Counselling 4 London

Frequently Expressed Doubts

Some Myths and Fears around Psychotherapy
Philippa Perry

followed by How long does Therapy Take?

Myths

Psychotherapy is all about just blaming your parents
Well, that’s a bit simplistic, but there is something in it.

I believe that we learn to communicate with others through our relationship with our first care-giver and if that carer was unresponsive, abusive, inconsistent or depressed it is highly likely that there will be psychological problems to overcome later in life. I’m not talking about a parent who occasionally misunderstands the child – we all do that from time to time – but when a parent consistently fails in understanding or gives up trying, their child will have to adapt and compensate for that. Sometimes these modifications can become habitual and form the child ‘s world-views which will not serve them well later in life.

If you are having problems communicating with others and this is holding you back, therapy can be useful in making you more aware and reflective about your responses so that you have more choice about how to be. It helps to look at the source of a common reaction to a certain stimuli so that you can understand yourself more fully and so the original pain doesn’t find another way of surfacing. Therapy can be about raising consciousness and to do that competently understanding our personal histories helps.

Most parents do their best, even if they made serious mistakes or found themselves in dangerous environment when rearing their children. And even if they didn’t do their best, blaming doesn’t help anyone in the long term.

Talking about yourself is self-indulgent
It may be self-indulgent to talk about ourselves . However it is not self-indulgent to seek to understand oneself and there is a difference. If we react rather than reflect we are often in danger of projection and transference.

Projection is where instead of having pure contact with another, we project a part of ourselves onto the other person and relate to our own projected parts on to the person in front of us. Transference is when we make subconscious assumptions about the person before us in the present, based on our experience of people we have known in the past.

If we can become more aware of these projections we are less likely to project our ‘shadow side’ onto others. It is very common to see ourselves as ‘good’ and the other as ‘bad’ and when we do this we are often projecting our own ‘bad’ side onto the other. If we owned more of our own insecurities, fears and aggressive drives, maybe we would not fight with each other so much. So I cannot agree that psychotherapy is self-indulgent.

In the end, it all comes down to sex
Tempted to say, yes, very true. Here is a quote from Andrew Samuels in the afterword of Couch Fiction, “Some kind of physical warmth between two people (call it sexual if you will) seems to be a necessity or precondition for the emotional growth and development of both of them. I guess the template is the parent-child relationship or other close relationship in the family. This is not incest (though tragically, the process I am describing does sometimes get abused). No, this is Eros in its widest sense – the Greek God inspiring a psychological principle of connectedness, relatedness, growth and transformation – life! Eros could be seen as a fertility god or a god of intercourse and conception, but he is also the flow of natural energy in connection. Nothing could be more innocent and more healing.”

Most therapists are mad anyway
Actually there is something in that statement. It is usually because someone has got so much from overcoming their own psychological hang-ups that they feel inspired to train to be able to facilitate other people to face and work through their issues. I’m not sure that a person with perfect genes who experienced a trauma-free, ideal environment for early development and subsequent growth would be sufficiently interested in psychology to make it their profession.

It costs a fortune - a holiday is cheaper and does more good
People who did have a ‘good enough’ mother are usually what we call ‘securely attached’ or ‘well attached’. This means that they find it possible to form and keep nourishing relationships in their lives. If the early mothering experience wasn’t ‘good enough’ people have what some therapists call an, ‘insecure attachment style’ which means relationships, and therefore life, is more difficult for them. A well-attached person is more able to self-regulate and self-soothe and is less likely to seek therapy. If you are well-attached and merely slightly fed-up then a holiday might do you the world of good. The key is knowing the difference!

Therapy does cost a lot and not only in money. It costs in time and it also costs in effort. Psychotherapists do not do your work for you, they only facilitate you to do the psychological work that you need to do.

At the end of this I have copied and pasted Robin Shapiro’s guide for how long therapy takes which can indicate how much it will cost.

