Older clients

My experiences with therapy, regrettably, have been more counterproductive than helpful. So much that therapists have done or said just didn't make sense to me. In fact, some of the things that most didn't make sense were their responses when I asked questions to try to understand or tried to tell the therapist that something didn't make sense. Sometimes things make sense if you make certain assumptions -- but if the assumptions don't hold, then the behavior doesn't make sense.

I have tried a number of therapists off and on over the years. I've also done a lot of reading to try to make sense of my experiences with therapy. A lot of what I have read also doesn't make sense, at least as far as something that would be helpful to me. I am not anti-therapy; I realize that it is helpful for many people. But in many ways it seems like religion to me. The different theoretical orientations seem to be based on beliefs that seem in many ways like religious beliefs. I am not against religion -- I realize that it is helpful for many people (although sometimes it can be harmful, too, as when someone from one religion considers someone from another religion "bad" just because they have a different religion.)

One thing I came across in my reading a couple of years ago (in a book Principles of Therapeutic Change that Work, edited by Castonguay and Beutler) is the assertion that therapy is less likely to help older clients -- which they defined as "over 35". This may have been part of my problem with therapy -- I was in my early forties when I first tried therapy (I am now in my mid sixties). I would be interested in hearing from anyone else out there who first tried therapy when they were over forty, or who is now my age, or who has had experiences similar to mine.

(My first version of this post had a few more paragraphs, but I've decided it would be better to put them in a different thread.)

Since you like to read...if you haven't already, I hope you will read "Talk is Not Enough: How Pyschotherapy Really Works" by Willar Gaylin.

I have been in behavioral therapies that helped minimally.
I am currently in psychodynamic/psychoanalytic psychotherapy that has been very helpful. I cannot always say exactly why. It is just the experience of the therapist in the psychotherapy that is helpful. I suppose I have internalized the experience(s).
I only know my life is immensely more comfortable most of the time, compared to where I was several years ago when I began this therapy. I also know that having the analysis of what I'm experiencing in my life is relieving and clarifying. I am learning to see other perspectives. I am learning (and this one takes much practice!) to see that there can be many feelings about one thing, that those feelings/thoughts can be 180 degrees from one another and all of the feelings/thoughts are valid. I have a lot more and deeper work to do.

Therapy is very helpful to me right now, at age 56. My life feels so much better. That's all I know.

I began therapy a few years ago, in midlife. It has been incredibly helpful to me. I have learned so much. I am happier. I understand myself and others better. I am more comfortable with myself. I learned to "listen" to myself better and recognize what I am feeling. I have improved my communication skills. I have learned to share deeply with another human being. There has been no down side (except for less cash in my bank account!).

Last week during my session, I was talking to my therapist about how now I would not put up with certain things in a relationship that I had put up with for years in my younger days. I would just say forget that! and walk away, or I would tell the person firmly that was not acceptable. If he couldn't accommodate, I would not get involved with him, etc. I have a much clearer view of what is acceptable in a relationship and what is not. I have begun to learn to set boundaries. My T told me I had almost no boundaries when I began therapy. As we were talking, I exclaimed to T something like, "I wish I had been able to do this when I was 25!" And he said that is so common in therapy--that many people do not go to therapy until they are older, and then learn all these things, are able to change, etc. I do wish I had gone to therapy when I was younger, but I also wonder if I would have been so ready to change and grow and heal? Would I have even had the dysfunctional patterns in my life emerge clearly yet? T said that many clients go to therapy in midlife, when they are really seeing their own mortality--their parents are aging and ill and their kids are approaching adulthood or have moved out. They are left with just themselves or themselves and their spouse, and wonder, is this all there is? Do I want to be this way for the rest of my life? Think this way? Relate this way? Feel this way? Without so much to keep them busy like childrearing and establishing a career, they have more time to ponder and recognize discontentment and one's "flaws" (or dysfunctional behaviors) that may have led down paths that ended up in unsatisfactory or damaging destinations. When I was younger, I am not sure I would have been "mature" enough for all of this deep work and insight. Maybe.

Anyway, that is my experience and some observations from my therapist.

