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.

 

[We Are Angels]

I relate, mainly because I am too far gone for therapy to be of help. They cant really do anything to help me. I will never be normal or be able to fit in society. Its over. Not everyone can be cured.

 

[mango-meridian]

I relate, mainly because I am too far gone for therapy to be of help. They cant really do anything to help me. I will never be normal or be able to fit in society. Its over. Not everyone can be cured.

Did they tell you they can't do anything to help you, or did you infer/decide that on your own? I hope it's not the former. They shouldn't say that even if they think it's true.

I don't want to feed into hopelessness but I also acknowledge that some people's emotional issues are so severe and complex that we (collectively) don't seem to know how to handle them. I've felt that way many times with my own issues and it's just awful.

I have radical beliefs when it comes to healing, though. I have hope that we will find ways to address many of even the worst cases in the future, whether it be through advances in understanding of relevant fields (psychology, biology, etc.) or through new technologies. And that's putting aside what you might be able to figure out on your own (or with the help of professionals who don't give up easily) given what we already have.

I dunno though. This is the recovery section so I'm trying to be an optimist.

 

[dazed.daydreamer]

I had a pretty similar experience with my former therapist. She was kind, and it was nice to be able to talk with someone a bit more openly. But it felt I couldn't establish enough context, we didn't do any techniques to tap into the unconscious to get past over-intellectualization and things I may have not been consciously aware of (if it was all surface-level, I could probably fix it on my own), solutions felt pretty surface-level. Have you looked into the psychodynamic method? Ik it can have a weird rep, but I've studied it a bit recently in a class about therapy methods and it sounds pretty aligned with what you're looking for. I also get if you're just done with talk therapy, I'm also probably not gonna go back and CTB soon (I don't think the root of my strife is issues that a therapist can fix; I myself AM the problem, fundamentally as a person).

 

[mango-meridian]

I had a pretty similar experience with my former therapist. She was kind, and it was nice to be able to talk with someone a bit more openly. But it felt I couldn't establish enough context, we didn't do any techniques to tap into the unconscious to get past over-intellectualization and things I may have not been consciously aware of (if it was all surface-level, I could probably fix it on my own), solutions felt pretty surface-level. Have you looked into the psychodynamic method? Ik it can have a weird rep, but I've studied it a bit recently in a class about therapy methods and it sounds pretty aligned with what you're looking for. I also get if you're just done with talk therapy, I'm also probably not gonna go back and CTB soon (I don't think the root of my strife is issues that a therapist can fix; I myself AM the problem, fundamentally as a person).

Yeah it sounds like we've had pretty similar experiences, even down to the over-intellectualization.

Yeah I've looked into psychodynamics a lot on my own. I've done pretty in-depth breakdowns of a lot of my psychological issues and how they might have been caused by my parents, siblings, family environment, school, religious upbringing, etc. In the end, though, once I saw the causes, I wasn't sure how to continue from there. I also wasn't sure if those really were the sole causes, or just a piece of the problem. Regardless, I tried doing EMDR for a lot of early childhood experiences/memories/environments that I think were problematic and I feel like it helped with some things but wasn't the root cause for a lot of other things.

My therapists have generally always asked me about my early childhood but never talked about or did much with that information. I guess it was just for context and to establish my background. To be honest, though, they SHOULD have looked into it more than they did. Why didn't they? I get somewhat frustrated at the thought of having to direct my therapists on which modalities to use when they are the professionals who went to school for years and should know a lot more than me.

 

[We Are Angels]

Did they tell you they can't do anything to help you, or did you infer/decide that on your own? I hope it's not the former. They shouldn't say that even if they think it's true.

I don't want to feed into hopelessness but I also acknowledge that some people's emotional issues are so severe and complex that we (collectively) don't seem to know how to handle them. I've felt that way many times with my own issues and it's just awful.

It's my own thinking that brought me to that conclusion.