Depression is a chemical imbalance and best treated with medicine
This is true of some types of mental illness. In addition it may be useful to medicate a client before they can begin therapy or, alternatively, some people will use the support of therapy whilst they come off anti-depression medication. It’s important to acknowledge, however, that sometimes talking therapy will reach the parts that the drugs cannot.

There's no point in raking over the past.
There is no point, I agree, in going round and round in circles and this is what people tend to do when they don’t have the support in place to tackle the source of their problems.

Sometimes I find it helpful to think of it like this. If we don’t face the origin of our pain and get to know what it is and where it comes from, we can condemn ourselves to a continuous low-level suffering by repeating the same self-sabotaging patterns. I think a bit of digging is worth it to save us from far too much raking. However, there isn’t a formula, psychotherapy isn’t like a recipe book, and therapist and client should work out a treatment plan that suits that particular client.

The therapist will fill you with psychobabble.
A therapist will use the client’s terms of reference wherever possible.

Psychotherapy is just psychiatry-lite
Or psychiatry is psychotherapy-lite!

Psychotherapists are trained to treat the person and not the illness. Whereas a psychiatrist traditionally treats the disorder, so if someone comes to me and I suspect that they have, say, bi-polar disorder, I will want him or her to see us both. It’s my role as the therapist to think of the unique human being in front of me, whereas a psychiatrist may be more likely to diagnose a client and prescribe a treatment for that diagnosis.

Therapy is not a substitute for anti-psychotic medication.

In my experience Psychiatrists and Psychotherapists tend to work together rather than fight!

Therapy will completely change my personality
Psychotherapy can be about looking at everything you’ve ever been told, overtly and covertly and every experience that’s formed you. Then it’s about deciding which of those directives and experiences you want to take with you, and which you want to leave behind. Hopefully this means that you come into your personality and become more truly yourself instead of being a victim of environment, circumstances and influences.


Fears

“I don’t know what's going to happen and I’m not sure what I’m supposed to do”

If you have never been in therapy before, then it is normal for you to feel unsure about what will happen and to be uncomfortable. Remember that you can take some time with your therapist to focus on the reasons that you are uneasy before getting into the reason you came for therapy. This will help you feel more comfortable. Another way to help this situation is to tell the therapist what you expect will happen in therapy. Ask your therapist how her way of working differs from your ideas. The therapist will probably ask you what brings you to therapy and won't think any the worse of you if you are not sure and some of your history. It is the therapist’s job to listen attentively. If you feel as though you are being heard by the therapist you may start to feel more comfortable. The more open and honest you are the more you will gain from being in therapy. Feel free to ask the therapist questions and to make suggestions that might make you feel more comfortable.

“I don’t see how therapy is going to work”

You may feel this because you feel somewhat hopeless about your situation, if this is the case, tell your therapist. Asking how the therapy can work for you is a good question to ask because every therapist has a different view of exactly how therapy will be helpful to you. It will depend on what your goals for the therapy are.

“I’m worried that I will have to tell the therapist things about myself that I uncomfortable feeling or admitting to a stranger”

Your discomfort is very understandable. Therapy is a place where embarrassing and painful emotions can be worked through. One of the goals of therapy is to help you to understand how difficult emotions may be adversely affecting you and as a result experience less conflict and pain in your life. You can always delay some discussions (in order to not feel too overwhelmed) until you are somewhat comfortable and able to trust your therapist before you being expressing difficult emotions.

“I might feel foolish”

The chances are that you may feel foolish, awkward, and even scared when you begin therapy. You probably have never opened up to a stranger and expressed your deepest feelings, desires, and fears. It is a unique experience to have someone listen to you attentively for an extended period. At the same time, as a result of taking that risk you will learn more about yourself and will eventually become more comfortable with revealing your feelings. When you have achieved that degree of trust, you will have unlocked your potential for growth, self-discovery.

“The therapist, my friends, family, people at work will think I’m mentally unstable as I’m coming to therapy. Only mad people need psychotherapy.”

