What is good therapy supposed to look like?

[Depression = 72% of members]

Hello,

Just as my subject line says, I'm wondering what 'good' therapy is supposed to look like?  I had been in therapy for a while but have not gone in months.  I wasn't sure I was getting what I need from it as I don't feel like I've really advanced and I keep sliding backwards.  No, I am not looking for a quick fix.  I have gone to my therapist for several years and she is a wonderful, kind woman and also... .I don't know the word... .shrewd/smart?

But, I don't feel like anything is really happening except for me talking.  She does seem interested in what I'm saying and tells me where she would like me to be but she doesn't give 'homework,' doesn't connect 'oh maybe this is why you do this' or things like that, or tell me/show me how to get to my goals.  She doesn't really talk to me about contributors to why... .but maybe they're not supposed to?  She has mentioned wanting to do CBT with me but I don't think it's started?  As I said, I think she is a caring individual.  But as this is my first time in therapy, I have no idea what it is supposed to look like.  Or what you get out of it.

Hope I'm making sense.

Thank you.

[sheepdog]

Hello,

Just as my subject line says, I'm wondering what 'good' therapy is supposed to look like?  I had been in therapy for a while but have not gone in months.  I wasn't sure I was getting what I need from it as I don't feel like I've really advanced and I keep sliding backwards.  No, I am not looking for a quick fix.  I have gone to my therapist for several years and she is a wonderful, kind woman and also... .I don't know the word... .shrewd/smart?

But, I don't feel like anything is really happening except for me talking.  She does seem interested in what I'm saying and tells me where she would like me to be but she doesn't give 'homework,' doesn't connect 'oh maybe this is why you do this' or things like that, or tell me/show me how to get to my goals.  She doesn't really talk to me about contributors to why... .but maybe they're not supposed to?  She has mentioned wanting to do CBT with me but I don't think it's started?  As I said, I think she is a caring individual.  But as this is my first time in therapy, I have no idea what it is supposed to look like.  Or what you get out of it.

Hope I'm making sense.

Thank you.

[Crumbling]

Hey Sheepdog!

Good to hear you are investing in yourself and your future.  I started my healing journey over 16 years ago.  I've done one on one counseling, and several forms of group therapies, over the years.

The fact that you are recognizing that your present form of help isn't really helping, may perhaps mean that you are ready for the next phase. (E.I.  it is progress, through awareness!) Deciding what that next phase looks like is between you and your T.

I've just started a group therapy based on ACT.  Acceptance and commitment therapy.  We are in the process of examining our experiences and deciding what goals we wish to achieve through the 14 weeks.  I'm really hopeful that this is going to get me out of my funk... .finally.  And where you want your therapy to go sounds a lot like this.

The best advice I ever got when I started my journey was this:  take ownership of the process.  You are in charge of your healing, and your T is the car you'll drive to get there.  You may sometimes need to switch vehicles,  for different terrain, and that's okay.  Sometimes familiar wheels work best. But the bottom line is, nothing will work if you don't actively pursue it, or start the engine and drive!

I wish you well.  Thanks for posting. 

[valet]

Hey sheepdog, I think that good therapy helps us feel good.

If you plan on returning, maybe it might be a good idea to discuss your frustrations in therapy with your therapist! She's not going to be able to give you proper treatment if she's not aware of the entire lay of the land. If you feel like your just talking and not making any progress, let her know about it. It may help ease things for you. 

[Grey Kitty]

  sheepdog

For some reason I was thinking of you and realized you hadn't posted in months, maybe a year, and was wondering how you were doing. Good to see you again.

As for what is a good therapy like... .well, it depends a bit on what you are looking for out of it.

What I'm hearing from you is that you wanted better results than you got... .and you didn't get either results OR an explanation that the kind of results you wanted weren't likely to happen, and an explanation of what was possible.

I guess my conclusion is you aren't getting what you want out of this therapist. So I'd suggest either

A: Explain more of what you want to resolve with this therapist and ask if she can provide a program to get you there.

B: Try a new therapist, and see if you can get directed toward better results.



I've been with six different therapists for couples therapy and had almost no individual therapy; Some were much better than others. here are a few things to look at.