In my case my issues are simply too complex and I was screwed over by having several disorders and being from multiple oppressed minorities, each one alone being enough to result in lifelong trauma. The resulting effect is that I'm a ridiculously unique individual just by my demographics alone, and I am even less normal psychologically speaking. So unique am I, that I have never meet someone quite like myself, even online. So no matter where I go, I'm a pariah because no one can fit me into a box or understand me. I'm not trying to sound special here, as this has driven me to the point of maddness, I'm just telling how it is.

No therapist is going to have the specialization in all of the required areas to help someone with my unique, hyper-specific issues. The best they can say is platitudes about improving your morale and mindset, which is useless. They certainly can't come up with practical solutions to a problem that is unsolvable.

 

[notwhereIbelong]

Speaking as someone who has had some success from therapy, sometimes it's just harder for some people. This therapist may also just not be the right one for you, finding one who gets you and can actually help you can be tricky, and you may have to go through a couple (or more). Different therapists also specialize in different methods of therapy, someone here already mentioned DBT and ACT, I myself am about to start CBT, so I'll just say again that those could be options for you.

Sometimes it's also good to just tell your therapist that what they're doing isn't working, maybe you need more frequent sessions, maybe this type of therapy isn't the one you need, etc., when you bring up these issues to a therapist, assuming they're worth something, they should listen to your complaints and figure out a better method, be it increasing the session frequency or directing you to another colleague.

About the issues being on a subconscious/unconscious level, this is going to sound like a very dumb suggestion, but writing stuff down can help. You don't need to be coherent, just a pure stream of consciousness is good. It takes a while to take the habit, I haven't mastered it yet either. A single phrase, a word, a sketch, anything, as long as you can somehow pin down the thought for later, so that you can come back and reanalyse it.

As for therapists being way too touchy about CTB, that's just something we have to deal with. I haven't heard of a single therapist that will just let you talk about it without at least suggesting hospitalization. It sucks, point blank.

 

[mango-meridian]

Had another session today. One thing that always happens is I reach a point with a therapist where we clearly haven't solved many of my problems, yet we're at some kind of impasse where they're not really sure what to do with me or how to continue treatment.

It's at this point that they... start recommending I come less often. Surprise!

To be fair, I'm usually a bit stumped, too, but isn't this something we're supposed to figure out together?

This happened today, which was only my fourth session with her. After the discussion of coming less often came up I asked for suggestions on what I might be able to do besides talk therapy to address some of the issues I'm dealing with and she suggested drawing pictures/art and journaling. Well, I already journal and drawing pictures isn't one of my mediums of expression, sorry! Also, does she really think I haven't thought of/tried these things?

I mentioned EMDR and group therapy as some other things we might try and she brushed past those suggestions. In the end I just tentatively agreed it would be at least a couple of weeks until our next session because I wasn't sure what else to say/do.

Yeah I could've pushed back and said that I wanted one sooner but I wasn't sure what the point would be if I didn't have a full and complete plan of what I wanted to do and talk about. It's always my job to have the whole roadmap, right?

I feel like this subtle shift of burden onto me (the burden of having to know exactly how I want to go about achieving my goals/outcomes 100% with little/no help from the therapist) is a way to softly and covertly phase out clients that are too difficult or complex. And it's happened to me EVERY SINGLE TIME.

"Therapy so awesome it helped me so much!!!!!!!!!"

 

[ConfusedClouds]

Oh @mango-meridian I relate so much to your experiences. I feel like trying to explain what I want is like narrating a game of whack-a-mole. It doesn't alleviate anything if I do manage to mention/describe it - it'll pop up again, just never on demand.

I have just stuck with the one therapist but I don't know if this is sensible/best or not. After a few weeks forcing myself to 'try properly', I felt like I hadn't gained any new words/insight to use to take to explain anything to a new therapist - I'd essentially be jumping around random reactions and historical connections all over.

I adapt the usual analogy of therapy untangling a ball of string of like me having a ball of elastic. One session we might find and end and be gradually teasing part of it out and feeling like we are getting somewhere but then 50 mins is up way too quickly, we have to let go of the 'end' and it springs straight back into the ball. So frustrating and sometimes even upsetting.

