Posted by Hermitian on February 18, 2008, at 10:39:37
In reply to Re: Therapy - Bang for the Buck? » Hermitian, posted by frida on February 18, 2008, at 9:55:52
Dinah, I'm pragmatic too, so please read on. I made it a point at the end of my OP of recommending this:
"But I would suggest to the people that gravitate to this forum who have had protracted relationships with therapists yet still feel dependent, that they sit down with them and map out a therapeutic game plan that points forward and an exit strategy."
That's all just sit down with the guy and ask those questions. Judgment is left to the patient who takes me up on it. The one who actually says, "Doctor, I've been seeing you for years now. I think it's time we formalized an improvement plan and exit strategy from therapy. Can you please set aside time to discuss this the next time we meet?" How hard is that? The therapist should not be insulted. In fact he should be happy that the patient finally wants to bail for positive reasons!
Now let me beat this dying nag of a thread to its unfortunate death by addressing some earlier comments. And I say unfortunate, because a topic area called Psychology implies a much more expansive discussion framework. That said, from previous posts:
Re: antigua3: "Developing a trusting relationship with a therapist and can take years for many."
Many years? Really? So say I'm conservative and "many" is only three years. And there are say 40 sessions per year at $175/session. If I do the math, it would take a patient 3 years, 120 sessions and 7 thousand dollars to form a trusting relationship with the therapist? What is wrong with that picture? Isn't it the therapist's job to effectively dialog with the patient to minimize that treatment phase? I can't believe after say 20 sessions (which is a lot of dialog) and nothing really happening, the therapist would not suggest alternative treatment. Now I'm not saying 20 sessions and a cure here, I'm stopping way short at trust establishment. That's it. Half a year and the guy can't get the dialog going with his patient? Then a full year? Then 2? Then 3? And the patient keeps showing up and shelling out? Sheesh...
And what is happening with recounting past traumas for years on end? Say a patient discloses genuine and significant past trauma. And therapist develops that thread in a sensitive way. Which is certainly appropriate. But then to stay with it for what 10, 20, 50 sessions? Two, four, six or more years? At what point has the subject exhausted itself?
All the therapist can do is provide insights and help the patient connect the dots. Once hes developed his own cause and effect understanding and has articulated that sufficiently to the patient, thats when the rehash no longer makes sense. When does the therapist say, OK that was then, this is now. Lets focus on now and later, not now and then. I mean the patient may recycle, which is certainly understandble, but youd think that the therapist would do the same with his prior guidance and then try to get back on the improvement topic. The question really becomes, is it crummy dialog management by the therapist or is he lazy or greedy or what? Whatever word you use to characterize his treatment style, it sure does not suggest "competent."
Augmenting what the Divine Miss K so concisely articulated, I'm not discounting attachment research. In fact, this is where the therapist-for-life really lays down on the job. Of course attachments change neuro-biological structures. That's why we have friends and families! Being with them is supposed to make us feel better! It's the therapist's job to get YOU attached to THEM, not to HIM. This is that huge, I mean gigantic opportunity cost again. Each years-out session plan with a guy who is warm and supportive without being skillfully challenging and truly instructive about forming genuine personal relationships and moving objectively forward is a time and money sink. Now that really stinks.
I am certainly not placing any blame on the patient for these relationships. I meant what the heck, they are searching for a solution. And if some patients continue to see a therapist for years on end with their eyes wide open about its benign but fundamentally marginal value, fine. But I'm sorry, when somebody has been in therapy for 6 or 7 years and still falls to pieces when the guy takes vacations suggests that something in the process is really broken. It's the therapists who extend and extend and extend patients who could be made more complete under a more effective regimen but don't know any better that give rise to my opprobrium.
Lastly, about therapist love and concern. Of course its genuine. But that's not the point of therapy. Empathy is greatly appreciated by us all. The therapist is supposed to be empathic in the context of providing a service that she charges for. Thats how she makes her living. Tell her the banks closed, youre outta cash and see how long that love lasts. Nothing wrong with that. The recognition just puts things in perspective when your are taking stock of the true nature of the relationship.
poster:Hermitian
thread:813285
URL: http://www.dr-bob.org/babble/psycho/20080210/msgs/813423.html