[Stacia]

What are the right things to consider when thinking of switching therapists?

[Bipolar Bear]

I'd consider:
Current status with current therapist (stale and not going anywhere, uncomfortable, etc.) Plus I"d also consider how long it will take to get settled with a new one and all that.

Some people have said that they just got to a point in therapy where they needed some new blood and it kick started things again. It took me so damned long to build a decent relationship with my current therapist, I'm not sure I'm ever going to be up for the idea of starting all over again.

[Silver]

Off the cuff (I'm on hold)... some thoughts as far as leaving the current therapist.

The predominant issues -
Whether you are making progress or not
Whether or not you find yourself making the choices you want to be making
Is there a belief that, if you changed therapists, you would be doing something differently that you're not doing now? Really? What is that something? How do you see the change in therapist affecting that?


Why the switch now?
What about the relationship disturbs you? Is it transference (in which the therapist reminds you of someone) (brief description of transference!), or does it feel unsafe? Those are two very different things.
If it's an issue of frustration with failure to progress, has it been discussed with the therapist?

[Stacia]

I've been in therapy now for a little over two years. I started profoundly depressed then went seriously hypomanic. The past few months are the only ones where I've been balanced and myself (i.e. my brain is along for the ride). The therapy is psychoanalysis, modern Freud. I hate the couch. That it so clearly brings out my authority and trust issues is probably a good thing. That is reduces my therapist to a talking voice behind my head isn't. It's not a set up I find easy to make a connection in. Bottom line, we have communication issues, some of it she recognizes, most of it she attributes to my issues. Apparently, I'm contradicting myself when I say, "we have a communication problem that has nothing to do with 'the couch," because I also say I have issues with the form of therapy. That's bullshit. Somethings are issues unto themselves, and I kinda think getting each other is a pretty basic MQ. Yes, there also is transference going on, which is probably the only reason that I'm questioning whether to bail instead of just bailing. Another thing is that she is not versed in bipolar and it's basically a non-issue as far as she's concerned. This might be overstated, but not by a whole bunch. I'm new to knowing I have this, taking drugs, and sorting through the mess left in it's wake. None of that is really addressed. She's also not covered by my insurance (another thing that isn't in itself a reason to bail). The communication issue came up again yesterday and today I paid her for next month and said I needed time to rethink this and that I hoped she give some thought to it as well. I'm not big on walking out of anything, but I didn't know how else to make the point. Talking about it in ordinary session doesn't seem to work. There's stuff in the plus column, I'm just hard pressed right now to think of it. Grrrr. I haven't cooled off yet.

This post has been edited by Anastacia: 27 September 2007 - 08:34 PM

[Silver]

ANother question would be: how would you know what the termination point for any therapy should be?

Are you going for a straight psychodynamic 'analysis,' or something more goal-oriented?
It is not unreasonable to go through little cycles of therapy - set a cluster of goals, get there, do something else, come back if needed.
I have a pretty strong cognitive-behavioral and brief therapy bent, so I'm biased, of course. I recognize there's more than just CBT out there, but endless psychodynamic work seems... endless.

This is sort of interesting; more oriented to people who are feeling ready to 'graduate,' but you might find something applicable.

Rapport with the therapist is a huge predictor of therapeutic success. So that is something to consider. (Not liking the thp, but rapport. Doesn't sound like you have either here.)

[Stacia]

There are things about my therapist that I like and others that I really respect. I wish she did a different type of therapy. It's endless psychodynamic therapy. No benchmarks, milestones, whatever. On the one hand, I like that nothing is rushed. On the other, I hate that a snail moves faster. I'm not sure that I'm ready to end it, but if there isn't some change, I will. Over the next couple weeks, I plan on interviewing other therapists to see if there's any rapport with someone who does a type of therapy I can imagine being beneficial. Then I'll see how things are with my current therapist. That's the game plan, anyway.

Thanks for the article. Yes, there's a little that is applicable.

This post has been edited by Anastacia: 27 September 2007 - 09:54 PM

[martasi2]

From my experience it is difficult to find a therapist who knows much about bipolar disorder. This includes knowledge of BP thinking patterns, problems w/disorganization and confusion generated by mood states (often mistaken for problems with decision making that need to be EXPLORED ad nauseum) and ability to sort out what is a manic, depressed or mixed symptom. Some therapists don't know much about BP meds -- except the most obvious ones -- or triggers for mood episodes.

