I have nagging thoughts about my new T

[Depression = 72% of members]

Hi everyone  

I'm hoping someone will share from their experience here.

I'm posting this to help me correct personal deficits acquired in childhood and for advice to maintain inner peace.


Issue.
I've attended about 3 sessions in the last 3 months with a new T. I've had increasingly nagging thoughts that work with this T won't be effective for me. These feelings led me to investigate further.


Reason for this new T.

• To enhance my self care.
• To get theraputic support while handling a difficult long-term negotiation situation with my FOO.
• To save money (my P is expensive—he's a consultant and has been in the field for 30 years)—and I don't need medication.

My agenda.
I told her early on that what I wanted was 2 things:
(1) theraputic support in my negotiations;
(2) training/touch-up in interpersonal skills (I'll label this "IP") with a DBT focus.

A secondary want would be for her use her expertise to spot any holes in my inventorying and preparation.


My concerns.
I've heard that good T's give some clients/patients some challenge in the theraputic relationship. E.g., interventions on problematic beliefs → pain.

Her bio made it seem like she went to Oxford and had at least 2–3 years of experience.

When I asked her about her years of experience—she asked me "why is that important to you?" rather than being straightforward about it. I didn't think much of it at the time.

She seemed to work at a reputable clinic under a P. It seemed to me through the first fact-find session that her clinic's operational method was that expertise from the P will be given on a regular basis.

The hourly billing seems to be market-rate for my city—so it seemed to be a good deal for me.

I did more research recently and found out she only has less than 1 year of experience after completing her internships. This shocked me. This is a big factor for me in reconsidering restarting my search for a new T.

Yes, I get that we all "have to start somewhere", but I'm paying market rates and I have to look out for my own interests too. T's are expensive and I don't have the time and money to play that kind of game.

After 3 sessions, I found I was trusting her less. Whenever expectations came up—she seemed to be quite careful about managing expectations.

She didn't seem to be able to talk with me when I brought up some BPD concepts.

I told her in the first session I want her to focus on avoiding ineffective transference. The reason for this is that my interests may conflict with that of at least one of my parents—and I didn't want her to boilerplate her expectations of what my family looks like. Simply put—my interests may conflict with my parent's interests, and I don't want her to do something like minimise my interests based on a transference event.

To clarify, e.g., she sees herself as the all-good child with her image of a 'normal' parent, thereby instinctively moving to protect this 'parent' image of hers from my conflicting interests. I hope someone can relate to this.

I printed out the DEARMAN portion of the manual to get the training going at my 2nd session. It's been 3 sessions (that's 3 billable hours)—and I haven't had even 1 minute of DBT practice.


My ideas.
1. Is it more effective for me to persist for a while, and wait for more certainty?

2. Is it more effective for me to seek out someone more experienced?

3. Is the middle ground here for me to take the leading role and push the agenda for my therapy?


Picking an idea.
I'm most in favour of taking option 3—but she said that my IP skills are already very good (thanks) and pushing my case with my FOO may make the situation worse. Not sure if that is the transference talking or advice that's actually in my interests.

I actually disagree with her assessment of my IP skills—because when I practiced on my own, I found that I was slipping in DEARMAN when it came to working on scenarios. This contributes to why I even wanted to put up so much money in getting a DBT-trained T to practice with.

At least—I think this experience has at least given me more certainty that I'm (1) in the area of willing acceptance with someone extremely difficult in my FOO and (2) persistence is really what I want.


Any ideas welcome.  Pleasant week to you all.  

[gotbushels]

Hi everyone  

I'm hoping someone will share from their experience here.

I'm posting this to help me correct personal deficits acquired in childhood and for advice to maintain inner peace.


Issue.
I've attended about 3 sessions in the last 3 months with a new T. I've had increasingly nagging thoughts that work with this T won't be effective for me. These feelings led me to investigate further.


Reason for this new T.

