Making The Most Of A Crap Therapist

[Dana1010]

So I made an intake appointment at a center for under-insured psych patients. I've been on the circuit long enough to know that the therapist they stick me with will, in all likelihood, suck. I'm now suffering from another form of PTSD -- post therapist stress disorder.

So this post is about how to drive your own therapy. How do you get some benefit from a therapist who just wants to run down the clock without talking about anything unpleasant?

I'm anticipating a sort of coaching/ pep talk instead of real therapy. Not so much "talk" therapy as "shut up" therapy. Lots of people don't like their dad. Lots of people lie about their background to peers. Lots of people feel this way. Lots of people feel that way. Lots of people have cancer, so stop complaining that you're dying, and try to have a good day. (Joke. I don't have cancer. )

Does anyone have any tips on how to flip the script and drive the session yourself? Especially when they keep changing the subject to something easier for them -- what do you do to bring the conversation back to what you need to talk about?

What ways have you found to get the most out of a crap therapist?

 

[Deleted member 28403]

Analyze their skills, see what they can do, guide in that direction

Confront them about their skill, and need of greater skill possibly

Confront them about whatever is bothering you

Latch onto their leg, and don't let them runaway screaming :p

 

[Justmehere]

I've been on the circuit long enough to know that the therapist they stick me with will, in all likelihood, suck.

This very well could be the case, but not always. One of the best therapists I ever had was a trainee at center for people with little to no income and insurance. That therapist changed my life more than any I have ever seen. Therapists who work with under-insured patients are not exactly in the job to be comfy. I have generally found them to be more willing to talk about hard things. I know you have had at least one therapist, if not more, that you felt like was avoiding hard subject. Many therapists who work at low income/under-insured centers because they want to dive into the hardest topics, which tend to be a little more prevalent amount those struggling financially.

I'm anticipating a sort of coaching/ pep talk instead of real therapy. Not so much "talk" therapy as "shut up" therapy. Lots of people don't like their dad. Lots of people lie about their background to peers. Lots of people feel this way.

Tell them this is not helpful for you. Right up front. If they go there, try to not see it not as the worst therapy session ever, but instead a chance to work on how to keep boundaries with someone.

Does anyone have any tips on how to flip the script and drive the session yourself? Especially when they keep changing the subject to something easier for them -- what do you do to bring the conversation back to what you need to talk about?

Bring a list of topics you want to cover and 3 specific goals for therapy overall, and 3 topics or areas to work on for each session. Share the list with the therapist. If they detour, ask them how it helps with what is on your list. If they can't answer, ask then how it is more important for your life than what is on the list.

 

[Thizette]

Tell them this is not helpful for you

Absolutely agree. It's good to say right at the beginning what you expect/need from your therapist. If you find your therapist consistently unwilling to follow a treatment plan you've agreed on, request a new one.

 

[GWhizz]

I think it ultimately depends on who you get. I have worked with people that are happy to work on my goals and others that decide they know what's best.

Either way you need to establish some sort of ground relationship and rapport first. I'm not 100% happy with my T. Initially she refused to let me write anything down as she believed it caused more problems to persist with my prior T. She's now coming around to the idea of using it as a limited tool. But I find myself constantly struggling to engage with her or agree with her decisions as to how she directs therapy.

But at the end of the day, most T's want you to stay and work with you. So I guess you just have to lay it out straight for them and clarify exactly what you're looking for and routes that you are not willing to try. If they really are 'crap', I'm not sure there's a lot to work with and in that case I'd suggest requesting a transfer based on incompatibility or something. I had a T who kept talking about coping skills. Yet she never did any but mindfulness. I kept asking her if we could work on specific coping skills. She'd say we would but it never happened and I realised she wasn't adept in that area at all. So I had no choice to move on even though I loved her. No point working with someone that could potentially cause you more harm than good long-term.

 

[Dana1010]

Many therapists who work at low income/under-insured centers because they want to dive into the hardest topics,

How different my experience has been. I've found that they're pretty much all "in the pit," because they just don't have the skills/experience to charge more. Hmm.

 

[Dana1010]

I had a T who kept talking about coping skills. Yet she never did any but mindfulness. I kept asking her if we could work on specific coping skills. She'd say we would but it never happened and I realized she wasn't adept in that area at all.

Classic cop-out from therapists who don't want to hear the hard stuff. You've really got to watch for this one.

 

[theshadowoftheliving]

One of my best therapists was in a free clinic. My worst? Also the most expensive.

Underinsured people often deal with massive amounts of trauma, so the concept of trauma and PTSD might not be so foreign to them as you might think.

I hope it goes well.

 

[Dana1010]

One of my best therapists was in a free clinic. My worst? Also the most expensive.

Can you articulate what it was that differentiated them and made them your best and worst respectively?

 

[sedna]

One of my best therapists was in a free clinic. My worst? Also the most expensive.

Underi...

I had the exact same experience. Because of my circumstances and wildly fluctuating financial situation...I went from wealthy to destitute- middle then lower middle all over the worst ten years of my life. I have the same experiences with mental health help that I did with lawyers.

Psychiatrists are the worst. Especially if they went to Harvard or Stanford. They actually tell you about their own problems and then give you massive amounts of drugs do you'll listen. :facepalm:

The best therapists I have ever had, for myself and my children, have all been interns or social workers. They care, they arent jaded yet.

I would be careful as someone with PTSD letting a therapist be dismissive of your feelings, it can set off feelings of worthlessness or resentment that sometimes you dont realize until much later. Most of us have feelings that are delayed. You might be sitting there thinking this persons just an a-hole, and you're not taking it personally, but then months later reflect back and feel victimized by how they handled your personal story and feelings.

It can be hard to see a therapist thats a lot younger too, I had to get past having an intern that looked 25 when I was 40. There are older ones around too if that helps.

 

[theshadowoftheliving]

@Dana1010 the worst just simply didn't believe me. It was when I was young. My family presented well and she just told me, over and over,, that I was making up the trauma.

The best has believed me on all accounts. That validation goes so far.

 

[EveHarrington]

Maybe this one won't be crap?

Maybe go in with an open mind as I think that will take you far.