I think sometimes therapists who only practice one approach might get kind of dogmatic and only be willing to deliver one type of therapy even if the client would do better with another approach. That reminds me somwhat of what can be dogma in religions. However, it seems like many therapists these days are eclectic and will use the best techniques for the presenting client. And therapists who are not so flexible may refer out if they realize their approach cannot help a client. I do think, for me, the most important thing has been my therapist himself and our relationship, rather than his exact approach. He has used techniques from several different schools of therapy with me, and we have had success with a number of them. I did have a therapist before him who stuck more closely to one approach, and our therapy was not as successful. I also didn't have the close relationship with her that I have with my current T.

( Sunrise))
I thought I would just add my perspective.
Speaking from the younger age range ( 23) I began therapy one year ago. Though i see the positive impacts that therapy has had in my life, i still question whether I should continue now or wait a few more years. Sometimes i feel so lost in who i am and what i want. There is still so much that I have to experience and learn about myself. There's so much that I want to know about myself. There just isn't a lot of younger people that enter into therapy or are not committed to their healing. Will I really be able to fully understand the value of therapy? I ask myself this everyday.

Wonderingmary I'm sorry to babble on about my issue. However, entering therapy at any age will enable you to make life long positive changes. As humans, we learn something new about ourselves everyday and there is no "age" limit with this.. Continue working hard and know that we are here to support you

Wonderingmary,
I started therapy when I was 17. I am now 37. I have been in and out of therapy, mostly in, this entire time. All I can say is that I didn't start getting real help from therapy till I was in my early 30's. I don't think age has anything to do with it. I think it is a mixture of the type of therapy, the therapist and your relationship with him/her, and what you put into it. Jmho.

Hi WonderingMary. I could see why you might think that therapy might not help people over 35, or just older people in general. As people get older, many do become more set in their ways and in their attitudes. But it seems strange to me that it would be written in a book about therputic change!

My experience has been, with myself and having been in group therapy with people that were mid-life and older, is that when you want change, you seek it. I began therapy at 19, but wasnt ready for the deeper things I needed to do until I was much older. I continued in individual and group from that time until I was 34. And the truth is, although I did a lot of good work and changed a lot, I couldnt go as deep as I am (trying) to go today. I took a 15 year break from therapy and began again about 1 1/2 yrs ago. Now, I didnt BEGIN as an adult, but I wasnt able to do as much work as I am now as an adult. Maybe the groundwork was laid when I was young. Or maybe I was functioning pretty well, or well enough, had achieved some goals (like getting married and having children) and didnt feel the need to do more work.

But I needed more help. My life was screaming for it. And I do more and better work in therapy now than I did then. I think as a young person, I didnt have the same perspective that life experience gave me. The bigger picture is clearer. What matters and what doesnt it clearer. Even though I did hard work then, looking back, its as if I was in some kind of fog, scratching the surface and unable to let go of my fear of going into the really hard places.

So, now, that said, Im surprised that a book about theraputic change would state that as we get older and more experienced we are less likely to change and grow and benefit from therapy. Maybe the author imagines that people are more open to another way of thinking and seeing things while they are under 35. It may be true on some level, but in my case, I was somewhat less able to be open to what therapy had to offer while young than I am now.

This is an interesting thread. I'm now 37 and have re-entered therapy after a nearly 8-year break. My previous stints at therapy were basically dealing with the momentary crises. I wasn't in a place to really know who I was or to even understand the hard work that would be needed to help me long-term. That being said, when I returned to therapy about 5 months ago, I went with a therapist that was closer to my age (only ten years older). I was skeptical about this, but I pressed forward. Mid-way through, we both recognized that I needed a completely different path due to a lot of things that came up, so I searched for a specialist in abuse/dissociation. I must say, though, the age thing was a psychological hindrance for me. For me, I have a deep respect for people who have wisdom from decades of doing things, and I make every effort to draw on that wisdom.

My search for an abuse/dissociative specialist was the first time I actually conducted interviews, and doing so taught me a tremendous amount about myself. What I believe is that clients need to understand they can take their time in finding someone, not just pointing to a name in a book and then going. I ended up with someone older (by approx. 30 years), but it was the right choice, and I'm glad I gave myself the time and space to be selective.

