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Re: can i jump in here for support too? platinumbride

Posted by fallsfall on April 4, 2004, at 10:03:13

In reply to can i jump in here for support too?, posted by platinumbride on March 30, 2004, at 23:03:36

Hi Platnum bride,

I didn't answer earlier because your question is pretty complicated and I had too much stuff in my brain as it was. I guess I didn't have the mental energy to delve into your question and give you a reasonable answer.

(As a matter of protocol, you probably should have started a new thread since, while the topic is the same you have a lot of details etc. But DON"T feel badly about that! We really are a very forgiving bunch, and I assure you that it won't be held against you (in fact it is already not held against you!). I mention this only because you asked.)

Now, to your question.

Do you know what kind of therapy your shrink is doing? Often MD Psychiatrists would tend towards Psychoanalysis instead of Psychotherapy. And, from your description, it sort of sounds like that: 3 times a week (though I am in 3 times a week therapy...), no structure, no continuity from one session to the next. Does he ask you to "free associate"? This is where you say everything that you are thinking whether or not it makes sense to you and whether or not you think it is important. It gets you into a mode where you aren't censoring what you are saying, so you tend to reveal more of your unconscious thoughts this way.

There are other kinds of therapy, and you might discuss with your shrink if one of those might not be more appropriate for you at this time.

CBT is very structured. You define problems in your current life that you would like to work on. The therapist helps you to see if there are any ways that you are seeing things that aren't quite consistent with reality (i.e. if your spouse never does the dishes, but you never ask them to, then you might be "fortune telling" - where you don't bother to ask because you already "know" what the answer will be). Then they would help you to recognize that and come up with a strategy to deal with it (i.e. try asking your spouse and tell them why it is important to you that they do the dishes - you could be really surprised with their response!). That's a pretty simplistic example, but the point is that you evaluate current problems, come up with strategies to solve the problems, try the strategies out, evaluate whether they worked etc. Often with CBT the therapist will even give you homework (like "tell your spouse this week that you want them to do the dishes", or make a list of all the times that you don't say something because you think you already know the answer).

CBT is great for a lot of people. It is a really good way to learn coping skills, so life doesn't *feel* so hard. Insurance companies like it because it is often time-limited (often CBT will only talk about a particular problem - the one you talk about when you start - and won't end up going off on tangents of other problems that might show up along the way. This is not always true, though).

I'm in Psychodynamic therapy. This is more like analysis in that we talk about my childhood a lot and *why* I feel and behave as I do. The basis of this therapy is pretty much Freud's theories. But, unlike analysis, you tend to have fewer sessions (2/week, or 1/week, or even every other week). And the sessions are more like conversations. There are analysts who talk a lot and Psychodyanmic therapists who don't, I sort of see them on a continuum (for instance, my therapist also does analysis, so I may actually get a mixture of the two). Psychodynamic therapists are less likely to ask for free association. The conversations have more give and take between you and the therapist (where with true free association, it is almost like the patient talks for 42 minutes, and then the analyst interprets for 3 minutes - well, that is an exaggeration...).

So, I think that it would be worthwhile having a conversation with your shrink. Ask what his therapy orientation is (it will probably be analysis, psychodynamic, humanistic, CBT (Cognitive Behavioral), eclectic (which means they use whatever they think will work best with each individual patient)). You can ask him to explain how that orientation works.

Tell him what you find frustrating about your sessions. Sometimes frustration is because you are in a type of therapy that doesn't fit what you need right now, sometimes frustration is because you are bumping into issues that you really aren't sure you want to talk about. So sometimes frustation means that you need to change therapists or therapies and sometimes it means that you have to work harder where you are.

It would be perfectly fine to tell him that you are frustrated with the way things are going, and that you want to learn more about therapy in general so that you make good choices for yourself. They are trained to be objective, and not be personally insulted if you don't like their style. I have found that most therapists really would rather have you see someone else, if that would help you. You really need to find the right "fit" (just like you do for a job or a spouse) with a therapist. Different therapists (and therapies) work better for different patients - or even for the same patient at a different time.

The money thing is not a particularly good situation. By the nature of therapy, the therapist has a lot of power in the relationship. Money is one of the few things that the patient has that balances things out. A therapist who has allowed you to go deep into debt without talking about it can put you in the kind of bind that you are in now. I would suggest that as part of this "evaluation" of your therapy that you address the debt. Try to find some kind of plan where the debt will be repaid (whether you stay or not). You don't say much about your financial situation, but it really isn't good for the therapy relationship for there to be long term, increasing debt.

Yes, I think you owe him a face to face discussion. As painful (and often embarassing) as these are, they are also frequently incredible learning experiences. Go talk to him. Tell him how you are feeling. Ask what your choices are. Ask what he recommends. Then follow your gut.

Let us know!
Good luck!




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