• To enhance my self care.
• To get theraputic support while handling a difficult long-term negotiation situation with my FOO.
• To save money (my P is expensive—he's a consultant and has been in the field for 30 years)—and I don't need medication.

My agenda.
I told her early on that what I wanted was 2 things:
(1) theraputic support in my negotiations;
(2) training/touch-up in interpersonal skills (I'll label this "IP") with a DBT focus.

A secondary want would be for her use her expertise to spot any holes in my inventorying and preparation.


My concerns.
I've heard that good T's give some clients/patients some challenge in the theraputic relationship. E.g., interventions on problematic beliefs → pain.

Her bio made it seem like she went to Oxford and had at least 2–3 years of experience.

When I asked her about her years of experience—she asked me "why is that important to you?" rather than being straightforward about it. I didn't think much of it at the time.

She seemed to work at a reputable clinic under a P. It seemed to me through the first fact-find session that her clinic's operational method was that expertise from the P will be given on a regular basis.

The hourly billing seems to be market-rate for my city—so it seemed to be a good deal for me.

I did more research recently and found out she only has less than 1 year of experience after completing her internships. This shocked me. This is a big factor for me in reconsidering restarting my search for a new T.

Yes, I get that we all "have to start somewhere", but I'm paying market rates and I have to look out for my own interests too. T's are expensive and I don't have the time and money to play that kind of game.

After 3 sessions, I found I was trusting her less. Whenever expectations came up—she seemed to be quite careful about managing expectations.

She didn't seem to be able to talk with me when I brought up some BPD concepts.

I told her in the first session I want her to focus on avoiding ineffective transference. The reason for this is that my interests may conflict with that of at least one of my parents—and I didn't want her to boilerplate her expectations of what my family looks like. Simply put—my interests may conflict with my parent's interests, and I don't want her to do something like minimise my interests based on a transference event.

To clarify, e.g., she sees herself as the all-good child with her image of a 'normal' parent, thereby instinctively moving to protect this 'parent' image of hers from my conflicting interests. I hope someone can relate to this.

I printed out the DEARMAN portion of the manual to get the training going at my 2nd session. It's been 3 sessions (that's 3 billable hours)—and I haven't had even 1 minute of DBT practice.


My ideas.
1. Is it more effective for me to persist for a while, and wait for more certainty?

2. Is it more effective for me to seek out someone more experienced?

3. Is the middle ground here for me to take the leading role and push the agenda for my therapy?


Picking an idea.
I'm most in favour of taking option 3—but she said that my IP skills are already very good (thanks) and pushing my case with my FOO may make the situation worse. Not sure if that is the transference talking or advice that's actually in my interests.

I actually disagree with her assessment of my IP skills—because when I practiced on my own, I found that I was slipping in DEARMAN when it came to working on scenarios. This contributes to why I even wanted to put up so much money in getting a DBT-trained T to practice with.

At least—I think this experience has at least given me more certainty that I'm (1) in the area of willing acceptance with someone extremely difficult in my FOO and (2) persistence is really what I want.


Any ideas welcome.  Pleasant week to you all.  

[zachira]

It is not unusual to have some concerns about who might be the right therapist for you and to wonder if you would benefit from therapy. I hope what I have to say is helpful and does not discourage you. First of all, therapy really is able to help a lot when it is the right fit, the right therapist for the client. Every therapist and every client is a person in their own right, and therapy can be really helpful in getting to know yourself, what you have in common with most human beings and how you are very different from most people, the things you will likely have to be aware of to attract the right kind of people into your inner circle. Every therapist has their own personality, own schooling, and training. When you have a flu, you can probably go to any doctor, and receive pretty much the same care, as there are specific expectations on what kind of treatments to prescribe. With a therapist, you never know what you are going to get, therefore it can be important to have some specific ideas about what you want, and know that it is not uncommon to find it hard to find a therapist that is a good fit.
The first step for the therapist is to build a rapport with the client, otherwise know as the therapeutic alliance, which may not take long or could take a really long time. A competent therapist will challenge a client to help him/her make changes, taking into account what the client is ready for. It may be very uncomfortable for a client to take a look at changing the ways he/she has been for a long time. Making small changes leads to big changes.
As I have read your posts many times, I would say you are very capable of change and deep introspection. As you keep seeking what you are looking for, you will get many rewards that will pay off for years to come. I have been to therapy for many years, and with different therapists, and it has changed my life, though it certainly was very painful and challenging at times, and it took time to find a therapist that was a good fit.