1. Seeming kind, caring, understanding, and shrewd/perceptive are all good things.

2. YOU have to trust them. This is personal, not just about their abilities. You just "click" with some people and can trust them more than others. Perhaps you find it easier or harder to trust somebody because they are male, female, older than you, younger than you, etc. If you find yourself reluctant or unable to trust, you won't get good results, even with a very good therapist.

3. Goals and directions for therapy. This is a bit of a joint thing between you and the therapist. If you have specific things you want to work on, it is up to you to communicate that, and then they have to direct you toward doing it.

I'd expect a therapist to assign some sort of homework for you. I certainly got some from the better ones.

With a new T, I'd expect to spend most of the first session getting to know each other, and wouldn't hold a lack of any concrete action or progress against them. After that I'd expect to get more of something.

Even if you aren't feeling like you've solved your problems, maybe you feel like you understand them better, or have found a more specific area where you are stuck.

[eeks]

But, I don't feel like anything is really happening except for me talking.  She does seem interested in what I'm saying and tells me where she would like me to be but she doesn't give 'homework,' doesn't connect 'oh maybe this is why you do this' or things like that, or tell me/show me how to get to my goals.  She doesn't really talk to me about contributors to why... .but maybe they're not supposed to?  She has mentioned wanting to do CBT with me but I don't think it's started? 

Hi sheepdog,

It seems to me there is not a "supposed to" or "not supposed to" connect the reasons for your various feelings and behaviours, but it depends on the type of therapy your therapist practices.

I agree with valet, your feelings about progress (or lack thereof) is probably a good topic to bring up with your therapist.  However, if you've been seeing her for "several years" and she has not changed her style... .I'm not there and I can't assess it for you, but maybe you've seen enough of what she has to offer?

Maybe if you tell us what your goals are for therapy, we can help you make your decision including choosing a style of therapy.

As I said, I think she is a caring individual.  But as this is my first time in therapy, I have no idea what it is supposed to look like.  Or what you get out of it.

That makes complete sense.  Nobody tells you "what therapy is supposed to feel like", so how do you know?  I can say though that I think a person can be caring, and intelligent, and still not the right therapist for you.   

[Reforming]

Hi Sheepdog,

I'm sorry that you feel you're not making progress in the way you need.

I think the other posters have offered really good insights.

I've worked with a variety of different therapists and therapies.

Couple counselling, psychodynamic, CBT and Schema, with differing results.

I found it really helpful to research different therapies and it also takes work to find a therapist who suits you.

I think it's really important and reasonable establish a realistic timeline for progress with clear, achievable goals. If a therapist is resistant to this I would seriously considering going elsewhere

Don't be afraid to change T you feel you're not moving forward. It's a big investment of your time and money and even though progress often isn't linear and consistent there should be measurable results.

As the other posters have said you need to own the process.

One or even two sessions a week will not yield results on their own - you need to work to apply the insights and skills that you learn from your sessions

Change can feel frustratingly slow at times, but good therapy and a good therapist can be a huge help

The best of luck

Reforming

[anon72]

Hi Sheepdog,

I'm sorry that you feel you're not making progress in the way you need.

I think the other posters have offered really good insights.

I've worked with a variety of different therapists and therapies.

Couple counselling, psychodynamic, CBT and Schema, with differing results.

I found it really helpful to research different therapies and it also takes work to find a therapist who suits you.

I think it's really important and reasonable establish a realistic timeline for progress with clear, achievable goals. If a therapist is resistant to this I would seriously considering going elsewhere

Don't be afraid to change T you feel you're not moving forward. It's a big investment of your time and money and even though progress often isn't linear and consistent there should be measurable results.

As the other posters have said you need to own the process.

One or even two sessions a week will not yield results on their own - you need to work to apply the insights and skills that you learn from your sessions

Change can feel frustratingly slow at times, but good therapy and a good therapist can be a huge help

The best of luck

Reforming

 Just wanted to bump up this thread also, as I had never thought before about the importance of having goals with respect to my therapist, being assigned some sort of homework and applying the insights gained.  Although it does make sense, so that we know whether or not progress is being made.  Thanks again everyone to your contribution to this thread, was very helpful!  

