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Therapy

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12:48 / 25.08.04

(I've just modified that last paragraph, BTW - but the board had one of its afternoon tits-up moments, and I'm not sure if the moderation request's gone through...)

13:01 / 25.08.04

My experience with therapy wasn't terribly positive, largely because a)I went under protest, and b)the therapist was some sort of Christian-based counsellor, who seemed mostly interested in whether I had any Satanic or demonic influences in my life. I hated her, and wasted $75 a week for almost a year to play mind games with her. She did give me a diagnosis and put me on antidepressants, but I quit taking them after a few weeks because they weren't doing anything but making me jumpy. (In passing, don't mention to health insurance people that you've ever been on antidepressants, or they may not give you coverage. Ye gods, I hate the insurance industry.)

I eventually got out of my depressive funk and addiction problems, but it was long after I quit going to therapy, and I honestly have to say I don't think it helped. It took a fundamental change in my outlook and my attitude towards myself, which was not facilitated by the therapist - it was brought on by some events in my personal life that sort of forced the issue.

Now, this is just my personal anecdote, and I have to say that I think many therapists who aren't total twats can be very helpful in facilitating healing. But ultimately, it IS up to the patient to let those changes happen. My therapist's attitude made me defensive and combative, so even if she had anything helpful to say I would never have listened. Find someone you respect enough to cooperate with. If you believe your thereapist is incompetent, chances are their work with you will be completely ineffective.

STOATIE LIEKS CHOCOLATE MILK

13:04 / 25.08.04

Can you do self diagnosis and repair on yourself?

That's kind of what I'm finding counselling helpful with (and yes, bengali pretty much nailed MY definitions of "counselling" and "therapy").

I get the counselling free; I was recommended by my doctor as soon as he heard the phrase "140 units a week on average".

13:13 / 25.08.04

Oh yeah, I probably ought to mention that pretty much everything I've said applies to my understanding of psychotherapies/counselling as practised in the UK. "Christian-based counsellor" isn't quite the oxymoron it (IMHO) ought to be, but it's rare for UK practitioners to take an overtly religiose approach (and I like to think "Satanic and demonic influences" went out with witch-ducking). You can probably still find them in the murkier reaches of the private sector, though...

Another US/UK difference is that it's extremely rare over here for a single practitioner to assume the roles of both psychotherapist and prescriber; it's generally considered that one compromises the other, so medication is almost always monitored by a separate doctor. I remember finding it bizarre when Melfi prescribed Tony antidepressants, but I guess that wasn't artistic license.

13:38 / 25.08.04

I get the counselling free; I was recommended by my doctor as soon as he heard the phrase "140 units a week on average".

Is it a specific alcohol counsellor, then?

There are a whole loooad of free counselling services out there, some of which accept self-referral while others will only take you if your GP's sent you. I don't think GPs are particularly obstructive when it comes to making referrals to counselling agencies; if that's what you're considering, Flyboy, you don't need to set the controls for the heart of the pub in order to get it...

Regrettable Juvenilia

13:41 / 25.08.04

It's kinda a given that fundamentalist Christianity will be a deal-breaker, I think...

'Nesh, that's actually a lot of help. I'm more interested in solutions than causes, because I think I already know the causes (thanks, Larkin).

13:51 / 25.08.04

All of the above?

Most probably, interesting stuff.

It's only little things, was just something I'd been thinking about.

13:55 / 25.08.04

I just thought I'd chip in my 2 cents. I went through a pretty rough time a couple of years ago, and without going into too much detail, my expereince was as follows:
I personally had very little luck with the NHS. My GP just handed me a prescription and refilled it every month without any sort of interaction. However I have to dsay I get the impression that this was as much to do with that individual GP than anything else. I ended up going to the university counselling service which was very much on the counselling end of the spectrum as described above. I found them a great help as it was good just to be able to talk to someone about my depression without any pressure or concern.
Some people I know have had quite a lot of success with CBT and transactional analysis.

