![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 57. Go back in thread:
Posted by antigua3 on February 17, 2008, at 19:32:00
In reply to Therapy - Bang for the Buck?, posted by Hermitian on February 17, 2008, at 14:42:08
OK, I'll take a stab at this, knowing that i'm not an expert, but certainly have had a lot of therapy and dealt w/probably every aspect of it that is helpful and unhelpful:
>there are a few things I dont get from reading the posts here.
>
> One is the length of time of some therapist patient relationships. Some of them apparently last for years. What exactly are the therapeutic goals in those relationships?<<Developing a trusting relationship with a therapist is very important, and can take years for many. Many people need/require the trust until they can open up and explore how past events are influencing their lives today.
>> Does the therapist ever explicitly spell those out? At what point is a therapist obligated to tell a patient that he/she has taken them as far as they can go?
>>Yes, I think many therapists tell patients they've taken them as far as they can go, and hopefully it's a mutual decision.
<<In my view, the implied open ended therapist-patient relationships border on malfeasance. I.e. the therapist using a patient as a cash cow without providing any real additional clinical benefit.
>>I used to accuse my therapist that I was just an appt. time/money for her, but once I got past that point and realized she was there because she cared, I was able to really get into my therapy, knowing that she cared.
>
<<The second question I have is related to the apparently excessive focus of session dialogs on past events.>>This is definitely the psychodynamic approach and not all therapists use it. Some use CBT, which is focused on changing behavioral reactions to current events that bring up past events. It works for many, not so well for others who need to explore the underlying event fully before they can make the behavior change in current life.
<<Once what has happened in the past is acknowledged to be true, whats the point of rehashing old ground?>>Acknowledging what has happened in the past to be true is a huge thing. at times, I still don't belive (irrationally, of course) that some of these terrible things could have happened to me. So acknowledging and dealing with the pain that it has caused can take a very long time. Sometimes outside verification is needed to point out the truth, and dealing with that can be very difficult.
<<At what point does the dialog become future focused? Apart from the hugs and soothing conversation, what therapeutic mechanism drives improvement in the patient? In fact, if the therapist consciously steered the dialog into a future seeking direction, maybe the hugs and soothing would not even be necessary because the focus is positive.
>>in many ways, my therapy is always future focused. How can I deal with the past so it quits interfering with my future relationships, etc. It's not as easy as it sounds. Breaking old abusive patterns can be a life-long commitment--to recognizing that they are occuring and stopping youself from engaging in them.
IMO, while many therapists deal with the past, their goal is to make us functional in the future. My pdoc doesn't focus on the past, unless it gets in the way of a present event and we work together to see how I can behave differently. But that never could happen unless I had already explored the underlying issues with my T. My pdoc's approach can be very harsh, and I would assume very damaging to someone who is just skimming the surface. Those old demons come back to bite you if you don't deal with them and put them away.
<<Is it so hard to understand that you get what you focus on? You focus on pain, you get pain. You revisit the same crummy life experiences over and over with a therapist, all it gets you is poorer. Does it not make sense that if you change your focus to a positive outcome and you are much likely to realize one?
>
>>Again, for full recorvery for many, dealing with the pain allows them to move forward. There is no time set for this; it's different for everyone.
>
<< Thirdly, do any of these therapists treat a patient holistically? I mean suggest they exercise and diet properly and engage in an active social life? And even beyond suggesting, actually challenging them in an appropriate way to step up holistically.
>
>>I think plenty of Ts and pdocs take this approach. I don't know many who don't. Taking care of the whole self is very important, but you can't MAKE anyone do anything; it's up to the individual person, but the T or pdoc does point out how much better a person might feel if they took a full body approach to the problem.<< Now where do I come from dropping out of the sky, issuing these kinds of comments? Well I started seeing a psychiatrist for ADD in the beginning of 2007. And of course I carried along some other baggage with that. So I then had talking sessions with him every two or three weeks for the better part of the year. And the discussion framework focused around one implicit rule and one objective. The rule was to minimize past thinking because it provides no value once it has been harvested for understanding.
<<There's a key point here: "past thinking...provides no value once it has been harvested for understanding."
Who is it to say when a a past thinking has been fully harvested for understanding? You seem to be very lucky that this happened quickly for you. It doesn't happen that way for many othr people. It can be a very long-term, painful process for others, like me.