Now that I'm feeling more settled in with this new person, I'm focusing on doing what I need to do, like being honest all the time and understanding that I cannot get from this person what I did not get from my parents. The latter realization has been profound for me, and I now understand that had I realized that in my earlier attempts at therapy, then perhaps there would not have been as much lost opportunity in my life. I’ve not told her about this realization. I’m moving slowly into telling her, waiting for the right time, because I understand that it will be incredibly shameful to admit it to someone and painful to fully accept it and do the work needed to move beyond.

Wonderingmary,

I'm 45 and began therapy in my mid-30's for the first time. I've been with the same therapist for most of that time. I believe I've learned alot from my therapy, but like you, I have been disappointed that it has not produced more fruitage. Regardless of my hard work in therapy, and the hard work of my therapist, change comes very slow to me, mostly because of the very thick emotional walls and other defenses that i've used for most of my life to feel safe. It has been extremely hard to trust my t enough with my internal life to set those defenses aside and expose the hurting, vulnerable side of me that is necessary in order to heal.

I've learned in therapy to be much more aware of my thoughts and feelings, and i tend to analyze a good bit. I've also done quite alot of reading about mental health and therapy. Like you, my t also often shares things with me that i already know. It doesn't bother me though because i tend to self-doubt, and having another person reinforce or validate what i think and feel helps me.

As far as things not making sense . . .we have experienced repeated times of miscommunication or confusion, often because i misinterpreted something she said or did. Thankfully, we always talk these situations through to resolution. The most problematic thing in my therapy (besides my defenses and trouble trusting) is for my t to truly understand what it is i am needing in order to heal. She has tried several things with only minimal success. And when i suggested something that i felt i very much needed, which took a great deal of courage and struggling, she didn't agree with meeting that need, which resulted in alot of damage to the therapy relationship. The bottom line is i believe my problems are so complicated, it's hard to find any one therapy approach that works for me. And i think my age does make it harder for me to rewire my brain and make needed changes.

BlueMoon, thank you for your very thoughtful comments.
I started at age 56 and exactly because the ingrained, automatic reactions that had made my life miserable are no longer tolerable. In earlier years I could distract myself, no longer. I want to be whoever it is that I am, to the best I can be, before my chance is over.
I have seen changes already; not done yet by a long shot, but it's not true that there are no possible changes. We each of us learn and change all our lives. What is it that my T said - we can keep growing, or we can just grow old. I guess there is a choice there. She ought to know; at 70 she is very alive, and full of life and growth.

Thanks for the book suggestion. I will put it on my "look at" list -- unfortunately, my "to read" list is pretty long right now, and I'm trying to put topics other than therapy as priority. My top priority to read re therapy (I've already got it -- had it for several months but not had a chance to read it) is Critical Thinking in Clinical Practice, by Eileen Gambrill.

I think my needs may be somewhat opposite of yours. Psychodynamic/psychoanalytic therapy is one of the things that seems like a religion to me. I don't mean that at all in a deprecating way, just that it doesn't fit me. A lot of my thinking/seeing the world is behaviorally oriented, although it seems that behavioral therapists think behaviorally differently than I do. I don't know if that sentence is saying what I am trying to say, so maybe an example will help. A cognitive-behavioral therapist that I tried said that he saw his job as breaking up therapy into steps that were appropriate for the client -- if the steps were too big, the client would get frustrated, but if they were too small, the client would get bored. That sounded great to me. But then he went ahead and started into all the "You this, ...", "It's not that way, it's this way," etc., etc. stuff that was exactly the kind of thing I need to learn to cope with -- he didn't seem to have any sense that that was part of the problem. (Maybe it's not very nice, but I thought of him as "Mr. My Mind Is Made Up, Don't Confuse Me With The Facts".) That aspect of the experience was often the case in my experience with therapists -- they intervene before I've had a chance to explain what the problem is, or else they ignore my explanation and go on to their own agenda for me. This one insisted that I didn't need therapy, that I was doing fine on my own -- all on the basis of very few words I had managed to get in edgewise.

Objectively speaking, it's always good to hear that therapy has helped someone. Subjectively, I must admit that I feel a little envious that you found something helpful. I don't think that I would find analysis of what I'm experiencing relieving or clarifying, though. I went into therapy seeing more than one perspective, and hoping for help in integrating/managing that complexity. I didn't receive any help with that. So often it was like the therapist pointing out the facade of a building, while I was trying to say, "Look, there's also this side, and the back, and the other side, and the top, and look how they all fit together," only to have her again point out the facade.

