About Psychotherapy in General

These blogs are about therapy in general, an overview in some cases.

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The “Not Good Enough” Therapist

I have answered a number of questions on Quora; many from people asking specifically for my response.  A large percentage of them speak of  variations on the same theme. They are either blaming or at least doubting themselves about their discomfort with their  therapist or the  lack of success of the treatment.  In each situation, I saw reasons to believe the therapist was either inadequate or downright unscrupulous and unethical.

This is such a set up:  People go to therapy  because they feel uncertain about themselves  or their life in some way, and that in itself makes the them vulnerable and not confident in their ability to critique the therapist. Plus, everyone really wants the therapist to be wonderful and help, even to be a really trustworthy parent figure.  Unscrupulous therapists can turn this to their own advantage in a myriad of ways: from seeing the client longer than needed to make more money, having sex with their client, to using the client to be  their friend. Poor therapy can be very harmful or at a minimum waste the client’s time and money, and it may turn them off to therapy altogether.

Some people automatically give the therapist credence just because they have an office and are in business. Please don’t! Question the therapist and trust your intuition as much as possible. You are not supposed to trust this professional just because they have a degree. The therapist has to earn the client’s trust and you can let that take as long as it takes. It some situations, that trust isn’t fully felt until the end of a long bout of therapy. And that’s just fine.

If you are uncertain if your therapist is useful  to you, it’s fine to bring this up and evaluate the therapist’s response. It can also be helpful to ask another therapist about your situation.  The ‘second opinion’ therapist may want you to try and work the  out your dissatisfaction  with your current therapist – considering the possibility of negative transference – but if you have given that your best shot, it’s really OK to find someone who works well with you. If you repeatedly have the same dissatisfaction, then it may indeed be negative transference and you need to pick your best choice  of a competent therapist and hang in for the long haul.

I have other blog entries and short articles about How to Choose The Right Therapist, what you should get from a good therapist and how to decide if and when you should leave as well, as well  as blogs about transference. Check them out if it would be helpful to you. You  can also write and ask me for my opinion.

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Fear of Change

Sometimes clients tell me that they are afraid to change, even if the change they are talking about is something they have wanted for a long time, it’s still frightening to do.  I often say things like  “you don’t have to change until you are ready,” and then I tell this story:

Snakes live in the forest. They spend all day traveling over rough, uneven ground. They go over fallen branches with hard bark, sticks, rocky areas, sharp pebbles and all sorts of terrain.

Every spring the snake sheds her skin. The old skin loosens as she travels over the rough ground. The baby new skin beneath it has to get strong enough to handle the terrain before the old skin finally peels off.

It’s never the therapists job to pull the skin off a snake.

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Stuck Grief : Why is it you are looking into therapy?

A man I work with came up with this phrase, “stuck grief.”   He was referring to himself and why he was having trouble with near psychotic thinking. The “crazy” thoughts were preferable to recognizing what they symbolized: another extremely painful  memory of abuse from his father. He was saying, very articulately, what was going on inside himself: stuck, or unexpressed (and surely unresolved) grief.

I realized that stuck grief was the basis for what goes on in therapy sessions including all of our histories and especially forgotten, denied  or ignored incidents and realities. People avoid what brings pain, and until they have dealt with the pain and resolved it, they tend to continue what ever emotional habits maintain their avoidance  Even very high functioning adults, maintain unhealthy behaviors  because they are not willing to face the truth of their childhoods. Sometimes it is  loss of the relationship with their families that they fear, or having to confront the imperfection of their parents.  Ultimately It turns out to be an avoidance of growing up.

If someone has something that needs grieving, and they avoid the recognition and therefore the grieving, I call that stuck grief. It is  accompanied by some behaviors that aren’t healthy for the person, their children, their spouse, their customers, business associates, someone.  They often use an addiction  to keep the pain out of their awareness, like  drug or alcohol use, over working, lots of sex. It can become confusing to tell the difference between what you need with what is best for your children, and a  handing down of all kinds of human distress.