>>So the past was surfaced, acknowledged and then put in the back of the closet where it belongs. And planning a future around complexity takes too much energy. Why not make it simple? So we disassembled the architecture into more simple components of connecting activity to objectives. I asked my guy one time early on why I was behaving in an unproductive manner even though I was taking medication and it was working. He looked at me straight on and told me, Because you want to. Youd rather do that than do something productive. The only thing thats going to change that behavior is you finding a more compelling reason to spend your time another way. I cant tell you what you want fundamentally. Thats your job to figure out. So why dont we talk about future objectives that are more compelling?
<<I'm glad you found a way that works. But it's different for everyone.
>
antigua
>
Posted by sunnydays on February 17, 2008, at 20:32:54
In reply to Re: Welcome to Babble, posted by Hermitian on February 17, 2008, at 17:50:27
In my experience, my therapist and I say have seen each other for a long time and don't have specific goals per say. And he can be warm and nurturing. But he also pushes me to make more friends and to live life outside of his office. Not to reconnect with family, because it is not healthy for me to speak with them (it makes me feel much worse). He encourages exercise, even though I resist it, and I actually exercise far more than I ever would if he didn't suggest it. I wonder why you feel the need to share this opinion of yours with those who feel that they have successful therapy relationships? I know that CBT works - I just don't happen to want to have a therapist that practices specifically that. I also know that a more eclectic approach improves my life.
sunnydays
Posted by Phillipa on February 17, 2008, at 23:16:09
In reply to Re: Welcome to Babble » Hermitian, posted by sunnydays on February 17, 2008, at 20:32:54
I guess I have the CBT type as she doesn't want to look back only acknowlege it and move forward. We're all different here with different needs at different times. Phillipa
Posted by DAisym on February 17, 2008, at 23:49:25
In reply to Therapy - Bang for the Buck?, posted by Hermitian on February 17, 2008, at 14:42:08
I would suggest that if you are really interested in some answers to your questions that you take a look at the attachment research. More and more it is being shown that the connection between therapist and client can actually change some of the neurobiological structures and help individuals learn to be less anxious, less self-destructive and more capable of sustaining relationships.
Learning to trust someone when you've been traumatized can be hard and can take time. Most therapy is hard, painful work - it hasn't been my experience that people are going in and having tea time each week. The idea of a paid-friend is one of those myths that persists and yet I'd guess most therapy clients would not characterize their therapy as a "fun time spent with a friend."
As lots of people have said, there are many kinds of therapy and therapists because there are many kinds of people. It occurs to me that we often discuss here long therapies - there is worry about it taking too long, or dependency, etc. But should we not also worry about short therapy and individuals who can't or won't attach? Can we assume that instead of being overly dependent that they are perhaps in denial or overly-defended against their feelings? How can we tell? I read somewhere of a therapist who swears he can "cure" almost anyone in three to six sessions. How can he know this?
I am very glad for all the research being done right now because sometimes I think people decide what they think about therapy - inclusive of techniques, medications, frequency, length of time, gender -- all of it -- based on a gut response or limited real (not media) experience with it. That includes those of us who might shake our heads at the 3-6 session guy. We need facts and lots of experiences to help us know what really helps, what harms and what is just a waste of money. Even then, we'll all still likely believe a whole bunch of different things.
Which is why I find the whole field fascinating.
Good discussion...
Posted by LadyBug on February 18, 2008, at 0:04:46
In reply to Re: Therapy - Bang for the Buck?, posted by DAisym on February 17, 2008, at 23:49:25
Great post Daisym.
And my thougts are like this:
I think that everyone seeks therapy for different reasons and if I go to my T for 11 years, then that's my choice. It's my money, my time, my heart and soul. So why would someone pass judgment on other people just because they did what worked for them?
If I want to pay my T to see her, to feel close to her, to trust her like no one else, then good. I've needed to know that there is someone I can do that with in order to find that I can do that in real life.
My marriage has got to have been the worst of the worst in many ways. She helped me be brave enough to leave and it took me this long to do it. Not her fault, I had to grow strong enough to leave.
I've had to overcome and deal with so many hurtful things the past 10 years. Can I deal with things better now that I did 10 years ago? YES!!!! And I owe my T for helping me do that. For that, my time and money have been worth it to me.
We worked together, the relationship was and is strong. I'm glad I've stayed as long as I have, otherwise I'd still be dealing with the old me that couldn't handle a thing. I had no coping skills! Now I have many.
