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Science Forum Index » Psychology - Psychotherapy Forum » unsuccessful psychotherapy...
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| schaperowpsychologycenter.com... |
 Posted: Sun May 04, 2008 6:28 am |
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From http://sam.schaperow.googlepages.com/unsuccessfulpsychotherapy
Unsuccessful Psychotherapy:
How it Can All Go Wrong Before or During the Initial Sessions
Psychotherapy has some of the highest no-show and cancellation rates
in the healthcare industry. People often have anxiety going to
therapy because they fear being judged, or they feel that they can or
should solve their problems on their own. It may take a major crisis
or many years of problems that won’t go away before making that
initial call to a therapist. Many people then will go only if the
therapist can accommodate special times, such as only early evenings,
and take their insurance, even if it means that the quality of service
might be compromised by the insurer’s policies. Additionally, the
therapist’s location, gender, phone friendliness, and age can be
factors that people use to determine who to see. All these criteria
can severely limit the prospective client’s chances of even starting
therapy, never mind continuing.
Much of the above also applies to people who begin seeing a
therapist. There are additional factors that come into play when
starting therapy:
Sometimes the therapist resembles a person you know. For instance, I
once starting seeing a couple and the husband looked like he was ready
to crawl up the walls. I later found out that the issue was that I
reminded him of his brother, due to how I look.
The insurer has substantial paperwork that creeps into the sessions,
directly or indirectly. In most cases, this will lower the quality of
treatment.
The therapist may have policies you disagree with, such as about
cancellations or length of treatment. In my own practice, I sometimes
get people that want to come in just when they want to come in. While
I’ll ultimately agree to the terms, at least for a time, it is very
rare (perhaps 3% of the time) that such clients gain much out of the
therapy.
The insurer states that there is a deductible, but the insurer applies
only a fraction of the fee paid toward it for therapists who do not
have whatever particular license type that the insurer prefers. And
so a deductible that should have been used up in a matter of five
sessions ends up taking ten sessions to be used up. (E.g., the
therapist charges $200 per session, but the insurer pays the license
your therapist has at the rate of $100 per session).
The insurer does not cover couple therapy, personality disorder
treatment, or a whole host of other diagnoses (nowadays most
therapists will see the main issue as, for example, a partner
relational problem, but will give a mental illness diagnosis to get
coverage).
It turns out that the therapist does not specialize in the issues
needing treatment.
The therapist offends the client: I once had a couple, and the wife
was experiencing paranoid delusions (believed things that were not
true). I recommended that individual therapy would be needed for her
to work on how her beliefs affect her and the marriage, but she became
very upset and abruptly walked out, never to return. She said that
her husband was going to use what I said against her. But, had I told
her separately, and she was not willing to disclose what was said in
private, he might have walked out for the secretive nature of this one-
on-one meeting.
The therapist gives or does not give suggestions: Some people appear
to be interested in constructive feedback, but do not try out the
suggestions and decide that returning to see me would be a waste of
time without utilizing the suggestions. Underlying this often may be
a person who was raised by critical parents, causing them to fear
letting their therapist know that they didn’t progress. In reality,
sometimes not doing an assignment is more useful as data to the
therapist than doing it. At other times, therapists see people who do
not show any request for direct suggestions, then they stop coming in
because they did not get enough direct suggestions, even if the
therapist is still assessing and getting to know their new client.
The therapist asks questions that you are not yet comfortable
answering, but you hide this discomfort and make a decision then and
there to not return.
The therapist is unprofessional or too professional: I know of a
therapist that, particularly with teenagers, uses swear words. I also
know that some therapists dress wear a suit and act so professionally
that some people are uncomfortable.
The therapist is practicing out of their training, such as one who has
no formal training in seeing couples, or does not specialize in it
(experience can be informal training, but is not always a
substitute). The article published several years ago stated that the
majority of therapists practicing couple therapy have no formal
training in it!
With so many factors that can prevent a successful therapeutic
relationship from forming, what can you do?
Be picky with a therapist’s experience, education, or skills. But
within reason, try to not be picky about factors such as age, gender,
cost, distance, or time slots. If you hate women, then see a woman
while allowing her to be the exception to your hatred. Who better
than a woman than to help you through your misogyny [if you can allow
her to be the exception]. If the therapist has no evening slots and
is the highest recommended person, find a way to make it in if it is
at all possible. Who better to help you than the top-rated-for-you
therapist in the area? When a person is truly ready to deal with
their problems, most of these factors become unimportant. People who
can overcome all obstacles to utilizing the best help typically
utilize the treatment vastly more.
BE HONEST! Do tell your therapist what your needs are, so that you
can see if they use a style that works for you. For instance, I am
typically an active therapist who provides much useful feedback, but I
also have training and experience at slower paced models. I do need
people to let me know what they need, and if it is within my
abilities, I will provide it. Say when something bothers you and you
can work it through with your therapist. People usually have the same
issues with direct communication in their personal lives, so do not
give up so easily when you get uncomfortable.
Do not blame your therapist for why you want to quit. Exceptions
include malpractice (i.e., the therapist trying to start a romantic
relationship with you, or the therapist has no training in what they
are trying to help you with), or they only have 10PM to 2:00 AM time
slots available, and your normal sleep pattern would be harmed by
attending.
Note that if you become offended by something the therapist does, this
may be related to your own issues at home/work/family of origin (e.g.,
the therapist charges you for a no-show, and you often argue with your
spouse about finances, or the therapist talks to you about your being
late, when being late is what you often do), and so if you can discuss
this offense with your therapist and try doing things differently,
this can help you with your own issues that you came in for help
with. Who better with, than your decade-long trained therapist, to
work through those topics that push your buttons?
The bottom line is that sometimes finding a therapist with whom you
feel most comfortable is not always going to be the most productive
for you.
If you have any questions about this posting, feel free to reply. |
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