What can clients do to increase the chances that therapy is helpful?

@kaleidoscopeheart

I also use this strategy.

The biggest culprit I could identify in why therapy was not very useful for me: I used it more as a distraction/escape than a form of treatment. It was became part of a long string of distractions I would get into instead of really tackling and working on the things that held me back. I'm not in therapy anymore and don't plan anytime in the foreseeable future, but this is what I would be the most careful about even though I don't have that issue so much anymore (thus it is easier to be aware of it). I think it is a version of not repeating old patterns that was mentioned above. I would also choose a compatible therapist much more carefully, because the two methods I used for the two Ts I had were not the best ones.

A bit different but related: I think I would benefit from goal-directled, practically oriented therapy the most. Not quite like CBT, for example, but therapy that targets specific areas of my life, those that are problematic, remains focus and track them to monitor progress. I did have good goals in the past but the tendency to distract myself with all sorts of unrelated psychological explorations from executing them took over, and it became mostly an aimless wandering, which I did not find helpful. I think it was interesting for the Ts though and probably part of the reason they did not help break that pattern. So next time I would also be very upfront with a T at the very beginning, would explain this past tendency, and would ask them to keep an eye on it.

I think for me it wasn't just not being so aware of the difference between therapists. It's that I was relying on the therapist to be able to accurately explain what was going on and suggest what I needed. Simply identifying your own issues as trauma-related is a huge step for a lot of people! And that's the step therapy was blocking, for me.

That's what I'm trying to ask here - sure it's helpful to go someone who specializes in what you're dealing with. But that assumes the client has sufficient knowledge of their own problems to do that. Which is often not the case.

I should also add that sometimes I can be picky and verbally combative with my questioning the treatment up front. I could be lest combative and more open and less picky.

That's were a competent therapist will recommend a client seeks a different therapist who is more experienced and skilled in working with any particular issue that they are not really able to do themselves. Unfortunately, either (a) the therapist doesn't do this, or (b) even if the therapist does this, the client may take it as a rejection rather than a recommendation and refuses to leave, getting sidetracked on issues of feeling rejected, which isn't really what is going on, rather than staying focused on getting the correct assistance for their issues.

As consumers of these services (therapy, medical, etc), we have to take the responsibility of trusting our gut when things don't feel right and moving on until we find the right service provider. This isn't just a therapy thing. We deal with it with physicians in my family because my husband requires very specialized medical care; we've done a great deal of trying out AND leaving specialists who were not knowledgeable enough, not communicative enough, etc. It's stressful and a pain in the drain, but getting the right care and quality care takes some determination, research, and awareness.

My last therapist and my pdoc were open enough to allow for the possibility that they might not be the right providers for me when my symptoms were seeming to not improve. My pdoc went so far as to recommend I get a second opinion to be sure he wasn't missing something. I followed through with that second opinion with a physician I chose on my own; the 2nd opinion doc didn't think my pdoc was missing anything but did have some additional recommendations that my pdoc followed which were helpful. I chose to stay with my therapist because I knew he certainly had the knowledge base and skills for working with my diagnosis and issues; my gut told me I was just stuck and things would eventually shift in the right direction, which they did.

Thank you. That is a good idea. I think that I'm going to try that.

I think that's really what I wanted to hit on.

I was repeatedly misdiagnosed with either major depression or generalized anxiety disorder. So the people I was seeing didn't even have the experience to figure out that there even were any trauma issues going on that might need attention. There'd be no referral because they did't think I needed one.

This wasn't just a one-time thing. I went through I think like 4 or 5 therapists who did the exact same thing. At this point I'd say it's more that I don't fit with your standard screening assessments and diagnostic categories very well. That and I think CBT has some real issues with handling gaslighting and covert abuse. But that also means that getting a second opinion was useless.

What can a client do there, other than going through therapists at random and hoping one eventually works? That doesn't seem very realistic to me, and there seems to be no real advice on differentiating between therapy being difficult or uncomfortable and therapy being bad or harmful.

Can I ask how long ago it was that you were going through this? The reason I ask is that truly have been some differences in the last 5-10 years that I think make a lot of sense. CBT failed for me too.

I didn't get real help until I got ill with psychosis, an illness that could be treated with medication. Prior to that I was misdiagnosed and perpetually ignored. I was told I couldn't be helped because my personality was disordered and beyond repair. The diagnosis didn't feel right, because it didn't explain my strange obsession that I had since I was 8 and my lifelong social issues. A few times I tried to contest it but never had success.

The medication I was given for 'depression' made me chronically suicidal, which made it appear that my personality was the problem. At the time I had no idea how to vocalize my feelings. I was longing to be heard. It got so bad that the only way was to cut my arm and go to the ER. For a time I was going to the ER about every 6 weeks. It was awful and I hated it. Eventually I quit therapy and got off the medication. The suicidal thoughts and SI disappeared immediately.

After I was treated for psychosis I realized that I wanted answers. It took a few years, but I discovered on my own that I had autism spectrum disorder, which explained all my struggles and psychiatric illnesses, GAD, MDD, and psychosis. I went for two assessments and got diagnosed by both clinicians with ASD. Shortly after that I started psychotherapy with an ACTT psychiatrist and a counsellor at a university that specialized in ASD.

Therapy changed my life. I think it is because I had made specific goals and was properly diagnosed. Now I work full-time and can relate to people. Healing and learning social skills made a profound difference.