As with Echoes, it is good to hear that someone "older" has found therapy helpful. Unfortunately, my experience was not so helpful. I suppose you could say I learned some things. I learned that one needs to be careful in trusting people, and that I was too inclined to question my own judgment when I should have trusted myself. I also learned that the problems I went to therapy for help with could be worse problems than I thought depending on the situation -- and therapy was a situation where they were bigger problems than in ordinary life. I became much less happy in response to therapy, although I have, over the years, managed to "recover" somewhat (not entirely) from my therapy experiences.

What you say about learning to recognize your feelings is one of those things that don't make sense to me. The way I see it is that all you can do is learn to identify your feelings as categorized in a particular framework. I believe that different languages categorize feelings in different ways, and that there is no "objective" classification. If anyone knows of any scientific evidence to the contrary, I am willing to look at it.

I had been making progress before therapy in improving my communication skills, but I definitely regressed in therapy. Fortunately, I have been making progress again in the past few years.

Learning to share deeply with another human being was not a goal of therapy for me. I value privacy and boundaries. I am not opposed to intimacy, but believe that there is a big difference between chosen intimacy and imposed intimacy. In therapy, and with one therapist in particular, I got imposed intimacy. It was a very negative experience. Since therapy, there are fewer people that I care to be really close to.

That is a skill that, in my experience, was a prerequisite for therapy. My lack of skill with setting boundaries was one of those things that was a much bigger problem in therapy than in ordinary life. In my experience therapists seem to be more insensitive to boundaries than most other people I encounter.

I have had therapists who call themselves eclectic but seem dogmatic. I suspect that in some cases, therapists who call themselves eclectic are eclectic in the sense of idiosyncratic -- they have their own theories, which they might have drawn from various theoretical orientations, but which they can be very inflexible in.

I think I may mean the same thing by "recognizing" my feelings that you mean by "identifying", but I'm not sure, as your comments didn't seem directed at my intent, so we may be missing communication here. What I meant was that I didn't know if I was feeling anything. I seemed to feel nothing. I didn't know how to "listen" to myself and sense if I was feeling anything. I was just very skilled at taking any feeling that might occur and stuffing it instantaneously deep inside so that I never knew it even existed. I didn't know if I was sad. I didn't know if I was angry. I didn't know if I felt joy. It has been wonderful to discover I actually do feel all of these things. I think the framework I may be referring to is my own, rather than that of a different language. (I am really most concerned with myself in therapy rather than with a universal, objective classification of feelings--simply not an interest of mine.) I now can feel sad/angry/joyful within my own framework. I remember very early in therapy, my T asked if I could say "ouch" if I found something hurtful, but it just seemed stupid to me. It was fake, I didn't feel hurt or pain. He would look at me expectantly when something hurtful would happen, but I would give no response. I felt a bit like he was trying to put me in the "box" of how he felt most people would feel and he was just wrong--I did not feel those things! But with lots of work in therapy, I have discovered that my therapist was right, I actually do feel all of those things, and can recognize them now when I do. And I could even say "ouch" now if my T were to ask.

It wasn't for me either. In fact, almost none of the benefits I have realized from therapy were goals of mine when I began. They have been "side benefits", and have actually turned out to be the most valuable things I have taken from therapy. I think that is common for quite a few clients. You start out with one intent but instead realize all these other gains, which you never even knew you wanted or were lacking in. Therapy can be surprising, with its hidden joys and unexpected twists and turns. Of course, it can be painful too. Being able to feel joy and pain makes me feel more human and alive.

I had never heard of "boundaries" until I began therapy. I think many therapists work with clients to help them learn to set boundaries and maintain them--it is a common presenting problem. My main problems with boundaries, unlike yours, were outside of therapy. I let people walk all over me, whereas in therapy, I had a trusted partner who would never take advantage of me. He respected boundaries that I didn't even have.

