Posted by jane d on August 19, 2004, at 17:09:41
In reply to return to therapy, posted by fires on August 19, 2004, at 14:05:15
Hi fires,
I'm too disorganized to actually post much so we haven't communicated yet but I think I share some of your views. I've always been very skeptical of therapy and therapists particularly the ones that seemed determined to ignore the physical side of some behaviors.
I tried therapy recently encouraged by some of the members of this board and was pleasantly surprised. It's easy to forget that we aren't the only ones reading up on the research and adapting our opinions. I think a lot of therapists (in my opinion the good ones) have changed their thinking a lot since 1989. And there is a whole new generation who went thru training with the need to reconcile the actions of medication with their theories. Some of them did.
I hope you go in expecting the best. I don't think I did but I hope I hid it well. The problem I see with your approach if you really are that aggressive you seriously risk offending the kind of therapist that you do want. Nobody reacts well to being convicted in advance. A therapist who is respectful, non dogmatic and scientifically oriented is not going to appreciate you coming in assuming he is an idiot. He may not even know the history of attitudes that you are objecting to. Remember that the last bad therapist you encountered back in 1989 may well have left the field long before your current therapist even entered it. (If it makes you better try visualizing that former therapist now retired and living in a trailer in florida - at least until the storm last week :) )
I agree with most of what you say you expect in a therapist but disagree with some of the details. And the very first is that you have to demand everything. I guess I feel that if you have to demand this stuff then you've already got a problem and should go somewhere else. I found that all the things I would have stated as my "rules" were voluntarily offered. Often with an attitude of "of course. how could it be any other way." That was definately reassuring.
Now to nitpick point by point. (Don't you love it when a stranger does that to you? The joys of the internet!) And, that nitpicking is one of the things my therapist has to put up with even tho we never did discuss it.
> For the first time since 1989, I am planning to see a therapist. CBT only, for physical illness coping.
I believe I've seen you mention Fibromyalgia and CFS, right? I know thats a touchy subject to those who suffer from it for all the years of people insisting they didn't exist because they coulddn't identify a mechanism. But my complaint is depression and I'm a firm believer in biological causes for depression so I object to your making that distinction. I hope I'm misreading you here. Somewhere I read a description of therapy as a way of helping people cope with a physical illness (and it was mental illness being referred to) rather than as a cure for it. And a necessary way of helping since we are a long way off from a real cure. That feels about right to me.
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> My therapist (likely "she") will be informed of my rules on my initial visit. Any violation of my rules may result in my therapy being summarily ended. The rules are that I will not tolerate any of the following behaviors on her part:I'm not sure of your gender so I don't know if the issue here is the difference between male and female therapists (I have no idea if there is one but I wouldn't be surprised) or if what you want is someone the same sex as you or the opposite. Whatever it is you should do what feels comfortable to you. I feel strongly that I want to talk to another woman but it's not something I had the confidence to make an issue of when I was younger. I felt guilty about feeling that way and that I should "work it thru". At this point in my life I feel that I have far more important things to "work thru" than how I relate to therapists. Sure a specific therapist of the opposite sex might work for me but why stack the deck against myself from the outset. See who makes you comfortable without apology.
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> 1) Stating/implying that my symptoms are due to "emotions" and/or "stress".Again. I'm very very convinced that stress is a physical thing. I think it's possible that somewhere in the chain of events there is a non physical trigger but that we are so far from understanding it that it might as well not exist. Further I think you do get some kind of reciprocal interaction going that I don't even want to begin to think about. Any theory that claims that all physical symtoms are caused by something in the environment has to account for all the people who do just fine under the same conditions. I've seen this in myself. But I've also seem myself react to circumstances. So which part of this is the stress?
> 2)Any attempt to coerce me into believing any theory of hers -- that I have rejected.
I would think that this should go without saying. Bearing in mind that disagreement is not necessarily coercion. At least not for everybody. My therapist and I don't agree completely about psychology I know. But she's never been disrespectful of what I believe and since I respect her, and since our opinions on many things seem so similar I find the differences interesting. Who knows. She might end up convincing me of some of it. There's plenty I don't understand - especially when you get into that "touchy feely" stuff (no offense to anyone here intended - I'm just trying to mock my own rather strong biological biases).