[Harri]

Hi gotbushels!

I hate finding a new T. 

Yes, I get that we all "have to start somewhere", but I'm paying market rates and I have to look out for my own interests too. T's are expensive and I don't have the time and money to play that kind of game.

I understand.  I would feel the same way too.  I think what would bother me the most is her dodging the question.  How did you respond to what she said?  The dodging speak to lack of confidence... not just due to inexperience.  I saw it all the time in the work I did when supervising interns and I have dealt with it from the patient end of things. 

To clarify, e.g., she sees herself as the all-good child with her image of a 'normal' parent, thereby instinctively moving to protect this 'parent' image of hers from my conflicting interests. I hope someone can relate to this.

I can relate.  I have had a couple of T's pull the "But she is your mother" stuff and talk about their relationship with their mom.   None of that changed the reality of my situation or helped me heal or work things through.  A T can't help you if they can't see beyond the veil of their own biases.

I'm most in favour of taking option 3 (3. Is the middle ground here for me to take the leading role and push the agenda for my therapy?)

Is this because of the time and financial investment already laid out? 

As for taking the leading role... what is the difference between doing that with her and doing it on your own or even here?   I can see where a mutual relationship can work and prefer that myself as I know me and my needs best.  I am questioning the lead part.  We can't see what we can't see and that is where a therapist comes in.   Just thinking out loud with you here. 

At least—I think this experience has at least given me more certainty that I'm (1) in the area of willing acceptance with someone extremely difficult in my FOO and (2) persistence is really what I want.

Can you elaborate on these points?  I am not sure I understand and I want to. 

[gotbushels]

zachira  

With a therapist, you never know what you are going to get [...]
know that it is not uncommon to find it hard to find a therapist that is a good fit.

Thanks for the reminders.  

The first step [is] to build a rapport with the client [which] could take a really long time.

Yes—when I was doing some research on how to do the 'search', I did see some advice to be patient and see how it goes. Thanks for sharing your experience zachira.



Harri  

I saw it all the time in the work I did when supervising interns and I have dealt with it from the patient end of things.  

Good to know. Thank you.

How did you respond to what she said?

I just "OK"-ed it. I figured that I wanted to see how my experience with her went—not judge her from her absence of experience. I thought if it didn't work out—I can always look for a T where the fit is better.

Perhaps it would have been more cost-effective to go in 'armed' with those interview-style questions like:

"What's your toughest experience with transference?"
"What has been your experience counselling non-disordered family members?"

Having written it out—and looking at my bills—perhaps it would have been a good idea LMAO!

I have had a couple of T's pull the "But she is your mother" stuff and talk about their relationship with their mom.

Hmm. If a T tries to inaccurately transpose their parent relationship and give therapy based on that—I would start to consider another T. We know here on the boards that we don't have 'normal' family dynamics—and treating it as normal seems to me to be a very naive move. I think to have a T that works with you from this position rather than one with an accurate awareness of the dynamics of a family with a serious mental illness—I think that would put us as clients in the dangerous position of aggravating problematic behaviours.

My thinking is as follows.

If learned that my self-role was the parentified child;
→ I wanted to step away from that;
→ but the T that didn't understand that being this role causes real problem;
→ then that T encourages me to intermediate/reconcile (when I've already been doing that for 20 years);
→ where differentiation and not togetherness is the most effective course;
→ then this therapy is going to be have obvious problems.

