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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Lonely on January 29, 2004, at 23:34:05
In May of 2003 my therapist (LMSW) died rather suddenly from a disease. I had gone to her for 3 years and was absolutely crushed. I'm still grieving. I posted to this board and received some kindly support that I appreciated. I guess maybe it also helped to validate my grief.
Since then I've seen 3 different therapists and was told by the insurance I could only change 3 times a year. That left me with a therapist who was in the same group but a completely different person ... kind've blah, really. I've never developed an attachment to another therapist - maybe the old attachment was too strong, I don't know.
Today I became overwhelmingly frustrated when she tried to tell me that I should call up some old clients who are either dead or have moved on or who don't work at the same organizations. (I'm mostly self employed and business is slow.) She said she was very frustrated at my feeling of being helpless. I felt even more helpless - feel like I'm fighting the therapist who doesn't know a darned thing about my business and who should be more supportive. The original issues that caused me to seek help are overwhelming and in some ways have become even worse - seriously ill recovering alcoholic hubby, financial issues, career, and other complex matters. My deceased therapist also used to ride herd on the career issue and it never worked. I end up feeling more defeated, lowered self image, less feeling of "can do it." And then I really fought back - verbally - which put a strain on the relationship. I've tried to explain to both (when the first one was alive) about the best help I got in my life which was from a personal friend and colleague. That person has literally moved to the other side of the world and is no longer around to be my advocate. That's more what I need - and that seems to be totally outside the radar range of any lowly LMSW or psychologist. It would help if the therapist even acted glad to see me - my friend did, years ago, and I made enormous strides achieving levels personally and professionally I didn't know were possible. Are there any therapists out there who can get past their dual relationship anxiety and still have ethics and a different approach than 45 minutes of meaningless hot air?
Posted by gardenergirl on January 29, 2004, at 23:45:18
In reply to Wondering About Therapy, posted by Lonely on January 29, 2004, at 23:34:05
I can't imagine what it would be like to lose a T like that. I'm so sorry for your loss and the subsequent struggle to find someone else with whom you can develop a therapeutic relationship.
Can you say a little more about the dual relationship anxiety? I am a little confused about that.
But based on what you did post, I wonder what orientation your T's have been. You sound as if you would like a more client-centered approach or perhaps even psychodynamic. Either way, it sounds as if the relationship is most important to you rather than any specific advice given to you. You might ask your current T what her orientation is and how she describes your problem. This may give you insight into whether or not she "gets it." If not, you can help her to understand better what is going on with you and what you are looking for in a T.
Remember, this is YOUR therapy. She is working for you, and you are entitled to ask for what you need. If she is unable to provide it for you, perhaps when you are again able to change T's you can ask for a referral to someone who's orientation and practice is more suited to what you are looking for?
I wish you the best. It sounds like it has been a difficult road lately. Good luck.
gg
Posted by Lonely on January 30, 2004, at 0:35:29
In reply to Re: Wondering About Therapy, posted by gardenergirl on January 29, 2004, at 23:45:18
Thank you. I was upset when I was writing and was a bit flippant/tongue-in-cheek/creative (?) (not sure how to describe it)when I used the phrase "dual relationship anxiety." "Dual relationships", as I understand the term from reading on the 'net, means a situation where a therapist knows someone personally and also works with them in some sort of psychologically theraputic role. Normally that is frowned upon strongly, but I have read of cases, one in particular, where a therapist worked with a couple in a couples counseling situation even though he knew them socially. It did work out well and their marriage improved. I can tell you the name of the article if it's allowed here on the message boards. I tossed in the term "anxiety" with "dual relationships" because I feel like the therapists I know have gone a bit too far in being aloof and are much too anxious about having any relationship outside of the 45 minutes in the office - a highly contrived arrangement, albeit standard. Yes, I do want professionalism and I definitely do not want a physical relationship but I think I could benefit from some different approaches to therapy even to the extent that the person sees me in professional and social roles to give me feedback and help me improve.
Another place where I think the professional distance was taken too far was when my therapist died last spring. I was advised by a mutual friend to see her in the hospital. I did ultimately go up to see her but stalled around because I was afraid that if she survived she would be angry but of course, if she didn't survive I would never see her again. I actually did not see her because she was exhausted which was understandable; if I had gone earlier and not stalled around I might have seen her again. Missing that last chance has been very painful for me. There's way too much left unsaid and undone and forever without closure. To me that is a case of the fear of dual relationships gone amuck. I still tear up and feel hurt when I think about it.
You've made some interesting suggestions that I'd really like to follow up on. Could I ask you what a "client centered approach" is? Would I use that exact phrase if I was interviewing a potential therapist over the phone? Is that a type of therapy that is typically practiced by an LMSW? A psychologist? LMSWs seem to be far more commonly found in our insurance. What is psychodynamic?
Yes, I think you've hit the proverbial "nail on the head" when you said that it sounds like the relationship is most important to me. I think that's quite true - I guess I'm a fairly emotional person.
Thank you for your insights - it helps.