[thisagain]

Not all therapists assign "homework" or lay out specific goals. I believe that's most common in CBT. My best therapist was really just about me going and talking every week, with no real goal other than to stop feeling so depressed. She would listen, validate (which was a new thing for me), and occasionally ask questions to direct me toward some sort of insight.

Last year I tried a different therapist, who on the surface would appear to have the same style. But it did not work at all. By that time I'd done the deep self-discovery kind of work, and was looking for practical tools to apply to keep the BPD anxiety from affecting the rest of my life. This board was much more helpful

So I think "good therapy" can look very different depending on your goals and where you are in life. The most important thing is a good fit with the therapist. The therapist I saw last year came very highly recommended but we just did not click.

If you feel like it's not working, I think it's worth bringing up with the therapist, especially since you've worked together for so long.

[unicorn2014]

Has she given you a diagnosis or a treatment plan? If she's not using CBT with you what is she using? I always took notes at therapy.

[sheepdog]

Thank you all for your replies.  I really appreciate them.

She hasn't given a diagnosis or a treatment plan.  And, honestly, I have not gone in months.  Partly because I don't feel it is helping and partly because she said something the last time I was there that made me feel not so great.

I know that many people on the board talk about the 'gift of BPD' and how because of the relationship with someone with the disorder they got so much out of it, even after they have gone through hell.

Maybe because of the circumstances with me, or my religion, or my choices, my shame, maybe all of it... .I can't seem to get over it.  Not in the sense that I miss the person or anything remotely like that.  There are days now where I don't think of him at all.  But more in the sense that now when I look in the mirror, I don't recognize myself.  I wonder how the hell I got here.  Who I am.  It was not a gift for me to meet the person with BPD.  It was one of the negative defining moments of my life... .one that you can measure before him and after.  And life was far better before.

I seem to be stuck hating myself, feeling shame, wondering how anyone could love me and, if they do, knowing they wouldn't if they knew things about me.

I thought therapy might help with that but it hasn't.  Then again, maybe no therapist can help.  I seem to be stuck.  No blogs, books, therapy, feel-good experiences... .nothing has helped.  It's always there.

Thank you again for listening.

[eeks]

I seem to be stuck hating myself, feeling shame, wondering how anyone could love me and, if they do, knowing they wouldn't if they knew things about me.

I thought therapy might help with that but it hasn't.  Then again, maybe no therapist can help.  I seem to be stuck.  No blogs, books, therapy, feel-good experiences... .nothing has helped.  It's always there.

I relate to this "if they really knew me, they wouldn't love me" thing.  And I thought therapy would help me, too.  The difference between us may be that you describe your life being better before meeting a pwBPD, but I've had these issues most of my life. 

It makes me wonder if you have a very strong internalized "inner critic".  Would you say this is the case?  www.pete-walker.com/shrinkingInnerCritic.htm

You may also be interested to read about Coherence Therapy.  One of the basic ideas is that symptoms always have a reason, but that reason can be hidden in implicit memory (non-verbal) and if a person can make the implicit memories explicit, then they can stop having the unwanted feelings or behaviours.  www.coherencetherapy.org/discover/ct-reconsolidation.htm

What I think happens sometimes is you want the good experience, but there's something in you that feels the need to protect you from some pain that it perceives will be worse than whatever benefit you get from the good thing.  And this shows up as self-hate, shame, feeling unworthy of love... .but at least in my experience, I can't speak for anyone else, on examination I find myself not to actually believe those negative things.  They are self-protective.

When I figure out how to change this in myself, I will be sure to let you know

[livednlearned]

I sometimes wonder if having a shared faith can make a difference, or at least a shared understanding of the culture surrounding that faith.

I saw my T for individual counseling, and was also in group therapy with her. One woman in the group had the same religion as my T, and I noticed that there was a level of understanding between them that the rest of us didn't share. There seemed to be a shorthand, and this almost made their interactions simultaneously more intense (emotionally raw) and more trustworthy at the same time.

Therapy and faith/religion can touch the same places in us, and a therapist who can leverage the same language may be able to walk with you with a degree of intention that someone outside your faith does not.