I impressed upon her right in the first session that I was specifically looking for a professional relationship with a focus on avoiding ineffective countertransference. It's my view that a good T for me has a clear grasp of this issue. I think this is the case because trying to advocate my interests in a looking-good family looks selfish to an outside observer that doesn't truly understand what these dynamics are like.

I think that may be asking far too much from a 1st year T.

What are your thoughts on this?

Is this because of the time and financial investment already laid out?

Significantly yes. Re time: I planned to step-up my negotiation in September 2019. I planned for this T to be part of my cheerleader squad    ready-to-go by September. Looking back I guess I was trying to ask for too much in too short a time.

Re cash: yes this is another major factor. I had some expectation that I may have to try a few T's before getting one that's suitable. I feel sad that I have to say goodbye to that cash—if I could go back I would have spent more time calling T's to interview them first. I called a few clinics but they made it seem like this is a "never done" practice—you have to buy a full 50 minute block to have time with the T. I'm beginning to think it may have been more beneficial for me to have spent that money on my reliable P. Also, I perhaps could have just taken a referral from him because he seems so successful that a want of fees wouldn't outweigh what's good for me.


I'll come back to the other things you brought up.



Thank you both for your encouraging comments and thoughts.

[zachira]

Just wanted to respond to your comment that you may be expecting too much from a first year therapist. From my experience, some of the best therapists can be the inexperienced ones, and some of the worst ones can be the experienced ones. With an inexperienced therapist, I think you can feel a little freer to really give constructive feedback. For example, when the therapist asked you about why you wanted to know about her qualifications in response to your inquiry, she gave you a standard answer that therapists in training are often taught to use when the client asks about their qualifications. Though that answer might work for some therapists, it certainly is not a good fit if it is something that the therapist is saying because he/she was told to use when what he/she is saying does not feel authentic to him/her.
Therapy does take time. It can take a long time to unravel what is going on inside of us, especially those things that play key roles in influencing us in making decisions that are not in our best interests. What is likely most important, is you keeping looking for answers  and you will find them as long as you keep seeking them. I have often wished that I could just one day become the perfect human being, and not have to do any more soul searching. The truth is we will always be challenged by the unexpected as long as we are alive.
 

[Harri]

I impressed upon her right in the first session that I was specifically looking for a professional relationship with a focus on avoiding ineffective countertransference. It's my view that a good T for me has a clear grasp of this issue. I think this is the case because trying to advocate my interests in a looking-good family looks selfish to an outside observer that doesn't truly understand what these dynamics are like.
I think that may be asking far too much from a 1st year T.

I am inclined to agree that it may be too much for this T.  How did she react when you laid out the specifics re: counter-transference?  Was she accepting, condescending, avoidant?

That she did not even respond when you talked about DBT concerns me.  Even if she wanted to reply with a "well, let me get a better handle on what is going on with you before we start with a plan as I may not agree" would be fine IMO, but to ignore it? 

I do agree with zachira when she says that some of the best T's are brand new ones right out of school or, in my experience, still in it.  The best T I have ever had and the one where I made the most progress on really difficult stuff was a post doctoral student whose primary interest was in research, not therapy!  He was very very good and closely supervised by another PhD therapist who I saw later after my 'student' graduated (darn it!)  I still miss him. 

I am hearing a lot of doubt in you so I am not sure how to advise you here.  Therapy and developing a good and trusting relationship does take time, again as mentioned by zachira yet it sounds like you do not want to go that route and at the same time do not want to start over.    

Where to draw the line?  Not sure from where I sit to be honest, but then I guess that is the point of this thread! 

[Skip]

What you are asking for is complex and you are well down a path (how many patients bring up transference) and hoping a T can just hop on and ride with you. 90% of T are not going to be able to do that.  That simply means your effort to find someone is going to be a little complex.

You probably need someone "better" experienced. As Zachira says, more experienced may not help.

And you probably need to be a little more patient - give them some time to catch up with you. Once a month is a long time. You may want to spring for a month of weeklies and the open up the time window.