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> 3)Addressing me by my first name prior to asking my permission to do so.I absolutely don't agree with this. I don't much like formality. Of course I expect to be able to use first names in return. But I wouldn't hold it against someone if they weren't sure about that up front. After all they might have just finished a session with you and been convinced of the importance of last names. I just want them to end up doing it the way I'm comfortable. I don't mind telling them that. (Well actually I very much mind having to ask for things like that but I'm trying to get over it.)
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> 4) Any behavior on her part that indicates that her thinking is too "fringe" for me or blatantly unscientific.Absolutely!! I think this falls under that "compatibility" criteria for therapists that never gets defined. But, if her last 9 opinions have been reasonable, I'd certainly ask a lot of follow up questions before I was sure that the 10th really was fringe and not a misunderstanding. I'm also careful these days not to assume that people are using terms the same way I understand them. Just because your therapist uses a buzz word that has been adopted by a fringe group doesn't mean she is endorsing that part of their ideas. The various understandings of the word feminism, a term I've been attached to for many, many years, currently floating around are the best example of that I can think of. (Actually there's a whole other diatribe there about the politics of that situation that I probably should leave alone).
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> 5)If she tolerates any behavior on my part which is whiny and/or age inappropriate.I don't know. I guess this is a personal preference. I'm for tolerance but not encouragement. I was asked at the very beginning however what I wanted out of her, and I think my response probably indicated something like that. I have no idea if she treats everyone that way. For the rest, I try to take responsibility for not bringing whiny or inappropriate behavior into the room. So far it works.
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> 6)If she fails to stay alert and/or awake.Of course. One of the things that amazes me is how focused therapists can be. I couldn't possibly do that for an hour but I'd love to learn that trick (technique?).
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> 7)If she encourages "needy" behaviors on my part.I agree. I really dislike the concept that you encourage dependancy to later overcome it. Seems to me later often doesn't come. And in the meantime you've lost your freedom to leave the therapy relationship. It makes me think of the kind of person in the office that protects there own job by making sure nobody else can find where they hid things. Of course it may be that excessive independance is one of my "issues" but if it is it's one I'm quite comfortable with.
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> 8)If she fails to give me my total amount of time (50 mins. ?)Of course but I'm a bit more flexible. If once in a while I'm cut short by a few minutes I'm not going to quibble. Especially if once in a while we go over by a few minutes. Again, it's a courtesy that I would happily extend any co worker who I liked (and not so happily extend to those I didn't).
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> Of course, I can choose not to summarily terminate her if I decide not to.Of course. Again. This should go without saying. But if you ever feel like you are doing her a favor by not terminating her, rather than just making allowances for human imperfection in someone who is otherwise helpful, then you absolutely should get out of there as fast as you can.
I guess that the nutshell version of this all which maybe I should have started with is I do not believe that therapists should get respect because they are therapists and you are a patient. I think that's backward. I think you should never get into a therapy relationship with someone you don't respect. And that respect is going to come in part from your finding the right person rather than demanding standard of outward behavior from them. I think I got lucky here and I hope you have the same good luck.
I think for your own peace of mind you should walk in taking for granted that that is exactly what you will get. It sounds to me like you already have the strength to walk away and find someone else if you don't so you don't need to rehearse that part the way I would need to. You're one up on me there.
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> Follow-ups to follow.Looking forward to them. I haven't written or posted this much in ages. I think you got a disjointed version of all the things that have been floating around in my mind over the last few months. Well not all of the things for which you should be very grateful.
Jane
PS. Who I am. Basically scientifically oriented, hates things that can't be proved, and have a great deal of trouble understanding them often. get very frustrated with people who don't understand the difference between what is proved or not and get even more frustrated when I think they are basically preaching my views but "getting it wrong".
And who, changeling child that she was, grew up in a family of social services types that thought things like math kind of strange. So I know first hand that there are very very good people out there who are honest, do care, and try to keep up to date. And who don't always buy all the jargon that gets into the media. Good people even if they do have to read those journal articles three or four times to get any sense out of them and can't do statistics in their heads.Again good luck. And some time we should have a conversation about how to ensure everyone gets a good therapist first time out.
poster:jane d
thread:379492
URL: http://www.dr-bob.org/babble/psycho/20040812/msgs/379586.html