And I so agree that psychotherapy changes the brain chemistry like you explained.LadyBug
Posted by MissK on February 18, 2008, at 8:45:33
In reply to Therapy - Bang for the Buck?, posted by Hermitian on February 17, 2008, at 14:42:08
>Is it just me or what?
No. I hold the position as well that the point of therapy should be to no longer need therapy.
>I asked my guy one time early on why I was behaving in an unproductive manner even though I was taking medication and it was working. He looked at me straight on and told me, Because you want to.
I agree to a degree. In theory a person will do or not do what they want. That said though it could discount the psychology of why it is a person does or does not do certain things. Therapy, or more specifically talk therapy, can let someone talk for as much or as little as they want on that 'why'.
>Thats your job to figure out. So why dont we talk about future objectives that are more compelling?
Yes, and particularly in talk therapy, the therapist will let the client talk about whatever they think they need to talk about to figure it out. Concerns future objectives, it's been my experience that the therapist will not lay out a 'game plan' as it were, rather will let the client figure that out as well through the talking. A therapist is not a coach after all. There are therapies that are exercise and goal oriented, though what you see on the board here is mostly of the talk, talk, talk, talk, talking kind. Therapy is a service that will let a person talk for however long they want.
I've been in therapy not quite two years. I see that extending to two and a half or three years. I don't see it extending to five, ten or fifteen years. Therapy can be as much a want as a need. I think there are those that want it as a part of their life for a long time. As long as they distinguish that is what they are doing and distinguish who this person is in their lives, I won't say it is wrong or right.
Posted by MissK on February 18, 2008, at 8:54:17
In reply to Re: Therapy - Bang for the Buck?, posted by DAisym on February 17, 2008, at 23:49:25
>But should we not also worry about short therapy and individuals who can't or won't attach?
Do not assume that 'attaching' is the goal and be all and end all for everyone in therapy. Not everyone needs that or even wants it in therapy and, I belive in the therapeutic context, the attachment is meant to be limited.
In actuality, one should be attaching to other people or to better attach to the important people in their lives, which I believe is the point of anyone seeking to 'attach' in therapy.
Posted by MissK on February 18, 2008, at 9:00:16
In reply to Re: Therapy - Bang for the Buck? » DAisym, posted by LadyBug on February 18, 2008, at 0:04:46
> So why would someone pass judgment on other people just because they did what worked for them?
I don't think he is passing judgement. I think he is trying to understand why it is therapy is required for years and years.
I don't think most of us went into therapy saying and thinking: "Okay, this will take 10 or 15 years or the rest of my life." No, I think most of us went in thinking we will eventually not need to do it anymore.
Posted by MissK on February 18, 2008, at 9:30:49
In reply to Re: Welcome to Babble » Hermitian, posted by sunnydays on February 17, 2008, at 20:32:54
>I wonder why you feel the need to share this opinion of yours with those who feel that they have successful therapy relationships?
He's entitled to share it. There are different perspectives out there. Is a short, or short as possible, therapy relationship any less successful? Believe it or not, there are those that believe the point of therapy is to address whatever one's problem is and leave therapy sooner rather than later.
Posted by frida on February 18, 2008, at 9:55:52
In reply to Therapy - Bang for the Buck?, posted by Hermitian on February 17, 2008, at 14:42:08
Hi,
I've been seeing my T for 8 years now.
I agree with what Dinah, Daisy and others have shared so far. It all depends on the needs we have, the therapy we need, what we're looking for,etc.
I wouldn't be where I am if it weren't for my T.
When you've been abused for 15 years or so since you were a little child, it takes time to build trust in others and in yourself..it takes time to learn that it's ok to talk, that you matter, it takes time to recover faith in life in general. You can't expect that 15 years of everday torture won't have an impact on your present and future life.
My T is helping me with that impact...so that i don't sabotage my present relationships and i don't stay trapped in those situations. Talking about it (which i can't do fully) helps to understand and put things in perspective and break the silence and secret. Keeping it all secret and never sharing with anyone is like living in hell all the time, as continuing the same secrecy and shame and isolation of the abuse.
I know that it's hard for other people to understand, if you haven't been there and that's OK.I've found that no matter what, what happened still interfers and influences my present. Being able to talk helps you see the difference ...