Stuck grief buried within a person can become the basis for just about anything that might bring someone into therapy.  This is why doing therapy takes courage, and a different kind of courage than many people are familiar with.   So, if you are looking for more than a bandaid, if you really want to understand yourself and make significant change, pick your therapist, your guide, carefully.

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When People Choose The Wrong Partner

This is my own personal opinion, borne out by many clients I have encountered.  I haven’t heard it from other therapists, and it certainly is not the usual explanation given in my profession. But it is my opinion:

When we are small children, we all need love, and we need it consistently. We need love that is intelligently given, so that, for example, as children we are  given age appropriate challenges that we can master – thus building or self esteem.  We also need to be loved just for existing, for being our parent’s pride and joy because we lie in our beds at night breathing.

Most people don’t get the kind of love they need. Many have parents completely unable to love them. When we grow up we still need that love we didn’t get. The longing to be loved  doesn’t go away just because it is time to move out of the house.

So we wind up picking someone as a partner who has enough of the attributes of the parent (or combination of parents) that they “feel” like the parent  we most still want to be loved by. In essence, we are picking a psychological stand-in for that parent. And then we work really hard to get that person to love us. But – because we are so good at picking stand-ins, we have picked someone who can’t love us either.  Often, because it really is the parent this partner represents to the child in us, this hurtful partner is hard to leave.

Many battered women fall into this category, and the sad thing is that if their parent was abusive they may have repressed any memory of the abuse ( for self – protection) and still pick people capable of abusing them.  When they hear this possible explanation, they can’t apply it because (1) they  have forgotten the abuse, and/or  (2) their denial of their parent’s cruelty keep them from acknowledging it. People want to believe they had good parents, otherwise their view of their childhood and their parents falls apart, leaving them with what feels like”nothing” to hang on to, to be their base.  They “lose” their parent.

This makes it hard for them to do successful therapy and strengthen themselves enough to leave an abusing partner, or one that simply is not well suited to them. I have found, however, if the therapist will  address whatever the person needs right now in therapy, then this in itself strengthens them to the point where they able to remember, work through whatever childhood issues they need to and make sense of their lives and their previous choices.  Best of all they are now free to choose a partner who can love them, as they deserve.

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Transference in Therapy

What is transference and why is it important?

Transference can be an aid or a hindrance in  therapy. It can also complicate any of our relationships.

Transference is the phenomenon of transferring feelings from a significant person in your childhood to someone else. It is unconscious and it happens all the time to all of us. For example: you meet a woman and she reminds you strongly of your older sister who you were very close to. You will probably like this person and wish for a close friendship even before you know her very well.

In therapy, there can be positive transference, negative transference, or countertransference.

Countertransference occurs when the therapist is transferring feelings about their important people on to the client. It’s very human of the therapist but it is imperative that the therapist is aware of it and keeps the transferred feelings in check. Otherwise the therapist’s therapeutic judgement and reactions to the client can become clouded and compromise the quality and progress of therapy.

Positive transference is common at the beginning of therapy when the client is wishing for a “super person” who will “save them”. Someone with all the wisdom and skill needed to succeed at giving the client everything the client needs.
Positive transference is helpful to the therapist as the client is open to what they say and compliant to requests. When asked people in positive transference will often enthusiastically characterize their therapist as “Wonderful!”

Negative transference occurs when the client transfers negative beliefs and feelings from someone who was hurtful to them, onto the therapist. The client may say to the therapist: “you are out to get me and make me feel wrong all the time, just like my father,” or “you are judging me just like my mother did” or “you’re angry but you cover it up.”

Great work can come from “working through” negative transference. A profound change can occur when a client sees the therapist as they are and then realizes how much negative transference influences the way they relate to other people in their lives. It’s eye opening! Some “people their world” with their hurtful parents and find it such a relief to stop.

Too much positive transference can be a problem because the therapist is bound to “fall from grace” at some point. Often when a client’s “wonderful therapist” disappoints them the transference turns negative.

