Monday, April 23, 2012

A Question Regarding Therapists/Counselors

I had one of those conversations when I talk about things with someone, momentarily setting aside the fact that this conversation will probably disturb me later. I keep wondering why I talk about these sorts of things with some people, knowing how they might respond, but I do keep talking. Maybe hope is a good thing. Maybe sometimes it will make me sad later. Oh, well. It doesn't look like I'll stop talking (at least not for too long).

But this came up again. The theory seems to go like this. I'm not better yet (better enough, whatever that is), so my counselor must not be a good counselor. I should find a new one. Okay, that's probably a bit oversimplified with some added black and white.

But here is what I wonder - no, first, here is what I think.
1. It's not fair to judge a counselor by their patient. Depression and OCD aren't always "fixed," even by the best counselors. At least, I'm pretty sure I could back that up, and much easier than backing up the opposite.
2. Just because you got over depression in half a year or a year and a half doesn't mean that I will "get over" mine that fast.
3. Too many things could factor into my mental illness. Let's not forget the chemicals. And the medication. Should I throw out my Psychiatrist because I'm still going through meds? (These people might think I should find a new psychiatrist - if I even need medication, so I guess that arguement doesn't hold much water for them.) But assuming the possibility of chemicals, a physical disfunction in the brain, and that sometimes it takes more time to find the right medication, these are all things that could offset whatever miracles a therapist might be working. Then let's add stress. Then let's add patient compliance (really, is it the teacher or the student's fault if the student isn't learning? Maybe it could even be both). Then let's add... I don't know. I'm still working through things, okay? I wasn't Miracle Woman, okay? My first medication didn't work for me, okay?

I guess I'm a little frustrated.

Anyway, maybe these wonder people have a point; maybe my counselor doesn't push me hard enough (of course, I don't want to be pushed too hard and don't want a counselor that pushes me faster than I'm ready to go - urge me, maybe, force me, never). Maybe my counselor isn't smarter than all the other people I've talked to about stuff I'm supposed to "get over." Maybe, just like everybody else, she can't solve everything.

Okay, I'm being way too frustrated for a good, present-a-question speech. Let's just say it.

How do you decide when to move on from a counselor?


  1. I've never met a counselor worth a sh*t. That's why I got into the field, in hopes of actually HELPING someone. I think they rely too heavily on drugs, and the field as a whole is too subjective. I believe we already have the answers, and a great therapist helps us discover that. When is it time to move on?

    1. If you feel dependant on your counselor. Counselors should never, ever be a crutch - they should challenge you. If you don't feel challenged by a counselor, it's time to say goodbye and find another. Therapy is NOT comfortable, but it is not detrimental: good therapy is challenging and hard.

    2. If your counselor does not listen to YOU.

    3. If your counselor pushes drugs. Drugs can assist, but ultimately YOU have to do it. If you are against drugs and your therapist keeps pushing it despite clear disadvantages, it might be time to say goodbye and find a new therapist.

    4. If you truly feel misunderstood and it's not an ego thing at all. Sometimes a true personality conflict exists, and it's not healthy for either of you to remain in the counselor/client relationship.

    5. If you do not feel you are making progress.

    6. If you don't feel you can ask questions and get answers. NOT REASSURANCE!!!! Real questions. Make sure to know the difference. Questions are always valid. Reassurance strengthens OCD and other disorders.

  2. Abigail, I certainly understand your frustration. I've had some counselors who were just not right for the job. But there are many good ones. I am fortunate enough to have an excellent psychiatrist and an excellent therapist.

    The main thing to consider is whether or not you are comfortable with your therapist and trust him or her. Do you feel comfortable discussing your concerns with him or her? Is this something you can discuss with your psychiatrist? My psychiatrist recommended my therapist to me because of his training and background, and it has been a great fit.

    None of us is on the same improvement plan. We go at our own pace. And medications can take time, and work differently with different people. If you are unhappy with the pace, is that something you can discuss with your health care providers?

    I have never had any physician or therapist push drugs on me. Whether or not drugs are appropriate is a decision to be made by the patient and the doctor. There are all kinds of schools of thought out there about the use of drugs. None of that matters when it comes to what you and your doctor decide is best for you. Even if you are taking drugs, it's still you doing the work. I am on medication, and I work hard. It is ultimately me doing the work, and there is absolutely no shame or any weakness in taking drugs.

  3. Tough question, Abigail. I think you have to go with your instinct on this one.

    I am blessed because I found an incredible cognitive behavioral therapist. I did drive over an hour away, one way to see her. She never forced me to do anything, but at the same time she strongly urged, encouraged, motivated, etc. In fact her motto was "comfortably uncomfortable." She taught me that if I were to get better, I should seek out that level of discomfort with ERPs.

    She also was not one of these types who thought everyone should be on meds. I really appreciated that. Though I'm on meds now, I was not for a long time. I will say that for me, my med has been a huge help. But I do think it's different for everyone. Not everybody responds to drugs the same way. Also like Tina said, the meds were only a help. I still have to do the hard work.

    The other thing my doc used to say all the time was that she was in the business of putting herself out of business. Meaning, that she was trying to teach me to be my own counselor, so that I would not have to keep seeing her forever. Now, I did see her for quite a while (2 1/2 years). However, I do feel that I've learned a tremendous amount.

    Does your doc(s) do what all of the most respected literature on anxiety disorders recommends? Is your doc(s) keeping up with research? Does your doc keep you accountable for your exposures? Does your doc recognize cognitive distortions and point them out to you? Just some thoughts.

    I do think you are right. You can't judge a doctor by their patient. A good CBT doc is like a coach. The patient is like the athlete. The coach can tell the athlete what's wrong with their form, etc., but if the athlete refuses to take the advice, then it's not the coach's fault.

    I don't know where you live, and I do know that definitely makes a difference. Thankfully, in the Boston area, there are many good CBT docs. Start heading a bit out of the city though, and the number of people who truly know how to treat OCD properly goes down exponentially. Before you actually change docs, you may want to do a lot of research on potential new docs first, like where did they get their training, how much experience do they have using CBT/ERP.

    Anyway, don't know if this helps at all, and I'm sorry for having written a book here! Lolly of Lolly's Hope just wrote an interesting post on taking advice from people. You may want to check that out too! Good luck with your decision and keep us posted.