Therapist recommendations?

May 2, 2012

I am currently not in therapy. I haven't been in therapy for very long at all at

any point - mostly because we've always tried to go as a family and, certain

people being the way they are, the therapy sessions have ended rather rapidly.

On the rare occasions that I have gone to therapy sessions by myself, I have

been told that I was too enmeshed with her to ever possibly be free and that was

the end of that (the counselor refused to work with me further) and I have been

propositioned with wine and sex (by another therapist who DID recommend the SWOE

book, so it wasn't a COMPLETE waste). ... Oh yes, and there was the one

counselor they took me to see when I was 18/19 who told me to read the book

Right From Wrong because " I was having trouble telling the difference. " I didn't

read the book. I lied to the counselor and told him what I thought he wanted to

hear (which was pretty much right on the money), so I got absolutely no help

from those two sessions.

Because of past experiences, I'm a little gun-shy when it comes to therapy, and

yet I see here that so many of you have therapists or have gone to therapy that

has helped you tremendously, and I'm just wondering: Where do you find these

people? How? Is there a list somewhere of counselors who know how to deal with

KO's and BP's? Or am I just better off trying to help myself by reading and

getting help from this group (and you all do help me-thank you!)?

May 2, 2012

Okay, first of all -- do NOT use family therapy as your primary support.

EVER. Get your own therapist you like and trust and can depend on who will

always put you first and foremost. The absolute most important factor in

whether or not therapy will be helpful to you is whether or not you can

trust your therapist. Family therapy can be undertaken simultaneously if

you should miraculously be able to get your family into it, but you want

your therapist to be YOURS. Under no circumstances should your therapist

be discussing you or your therapy with your family members either, without

your express consent and agreement.

It sounds like you've had a couple of questionable experiences with

therapists, but I urge you not to give up. Patient-therapist " fit " can be a

tricky thing and it's worth trying a sample of people, styles, and

techniques to find what works for you (keeping in mind the limitations you

might face due to financial issues and accessibility issues.)

There are more or less three main categories of mental health care

providers (with some smaller categories), and each has its benefits and

advantages. I'll try to give you my point of view on the Big Three and

maybe some others can chime in.

1) Social workers. These can be good, but they don't have a huge amount

of psych training and sometimes have a harder time dealing with issues like

personality disorders. Mostly they specialize in things like " adjustment

disorders " , where people just need some help and support at difficult

periods in their lives. They are often cheaper and more available than the

other kinds of therapists though. Their focus will tend to be on improving

your social functioning and they may or may not have a solid theoretical

grounding in the latest psych ideas and approaches. But if you can find

one who will listen, support, guide you, and provide a solid " reality

check " , they can be very helpful. My current therapist is a social worker

(LCSW) and while she isn't perfect, she very open-minded and supportive,

and encourages me to seek out and explore other approaches and then bring

them in and tell her my experiences with them. Make sure you go to someone

who is licensed!

2) Psychologists. Usually these folks have the best theoretical grounding

in psychology and therapeutic techniques. Look for someone with at least a

Master's. If you can afford it and can get access, someone with a PsyD

degree can have an impressive amount of theoretical background and a lot of

supervised training. Expect them to be up on the newest ideas and

techniques. But you may have to pay for the expertise and you may have to

travel to find one. Again, make sure they are licensed by the appropriate

agencies.

3) Psychiatrists. Generally NOT a good choice except for medication

consults if you should decide that you want to give meds a try. It used to

be that psychiatrists were also trained as therapists (and some of the

older ones can still be very good) but mostly they are medical doctors who

regard mental illness as a primarily physical problem to be treated with

drugs and other medical techniques. These days few of them are even

trained in any but the most basic techniques of talk and cognitive therapy.

Also, they will be VERY expensive for what you get (those med school loans

to pay for...) But if you should need or want meds, particularly if you

want someone to help you sort out which meds or combo of meds will be most

helpful for you, this is the place to get this expertise. Oh,

psychiatrists can also be fairly good for figuring out if the emotional

symptoms you're experiencing might be caused by physical illnesses like a

thyroid malfunction, as they are trained to spot those things. But your

family doctor should also be able to spot things like that, and probably

more cheaply, so go to her first to make sure you're not having hormonal or

neurological difficulties, if you suspect those might be present or

contributing.

