How do I best make use of psychotherapy?

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By the good graces of someone close to me, I have at least a few months with a psychotherapist. I found a therapist who I like and trust. I've seen her three times. I'm happy with how things have gone so far, but I'm aware of the dollars per minute. How do I make the best use of my limited time with her? If you have a therapist, and if you could do things over again, what would you talk about? If you are a therapist, how have your best therapeutic relationships gone?

My therapist and I and my benefactor all recognize that I need long-term therapy. My benefactor might fund further therapy, but I would like to know how I can make the best use of the time I have available to me. Your insight would be invaluable.

[beggarsblanket]

By the good graces of someone close to me, I have at least a few months with a psychotherapist. I found a therapist who I like and trust. I've seen her three times. I'm happy with how things have gone so far, but I'm aware of the dollars per minute. How do I make the best use of my limited time with her? If you have a therapist, and if you could do things over again, what would you talk about? If you are a therapist, how have your best therapeutic relationships gone?

My therapist and I and my benefactor all recognize that I need long-term therapy. My benefactor might fund further therapy, but I would like to know how I can make the best use of the time I have available to me. Your insight would be invaluable.

[heartandwhole]

Hi beggars,

I think you'll probably find different answers coming from all of us, but I'll chime in with my experience. I often found myself just getting warmed-up when the session was over! So, often, a day or two before my session, I would reflect on what issue I wanted to talk about—even thinking about (or writing down) some keywords and/or questions.

Of course, I veered off into other directions in the process of talking about a subject, but that is as it should be, in my view. I don't know if "planning" a bit is just my personal control mechanisms in place, or if it is practical. I like the idea of free-association, too, and going in with no agenda and seeing what comes up. But, like you, I was very aware of the clock ticking and cashier bell ringing, so I tried to go in with something I was working on. 

heartandwhole

[Naughty Nibbler]

Hey beggarsblanket:   

When I started therapy, my therapist accepted the insurance I had, so I only paid a modest co-pay for each visit.  Then, I had to change my insurance to something my therapist doesn't accept, so I'm currently paying out of pocket. One way to look at it, is that your therapist is working for you.  It can help to make some goals regarding what you want to achieve from therapy

I've used heartandwhole's strategy of making a list of what I want to talk about during a therapy session. I've even gone so far as to prioritize the list. For the most part, my list has been flexible.  I don't pull out an agenda and hand it to the therapist, but currently, I generally go to a session with some specific ideas of how I want to steer the conversation.  Although I have some sessions where I just freely talk about whatever is on my mind, I've felt that it's good to have some specific thoughts of what I want to talk about.

There is certainly value in just talking during a therapy session, letting the thoughts and feelings flow, letting the therapist ask questions, etc.  I participated in a lot of that type of interaction.  At a point, however, I decided I wanted to be more proactive and do some steering during the sessions.  I've brought some lessons with me, from this website.  When my therapist brought up a suggestion of using "I" Statements, I went home, Googled it and found some samples and material to practice with.  Then, I brought in some practice "I" Statements that would apply to my situation and we reviewed them, during a session and my therapist coached me on how to improve my statements and suggested a strategy for using them.

I tend to worry a lot, so I asked my therapist for some suggested reading material.  She suggested a couple of books.  I bought them, and subsequently I steered a couple of sessions to discuss some of the material.

Perhaps, you might want to talk to your therapist about setting some goals for your therapy, prioritize the goals and then get more goal oriented for future sessions (or part of sessions).  You could choose to be goal oriented for part of a session and then just free form the other half.

[steelwork]

Another vote for jotting down some things you want to talk about. You don't have to stick to it, of course, but it's a good exercise, and it might help you focus your sessions.

For me, it's even more important to take some time after the session to write down your thoughts, and anything really interesting that came up. I keep a notebook in my bag for that purpose, and I try to spend a few minutes with it after every session.

[beggarsblanket]

Hi friends,

I've definitely collected my thoughts beforehand. I collect my thoughts to a fault. I have so many thoughts that we can't address all of them in a single hour. I'm fearful of heartandwhole's idea of going in without an agenda. I need something to say. My therapist encourages me to say what I want out of our time together. I trust my therapist, but I struggle to state these basic needs. I know I would not have gotten into an intense BPD relationship without deep needs of my own, but I struggle to believe that my needs are in the field that my BPD relationship reveals.

