Day: August 31, 2015

“It takes a few tries to find the right therapist. Don’t give up.”

I was told variations of this multiple times by multiple people. They were people who had struggled in similar ways, so I believed them. Except that it was repeated often, in almost the same words. Following this seemingly simple instruction turned out to be very difficult that I began to wonder. Is this just a platitude? A thing we say to offer hope in a hopeless situation? Ultimately I’ve come to the conclusion that it is not just a platitude. It is a fact and a necessary process. By the end of this post it will be clear why.

I had no good methodology for finding the “right” therapist. Sometimes I went on recommendations from friends, neighbors, or primary care doctors. Though most of those recommendations were “I’ve heard of this therapist and have a vaguely positive impression attached to the name.” The few times I got an extremely specific recommendation from someone who had worked extensively with that therapist, the therapist was invariably closed to new patients.

I was left with trial and error, which is not a great process for someone who is struggling with feeling hopeless. Unfortunately this mirrors the medication treatment process for mental health as well. So we spent a couple of years trying this therapist and that medicine before switching things around. One kid got better, but not in any way I could relate to the therapy sessions she’d had. Two other kids got much worse. Until lately they’ve been better at least partially because of our experiences with therapy.

I’ve now had direct experience with seven different therapy relationships across four family members. At this point I can tell you far more about how to tell when you have the wrong therapist than I can about finding the right one. It finally occurred to me that this is actually useful information. No one told me what should constitute “not working” and so I stayed in several of the therapy situations much longer than I should have. It is hard to make good judgement calls in the midst of emotional chaos. It is even harder to abandon groundwork that you’ve spent effort, time, and money to establish in order to start over with yet another complete unknown. The thought of having to start over kept me doing “one more session” for weeks. So I’m going to tell you the knowledge I gathered from my experiences. Then I’m going to tell you the stories of how the therapists we had were wrong. From the combination you may be able to glean information to inform your decisions.

Knowledge

My experiences are not universal, some of what I say here may not apply in your situation or may be wrong for you. Listen to your own instincts, which can be hard in the midst of emotional chaos, I know. Listen anyway. Only take the pieces of advice that help you. Discard the rest.

It should only take 4-6 sessions for you to build a rapport with a therapist and start doing emotional work that is beneficial. If you don’t feel these things, move on.

It is not rude to abandon a therapy relationship. You don’t have to apologize or even explain. You can say “this isn’t working” or you can simply cancel your appointment and go elsewhere. Therapy professionals will not be offended or hurt. They understand that some relationships just don’t click.

Your therapist should never make you feel judged. If you feel judged you are not safe to find out what you really think and feel.

If you’re helping someone else with their therapy, how they feel about the therapist matters more than how you feel about the therapist.

It is normal to sometimes resent your therapist, but if that is happening week after week, it is time for a different one. Resentment is a sign that you feel attacked, which means you don’t feel safe with the therapist.

It is easier to have a regularly scheduled appointment than to have as-needed appointments. If you need a non-regular schedule, don’t leave the therapist’s office without scheduling your next appointment.

A sign of a good therapist is that they’re willing to change tactics when one is not working.

One of the reasons it may take several tries to find the right therapist is because you don’t know what you need until you start dealing with one. It is an iterative process.

There are different methodologies in therapy, what helps one person will be ineffective with another. Sometimes the therapist is a mis-match because they’re most comfortable with a methodology that doesn’t work for you. (IE: cognitive behavioral therapy when what you need is PTSD focused therapy or dialectical behavioral therapy.)

The financial cost matters. Sometimes a therapist can be wrong for financial reasons, because high cost can give your brain yet another argument not to go. This stinks, but it is true. Many universities have low-cost clinics where their grad students get to practice being therapists.

The therapist should be respectful of the anxiety and emotional energy that goes into admitting help is needed. One who doesn’t answer phone calls or drops you as a client is the wrong therapist, no matter how good they might be when you actually have an appointment.

Stories

Therapist #1: For Gleek. The therapist was young, a grad student. I thought this would help her build a relationship with Gleek. But all the sessions ended up with me and Gleek together sitting on the couch. The therapist spent most of her time dissecting the parent/child relationship rather than digging in to find out the inner workings of Gleek’s thoughts which Gleek hid behind a shield of chatter. I came away from most of those sessions feeling resentful and judged. It is likely I was projecting my own self-judgements onto the therapist, but she wasn’t sensing or solving that. The therapy relationship ended because the therapist graduated and moved away.

Hindsight: The therapy format was wrong for what we needed. It was set up to treat the parent/child system and ended up giving me lots of parenting advice that I already knew and had already applied. The next time I set up therapy I specified individual therapy.
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Therapist #2: For Gleek. She was a woman in her fifties with a long practice dealing with children. I deliberately sought that out because I wondered if my reaction to the other therapist had been an inexperience problem. This therapist was recommended to me by Gleek’s church leader, specifically because the therapist did art and play therapy. I found the therapist good and easy to talk to, but Gleek became increasingly resistant to going. “I don’t like how nosey she is.” Gleek said. Ultimately Gleek was doing so much better (because of medication and changes at school) that the therapist and I agreed we could stop therapy for a time.