Anyway, as you requested, you are getting a number of responses in your thread from "older clients." It is looking like older clients' therapy experiences vary quite a bit. In general, I think one's response to psychotherapy is probably more strongly influenced by other factors than one's age. Aside from your age, what do you believe strongly influenced your experience in therapy? From reading about your experiences, I wonder how much was external (you were unlucky and got "bad" therapists) and how much was internal?

Oops. My error. I guess I was confusing what you said with something I have read several times about therapy other places.

Wow. That is so different from me. I just feel, and feel, and feel so much, so many emotions. It can be a real pain in the neck. I often wish I could just stop feeling. The problem just got worse in therapy.

If you substitute "think" for "feel" in this sentence, it comes close to describing one thing that was so frustrating for me in therapy. Therapists just seemed to assume that I see things differently from how I see them. I suspect that it is in large part because I tend to see things in complex terms, and they seemed to see things in such simple terms.

I'll second that therapy can be surprising. I found it hard to deal with the negative surprises -- and most of them were negative for me. There were very few positive ones, in my experience, but there have been some.

That makes sense to me.

I guess I communicated well enough here. I appreciate your recognizing that my situation was different from mine -- particularly since one big (negative) surprise with the last therapist I tried was when he said, "I think you are harming yourself by focusing so much on how you are different from me. I think you should focus more on how we are similar." Ironically, that was shortly after a positive surprise: I found that talking with him had been helping me deal a little better with the "therapists in my head," and as a result freed up energy for me to implement additional means to deal with my intrusive thoughts and accompanying emotions. I tried to explain (in the next session, after writing out my thoughts to increase the chances that I could articulate them) why I think focusing on differences is so important, giving several examples in my life where that has been the case. But he seemed unresponsive. In a later session, I asked him why he thought I should focus more on similarities. He said it was because he believed in balance. That didn't make sense to me. Overall, my experience with him was the most helpful I have had -- but it was like two steps forward and one backward: I slid backward from the gains I had made, but not entirely. The sliding backward, the loss of the at least somewhat supportive relationship, was very painful, but I did come out with a little less fear of therapists, which enabled me to do more reading about therapy with not as much anxiety, pain, and shame.

Yes, which to me brings a little bit of comfort -- it gives an affirmative "reality check" to my perception that one size does not fit all in therapy and that therefore it is reasonable to (at least try) to tell a therapist when they seem to misunderstand me, and what does and does not work for me.

I'm not entirely convinced that age is always a minor factor, partly since age can influence so many other things. Also, the people who responded were all noticeably younger than I currently am by several years. Thus they come from a different age "cohort" (in particular, are baby boomers, which I am not, and I believe that that is something about me that influenced my experiences in therapy), and also started therapy in a later year, when some changes had begun in the profession.

I'm going to try to assert some boundaries here: I would appreciate the kindness of your not asking me personal questions without a very good reason for knowing the answer and without telling me the reason. I don't like being treated as an object of interest, so your question is de facto asking me to do you a very big favor. It's definitely not supportive; quite the opposite, it is confrontational by way of being intrusive. I don't think you are ill-intended, nor that you intend offense, just that you do not understand where I am coming from -- i.e., inaccurate empathy (which is understandable given what you have said above that shows how we are so different in our emotional histories.) I hope you do not take offense at my response.

Wow. I think I've only had one therapist who was as much as ten years older than me, and I'm not even sure he was that much older than me. Most of the therapists I've tried have been younger than me. The first ones I tried were only a few years younger than me, and at the time I anticipated that that wouldn't be a problem, that we could interact to some extent as peers. But that didn't turn out to be the case. On the one hand, they seemed to take more of an authoritarian position than I expected, but at the same time, they seemed shallow. (Perhaps the two were related). So after a couple of bad experiences, I deliberately sought out someone older than me -- but she was less than ten years older. Unfortunately, that also turned out to be a counterproductive experience.