When you've lived without having some basic needs met, that just doesn't go away because 'it's in the past'. I feel grateful that my connection with my T has helped me repair some of that, and that my T is so committed to our work together.I have no doubts that she does care about me and values what we share.
I'm glad you found a therapy framework that works for you.
Frida
Posted by frida on February 18, 2008, at 10:01:25
In reply to Re: Therapy - Bang for the Buck? » Hermitian, posted by MissK on February 18, 2008, at 8:45:33
i guess i don't agree that the goal of therapy should be not to need therapy any longer. I understand why you'd think so..We all have different opinions, experiences and needs.
my T has changed my life in the 8 years we've known each other. I think that she'll always be part of my life somehow. I feel grateful to have had this chance and this deep relationship that has enabled me to recover faith in life.
She has become really important to me and I love her dearly, and I know that what we've shared has changed her too. I feel grateful for that, and we've talked about how we'll always be part of each other's lives.but we all have different ideas and opinions.
I guess it's difficult to understand if you haven't experienced that bond or the life experiences that have led you there.Frida
Posted by MissK on February 18, 2008, at 10:07:46
In reply to Re: Therapy - Bang for the Buck?, posted by frida on February 18, 2008, at 10:01:25
>i guess i don't agree that the goal of therapy should be not to need therapy any longer.
Fair enough. That's how it's evolved for you. What were your thoughts going into therapy?
Posted by Dinah on February 18, 2008, at 10:17:22
In reply to Re: Therapy - Bang for the Buck? » Hermitian, posted by MissK on February 18, 2008, at 8:45:33
> Therapy can be as much a want as a need. I think there are those that want it as a part of their life for a long time.
I have been taking several medications for a long time. I imagine I'll take them for a long time more. Are they a want rather than a need? Should I stop taking my migraine prophylaxis? I take it even when I don't have a migraine.
My therapist and I, have discussed this topic at enormous length and excruciating detail. And to me, what we have concluded is the important thing. Since others have little access to the information that my therapist and I have. Nor do I wish to make that access more widely available. My general assumption is that I have as little access to the information that would be pertinent to the decision for others as they do for me.
But on the other hand, if I can't accept that there were *always* be people who find my choices incomprehensible or worse, while being clear on who I am and that my decision is right for me, then my years of therapy won't have been much benefit to me.
It does occur to me that from a pragmatic viewpoint it is unlikely that negative statements about long term therapy will do anything but harden the hearts of those in long term therapy. And that a more efficacious response might be to extol the virtues of focused short term or medium therapy. Or to talk about how one is looking forward to termination and to moving on in life. Or to talk about how goals are being met, and contributing to overall wellbeing and the eventual end of therapy, which is one's overall goal.
After all, few people are likely to say "My god, you're right! I've been a bloody fool. I shall go immediately and fire my therapist of fifty years, because no one else has ever pointed out with such eloquence the folly of my going to therapy for fifty years!"
One may be rather more likely to consider that fifty years of therapy has shown more benefits than one has otherwise considered.
How much more persuasive (or at least it seems to me) it would be to tell of the wonderful benefits of being in medium or short term therapy. To show by example and by words that medium or short term therapy is clearly enormously beneficial. That medium or short term therapy helps people gain wisdom and compassion and resilience and tolerance, or whatever all the many qualities that help with mental health might be, as exemplified by medium or short term focused therapy.
Or so says my pragmatic soul. And my thirteen years of therapy.
But I could be all wrong. Perhaps people are equally persuaded by statements that people are wasting their money with therapists who are only out for a buck and are totally irresponsible at allowing open ended therapy, and that such therapy may feel good but is not a need but a want. But that people are certainly entitled to spend their money to feel good once a week while other areas of their lives languish. If I am understanding the arguments correctly... Which I fully admit I may not be. Perhaps certain phrases are catching my attention and drawing it away from the overall point.
In which case I proffer my apologies for my misunderstanding.
I was about to start a post to you yesterday, Miss K. Telling you that you reminded me of me in many ways, in that we both seem to be quite pragmatic. And expressing a gladness to get the chance to talk to you on Babble. So I'll just include that here. :)
Posted by sunnydays on February 18, 2008, at 10:34:49
In reply to Re: Welcome to Babble » sunnydays, posted by MissK on February 18, 2008, at 9:30:49
> >I wonder why you feel the need to share this opinion of yours with those who feel that they have successful therapy relationships?