Therapy is becoming more accepted by more and more people. If you are concerned about stigma you do not need to tell anyone if this makes you feel more comfortable. The fact is not only mentally ill people need therapy, everyone at some time can use a guide to help give them a clearer perspective on their life. Its mad not to take advantage of the self-empowerment that therapy can give you.

“I may find out that I am mentally ill”

This is a very common concern because many people are afraid that deep down inside they are somehow different from everyone else and “nobody thinks the way I do”. In fact, individuals who have lost touch with reality are not usually concerned about whether or not they are crazy. You may have developed some very creative ways of dealing with difficult situations. However, that does not mean you are crazy. Talk to your therapist about this for clarification.

“Therapy is too expensive”

Therapy may seem expensive at first, but what has more value to you that your mental well-being? What is more important than getting the most out of life? Therapy can provide you with immeasurable rewards in well being, greater energy, and joy for living, which will be more than adequate compensation for personal expenditures.

“The therapist will not be able to understand me.”

You have to remember that a therapist is trained to understand and empathize with emotions. You may have not felt understood trying to explain yourself to family or friends in the past, but it is likely that when you are speaking to a trained professional, that you will be better understood. If this point is a sticking block for you this may indicate that you have some fears or blocks associated with dealing with your feelings. Discuss these issues with your therapist.

“What if the therapist isn’t any good? What if she can’t help me?”

Not every therapist is a perfect match with each person comes for assistance. Some therapists offer the first session at a reduced rate, or will not charge you if either of you decide not to work together. Evaluate what you feel in her presence about her competence and talk to the therapist about this. Sometimes a therapist will not be the right match for you and sometimes blaming the therapist for your lack of progress or challenging their effectiveness is a way a client can avoid facing up to his own problems or discomfort which is why it is very important to talk about this matter with your therapist.

“I don’t deserve to have this time devoted to me. The therapist should be helping someone who “really needs it”.

The fact that you’ve enquired about counselling and psychotherapy services indicates that a part of your really does want help but you are not feeling good enough about yourself to feel okay with receiving comfort and professional help. You may have learned from your family that “you should not be selfish” or that you “don’t deserve anything good”. Remember that you do deserve it.

“I feel weak if I ask for help. I should be self-sufficient and able to work things out for myself”

If something goes wrong with your T.V., do you feel that you have to fix it yourself? Once you’ve checked the plug and maybe hit the side and the telly doesn’t get better after several days, you probably will want to call a specialist – a technician who spends his days fixing televisions. People and emotions are much more complicated than your television set. Learning how to solve emotional problems isn’t part what we are taught at school. Fortunately, there are people (therapists) who specialize in deciphering emotional problems in order to help people recover from emotional difficulties and traumas. (Unlike the television technician though, the therapist can only facilitate you to heal yourself, she can't do your healing for you).

I know that it can be hard to ask for help, but it is in fact a strong willed person who can put aside all of the issues raised in these notes, and set aside all of the thoughts about what other people will think, and take that scary step that leads to growth and self-understanding. It takes courage for people turn to the experts to help tackle a problem. It's okay to ask for help.

“The therapist will see things in me that other people can't see and will pass judgment on me.”

Therapists are not mind readers. They are good at noticing body cues and facial expressions, but they do not know what is going on in your mind until you tell them. Good therapists, will not blame, ridicule, or pass judgment on you. If they do, then they are not doing their job properly. If you feel that a therapist is being judgmental then discuss this with her and if you are not satisfied with the outcome, then find another therapist.

“The therapist may not like me.”

There is always that risk. But why start the relationship thinking that he or she will not like you? Maybe your therapist can identify deeply with your situation and maybe he or she will even fully accept you for who you are. Good therapists are very accepting and you owe it to yourself to give it a try.

“My problems are not my fault. I'm not the one that needs to change.”

Whenever you are in a situation with more than one person, every encounter will always have actions and reactions. If things are not going well with parents, spouse, or friends, and it is all "their fault," then consider that you may be able to learn more effective ways of dealing with their reactions.