14:01 / 25.08.04

I'm more interested in solutions than causes, because I think I already know the causes (thanks, Larkin).

It's usually the mother. Mine turned me gay, y'know. That's her skin on the lampshade.

Ahem.

Sounds to me like you might benefit from a cognitive-behavioural approach then, at least initially. I'm afraid my own knowledge of CBT practitioners is limited to the NHS, and they tend to be a tertiary service: you can, if you're near-inhumanly patient, get your GP to refer you, via the local psychiatrist, to a CBT psychologist. Otherwise, I guess you could do an online search, or 'phone up individual therapists and ask 'what school/approach do you use?' (hint: if they can't tell you, avoid 'em). Or there's this, which seems reasonably sound.

STOATIE LIEKS CHOCOLATE MILK

14:43 / 25.08.04

Yeah, 'nesh, a specific alcohol one this time. The first was for depression- the second (weird) one was for alcohol. However, I don't think he'd ever had a beer in his life- he just didn't get it). This, third one, is also alcohol-specific, though what with it being counselling and me being the one doing most of the talking, the two seem interchangeable.

15:00 / 25.08.04

In passing, I don't think the fundy Christian approach is terribly pervasive in the US either, but that's who I got referred to - she was a friend of the intervening relatives and yadda yadda. Plus she was fairly cheap, as therapists go, and I was in college, poor, and too embarrassed to ask my parents for help - they didn't even know I was in therapy till after the fact. I'm not Christian, never have been, and she was of a particularly odd stripe - i.e., the kind that still believe in demons, exorcism, and the like. I didn't find it terribly helpful that she'd spend half an hour obsessing on the fact that my mother once gave me a ring with a moon and star design on it, like she thought this was a definite sign that my mother was a witch and my family was cursed.

As I said, not a good experience. Do shop around if you can. Keep in mind that some psych professionals (actually, probably a lot of them) are just as messed up as you are.

Goodness Gracious Meme

16:46 / 25.08.04

'nesh. fair point on the 'namings', counsellors do tend to be less about specific icons and more about a toolkit of various approaches...

on the UPR-speak, looking at the dates, that may have been me in the midst of counselling training, unable to talk without regurgitating classwork

But I would say that while 100% person-centred counsellors are thin on the ground (but do exist: I was taught by one, and great as he was, no, I wouldn't want a totally PC approach either. His bad points wehre definitely from concentrating too much on a purely PC approach.) Rogers is, as a basis/ingredient in the 'toolkit' for the humanistic forms, still immensely influential.

then there's pyschiatric pyschotherapy:
Hannibal Lecter.

20:31 / 25.08.04

In passing, I don't think the fundy Christian approach is terribly pervasive in the US either, but that's who I got referred to - she was a friend of the intervening relatives and yadda yadda. Plus she was fairly cheap, as therapists go, and I was in college, poor, and too embarrassed to ask my parents for help - they didn't even know I was in therapy till after the fact. I'm not Christian, never have been, and she was of a particularly odd stripe - i.e., the kind that still believe in demons, exorcism, and the like. I didn't find it terribly helpful that she'd spend half an hour obsessing on the fact that my mother once gave me a ring with a moon and star design on it, like she thought this was a definite sign that my mother was a witch and my family was cursed.

Sekhmet, this whole experience is more akin to coercive (attempted) brainwashing than counselling. The fact that you complied with it under duress would seem to undermine the basic contract underpinning legitimate counselling - and the counsellor's obvious theological bias and association with your parents would flout any and all of the basic principles. This was not a counsellor, not as we know it (Jim).

20:43 / 25.08.04

Yeah, 'nesh, a specific alcohol one this time. The first was for depression- the second (weird) one was for alcohol. However, I don't think he'd ever had a beer in his life- he just didn't get it). This, third one, is also alcohol-specific, though what with it being counselling and me being the one doing most of the talking, the two seem interchangeable.

