Kate has been in therapy for the first time for the past several months. She likes her therapist, but for the last month or so has felt like sessions have been dragging – she doesn’t have much to say, they seem to covering the same ground – but she thinks maybe this is how it is supposed to go.
Ben has seen his counselor 6 times and he’s ready to bail. The first couple of sessions were fine – he was in crisis and simply having someone to talk to helped a lot. But now he’s thinking that it’s not a good fit.
A therapeutic relationship may be a different type of relationship in many ways from others in your life, but it’s a still a relationship. And like any relationship, it’s helpful to periodically step back and see how well it is or is not working.
But this can be hard to do. If, like Kate, you’ve never been in therapy before, are unsure what to expect, it’s easy to take what you get, or to assume, much like seeing your doctor, that your therapist is the one in charge and so your stance is a bit passive.
Or you just fall into routine and habit: It’s “good enough” and rather than rock-the-boat, you decide / rationalize to give it more time and see what happens. Or maybe it’s not really good enough, but you don’t want to invest the effort in starting with someone new, and so you uncomfortably settle.
Or maybe you’re like Ben and realizing that it’s really not a good fit – your personalities don’t match, the therapists’ approach isn’t as helpful as you thought it might be, or you’ve been going for a while, and you realize that you are beginning to outgrow your therapist – he or she doesn’t seem to have much more to offer. It’s time to move on.
Here are some questions to ask yourself to assess the current state of affairs:
Do you feel safe?
Therapy certainly is about talking about things that you may be reluctant to talk about, but to do that it also needs to be about safety – a place, a relationship where overall you don’t worry about being judged or dismissed.
Sure, it’s normal to feel anxious in the first few sessions as you get to know each other, but at some point, should begin to feel that your therapist is doing her best to help you relax and settle, and that you, albeit slowly, are. If the safety isn’t there, this is going to get in the way of you making the most of your sessions.
Do you feel like you are treading water?
While some may say that therapy is the art of essentially saying the same things over and over again, there should be energy in the room, it shouldn’t feel like you circling around the same well-worn topics with no forward movement, or talking about more mundane topics that don’t address your pressing concerns.
If this is going on it may indicative of a few underlying dynamics at work. One is that the safety isn’t there and you hold back rather than taking the risk of being more open. Or it may be that you and your therapist have both fallen into a comfortable pattern where she doesn’t push and assumes you are getting what you need, and you go-along and convince yourself it’s going okay.
Or it may be that there actually isn’t much more to be more open about. The pressing problems you had when you walked in have essentially been resolved but you enjoy having the relationship itself, as does your therapist, and you both are going on habit or don’t want to give it up. And if you are lonely or isolated this pull is even stronger because this is the one place in the week where you feel connected to someone.
The clinical and ethical question here is whether the therapy is actually helping you solve problems and move forward in your life, or offering you the support that you can’t get anywhere else and that you absolutely need to remain stable and functional in your life; or is it essentially a case where you are just treading water?
These are can be difficult to sort out but it’s helpful to ask yourself the questions and not go on auto-pilot. The underlying danger here is that of dependency, which can be defined as good relationship but no change, and is an ethical responsibility for all clinicians. It can take the form of a therapist being over his head and can’t admit it, and instead falsely believes that just giving things more time will improve your situation.
Or it is about both of you emotionally getting something out of the relationship itself but neither one of you, especially the therapist, has the courage to speak up and talk about the elephant in the room and what you both are doing. Or, in the worst-case scenario the therapist is essentially stringing you along, keeping the relationship going for money or her own emotional needs, and may even guilt you into not leaving.
Do you feel like the therapist’s style and approach is a good fit?
Most people do come into therapy in some form of crisis and, like Ben, initially find that just having a place to unload is helpful. But after the dust settles and you are able to come up for air, you may find that it is not a good match – the therapist talks too much or too little, or her way of thinking about problems and her focus just seems too foreign and unhelpful to you.
Again, if you’re new to therapy and don’t really know what to expect or what options there are, if you have fallen into a passive role where the therapist knows best, it can be easy to avoid or be unable to answer these questions.
The starting point is trusting your gut – do you feel better when you walk out than when you walked in? You can also explore, through friends in therapy, or online, other approaches. In some ways this is much like what some experience with religion: How much do you try to fit the square peg of you into the round hole or simply look for a squarer hole?
Why now? What are your own relationship patterns?
A question that might be helpful for Kate and Ben to ask themselves is whether they’ve been in this place before in other relationships. Kate may realize that what is happening in therapy is what has happened in a lot of her intimate relationships – that she takes what she gets, becomes too passive, settles too quickly and falls into habit and routine. Or Ben’s cut-and-run approach is actually old news: As soon as he is pressed to deal with something he is reluctant to face he decides this isn’t working and bails.
This is about problem replication, where the problems out-there become enacted in the room with the therapist. While it’s largely the therapist’s responsibility to look out for these patterns, if she doesn’t know you well enough yet, or you both have settled into some unhelpful comfort zone, the therapy is in danger of becoming less of fulcrum of change and more a more-of-the-same.
Breaking out / Breaking up
If you feel any of above – the lack of safety, the treading water, the bad fit – it’s time to do something about it.
The starting point is talking about the relationship and process itself with your therapist. Yes, this can be difficult, especially if this type of assertiveness is something you already struggle with.
But realize that you are the consumer here, that this is your therapy, and speaking about what may not be working is not different in some way than complaining about a new lawnmower that won’t start or a dress that is falling apart after two washings. If it’s too difficult to do in person, send an email where you have time to lay out your concerns, and then follow up with a conversation in person.
You can also prompt your therapist to take the lead. Say at the end of a session that you’d like to take some time next session to review your goals and would like your therapist’s input about how and where she things you both are going. This will give her time to step back and assess, and puts the responsibility on her to jump-start the conversation.
Then, depending on how these conversations go, you may decide to take a break and see how you do without the therapy’s support, or you may try spreading out sessions and see how you feel. Or if you think you have outgrown your therapist or it is not a good fit, ask for names of other therapists to consult with, or do some research on your own.
And if your therapist makes a case that maybe you are in fact repeating old patterns – Ben’s cutting-and-running – take it seriously but also speak up. The cutting-and-running, or the settling, for example, are not the problem but a bad solution to an underlying problem. Here you may need to talk about what the therapist needs to do to help you feel safer, or whether she needs to take a more active role or ask harder questions to draw you out.
If on the other hand, you feel that your therapist is not taking your concerns seriously, is not offering a solid argument for continuing, and leaving you feeling guilty or scared into not leaving, this is good reason in itself to leave. Intimidation should never be part of therapy.
The bottom line here is the bottom line, namely, that therapy is a relationship that is never perfect, that changes over time, but is one that is focused and serving a distinct purpose, that is, helping you change what it is you want to change, and give you some of what you need most right now.
It is your therapy, you are the consumer, you have a right to get what you are paying for.