> I can't imagine what it would be like to lose a T like that. I'm so sorry for your loss and the subsequent struggle to find someone else with whom you can develop a therapeutic relationship.
>
> Can you say a little more about the dual relationship anxiety? I am a little confused about that.
>
> But based on what you did post, I wonder what orientation your T's have been. You sound as if you would like a more client-centered approach or perhaps even psychodynamic. Either way, it sounds as if the relationship is most important to you rather than any specific advice given to you. You might ask your current T what her orientation is and how she describes your problem. This may give you insight into whether or not she "gets it." If not, you can help her to understand better what is going on with you and what you are looking for in a T.
>
> Remember, this is YOUR therapy. She is working for you, and you are entitled to ask for what you need. If she is unable to provide it for you, perhaps when you are again able to change T's you can ask for a referral to someone who's orientation and practice is more suited to what you are looking for?
>
> I wish you the best. It sounds like it has been a difficult road lately. Good luck.
>
> gg
Posted by Dinah on January 30, 2004, at 1:13:17
In reply to Re: Wondering About Therapy » gardenergirl, posted by Lonely on January 30, 2004, at 0:35:29
Don't be afraid to ask for what you need, either. I often tell my therapist that he's trying to fix things again when what I need is for him to listen.
My therapist is very far from a blank slate, often uses self disclosure and humor, but there is no resemblance of our relationship to a friendship. And I doubt you'll find many or even any therapists who would be willing to see you in a social role, although you could ask if you could role play social situations to get feedback.
Maybe it's one of those situations where you need to look to more than one person to get different aspects of your needs met?
Posted by gardenergirl on January 30, 2004, at 11:03:33
In reply to Re: Wondering About Therapy » gardenergirl, posted by Lonely on January 30, 2004, at 0:35:29
> "Dual relationships", as I understand the term from reading on the 'net, means a situation where a therapist knows someone personally and also works with them in some sort of psychologically theraputic role.
Your definition of dual relationship is correct and it is discouraged, but not impossible. Your situation with your old T seems a bit different, however. T's and clients sometimes can't help but have inadvertent contact in the community. Most T's treat this by not acknowleging the client unless the client acknowleges them first. This way it protects the client's privacy. It seems like your visit to the hospital, although not inadvertent, does not really create an additional relationship. You were a client who was concerned about her T and needed something from her. What an awful situation for both of you!
> There's way too much left unsaid and undone and forever without closure. To me that is a case of the fear of dual relationships gone amuck. I still tear up and feel hurt when I think about it.
I'm so sorry this is still so painful. I hope in time you will be able to process this either with another T or with a good friend. Or even here!
>
> You've made some interesting suggestions that I'd really like to follow up on. Could I ask you what a "client centered approach" is? Would I use that exact phrase if I was interviewing a potential therapist over the phone? Is that a type of therapy that is typically practiced by an LMSW? A psychologist? LMSWs seem to be far more commonly found in our insurance. What is psychodynamic?Client-centered therapy was developed by Carl Rogers. Both LISW's and psychologists may practice. There are aspects of Rogerian therapy that pretty much all T's use, at least in the beginning stages of work and they are warmth, unconditional positive regard, and empathy. Client-centered therapy is one that is "led" more by the client. Whatever issues or needs you bring to the sessions are what the T works on with you. There is not really an agenda or specific approach the T uses, say as in CBT. This is an awkward explanation, but I hope it helps.
Psychodynamic therapy emphasizes the emerging and changing relationship between the T and the client through exploration of the client's past, defenses, wishes, desires, and needs. It is much less structured than CBT, which for some is great and for others feels too vague. In psychodyamic therapy, the goal is for the client to gain insight into what is in their unconscious, what is unknown to them, which then frees them up to behave in a different manner or feel differently about something. There is also a concept called transference, which is key. With transference, the client "transfers" or projects onto the T wishes, desires, needs, etc. which the client may have towards someone else in his or her life. For example, my own parents are highly self-centered. I never got much positive attention and validation from them as a child (or even now). That really hurts, and I still seek that "gleam in my parents' eyes" as my T puts it. I have, in therapy, transferred this need onto my T. I realized this when I wanted to call him to give him some good news about a recent school achievement. I realized I was becoming dependent on him, which felt scary, but also liberating to acknowlege and process with him. I hope this makes sense. My own preference is for psychodynamic therapy, so I feel like I know more about this.
When interviewing new T's or talking with your current, you can ask what their theoretical orientation is. There are many different ones they may say, or they may say "eclectic" which means they use techniques and stuff from many orientations. Or you can ask directly if they are CBT, client-centered, dynamic, etc.
> Yes, I think you've hit the proverbial "nail on the head" when you said that it sounds like the relationship is most important to me. I think that's quite true - I guess I'm a fairly emotional person.
You might also like interpersonal psychotherapy or emotion-focused therapy. These are not as common, but are still out there. But I think any therapist with a dynamic orientation may be good for you. That is if you can deal with the unstructured approach and with the T fostering the transference, which can be scary.
>
> Thank you for your insights - it helps.I hope this helped. Please let me know if you have other questions, and good luck!
gg
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