There are still (IMO) too many therapists who want to work only on "family of origin" concerns and relate all current problems to what happened BACK THEN as though there is a logical connection if we can only stick with it long enough to find it. I have also found therapists who just don't have skills to do the kind of BP problem-solving that comes up with an illness that affects so many areas of function and competence.

In the past I'd stick with a TDoc for quite a while even if nothing positive was happening. For a long time I lacked the strength and courage to terminate therapists because of my dependence and the belief that all therapists are equally qualified and had more power than I had. I didn't yet know how to demand what was needed and cut loose any therapist who didn't produce or meet my needs.

It's important to ask ourselves what we want from therapy and why we are entering into it. I do think bad therapy can be harmful, and we owe it to ourselves to seek out the best.

[Rayjean]

I too think it is difficult to find therapists who understand bipolar disorder. Quite frankly, both I and family members have never been able to find one in our area. After 10 years of trying, I gave up about 20 years ago. When I was younger, it would have been nice to have found one that would have helped me learn how to live with the illness, emphasize keeping my life on a regular eat-sleep-etc. schedule, and encourage me with the medications. Instead, their emphasis was to focus on my relationships or the problem of the day....of course, when my meds were straightened out, those things weren't problems of an unmanageable order. My spouse, through the years, has become the person I can talk to and helps me. Does that create problems? Sometimes both of us wish I had someone else to talk to that understands as it gets burdensome. But, other than my pdoc, we can't find that person. And if you just go talk to anyone when you're having a mood swing, they don't always get it either. My pdoc is excellent at making me realize what things are manifestations of my illness (that is, not real-life problems) and what are things I can work on when I'm healthy. My job involves a lot of contact with therapists/psychologists and while I probably shouldn't say this, when you really sit and talk with them, their knowledge/education about bipolar is often very slim, unless they have pursued extra study in that area. I'll never forget when my daughter became ill in college and until she could get to care, the pdoc suggested she see the college psychologist for awhile. What a joke! The college had a team of highly educated psychologists and their fields were womens issues, addictions, sexual concerns, but as far as mental illness other than basic depression....they didn't have a clue! All they wanted to tell her after 2 years of college was apparantly she was having trouble adjusting to college life. My efforts to tell them the family history & I was afraid she would harm herself was met with...."these things happen in college and they need to separate and decide on their own for a few days, just let her call you when she was ready". Thankfully I got her to the pdoc the next day who had a whole different story .

[Bipolar Bear]

(is very thankful for the psychological health clinic at my school that is filled with awesome providers, with a few asshats mixed in)

I know this is a stretch, but have you considered looking for a bipolar group therapy? My therapist has been pushing me towards group for about a year now, and his whole argument is that you can learn a lot from people going through the same thing. (Really? maybe someone should start a website like that. Oh wait... someone did...) It's just a thought, but I find it easier to take advice from people that have been there.

[milkchan]

I'm unipolar, but I just started seeing 2 different tdocs after a yearish hiatus, hoping to decide soon which one I like better and stick with her. One does the analysis thing, and the whole first session was spent going over my family history. The other is more goal-oriented and focuses on grief and trauma, and prefers to get people in, get 'em fixed up & get 'em out rather than have them coming in for years. At our first session, she said she's not sure I'm really depressed, but thinks I rather have "complicated grief". I'm not sure about that, but I do like her, and her office is way cozier than the analyst's.

Before I saw these two, I figured the grief-tdoc would be more suited for people with less chronic or more narrowly specific problems, but now I'm really not sure. As for the analyst, it's probably natural to feel that hardly anything was done in the first session, given the glacial nature of the method. So this thread has brought up some interesting points for me to consider.

How long should I take to decide between the two? (if it's not too big of a threadjack - if it is, just ignore)

[Stacia]

milkchan, on Fri 28 September 2007 15:11:37 GMT +0000, said:

I'm unipolar, but I just started seeing 2 different tdocs after a yearish hiatus, hoping to decide soon which one I like better and stick with her. One does the analysis thing, and the whole first session was spent going over my family history. The other is more goal-oriented and focuses on grief and trauma, and prefers to get people in, get 'em fixed up & get 'em out rather than have them coming in for years. At our first session, she said she's not sure I'm really depressed, but thinks I rather have "complicated grief". I'm not sure about that, but I do like her, and her office is way cozier than the analyst's.

Before I saw these two, I figured the grief-tdoc would be more suited for people with less chronic or more narrowly specific problems, but now I'm really not sure. As for the analyst, it's probably natural to feel that hardly anything was done in the first session, given the glacial nature of the method. So this thread has brought up some interesting points for me to consider.