[Sunfl0wer]

Obviously, what each of us needs is personal and individual, so having said that... .After spending lots of years in "talk therapy" and now having a therapist who is certified in EMDR, hypnosis and other very trauma related modalities, I would never go back to simply talking out things cause I can get that online, through friends, etc.

So now putting that bias aside in terms of modality I would insist upon... .

I can't say enough about two things already said which are

1. Setting goals!

2. Jotting down notes post session** This was huge for me!  I kept a small notebook to journal in about stuff I wanted to share, work through and also for writing review notes for each session.  Often I would leave session a bit dissociative or only focusing on one point and the rest of the session would be a fuzzy thought or simply forgotten.  Yet, forcing myself in the parking lot after session to jot down as much of the session as I could, then fill in as many details as I could... .likely helped me to retain important points like 10 fold, not kidding.  It also helped to maintain the info in my awareness throughout the week until next session.  I often had the notebook open in session for doodling in, but took a moment to jot down highlights as we talked.  (My memory is super poor especially when chatting about triggering stuff).

Then maybe... .

3. Not being afraid to bring up any topic especially barriers to the session.  I was taught in T years ago that if I am mad, frustrated with T, speak up.  This is an opportunity to work out and deal with interpersonal issues that are coming up in real life anyway, but at least in a safe enviornment, easier to sort this out.  No sense in being shy or scared for weeks going by and hiding parts of the experience for whatever reason... .this is actually a great chance to get some good work happening by confronting the obstacle.

4. Ask if T has any suggestions for "homework."  Sometimes this helps me, other times not.  It just depended for me on what was happening in session and what we were working on.  Sometimes if the T wasn't the homework giving type, but I felt like I wanted to be doing more, I may ask for a book recommendation.

I collect my thoughts to a fault.

My very first T that I choose... .(Not appointed to me as a kid)
I entered the session overwhelmed.  I had a two or so page list of issues in my life I wanted to be addressed.  I felt like there was no hope since it seemed so lengthy.  I was so afraid I'd chicken out in sharing, so I simply handed the list to T to see what she would say.  I was fully expecting her to look overwhelmed or like this was going to be a bit much.

Instead she did something wonderful in that moment.
She looked at my list and back at me and asked if I realized that lots on my list were the same thing.  I actually didn't realize that.  She began to classify and put my issues into groups. For ex: hypervigilance was an issue at the time, yet I had like 8 examples of how it was bothering my life.  So once she looked at my total list, seemed ok and clear and grouped stuff, it suddenly felt less unmanageable.  Wow!

My current T I tend to email him things that feel unmanageable and that I am afraid to express with him.  He doesn't email back, but at least I found a way to get it out and he admits either to skimming or reading and then I know it is on the table to deal with when I am ready.

Last important thing for me, but sorta already mentioned in talking to your T about obstacles, is if things are not progressing, you feel discouraged, or you are just not sure if you are gaining... .don't be afraid to directly speak about this.  Sure, we are grateful to have this person, but often, me directly stating that: "Hey, I have these goals but we don't talk about them, and seems like this time is not going anywhere to help them."  Has really helped me not waste time.

My point: Sometimes it is a good idea to share everything on ones mind vs picking and choosing as then I left feeling nothing got addressed... .cause only a tiny fraction did.  Sometimes it helped me feel better by opening session spending 5 mins in rapid fire... ."These are all the things going on in my head that I am concerned about this week.  I know we cannot discuss ALL today, but thought you should know what is on my mind.  Any suggestions on where to start with this?"

Often, simply initially throwing it all on the table has got me a good result.

[beggarsblanket]

3. Not being afraid to bring up any topic especially barriers to the session.  I was taught in T years ago that if I am mad, frustrated with T, speak up.  This is an opportunity to work out and deal with interpersonal issues that are coming up in real life anyway, but at least in a safe enviornment, easier to sort this out.  No sense in being shy or scared for weeks going by and hiding parts of the experience for whatever reason... .this is actually a great chance to get some good work happening by confronting the obstacle.