They probably aren't interchangeable, however they appeared at the time. Although those who drink heavily have the same problems as anyone else (it's just that alcohol has, for whatever reason, become a coping mechanism), alcohol counselling requires particular skills.

Having said which, I'm reminded of a particularly 'posh' (or so he appeared to me) former consultant to whom I was attached as a junior psychiatrist. I used to cringe when he'd advise depressed ex-junkies from the local estate to "take up golf - it's tremendously therapeutic". Anyway, he decided he was going to give up alcohol for six months in order to empathise with the alcohol-dependent. I was tempted to suggest that he drink solidly, daily for three months then abstain - but, being a teeny-weeny baby shrink, I never had the confidence to point this out to him.

20:57 / 25.08.04

One of the main reasons I think I might need therapy is my current aversion to it, which is almost entirely illogical and very vehement and emotional - Flyboy

I went through exactly the same thought process years ago when I resisted my GP's continued entreaties to supplement my SSRI therepy with counselling. The extent to which the prospect filled me with horror concerned me a bit, deep down. When, years later - with depression behind me - I had what my doctor diagnosed as a 'psychotic episode', he insisted I saw a counsellor and referred me accordingly. I was still sceptical, but more than half expecting that this would be one of those times where I'd get to eat my words. Since the counsellor was vouched for a proper doctor, and was in fact attached to the surgery, privately my hopes were high the counselling might also cure my aversion to it.
Anyway, long story short, my experience was not a good one. My counsellor did nearly all the talking, mostly about her (so, at least one presupposition debunked), and the experience over 10 sessions piqued a suspicion that for her, being a counsellor was an extension of own therapy. Perhaps that's as it should be, but I did find it alarming that she seemed so much more fucked up than me. Like Stoatie's, she seemed very keen to blame my parents for everything. I remember her telling me that they had 'narcissistically abused' me. Maybe that's a real thing, but had I been a little less robust and a little more impressionable, that suggestion could have had very unpleasant consequences - not least for my relationship with my folks. She also told me that she was psychic (you know, proper psychic) so I'm not sure that she was really going by the book.
We had a laugh though. I always left smiling. She had a fantastic way of confirming her intuitions.
Her: 'You have a very stressful job, don't you.'
Me: 'No, actually I don't' (I don't)
Her: 'Ah ha! You see, the people who are most stressed are the ones who think they're not'

21:06 / 25.08.04

'nesh. fair point on the 'namings', counsellors do tend to be less about specific icons and more about a toolkit of various approaches...

Which is, I think, healthy - but possibly also why I failed to definitively associate counselling with any specific 'founders'.

Rogers is, as a basis/ingredient in the 'toolkit' for the humanistic forms, still immensely influential.

I think that - as with pretty much any other 'school' of psychotherapy - Rogers is more valuable as one tool within an eclectic arsenal than as a single-philosophy approach.

then there's pyschiatric pyschotherapy:
Hannibal Lecter.

Much as I'd like to deny it, it's true that psychiatrists-doing-psychotherapy is, at best, hit-and-miss. We all have to undergo basic training in psychodynamic psychotherapy - we have to see a dynamic therapy patient once a week for at least a year - but that's pretty much it. What psychiatrists are good at, generally speaking, is deciding which individual might benefit from which therapy. I'm not sure we should try to administer it ourselves, though...

00:28 / 26.08.04

Hang on, aren't psychiatrists the ones who do the therapy?

'Yeah, you want to see Bob, he's good at that'
'I dunno what Mike's telling you, haven't done a session in years!'

00:54 / 26.08.04

Hang on, aren't psychiatrists the ones who do the therapy?

Perhaps in the US they are. Here in the UK, there's a clear division of roles. Some psychiatrists go on to specialise in one or more psychotherapies, but most work to a more 'conventional' medical model. We have to do a little psychotherapy as part of our training, and many of us subsequently become conversant with psychodynamic and/or cognitive frameworks. Psychotherapy-proper is quite time-consuming, though, and tends to become the province of psychologists, psychotherapists or counsellors.

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