Bringing this phenomena of transferring feelings and beliefs to conscious awareness gives the client access to reality.  Then they can see the actual positive and negative attributes of the person who has been the target of their transference. It often has the effect of moving the person forward in personal growth and maturation.

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Evaluate Your Therapist

Are you dissatisfied with your therapy? Is it you or is it your therapist? Let’s evaluate and find out.

First I will tell you what is reasonable to expect from a competent, experienced therapist. In the next post I will explain the notion of transference, positive and negative, and then how to work with your current therapist to see if negative transference is the problem.

Here are some fair expectations you should have of your therapy process and your therapist:

  1. You should make progress. If you don’t think you are, ask your therapist why they think you are or aren’t making progress. Don’t automatically discount your your own instincts. Listen but don’t assume the therapist knows more than you do just because they are “the professional” if what they say doesn’t make sense to you.
  2. You should get something new out of every session. If you are not, ask yourself if your therapist is:
    • not really working when you are in session – they should be.
    • just being “someone to talk to”: therapists should have a lot more than this to offer.
    • not clearly showing you how to get engaged in your sessions: You have to if you want to grow.
    • just giving advice: you should be learning how to answer your own questions and make your own decision.
  3. You should be learning from your therapist. Your therapist should know more than you do about the general kinds of issues you are dealing with. They should be able to clearly relate this understanding to your specific situation.
  4. You shouldn’t feel worried about your therapist’s feelings – it’s the therapist’s job to take care of themselves. The therapist should call you on doing this and reassure you they don’t need or want this from you.
  5. You should feel your therapist likes and cares about you. If your therapist doesn’t accept who you are and like things about you, you deserve more.
  6. Your therapist should have several ways to approach you and your problem. You should never feel like you are supposed to fit into their way of doing therapy.

If these expectations are not being met, talk to your therapist about them. It is also reasonable to look for another therapist. Remember, just because this therapist is set up in an office or clinic doesn’t mean they are good at their trade.

On the other hand, if you find yourself repeatedly switching therapists I would recommend you stick with your current therapist and make a sincere effort to work out your dissatisfaction.

If you fire a therapist, it may rid you of the problem at hand, but another version of that same problem will likely show up with your next therapist. You need to give your current therapist 3 to 5 more sessions while you focus on working out your relationship. This may well be about transference which is the unconscious phenomena of transferring feelings from one person to another; in this case unconsciously transferring your feelings for some one else in your life to your therapist.

Transference is one of the reasons therapy can work so well and it is also a reason why it can fail. More about that next in “Transference in Therapy“.

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Reluctant to take Medication for Depression, Anxiety or Bi Polar Disorder?

You are justified in your concerns about “putting strong drugs in my body,”  as many of my  clients put it.  How do you decide if it is the right thing to do?

It depends on how severe the depression, anxiety or bi polar symptoms are; how much it is effecting your life.  Some people with mild to moderate symptoms are sure they are not being effected enough to warrant the use of psychotropic drugs. Other people can get a clearer perspective by talking  with the people they are close to and spend a lot of time with.  The people who live around you can often see changes in you that, subjectively, you can’t see but can recognize  when they are pointed out.

Let’s say that your mood problem is effecting your life enough that you want to do something for relief. You can try the medication, see  how helps, and then decide whether or not to stay on it.  You can also try holistic methods, like daily aerobic exercise (for depression), acupuncture or homeopathy. I’ve had clients stop therapy because one of these methods improved their life so much they didn’t need it any more.

Of course there are people  who stay on a maintenance dose of medication to keep their lives worth living. Many have told me they are  glad the medicine exists, knowing that generations back people just suffered.

I strongly recommend seeing a professional if you think you have one of these mood problems.  Good therapists can often determine if the kind of problem you are struggling with will respond to medication or holistic help. You don’t need to suffer, or function at a lower level than you can.  Take hold of your life, it belongs to you. Make it good.

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More Common Questions

I’m afraid of not liking my parents if I find out they hurt me when I was little.  I want to be able to love them and be close to them.  Maybe it isn’t worth finding out what happened to me, or is it?