Hindsight: Gleek did not have the right rapport with the therapist, so the therapy was not working as it should. It is possible that the therapist and I could have banded together to push through her resistance. Instead we opted to give her some control. That turned out to be the right call. We did establish that if life gets hard again, back to therapy we’ll go. But we’ll pick a different one.
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Therapist #3: For Link. I chose to go through the comprehensive clinic at BYU in part because it was far less expensive than other options and we were paying out of pocket for everything. I also thought that a young male therapist might have a better chance to connect with Link. This meant a grad student therapist again. By week four the therapist was having trouble getting Link to open up, so he brought me in for a joint session. It went really well. Unfortunately this meant that the therapist always brought me in for all the sessions. It became relationship therapy between Link and I rather than the individual therapy that Link needed. He needed solutions which did not include me. Also I think that speaking with me was more emotionally rewarding for the therapist than speaking to Link. The therapist could poke at my pain and induce me to open up. He was completely unable to do the same for Link. I kept trying to keep him focused on Link, but we ended up talking about me half the time anyway. It took weeks of me being increasingly stressed and resentful of the therapy, and Link feeling the same way, before I recognized the problem and called the clinic to request a different therapist.

Hindsight: This was a similar problem to the one with therapist #1. We had different visions for what the troubles were. I probably could have had a meeting with the therapist and re-calibrated the treatment, but starting over was less work and Link was more likely to cooperate. Continuing to make Link go to a therapist he didn’t like would have damaged my relationship with Link.
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Therapist #4: For Sandra. This was actually the same therapist as #2. She hadn’t worked for Gleek, but I’d enjoyed talking with her. The interactions with Therapist #3 had forced me to see that I was struggling, so I made an appointment. It went well. So did another one. Unfortunately she was by far the most expensive therapist we’d gone to and everything was out of pocket. We finally got onto an insurance plan which covered mental health care (Yay Affordable Care Act!) and she wasn’t listed on the plan. I’d paid her prices for Gleek, but it was harder to justify paying her prices for me. So I’d delay between sessions until I was in crisis. Then I’d call for an appointment…and she’d fail to call back. I’d call again and she texted two days later saying “I have an appointment available in two hours, does that work?” It did not work. Also, I’d requested a phone call to make the appointment, not a text. Ultimately these communication issues were the reason I dropped her. If I gathered the emotional energy necessary to call and set up an appointment, I needed the process to go smoothly rather than stretch out for days adding stress to my life.

Hindsight: She was a good therapist, but her business running skills interfered with my willingness to go to her. My next attempt at therapy for me will be an office with multiple therapists and a full time secretary who handles appointments.
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Therapist #5: For Link. This was the therapist we were assigned after therapist #4 went badly. I’d considered changing away from grad students, but decided to give it one more shot. By this time I’d been told the advice about giving a therapist 4-6 sessions to connect, so that was the plan. Right around session four, the new therapist ran aground in almost exactly the same way as the prior one had. Link wasn’t opening up. He’d give answers, but they were mostly shrugs or “I don’t know.” This therapist met with me separate from Link and hammered out a new plan. He started playing games with Link. The whole goal was to connect first and then gradually use that connection to teach Link how to connect without games. Then they could get at emotional issues. It was a brilliant plan. I approved. I think it would have worked. Unfortunately about a month later the therapist made a personal decision that took him out of the grad school program. He worked to hand us off to another therapist, and was as conscientious as he could be, but it was still a big blow to Link and to me.

Hindsight: Not much useful to offer here, except that this process can be hard in unexpected ways.
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Therapist #6: For Link. This was the therapist that therapist #5 handed us over to. They had this nice transitional plan where the new therapist would attend sessions with Link and the prior therapist. She was a young and pretty grad student. Link met with her twice and told me that he wasn’t comfortable with her. I wasn’t surprised. There had been a young pretty female math teacher at school that Link had refused to go to for help. Talking to people is hard for Link. Talking to girls is even harder. I called off the appointments and put Link on a therapeutic hiatus while some other things settled down in our lives.

Hindsight: Link needed an older brother/ role model and a young female therapist was not going to work in the same way. An older, motherly or grandmotherly woman would probably be fine. Any future therapist selections for him will keep this in mind. I’m also likely to try a therapist with a different approach, such as dialectical behavioral therapy instead of cognitive behavioral therapy.
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Therapist #7: For Patch. I think we began seeing this therapist before Link’s good therapist quit, but I’ve put her last on the list because she’s the only one whom we’re still seeing. She’s a grad student at the same clinic as Link’s therapy. She and Patch hit it off right away. It helped a lot that I recommended that games be part of the therapy. (Having learned from Link’s experience that this can foster connection.) I can tell the therapy is working because Patch doesn’t resist going. Often he is excited or happy to go. Also the therapist usually brings me in for the last few minutes to let me know what they talked through and what would be a good focus for the week ahead. I know that they really are beginning to dig down in and untangle some of the emotional knots that Patch has been carrying around.

Hindsight: This is how you know when therapy is working, life feels easier. It is subtly easier so that you may not even be sure if it being easier is because of the therapy.
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I don’t have many concluding thoughts, except to say that writing up this post helped me to see why it is sometimes necessary to try multiple therapists before settling. Each therapy relationship helps you learn more about what you need and want in a therapy relationship. It is not a failure to need to ditch one therapist and try out another one, it is a refining process. I wish I’d known that when I first started, it would have made the process easier.