>
> He's entitled to share it.**** I didn't say he wasn't, and I didn't mean to imply he wasn't. I was simply wondering about the why... why as a new person on the board, that was what he felt compelled to share. I seriously don't mean to imply there is something wrong with it, I am just curious.
There are different perspectives out there. Is a short, or short as possible, therapy relationship any less successful?
**** Nope, it's not any less successful. Plenty of people find short therapy relationships to be incredibly beneficial. I just don't think that the answer for everyone has to be to have a short therapy relationship. And I know that's not what you're implying.
Believe it or not, there are those that believe the point of therapy is to address whatever one's problem is and leave therapy sooner rather than later.
**** Yes, I believe that. And you know what, that's my goal too. I just happen to know it is probably going to take me years and years and years. I have been severely traumatized, and there are a LOT of trust issues that go along with that. One little rupture or slightly off interpretation on my therapist's part can take an entire session to repair, so it takes a long time for me. I hope to address my trauma as quickly as possible - I keep complaining to my T that this is taking too long. I don't know about leaving therapy. This is the first relationship in my life that has been supportive. My T has told me I can come for as long as I want to, and I plan on it. I suspect new challenges with the trauma stuff will arise as I start dating and get married and all that stuff, so I suspect therapy will be useful for me for quite a while.
sunnydays
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.
Posted by Dinah on February 18, 2008, at 11:19:33
In reply to Re: Therapy - Bang for the Buck? » MissK, posted by Dinah on February 18, 2008, at 10:17:22
I don't suppose that anything I write will cause you to say "My God! I shall change my conclusions forthwith because no one has ever before explained so eloquently the benefits of long term therapy!"
So I don't think it would be of any advantage to you for me to answer substantively.
I will say that it is possible for an intelligent and thoughtful person to consider the same points that you, as an intelligent and thoughtful person, consider, and reach a different conclusion. This is what I've been taught is the difference between fact and opinion, or conclusion.
Recently, my husband (with whom I have an excellent relationship) and I were attending a discussion about controversial issues with several new friends (with whom I am developing, and hope to continue to develop, an excellent relationship). My husband expressed concern about whether such a discussion could turn unpleasant. And I told him that I had every hope that people who respected each other would behave respectfully toward each other, and allow that reasonable and thoughtful people can examine the same facts and come to a different conclusion.
After all, that's what controversy is, isn't it? It's a topic on which reasonable, intelligent, and thoughtful people have examined the same facts and come to different conclusions.
Posted by Dinah on February 18, 2008, at 11:20:50
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 10:39:37
Posted by Dinah on February 18, 2008, at 11:58:42
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 10:39:37
Also, since you are new here, I thought I'd give you a friendly nonofficial heads up about the civility guidelines.
http://www.dr-bob.org/babble/faq.html#civil
Posted by frida on February 18, 2008, at 13:33:02
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 10:39:37
I must say i don't agree with the points you've expressed...
I guess it's hard for someone who hasn't understood or been thereWhen you've been tortured for 15 years, every day, of course it takes time to build trust. Yes, it takes years for some. It took me a year and a bit more to even tell my T i had been s.a by my father for that long. And what happened during that year wasn't "nothing". It was building trust, something i had had shattered for years at home.
Maybe you are not considering that past trauma doesn't just go away and stays in the past. It affects your every day life and issues. It isn't something you talk about some sessions, or a year, and then that's it, it doesn't affect you anymore. It is there, and it affects what happens in your life.
Even though it is valid to hear that was then, this is now..that doesn't solve things. I find it much more helpful to talk about things so i can truly feel that way and what is happening now that is triggering something from those issues stops happening or gets better. My T has plenty experience and i find it a little hurtful that you say that that kind of treatment style would be "greedy" or "lazy".
My T has done so much for me to help me talk and heal some of the scars of childhood sexual abuse.I agree that we have family (well, not everyone has) and friends, but a T's role is much different and the relationships we form are unique.
You say "Tell her the banks closed, youre outta cash and see how long that love lasts".My T would continue seeing me and I'd pay her when i can. I've done that when I've been in finantial troubles. She waited for me for months and one year I just couldn't pay everything, and she told me that she valued my effort and to accept that I was paying as much as i could and that was fine for her. I know she genuinely cares about me and she has told me that a thousand times. I know that if i couldn't pay that love wouldn't just go away. We'd find a way for me to see her if i needed to.