Then there are a lot of more " fringe " mental health providers. They work

for some folks, but I would be very, very careful of working with a

non-licensed mental-health provider of any kind. Check them out very

carefully before putting your health and wallet into their hands.

Next thing to consider is the therapeutic style you might want to

investigate. Some styles are shown to be more effective in some types of

problems, depending on what the issue is. For example, if you were, say,

terminally shy or passive-aggressive, you might do well in a therapy that

emphasized getting in touch with and accessing your feelings. On the other

hand, if you have rage issues, accessing your feelings is probably the LAST

thing you need help with, and you want to get into a cognitive therapy

style program that will help you learn techniques to calm yourself and

refocus your energies in effective ways.

Also, it helps to seek out a therapist with some experience and interest in

the specific situation and issues you are struggling with. If your

problems are rooted in child abuse and trauma, you will probably do better

with someone who has worked with Adult Children and is familiar with their

issues. Don't be afraid to ask around and try to find the right person.

Also don't be afraid to go for two sessions, then decide the fit isn't

working, and find someone else. BEWARE of any therapist who tries to hook

you into staying in therapy you're not comfortable with on the grounds of

" If you hate it, we're on the right track! " . That's not necessarily

completely wrong, but you won't make any progress if you don't feel safe.

A good therapist WILL challenge you sometimes, but not to the point of

making you panicky or enraged. The old Freudians sometimes tried to

provoke extreme reactions in their patients in the idea that it was good

for the patient to " transfer " these emotions onto the therapist, and if you

didn't " transfer " properly it wasn't going to work. That turned out to be

nonsense. You should never feel coerced into ANYTHING by your therapist.

As to the particular experiences you have had:

1) " Too enmeshed to ever possibly be free " ? That sounds completely off

base. Large amounts of enmeshment with our Families of Origin (FOOs) are

completely normal and expected, especially for those of us who have

personality-disorder parents. I have enmeshment issues myself, and my

therapist sometimes gets exasperated ( " Let's talk about you, not your Mom " )

but it's an issue to WORK ON, not a prescription of doom. This is where

finding a therapist with a background in helping Adult Children would be

very useful. No one with experience with Adult Children would say

something like that.

2) Wine and sex? Okay, that's actually illegal. I hope you filed

complaints against this person in every venue you could find (his

professional associations, his licensing board, his supervisor(s) at the

agency, whoever.) That kind of behavior is grounds for loss of license and

job at an absolutely minimum and you probably could sue his ass too. (I'm

being a bit biased here assuming it was a male therapist -- but I HAVE

heard of things like this rarely happening with female therapists

sometimes. It's rarer, however.)

3) There's nothing wrong with the counselor offering books (my therapist

introduced me to Alice , for example) but I'm a bit shy of one

saying " Here, this book will provide all your answers! " because that never

happens. Also, by definition, if you are lying to your therapist about

things like this, you don't trust your therapist -- time to get a new one.

If your therapist is going to be useful, you need to be able to be honest

with him or her. If you can't do that, there will be no benefit.

So to summarize:

1) Find a person you can trust.

2) Find someone who is licensed.

3) Find someone with experience in your area of concern; if you have

interest in a particular therapy you want to try, try to find a therapist

who knows about that therapy and can guide you in it.

Just in the interest of satisfying my own Fix-It urges (an issue of mine),

I'll throw out the title of a book I think is very good for Adult Children

that I found recently. It goes by the unappealing title of " Reinventing

Your Life " , ( E. Young, Janet S. Klosko) which makes it sound much,

um....squishier?....than it truly is. It's actually a very solid practical

introduction to Schema Therapy, which is a relatively new discipline that

is catching on. It's hard to find anyone who actually practices it outside

of the New ENgland/Mid-Atlantic region at the moment, unfortunately, as

that's where it's being taught. I think it has a lot of strong potential

for Adult Children of many stripes.

There is an evolving view of psychotherapy that holds that effective

talk-based psychotherapy has two essential but separate components or

steps, and Schema Therapy attempts to integrate the two steps.