This hits home for me. There is one thing that frustrates me. I'd like to talk more about the hurts that I have rarely if ever talked about. My therapist often reframes my negative experiences to show the good side. It sounds good, right? It can be. She showed a good side to one long-lasting experience in which I could only see terror and shame and vulnerability. For that I am grateful. But she often jumps to the reframing before I've had a chance to talk it through. My life is full of dark clouds. I lived under those clouds for years, even decades. The silver lining in most cases is not new to me and does not brighten the darkness. How do ask her to delay the reframing or to time it more appropriately? Twenty years of unspoken or barely spoken hurt is a lot of hurt to be reframed in a sentence.

In the last week, I have begun to fear that I am too broken to be fixed. It's probably not true, but she ought to know about it. How do I communicate this fear without it being a judgment of her therapeutic skill?

My point: Sometimes it is a good idea to share everything on ones mind vs picking and choosing as then I left feeling nothing got addressed... .cause only a tiny fraction did.  Sometimes it helped me feel better by opening session spending 5 mins in rapid fire... ."These are all the things going on in my head that I am concerned about this week.  I know we cannot discuss ALL today, but thought you should know what is on my mind.  Any suggestions on where to start with this?"

Often, simply initially throwing it all on the table has got me a good result.

I like this idea so much! I have a backlog of concerns that grows with every meeting.

[Sunfl0wer]

This hits home for me. There is one thing that frustrates me. I'd like to talk more about the hurts that I have rarely if ever talked about. My therapist often reframes my negative experiences to show the good side. It sounds good, right? It can be. She showed a good side to one long-lasting experience in which I could only see terror and shame and vulnerability. For that I am grateful. But she often jumps to the reframing before I've had a chance to talk it through. My life is full of dark clouds. I lived under those clouds for years, even decades. The silver lining in most cases is not new to me and does not brighten the darkness. How do ask her to delay the reframing or to time it more appropriately? Twenty years of unspoken or barely spoken hurt is a lot of hurt to be reframed in a sentence.

If it were me, I simply confront my T.  "Sometimes when you are quick to reframe stuff, I feel like I am left feeling unresolved.  That they are your conclusions I am being spoon fed vs something I am arriving to and internalizing."

One T told me of my ex who had little sense of self that T would serve to "be his ego." So I suppose this means a bit of internalizing the T until the client is "thinking on his own."  Which really means substituting or borrowing ones philosophies.  I am not exactly sure that is what he meant, but that is how I understood it.

Well. I would then suspect that there should come a time where a oerson is to confront the other and challenge, question things so as to develop their own moral base to work from, their own ego.

Yet, I imagine one does that when they are comfortable.  Not to say every T is comfortable being questioned, confronted, etc, but imo, they better damned very well should be willing and welcoming to a client questioning and confronting and engaging in such a way.

... .

On the other hand, your T may be of the opinion that you are remaining stuck on some things and that the rehashing it is not resulting in a healing, but rather serving to remain you stuck.

Maybe you are continuing to bring up the same themes but in different scenarios. It isn't practical or worthwhile to relive all of your trauma with T.  Usually certain themes may show up and once the themes are worked on, then many issues similar should be helped towards resolution.  One need not go through ever example of multiplication problem in the world to feel secure in managing multiplying all number combinations.  Rather, you apply the rules and generalize the info to solve what is presented.  Maybe ask her if she thinks your are stuck? And if she thinks so, what to do overcome it?

In the last week, I have begun to fear that I am too broken to be fixed. It's probably not true, but she ought to know about it. How do I communicate this fear without it being a judgment of her therapeutic skill?

Well the way you phrased it here is all about you so no way for her to be offended imo.
However, the T I had before this one, I point blank told him I felt like my issues were beyond what we were doing in session. I felt we weren't getting some things resolved and I was working as hard as I could but it still felt like we were missing the mark somehow.  I stated I think maybe seeking a trauma therapist could help and asked if he would recommend one.