How long should I take to decide between the two? (if it's not too big of a threadjack - if it is, just ignore)

Well, since I started the thread, we'll make the threadjack completely sanctioned.

Take as long as you need to figure out which one your gut says is not full of shit, respects you for who you are, doesn't want to make you be her concept of who you should be, doesn't use phrases like "you should be," and most importantly, that you can develop a real bond of trust. As frustrated with therapy that I might be right now, I do recognize that the relationship with the therapist is just as, if not more, important than whatever form of therapy is used. If it's a real draw, I'd go with the grief counselor simply because it's a shorter type of therapy. If it turns out to not do it, then go for the long road - you won't be far behind where you would have gotten, anyway. Okay, that was flip. There are benefits to doing analytic therapy. One being that it is largely driven by you.

[Stacia]

martasi and rayjean, thank you. One of the reasons that I want to check out a few other therapists is to see if there's one out there who understands BP enough to be of use in that regard. Bipolar issues are not the main focus of what I want out of therapy, but they are not far behind. Idk, you'd think that if therapists say they're experienced with mood disorders, it'd include the big one.

Verity, yes, I've thought about a bipolar support group. I was wait listed with my HMO. The only thing I know of now is 50 miles away. I also have this picture in my head of a bunch BPIs much younger than me, which isn't exactly what I'd be seeking.

I think I'll post a separate thread on books on bipolar to give a therapist.

This post has been edited by Anastacia: 28 September 2007 - 06:50 PM

[martasi2]

Anastacia, on Fri 28 September 2007 18:48:42 GMT +0000, said:

Verity, yes, I've thought about a bipolar support group. I was wait listed with my HMO. The only thing I know of now is 50 miles away. I also have this picture in my head of a bunch BPIs much younger than me, which isn't exactly what I'd be seeking.

I'm sure you're aware (it was posted quite a bit on the old site) of the DBSA bipolar support groups. If you go to www.dbsalliance.org you can search for a group in your area. This is no guarantee you'll like the group or get anything out of it, but it is a resource. BTW, I attended one several years ago and group members ranged in age from mid-teens to 65+. It was truly a mix of ages, perspectives and life experiences. Unfortunately, BP is no respecter of age; often aging brings its share of unanticipated problems.

Another online "find a therapist" resource is:

www.therapists.psychologytoday.com

Lots of therapists advertise on this site. Most provide photos, detailed practice info., education/training, and some list private client GROUPS in their area of expertise. Again, no guarantees implied. One good thing about it is that you can zero in on professionals in your geographic area.

[Stacia]

martasi2, on Fri 28 September 2007 20:55:26 GMT +0000, said:

I'm sure you're aware (it was posted quite a bit on the old site) of the DBSA bipolar support groups. If you go to www.dbsalliance.org you can search for a group in your area. This is no guarantee you'll like the group or get anything out of it, but it is a resource. BTW, I attended one several years ago and group members ranged in age from mid-teens to 65+. It was truly a mix of ages, perspectives and life experiences. Unfortunately, BP is no respecter of age; often aging brings its share of unanticipated problems.

The one 50 miles away is DBSA. That's encouraging to hear about the age range. One of these weekends I'll go check it out, but the distance and travel time involved is a bit much.

Thanks for the link. I can match those on my insurance to what pops up at the site. Only a handful of psychologists in my area are covered, but there are lots and lots of MFTs.

This post has been edited by Anastacia: 28 September 2007 - 09:05 PM

[Rayjean]

I found a bipolor support group was helpful when I was in the early years of this illness because it connected me with resources in the community and helped me find my current doctor. Unfortunately, the reason I stopped going to the local bipolar support group, is that my twin siblings run the 2 groups in town and then several of my relatives attend, and quite frankly, it makes more problems than help for me as they bring up things I said later and want to tell me what to do, etc. If I ever decide to go that route again, I'd consider going out of town although my siblings actually know/helped start some groups in nearby cities and they occasionally go to those meetings. Fortunately, reading of the med stuff on this board is a tremendous help.

[StrungOutOnLife]

This place will help you find IPSRT therapists.

[Stacia]

Thanks all. After I posted this thread, my tdoc and I had a good talk. We're good again. I'm now more aware that I'm not getting straight psychoanalysis, but a blend of a few modes dependent on where I'm at. I also realize that when I posted this I was in a pissy/hypo/mixidish place, and being a good BPer, lacked the self-awareness. This is not something tdoc pointed out, btw. It's something I realized a couple weeks later when I was a little more stable. Aargh. The self-awareness going partly off-line is a real bitch, eh.