My one difference is your last post. I luckily haven't been shunned by her. Maybe as I stuck around too long at the beginning - forcing it to shut up friends who were concerned about me and saying I should 'talk to someone' - but then got so frustrated and confused and lost and trapped that isolated myself away from them, so the therapist is my only main continuous contact. Then finally 2 years later she is quite good at reading my non verbal reactions/signals. Which leaves me even more trapped with not being able to explain anything to anyone else. And still frustration at getting nowhere in 50 minutes. The same stuff still popping up all over.

 

[mango-meridian]

I feel like trying to explain what I want is like narrating a game of whack-a-mole. It doesn't alleviate anything if I do manage to mention/describe it - it'll pop up again, just never on demand.

Do you mean what you want from therapy or want in general?

But yeah I think we have some relatability. It sounds like we both deal with not being able to quite articulate what we are feeling/going through on the fly in a short time period. And what you do work through tends to snap back by the next week.

 

[notwhereIbelong]

I mentioned EMDR and group therapy as some other things we might try and she brushed past those suggestions.

Honestly, this makes it sound like she's not the best at her job. You shouldn0t just dismiss your clients like that. I'm a bit of a fan of EMDR as it has helped me massively, so if you're willing to give it a try you should push for that.

Since you say you already journal, you could try and use that to 'fix' the problem of not being able to get your thoughts across to your therapist? As in, reread your entries, and make some bullet points about stuff you'd want to bring up and work on to bring at your next sessions. I'm just throwing stuff at the wall and hope something sticks.

Personally I'm really peeved at her scheduling your next session two weeks away, usually that only happens when the patient is doing better and doesn't need as much support anymore, which I assume is not the case here.

Again, she may just not be the right one for you. Some people never find the right one. Another idea off the top of my head, ask her directly if she has any colleagues that specialize in EMDR (as an example) or who she thinks may be better suited for you? If she brushes you off again, just start looking for one on your own.

Hiccups during therapy happen, but it should be on the therapist to help you get over them.

Best of luck hun

 

[LaVieEnRose]

I agree with all of what you said and have has the same experience and impressions.

I think the clear conclusion is being skirted around. Therapy just isn't for you.

That's okay. It isn't for everyone. No way. And you said you like doing it because it feels like you're doing something conducive towards your mental health and that is in line with whay people say you "should" do.

That's understandable. But really it is okay if therapy is not for you. It really doesn't mean you didn't try or that you aren't trying to "get better". Critical people will always criticize how we go about our mental health.

Therapy has a lot of flaws and limitations as a concept.

And like you alluded to, it's unreasonable to keep on looking for that unicorn. That's not like looking for a needle in a haystack. That's like looking for a piece of hay in a needle stack since you'll have to go to poked and stuck by needles so many times.

 

[mango-meridian]

I agree with all of what you said and have has the same experience and impressions.

I think the clear conclusion is being skirted around. Therapy just isn't for you.

That's okay. It isn't for everyone. No way. And you said you like doing it because it feels like you're doing something conducive towards your mental health and that is in line with whay people say you "should" do.

That's understandable. But really it is okay if therapy is not for you. It really doesn't mean you didn't try or that you aren't trying to "get better". Critical people will always criticize how we go about our mental health.

Therapy has a lot of flaws and limitations as a concept.

And like you alluded to, it's unreasonable to keep on looking for that unicorn. That's not like looking for a needle in a haystack. That's like looking for a piece of hay in a needle stack since you'll have to go to poked and stuck by needles so many times.

I appreciate your perspective!

I like how you said it's okay if it's not for me. I think a lot of people assume that it should be for everyone and that it's the universal responsible the to do, e.g., "If it worked for me it must work for all." I think that program has been running in the back of my mind without me realizing.

I also like how you acknowledge that there are costs to continuing to look for the right therapist. Obviously, there is time and money, but there is also the emotional investment, not unlike that of a romantic relationship. You hope that it will work out and if it doesn't, it stings, and it can be hard to bring up the fact that it isn't working.



P.S. Love your profile picture!