That is a real and serious question.  Would you rather live with the truth or with your hoped for fantasy? Would you rather have your whole self, or your relationship with your parents?  I suggest you look at what troubles you in life and decide how much you want that to be different.

 

So what in me probably has to do with past childhood abuse? No one is perfect, what can I assume about myself is attributable to childhood abuse? 

Low self esteem, relationship dissatisfaction, trust issues, lack of self actualization, unnecessary fears and anxiety,  problems with your sexuality, to list only the most obvious.  I have never known a person who has worked on their childhood abuse be sorry they did.

 

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The Bottom Line on Therapy

So what is the purpose of therapy, anyway? What is it supposed to do for you?

Therapy gives you choice. It allows you to have choices instead of  automatically thinking/feeling /acting  from what your history taught you  – about yourself, other people and the world.

Your history, in this case, means your childhood.  During those early years you learned by experience what the world is like, what  to expect from other people,  and who you are.  For an example: for the child who was expected to mommy’s little helper and take care of her younger siblings learned that to be a good person was to figure out what someone else needed and do it for them. Maybe she learned to put her own preferences  and needs in the background, to never complain or think of herself first,  to think of herself as valuable only  in the ways she  could serve others.
So she grows up to be a what we all call a caretaker, giving “selflessly”, and  depressive without knowing why.  After all, everyone she knows says she is wonderful!  She finally decides to get her own career, and, you guessed it, she becomes a nurse. More depression.

She comes to therapy and discovers what she thought were her own choices where based on what she learned as a child  and decides to throw it all off.  Her kids do more chores around the house. Her husband comes into therapy with her because she is fed up of his self centered ways and expectations that she be his maid, lover on demand, and the one who takes care of the kids. She gets a new hair cut, loses weight,  quits the subservient good girl role at work and becomes an administrator…..you get the picture.

Therapy teaches you how your childhood effected you and gives you choices about what you want to do, who you want to be.  How does it do that? Look around at other blog entries, and if you have specific questions, leave a comment and I’ll do my best to explain.

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Roots of Self-Esteem

Positive self-esteem is developed in many ways in children.  If your parents value you and respect your feelings, thoughts, preferences, and proclivities, while challenging you with age-appropriate, achievable goals – you will likely develop good self-esteem. This positive sense of who you are becomes a natural part of yourself – something you take for granted and something that holds up against life’s disappointments and failures.

Negative self-esteem can develop in a myriad of ways.  It is pretty obvious, if you have been reading much of my blog, how being emotionally, physically or sexually abused teaches the child that they are worthless, and that certainly will grow roots of poor self-esteem.  One of my Stories for the Unconscious “The Good Prince” illustrates how negative self-esteem can develop in a person who is, by all outward measures, very loved and given lots of positive regard by his parents; but wasn’t allowed to find his true self.

I have seen over the years in my practice this exact problem in some adults of wealthy parents. In this situations,  the parents wanted control of their child and didn’t allow the child to investigate his /her own proclivities and learn his /her own strengths and talents. These parents have many values and directives that they press upon their child. As the child grows older,  the parents continue to hold the child hostage by the magic of their money and the threat of taking it away.  Other parents control the child by dint of their own personality – and use love, approval or fear as the currency of their control.  Most children are influenced to some degrees in this way in that we take on our parents values. (” Of course they expected me to go to college, they talked about it ever since I can remember” – can be a positive value and directive.  Oops! I guess my values are showing here!)

The difficulty lies for kids whose parents take so much control that their child, in order to win acceptance, pushes the best parts of themselves “underground” where the parents can’t see it. The abused child does this so the parents won’t damage that part of them.  For example, the boy who has talent as a writer and whose father would surely ridicule and beat him so he won’t embarrass Dad by being a sissy. This kid could shove that talent so deep inside himself that he wouldn’t even know he can write well until he takes a college course in creative writing.   The Good Prince put his real self underground in response to the enormous pressures of inheriting the Crown.