I cut and pasted most of the following from Robin Shapiro's web site. Robin is an EMDR therapist in the States. It was written as a guide for therapists rather than potential clients and I agree with most of it. http://www.emdrsolutions.com

How long does therapy take?

* Fly-over: never a "customer", leaves after a few sessions because it wasn't their idea to come, or the therapist isn't a fit (lost one because I wore Birkenstocks in the 80's), or she's too scared to stay.
* Questioner: Needs something normalized. "Am I crazy because. . . I'm grieving/I like to have sex the way I like it/I just moved and I don't immediately have new friends, etc." This client needs information about normal human behaviour and reassurance that a trained professional finds her/him sane. (Not to be mistaken for a client with underlying issues who tests you with this kind of question.) One session.
* Three-session wonder: The famous (and extremely rare) well-attached car accident victim who clears the trauma in two sessions and comes back to praise you wildly on the third. For them, therapy is penicillin: Take a good dose, and the symptoms go away.
* The Next Developmental Step Client: She's at the cusp of differentiating from her family of origin/partner/workplace and finding out how to be herself. If she's reasonably well attached and reasonably untraumatized, she'll be around from three to eight months. If more traumatized or with an abusive or alcoholic or otherly dysfunctional family and/or attachment issues, you might be seeing her from months to a few years.
* Big "T" Trauma client. She takes some time. If she was raped more than once or injured badly in the accident, or spent too many months in that war zone or horrible work environment, you have months to a few years of work. Best case, you nail the root trauma early (that molestation by the neighbour) then the rape, then work on integrating it all and dealing with her current, hopefully safe, life. Worst case: despite your thorough intake, you keep finding more and more surprise antecedents and the current life stays unsafe and in flux, and you spend three or four years getting her life in order and trauma moved through.
* Horrible attachment, relatively light trauma: Years of finding the baby parts that go into shut down or cling or fight or flight. Years of helping him own the baby and hold the baby and soothe the baby, instead of reflexively disappearing or pushing you away. He de-hunkers. He connects. He finds someone else with whom to connect. He learns self-regulation. He leaves therapy, after checking 6 times that he can return, if necessary.
* Bad chemistry clients. It depends. If she gets on the meds and "feels like myself again" and the good feeling stays, say goodbye and thank you god. If he only gets depressed in the summer. You may see him for a year or so, the first go round, and then every time he goes down. You'll remind him to call his medicator person for a medication adjustment, and help him cope with the affects and effects of the bipolar/major-depressive dx/schizo-affective dx. In every round of therapy, you'll help him clear some more trauma and help him reset his thoughts (there's nothing wrong with Cognitive Behavior Therapy, when you need it.). When he's back on the horse, you review what you both learned, and cut him loose until the next round. If he's more chronic, fighting debilitating chemistry with little respite, or rapid cycling, you become insulin. The attachment relationship is paramount. Attachment to you may be thing that keeps this client around. Each interaction raises hope, reregulates your client, gives them an experience of being witnessed and loved. You won't fix him. You will help him cope. If attachment disruption and trauma created the depression, therapy can, finally, nail it. And it will often take years. If it's 95% "bad brain", you need to hold to your presence as the most healing tool you have. Use all your tools: CBT, EMDR, adoring your client, cheerleading ability, and connectivity. Work with them to try yet another med, keep exercising, keep eating well, get to work. Find them the best psychiatrist in town. And settle in for a long-term relationship.
* Severe dissociation with awful attachment and horrible trauma: Settle in for the long haul. You and the therapy are both penicillin and insulin. It may take months or years to make a good, trusted attachment relationship. It may take just about the same years to stabilize your client. Then you can tackle the trauma with some good penicillin (EMDR, Life Span Integration, Brainspotting, etc.) And tackle more trauma, and more trauma, and more. Then you can help her integrate all the changes. It's 10 years later. She's in a good relationship; has a better job; can have sex; and finally can say, "How do I know if I'm done?" She's making her own insulin. She may come back for another dose of penicillin. Maybe more than once. But you did your job.