I don't know if you were asking me, or someone else, but when I entered therapy, i wanted to find a way to feel worthwhile and to feel it was ok for me to be alive. i wanted someone to help me stop feeling dead inside.
and i found that...
yes, i've been in T for 8 years. But 15 years of being hurt, plus years of internalizing those 'teachings', take time to overcome.There are very good T's out there , and long-term therapy works for a lot of people.
Maybe it just doesn't for you, but it does for a lot of us.If you haven't experienced this, I guess it's very hard to understand.
Frida
Posted by frida on February 18, 2008, at 13:36:47
In reply to Re: Therapy - Bang for the Buck?, posted by MissK on February 18, 2008, at 10:07:46
Hi,
When I entered therapy I couldn't think of a future. I just wanted to be able to find life bearable and be able to feel safe for once...
I wanted to be able to trust someone for the first time ever without having that trust betrayed and abused.Frida
Posted by sunnydays on February 18, 2008, at 15:29:21
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 10:39:37
What is broken is that the patient has suffered severe trauma. I will not assume you haven't suffered trauma, but in my experience, some people who haven't suffered trauma don't understand the extent to which it can damage one's ability to trust ANYBODY. Being able to trust the therapist is the first step to being able to trust other people. And after 10 sessions of me not talking hardly at all, my therapist asked me if I wanted to continue, and I did. Because I WAS getting something out of the sessions - I was learning that people will sit with me and listen to what I have to say and not criticize me or hurt me. One can't assume that that is a given to everybody. For those who have been severely traumatized trusting is a skill that must be learned. And, like drawing, or those other skills, it is one that can take years to fine-tune and perfect. I don't think many would say that someone who takes drawing classes for 20 years would be wasting their money, even if the last 10 years they see only marginal improvements in their skills. What looks marginal to one person can be SIGNIFICANT gains to another person. I wish that everyone in the world could realize how severely trauma can affect people, and how long it takes to heal from that. Even connecting the dots is not as simple as it sounds. I can connect the dots in a session, but then when I go home and have to have contact with my abusers, it can call it all into question again, and I have to go back and reconnect the dots.
I hope that helps explain how long-term therapy can be beneficial to some. I truly, truly hope that you can come to accept that long-term therapy can be something beneficial and in fact VITAL to a person's mental health and personal happiness and well-being.
sunnydays
Posted by seldomseen on February 18, 2008, at 16:16:24
In reply to Therapy - Bang for the Buck?, posted by Hermitian on February 17, 2008, at 14:42:08
I've always thought of therapy in terms of the proverb:
"when the student is ready, the teacher will appear".While I do certainly think there are some lazy therapists out there who see us as cash cows, I think most of the speed at which therapy proceeds is up to the student so to speak.
My therapy has been punctuated by a series of what I call "holy crap you are so RIGHT!" moments. I just had to be ready to hear them and accept them. Developing a trusting relationship - dare I say - attachment to my therapist helped a lot. I can say that unequivocally.
I do think there is some merit in what you say about re-hashing the past ad nauseum. In my opinion, there is a fine line between wallowing and discussing.
But even that re-hashing seems to come in phases: the recognition, the anger, the mourning, the acceptance and finally, the desire for change. Each phase I think has its own time course for different people.Mine took about four years and was complicated by all kinds of therapy crap, but even that crap helped me in the real world. Then I got to work. The "teacher" appeared so to speak.
Looking back on it all, I'm not sure I could have gotten here any faster. The student just wasn't ready.
I still relapse and collapse back in on myself. It's such an old pattern, so so hard to break. But I'm working on it. We are working on it together I guess.
Seldom.
Posted by antigua3 on February 18, 2008, at 17:43:55
In reply to Re: Therapy - Bang for the Buck?, posted by Hermitian on February 18, 2008, at 10:39:37
<<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...
>>Your comments re: my post are unsettling to me. I don't think you have the knowledge of my situation to impose time limits for me as a value judgment. It took me YEARS to open up, and I never would have if my T hadn't been so patient. Her orientation works for me because we've built that trust. And to assume with "sheesh" that I'm a fool for doing so makes me feel insulted.
antigua
Posted by MissK on February 18, 2008, at 18:16:34
In reply to Re: Therapy - Bang for the Buck? » Hermitian, posted by sunnydays on February 18, 2008, at 15:29:21
>I was learning that people will sit with me and listen to what I have to say and not criticize me or hurt me.