I realized from the very beginning that it would be wise to interview a prospective therapist, and tried, but it didn't go very well. I didn't really know what questions to ask. I knew there were various "schools" of therapy (I hadn't learned the phrase "theoretical orientation" yet), so asked about that. But the answers were just words to me, with no meaning attached. Also, I was extremely self-conscious, and gave up pretty quickly. When I tried interviewing the therapist who was older than me, I did ask her the question about "school" of therapy (and didn't understand the answer), and how old she was. Since one thing problematical about the previous therapists was that there was no attempt at informed consent, and answers to my questions often seemed vague or evasive, I asked her if she let her patients know what she was doing. (I was only trying psychiatrists at that point, since I had had negative experiences with two psychologists.) She said yes, that she even gave them things to read. It turned out that she did a little bit (specifically, she gave a written sheet about appointment lengths and charges, which the previous therapists had not done, and when she suggested that I take an antidepressant, she gave me a copy of the information about it from the Physician's Desk Reference). But when I got up the courage to ask why she was doing what she did, she gave me answers like, "I'm trying to put together a puzzle" and "I have my reasons." I felt intimidated by her, but she didn't earn my respect either.

I remember another time when I tried to interview a therapist over the phone. I asked him what his philosophy of therapy was. (I still hadn't learned the phrase theoretical orientation) He said he didn't know what I meant. I said something like, "What beliefs do you base your work on?" He replied, "Therapy is not a religion." I once more felt put down.

So I admire your ability to interview prospective therapists. I just did not have that skill.

I remember once wishing I could find a book on "How to get along with your therapist."

Thanks for your contribution.

I've always felt very uneasy around people who are touchy-feely, emotive types, but I could never say why. After two years with T, WHAM! I realized that it's a reaction to their unpredictability; up to age 4 my father was at home, emotionally unstable and often violent. Today, people who seem far more influenced by emotions than reason really make me anxious. But now I know why, and to me it is worth a lot.

Also, I've learned that feeling hurt by someone is a vulnerable position and that I prefer to be angry, because it gives me an illusion of control, But I know now that my feelings really are of hurt; the anger is on top of that, a shield against pain, if you will, although not a good one.

This is some of what came to me when I read, "learning to recognize your feelings".

This is something I forgot to respond to in my earlier reply. When I first started therapy, one thing I hoped for was better understanding of others. I had become aware that people have different values, perceptions, etc., and (naively) assumed that a therapist would have expert knowledge of individual differences and would use that knowledge in their work and would help me learn some of it. I also anticipated that I might understand myself better.

Unfortunately, therapy did not help me in either of these ways. (In fact, with therapist #3, I put considerable energy into trying to understand her, and in trying to help her understand me, but with little success in the former, and no apparent success in the latter.

But I did find some help with both of these a few years after my initial attempts at therapy, when, in my reading to try to help me, I came across the Meyers-Briggs-Jung personality types. So I suggest that to anyone else who is seeking to understand others and/or themselves. The best source I found was Type Talk by Kroeger and Thuesen.

I do have some reservations about this typology, though -- at least, about how some people use (to my mind, misuse) it. Although Kroeger and Thuesen do not seem to do this much, the subtitle of their book ("The 16 personality types that determine how we live, love, and work") does suggest this misuse, by using the word "determine". I don't see the types as determining so much as influencing. Indeed, Kroeger and Thuesen call the types preferences, and emphasize that they are just that, not rigid limitations. Unfortunately, I have encountered people who said things like, "You are this type, so you need ...", not taking into account the wide variability of people within each type. I hope nobody in this forum will do that! It's both unkind and inaccurate.

Hmm. There are many touchy-feely, emotive people that I have felt uneasy with (therapist #3 is one example), but some that I like very much, and enjoy those qualities in. I see it more as my dislike of what I call imposed intimacy as contrasted with consentual intimacy. (Therapist #3 was big on imposed intimacy.)

But the touchy-feely, emotive vs reason preference is in fact one of the things addressed in the book I mentioned in the post I sent a few minutes ago. So that might possibly be helpful to you.

Oops -- In my reply to Sunrise Yesterday (Tuesday) at 09:31 PM, I said, "I guess I communicated well enough here. I appreciate your recognizing that my situation was different from mine." The second sentence should have been, "I appreciate your recognizing that my situation was different from yours."

PS. Can anyone tell me if there is a way I could have edited my post directly?

Thanks for the response. When I conducted interviews, I pulled a list of questions off the Internet and ended up looking like a fool; although, I think the psychologist may have been somewhat amused. She, like one of the T's you mentioned above, is a puzzle solver, and I've come to believe that it's a good thing for what I need. In the end, I'm very glad I went with her. I have very good faith in her skill and expertise. Regarding the "warmth" that many seek: I'm using the potential lacking of that to learn how to give that to myself.