Step One is actually the easier of the two, but it has to come first --

that's the * " Insight " * step. That's when you sit down and try to figure out

what your issues are, how many of them come from outside forces (which you

have limited control over) and how many of them come from inside forces

(which you have significantly more control over, and in which you can

practice and strengthen your control strategies to improve your skills.)

" Experiential " therapies are really good for this -- this is what " getting

in touch with your feelings " , " developing awareness " , " scanning your body "

and so on are all about. It's all about learning to develop your focus, to

pay attention to your internal and external world, and to become able to

determine what signals (mental, physical, internal, external) are actually

meaningful and which signals are " noise " that can be safely ignored.

Step Two is the harder of the two, and that's " *Working It Through* " --

applying your new knowledge and awareness to make the changes in your life

that you want to see happen. This is harder and much slower, but definitely

doable. Some folks get into therapy and get through the insight stage and

feel such a surge of newfound power and clarity that they think that's all

they need -- and for a few people it might be sufficient. But for most

people, actually breaking themselves of the bad habits they've gotten into

and developing new, more effective skills in managing stress, emotion

regulation, interpersonal skills, and so on, is a struggle and requires

patience, time, and the ability to forgive yourself for setbacks and keep

slogging toward your goal of improving your functioning. " Cognitive "

therapies are really good for helping people " work it through " .

Some folks can even manage, with sufficiently good cognitive therapy, to

" work through " their problems without ever necessarily achieving real

insight. This is great for things like phobias, where it's not actually all

that necessary to uncover what hidden trauma caused you to start believing

that spiders were a horrible deadly threat to you such that you can't even

look at one without screaming, but more important (and time effective) to

just break yourself of the panic habit using cognitive techniques. With

more complicated psychological issues, though, you often see that if

cognitive therapy is used to " fix " a problem (an obsession,say) without

uncovering why the obsessive need exists in the first place, all that

happens is that the client will simply find something ELSE to obsess about.

And you can end up playing psychological " whack a mole " , constantly

correcting old bad behaviors only to find new ones taking their place

almost immediately. Then you need to backtrack to the insight stage.

Psych workers have tended to sort of divide into camps over the " It's what

you* think/feel* that's most important " / " It's what you *do* that's most

important " and take up sides. (Generally social workers will be heavily

into " insight " , and psychologists will be all over " working it through " --

but that's definitely a generalization as there are therapists who don't

fit that mold on both sides.) The best psych workers, in my opinion (and

experience) take a stepwise approach --* first feel, then think, then do*.

So that's kind of my overview on talk therapy and how to get the most out

of it. I would strongly encourage you not to give up on therapy just

because of a couple of bad experiences. There are MANY good therapists out

there who genuinely want to help and have the skills to do it. Finding the

right therapist for YOU (not your family -- YOU!!) takes some research and

work but the payoff will be worth it.

Hope that helps a little!

-- Jen H.

On Wed, May 2, 2012 at 7:05 AM, Alice Spiedon strugglingmom2@...>wrote:

> **

>

> I am currently not in therapy. I haven't been in therapy for very long at

> all at any point - mostly because we've always tried to go as a family and,

> certain people being the way they are, the therapy sessions have ended

> rather rapidly.

>

> On the rare occasions that I have gone to therapy sessions by myself, I

> have been told that I was too enmeshed with her to ever possibly be free

> and that was the end of that (the counselor refused to work with me

> further) and I have been propositioned with wine and sex (by another

> therapist who DID recommend the SWOE book, so it wasn't a COMPLETE waste).

> ... Oh yes, and there was the one counselor they took me to see when I was

> 18/19 who told me to read the book Right From Wrong because " I was having

> trouble telling the difference. " I didn't read the book. I lied to the

> counselor and told him what I thought he wanted to hear (which was pretty

> much right on the money), so I got absolutely no help from those two

> sessions.

>

> Because of past experiences, I'm a little gun-shy when it comes to

> therapy, and yet I see here that so many of you have therapists or have

> gone to therapy that has helped you tremendously, and I'm just wondering:

> Where do you find these people? How? Is there a list somewhere of

> counselors who know how to deal with KO's and BP's? Or am I just better off

> trying to help myself by reading and getting help from this group (and you

> all do help me-thank you!)?

>

May 2, 2012