[Reforming]

Hi Sheepdog,

I seem to be stuck hating myself, feeling shame, wondering how anyone could love me and, if they do, knowing they wouldn't if they knew things about me.

I thought therapy might help with that but it hasn't.  Then again, maybe no therapist can help.  I seem to be stuck.  No blogs, books, therapy, feel-good experiences... .nothing has helped.  It's always there.

Thank you again for listening.

I'm sorry that things are so tough at the moment - I think that a lot of us can relate to your feelings.

I can totally understand your disappointment

A poor therapist - and I think there are plenty out there - can do a lot of harm or at the very least be a waste of time and money

But therapy can also be hugely helpful so I wouldn't right it off on the basis of one or even two negative experiences

In my experience it takes time and effort to find the right therapy and therapy. Persistence is the key - don't give up... .

I found forgiving myself one of the hardest parts of recovering from my breakup and I still struggle with it at times.

A deep rooted belief that I was at fault, that I wasn't loveable and that I was left for a reason.

It's taken a lot of work - and it's an ongoing process - to confront this, but it's definitely possible.

Inner child dialogues can help a lot with this too.

Healing is possible. You might feel like you're looking at a mountain, but if you keep chipping away you can turn it into a molehill

All the best

Reforming

[sheepdog]

I sometimes wonder if having a shared faith can make a difference, or at least a shared understanding of the culture surrounding that faith.

I saw my T for individual counseling, and was also in group therapy with her. One woman in the group had the same religion as my T, and I noticed that there was a level of understanding between them that the rest of us didn't share. There seemed to be a shorthand, and this almost made their interactions simultaneously more intense (emotionally raw) and more trustworthy at the same time.

Therapy and faith/religion can touch the same places in us, and a therapist who can leverage the same language may be able to walk with you with a degree of intention that someone outside your faith does not.

That is exactly why I picked her... .she is of the same faith as me... .

Hi Sheepdog,


It's taken a lot of work - and it's an ongoing process - to confront this, but it's definitely possible.

Inner child dialogues can help a lot with this too.

Healing is possible. You might feel like you're looking at a mountain, but if you keep chipping away you can turn it into a molehill

All the best

Reforming

Hi Reforming, HOW do you confront this?  Or is confronting it with your therapist?

And is inner child dialogues done with your therapist, too?  I've heard of that but don't quite know what it is... .

[eeks]

Hi Sheepdog,


It's taken a lot of work - and it's an ongoing process - to confront this, but it's definitely possible.

Inner child dialogues can help a lot with this too.

Healing is possible. You might feel like you're looking at a mountain, but if you keep chipping away you can turn it into a molehill

All the best

Reforming

Hi Reforming, HOW do you confront this?  Or is confronting it with your therapist?

Hi again Sheepdog, I don't know if you relate to the idea of having a history of childhood trauma that contributed to your getting into a relationship with a pwBPD, but whether you do or not, what you have described sounds like a response to trauma to me. 

I would say most people, even many who are functioning pretty well in life, have some degree of wound to their wholeness in childhood.  The only way a child can make sense of this selective lack of attunement of the parents is that those feelings/behaviours are bad, and they (the child) are bad if they have them.  The alternative would be to realize that their caregivers are not dependable, and I don't understand why this is, but I've read it phrased many different ways that for the child to acknowledge that the parents can't be counted on is an intolerable thought.  Again, even if you don't relate to that, the loss of an adult relationship can still be traumatic, humans are wired to bond with one another and the end of such a bond just about always involves a lot of pain and grief. 

I notice that if I blame myself for being unlovable, I'm less likely to want to try to get close to someone again, or to feel anger about whatever the other person's role in what happened was.  I think it also prevents facing the pain of grieving.  (hmm, some for me to think about here.)

You've mentioned feeling shame, and thinking you are unlovable, hating yourself. What do you notice this stops you from doing?  (your answer may be different from mine.)   

And is inner child dialogues done with your therapist, too?  I've heard of that but don't quite know what it is... .

Here is a thread on the Coping & Healing board with some examples of inner child exercises  https://bpdfamily.com/message_board/index.php?topic=241251.0;all

The exercises can be done alone, but some people find it too raw or emotional (or want to punish their inner child) and in that case it's probably best undertaken with a therapist.