

Therapists in general (but especially my therapist) cannot take a chill pill when it comes to CTB ideation. Before each session, I have to take a survey on an ipad that asks me whether I have been having thoughts of CTB lately. I answer "no". Then, my therapist asks me at the beginning of the session if I have been having thoughts of CTB. I answer "no" again. Then, she asks me MORE about it throughout the session, even though I answer "no" every time. She seems to take every opportunity to steer the conversation toward CTB even when it doesn't flow with the conversation at all. Maybe she's paranoid about being held responsible for a client who might CTB? Regardless, I hate having to mask this part of myself. And the fact that we can be locked up, traumatized and forced to pay thousands of dollars for wanting to CTB makes therapy adversarial and everybody knows it.

The system is extremely flawed, for sure.

I don't know this would be so much a paranoia on her part as maybe she's inferring there's a little more to it than what you're telling her. Although you occasionally see stories from people saying their therapists or doctors were quick to section them, it's generally safe to speak of suicidal ideation -- passive suicidality (keyword: "passive").

 

[mango-meridian]

Your issues seem to be very complex.

If you don't know what's causing the issues then a therapist has to find out the issues and then come up with a comprehensive solution to it. To achieve that you must tell your therapist everything regardless of how much time it takes.

Due to the obvious complexity of your case one session a week may not be enough, as you already say in 1.

Therapy isn't a cure for everything - it may or may not help. Depending on whether the problems that are causing you MH issues can be solved or not. I'm sorry you have to go through this.

It's nice to at least hear an acknowledgement that they're complex. Intuitively I agree that the therapist should have a full understanding of the situation regarding any mental health issue, it just feels as though I've never even been close to that. Sometimes I think they gain a lot understanding within one session, but then they forget it by the next one (based on the things they say/ask). I'm guessing a lot of the problem is that it's common for therapists to have 15+ clients, and that's a lot of people/stories/information to keep track of, but I don't really know.

What are your goals with therapy?

In therapy, you want to look at SMART goals...

• Specific -- detailed rather than generalized
• Measurable -- you want to be able to track progress
• Achievable -- they need to be realistic
• Relevant -- you want them to align with your values and needs and what you view as worthwhile
• Time-based -- start date, end date

As @Praestat_Mori said, your issues sound very complex, in which case talk therapy would ideally only be part of a larger, intensive treatment program. But this is only an ideal rather than a reality. We need to stay grounded in what's realistic.

So, when looking at goals with therapy, you want to keep in mind the complexity of your situation and the type of therapy you're doing. This goes towards the 'A' in 'SMART' -- what's going to be realistically achievable doing weekly sessions of talk therapy.


If you're primarily attending therapy to satisfy other people, then I would keep expectations relatively minimal. (There is absolutely nothing wrong with this. It's just that outcomes in therapy are highly dependent on the patient's mindset going into it.)


This is very good for gaining an understanding about yourself and the issues you're dealing with.

With treatment, though, you really want as much structure to it as possible, and this is where the therapist comes in. (Again accounting for the fact that talk therapy as a standalone treatment will have limitations in complex cases.) There may be some high-quality self-guided programs online as well that could help keep a structure to it.


Echoing this, yes, absolutely, if these are accessible to you, even if you've already done these in the past.


The system is extremely flawed, for sure.

I don't know this would be so much a paranoia on her part as maybe she's inferring there's a little more to it than what you're telling her. Although you occasionally see stories from people saying their therapists or doctors were quick to section them, it's generally safe to speak of suicidal ideation -- passive suicidality (keyword: "passive").

Appreciate the thoughts. I would say the primary reason I am doing it is to improve quality of life. Shielding myself from criticism that I'm not being responsible is only a bonus.

I think having more structure is a good idea. I may think about how to add more structure to what I am able to research/ponder/explore on my own.

Thanks @reallysleepy for mentioning DBT and ACT. I think I've heard those acronyms but I may look into them on my own or see if my therapist can implement them more in some way.

As much as I have been told that it's okay to mention passive suicidality, I've also heard enough anecdotes (both on this website and elsewhere) of people being sectioned for simply mentioning wanting to CTB that I don't want to risk it. If I bring it up, it also gives them room to pry, and once they do that, something more may slip out. Saying I never want to CTB is a simple strategy that works, with the only downside being that I have to mask that part of myself. And honestly, I wouldn't want to be honest about CTB with pro-lifers anyway haha.