Hermitian already said that being an emphatic listener is part of a good therapists job. You were discovering what it is a therapist does.
>I wish that everyone in the world could realize how severely trauma can affect people, and how long it takes to heal from that.
I do know how it can affect me. I also know that others can go through similar things in life and still approach therapy differently. Is it inconceivable to you that someone can actually frame it in mind that they are visiting a professional and do not need years to 'trust' that professional to do their job, which is to hear whatever your issues are and offer their trained and skilled therapy back?
For whatever reason you, and others apparently, need(ed) to have some kind of drawn-out relationship before you can / could get to the heart of the matter(s). I don't get that anymore than I would get it if you had to know and trust a dentist three years before you would let them near your mouth. As I said different approaches. I don't think it does anything to continually harp about "you haven't experienced it and so don't understand". Give people some credit. Some have experienced SA and other traumas and don't need years to trust a therapist to talk about their issues. Some do. Each in their own time, I guess.
Posted by Hermitian on February 18, 2008, at 18:57:45
In reply to Re: Therapy - Bang for the Buck? » Hermitian, posted by antigua3 on February 18, 2008, at 17:43:55
Well this sure isn't going anywhere. Of course you folks are going to defend your therapists and your treatment strategies. Otherwise you would still not be seeing them. If you were seeing psychics for years on end youd be issuing the same apologias for them too.
Now before you get too stirred up, I am not equating the competence of therapists to psychics. But how about this, how about we agree that I personally do not have a dog in anyones fight here on this forum? Does that make sense? Do I know anybody here personally? I have not criticized any specific individual regarding the choices they have made related to therapy. I merely made observations about the extended therapeutic strategies that some have subjected themselves to that from an innocent bystanders PoV, do not appear to have been all that effective.
Look at it this way. Say theres a sympathetic lurker who visits this forum occasionally for who knows what reason. And say he has personal experience with mental illness. And lets say that perhaps he lost his mother from schizophrenia. So he fully knows whats what. Now suppose too when he reads these posts, many of them appear to be from people who have acquired this terrible sense of learned helplessness. And they also have these inordinate and in some ways disconcerting relationships with their therapists whom they have seen for years. And their reports of their therapeutic dialogs suggest meandering emotionalism with not a whole lot of actionable guidance from the therapist. And this person finds all of that very disheartening. And in some ways disturbing.
So this lurking person is indeed very sympathetic to their plight. But with that sympathy he engages in a why are they so after so long? rumination. So yeah, if someone has been in intense therapy for years, and they do not have an organic brain disorder, why are they still so miserable? And after so many years, why are their therapy sessions sowhats the word?inchoate? ambiguous? ad hoc? I dunno, pick one.
If I were camped out on this forum like many here and was engaged with a therapist myself, Id be asking the same questions that this lurker is ruminating about. Apart from the electronic hugs, I'd be prompting those still miserable people to question the value of the service that they have been paying good American green for so long. By circling the wagons, you are doing a disservice to the poor people who actually are being professionally disserviced by therapists who have not proven themselves to be effective for whatever reason.
And let me make one last point and then Ill retreat back to the sports blogs where I belong. The fact that someone required very extended amounts of time to see positive results from therapy could indeed be a function of the complexity of their condition. But it could also be a function of a pedestrian skill set of the provider. You could hire somebody you really like to shovel the snow off your walk and if he uses a soup spoon but still does an adequate job, you could likewise sing his praises. But that does not mean he objectively did a good job expending resources. If a mechanic had your car in his shop for 3 months, youd start asking questions, wouldnt you? Why should a therapist whos lassoed a patient for years be exempt from the same kind of professional criticism?
I dunno, I surely do not know what goes on in anyones therapy session. You if you want to dump on me for hearing a duck quack and suggesting it is indeed a duck, no big deal. Have at it. And if hand holding for years provides the therapeutic value that you need for whatever reason, well have at that too. I'm just speaking as somebody whos been around the block with mental illness. And I really think that there are some people who visit this site that are tragically captured in a therapeutic road to nowhere. And that indeed is a lousy way to live.
Dinah do you worst. Feel free to suspend me, ban me, shun me, even sentence me to multi-years of ineffectual therapy. I can take it...
Out.
P.S. How come when I cut and paste from Word to here, it screws up the punctuation marks?
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