Why not ask your P for a referral to start? They get it. And you will be  in touch with him periodically for meds review.

[gotbushels]

Harri  

As for taking the leading role... what is the difference between doing that with her and doing it on your own or even here?

Yes if I do it on my own—there's a few reasons why that's an issue:

• I've done a lot of work on my own already. So I want a T (or a few) to build on the work I've already done and with what I've got.
• If I don't maintain an ongoing relationship with a T then I don't get qualified advice- this isn't my field, and I don't expect to give myself expert advice.
• The person I'm negotiating with is cunning and shrewd- this person is also in FOO relationship with me and that may work against me. This is where therapeutic support could be invaluable to me.

I am questioning the lead part.  

You're right, how can I lead if I don't know where do go. I think that's what you mean (correct me).      I don't know how to give words to this benefit. If think if I lead (more) then I can take the therapy where I want, and I get my expectations met. E.g., I want training in DBT things, she gives me that, I take that to my negotiation. I mean it in a way similar to the emotional caretaker advice.

Of course—it's a two way street. I share an example. At my last session, she brought up willingness vs wilfulness. Of course, if I can get to point B in my negotiation without going through 20 sessions of DBT to learn interpersonal skills, then I will of course work at her suggestion for willingness vs wilfulness. So she takes the lead there—over an above my direction to clock-in 20 sessions of formal DBT.

To me—in a BPD context—what that means is similar to accepting what partner you've got; knowing what you want, and being the emotional caretaker (that almost always sets the lead). We know here that's the most effective state to working with a BP.

Therefore I'm thinking I'll prod the direction of the therapy to go where I want it to go to get my goals met (3 reasons I bulleted in OP)—but of course with a looser grip on the racket because my dialogue partner isn't a BP.  

I hope that makes sense.    Thanks Harri.

Just wanted to respond to your comment that you may be expecting too much from a first year therapist.

zachira    Mm-hmm.    Having thought this over a week and coming back to the replies—I think you're right.

What you said reminds me of the interests in this relationship.

I have an interest to be skilled-up as quickly as possible (cheaper).
She'd had an interest for me to go slower (can bill more hours).

I think perhaps I now have the idea that I can share this with the T and assure them that I'm also interested in maintaining the ongoing relationship after I've been up-skilled. I think that would ease a lot of the pressure between these two competing interests. I think this is important because I remember this is a concern for anyone in a new role—they have to pay the bills, they have very little savings, their job security is much lower than everyone else's—so what's the best way to secure their paycheque. To me, that seems more of a concern to a 1st-year T than a 30th-year P. Thanks for helping me think this part through zachira.  



Skip  

What you are asking for is complex[, hoping] a T can just hop on and ride with you. 90% of T are not going to be able to do that.

Oh this image gets things done. Thanks a lot for this. I was thinking of a church group I've visited recently and I expected to find some people with difficult FOO issues that I can discuss things with. I was quite wrong. It seems like no one shares that they have difficult families like that. On the contrary—two of two cars I've seen the guys drive were a like-new Mercedes and a BMW. That one group is therefore probably not a place for me to be looking to relate to damaged families ROFL.

So expecting a T not in the my area of where I want them to be—yes you're right my search is going to be more complex.

You probably need someone "better" experienced.

Yes. I think my excitement to build my support group with a T was so high I jumped the gun in getting sessions. I just paid-off a big liability these last few months so I think I was in a shopping mood. It was a massive burden off. Maybe I'll sign up for impulse control classes rofl. Yes—someone that treats BP children (around her area) could be a circle to my triangle block—a poor fit.

You may want to spring for a month of weeklies and the open up the time window.
[...]
Why not ask your P for a referral to start? They get it.

I decided to try do twice-a-month—I booked a slot next week. I don't have the money for weeklies—I couldn't get any subsidies or bill deductions for this T's bills. If I can't make it work with this T—then I'll ask my P for a referral.

Thank you!