Peace,
writing

If you are the writer, and no one has responded, you should see an "edit" button that no one else sees.
At least when I have edited, that's how it seems to go. After there is at least one response, I don't know that you can edit any more.

There is a time limit during which one can edit one's own message.

Thanks for your response.

When I tried interviewing therapist #4 (the psychiatrist), she certainly seemed to find it amusing -- she said it was such fun to be asked questions; that patients rarely did that.

I have remembered another question I asked her: What her strengths and weaknesses as a therapist were. I don't recall if she said anything about strengths, but she did say that the only weakness was that sometimes her patients told her she didn't take her seriously enough because she sometimes laughed at them; but she "couldn't help it; people sometimes get themselves in the darndest places."

I imagined that what she was talking about was laughing about some little thing, then apologizing. Unfortunately, it wasn't like that at all. I think there were only three times (in six months) that she laughed at me, but they were really biting.

One was when I was trying to tell her how my emotions are sometimes complex -- one may prompt another, and then sometimes that prompts a third. She laughed and said, "Oh, you make things so complex!" I was speechless (a common experience in therapy for me). It seemed like dismissing something that was an important point. I remember reading somewhere a few years later that this is indeed a sign of more severe problems, that are more difficult to treat.

The second was when I boldly said that she didn't seem to be giving me as much positive feedback as she initially had. She responded in a mocking tone, giving syrupy, exaggerated compliments and laughing. I felt extremely embarrassed and begged her to stop.

The third and very worst needs a little preface. The previous session, I had come in wanting to talk about shame (which has been a big problem for me). She asked an unrelated question that got us off on a tangent. So I came in the next week quite assertively (for me) saying that I wanted to talk about shame. She said that she didn't know what I meant by shame; she had even looked it up in the dictionary and still didn't understand. I found it quite amazing that a therapist wouldn't understand the word shame, but I tried to explain. She said she didn't understand my explanation. I tried again. She said she still didn't understand. I tried again. She then threw up her hands, threw her head back, laughed, and said, "I have no idea what you're talking about." Guess what: I felt ashamed.

Looking back, I find it so amazing that I went back after even the first incident. But at the time, I told myself that I knew in advance that she sometimes laughed at clients, and that I needed to try not to expect too much (since therapist #1 told me that I expected too much), and that I needed to be tolerant of others (this therapist had told me that), and that the problem was just that I was hypersensitive. I clearly was in bad shape. I sure could have used some help. I now think that I was being too tolerant of unacceptable, unprofessional behavior.

Unfortunately, my therapist #4 was a very poor puzzle solver. To extend the metaphor, when I went to therapy, I had put together a bunch of pieces of the puzzle I was dealing with. But there were some that didn't fit in, and some that were clearly missing. I (naively) thought therapy would help supply the missing pieces and help me where I was stuck. But with this therapist, it was as if she had grabbed the puzzle pieces from me and was holding them out of my sight. Then every once in a while, she would show them to me the way she had put them together: She had taken apart the pieces that I had fit together well, and had crammed them together in ways that didn't really fit (much as a small child sometimes does). If she had been a good puzzle solver, that would have been a different story.

It's always good to hear of cases that do work out (though the envy does arise).

Sounds like resourcefulness on your part.

I don't think I have brought up warmth in any of my posts. To be honest, I'm really not sure that I understand the concept well; when I think of characteristics of people, "warmth" isn't one of them. I've tried looking it up in a dictionary, and that makes it sound like something that I would find difficult to deal with in a therapist, unless moderated by reserve in its expression.

If anyone would be willing to try to explain what they mean by warmth (at least in the context of therapy), and how they find it helpful in therapy, I'd appreciate it.

For what it is worth, I was in my forties when I started therapy, and now in my fifties I am preparing to end therapy. Therapy has changed me. It has been well worth the effort my therapist and I have put into it.

My mother went to therapy for a few years in her sixties and it was amazingly helpful to her. She is much more honest and comfortable in her own skin. She has some issues still but she is so much easier to deal with now. I think she finds the world easier to deal with too.