While he refused to recommend one, (which I feel was unethical now that I see one and see how night/day the difference is) he didn't appear offended.  Honestly, if he did appear offended, it would be good for me to know because it is his job to cope and manage his feelings without putting FOG on me or anything.  He should be ok with me being honest so long as I am not being harmful in some intentional manner/abusive.

Imo, a T getting angry at me for questioning them would be like seeking a pulmonologist to help with my lung issues and him lighting up a cigarrette in the room.  Just wouldn't make sense for me to see.

[beggarsblanket]

If it were me, I simply confront my T.  "Sometimes when you are quick to reframe stuff, I feel like I am left feeling unresolved.  That they are your conclusions I am being spoon fed vs something I am arriving to and internalizing."

I saw her earlier today. She closed the meeting by asking if I have any complaints. I told her exactly what I expressed here: that I'd prefer she delay the "reframing" till she understood the matter better. I described how it had been deeply helpful in the one matter of terror/shame but how it moved too fast in other circumstances. She welcomed this guidance. She may just be doing her job, but I love her to pieces for soliciting criticism.

Next time I want to reciprocate: what am I doing that gets in the way of the therapeutic process? Do you have any insight into this, Sunfl0wer? Does anyone?

[Sunfl0wer]

what am I doing that gets in the way of the therapeutic process?

I cannot imagine ever having a T tell me things that I am "doing wrong." Not sure how else to frame this question so I could get an answer from a T.  I did have one T tell me I was not integrating info, yet I didn't grasp this because I felt I was... .  oh, well... .idk

Maybe another way to frame this is... .
"How can I get the most out of the sessions?"
(But you already asked that here)

Maybe as long as you have goals and are seeing movement towards them, that can be reassuring?

... .

For me, I find it hard to measure my current progress because I sometimes hit plateaus, but then have some internal crisis, which causes movement past a plateau.  So it may seem like my progress is up and down, but my ultimate goals are to do with decreasing dissociation in life, and overall, the movement is heading in a positive direction, even if it is an up/down, it's ultimately up movement.

... .

Maybe you are doing just fine?

[Reforming]

Hi Beggars

You've already got a lot of very helpful suggest from the other members.

I worked with a variety of different therapists and therapies before I settled on one therapist. Some were better than others but there was something to learn from every one of them. My thoughts are;

1. Do your research. There is a vast and often confusing array of therapies out there. Finding the best fit for you can feel like searching for a needle in a haystack so it's important to do some digging before you commit.

There are some very good resources on this site and online that can be a huge help. There are also some very good books that can give you a useful introduction and grounding in different therapies. CBT, Schema, DBT etc

2. Research potential therapists. What is their background and training? What is their clinical experience? A good therapist will agree to an initial interview / consultation - some don't even charge for this - where you can interview them and try and establish whether they are a good fit for you. Therapy requires a substantial commitment of your time and money - don't forget that you're the client here

3. Agree a clear road map and goals with your T. They will need a couple of sessions to assess your problems but after that they should be able to outline a realistic treatment plan. Regular progress updates are a good idea and should be built into this. How does your T feel about your progress. What are the sticking points? How can they be overcome?

4. Record your sessions and write up notes afterwards. I did this on my iPhone and it was hugely helpful. It's hard to stay focussed during a session - especially when you're discussing painful issues. Reviewing both my own interaction with my T and my T's insights allowed me to get much more out of my sessions.

5. Practice what you learn. In my experience most good therapy is skills based. It's great to gain insight but changing cognition and behaviour takes effort and application. You'll get much more out of your therapy if you try and practice healthier thinking and behaviour every day. It's doesn't have to be huge - in fact small, incremental changes are the real building blocks of change. Be patient and kind to yourself but it's important to persist.

6. Don't be afraid the change up. If your therapy isn't helping you move forward it's ok to call it. It's hard to find a good fit and even if you do at a certain point you may find that your professional relationship has run it's course.

I would qualify this by saying that it's important to be honest with yourself about the reasons. Changing therapist because you lack a good connection or you don't believe that your relationship is helping you progress is perfectly acceptable provided you stick to your goals and find another therapist.

Running away from a therapist to avoid dealing with a painful issues is just evasion and a step backwards.

Good luck

Reforming