How do you know what to take the lead about?

stopdog · Jun 18, 2012, 08:21 AM

Those of you who "take the lead" -how do you know the sorts of things to talk about that will help with why you see a therapist in the first place? If I knew what to say that would help, I could just tell it to my dogs or something and not need the therapist at all. Once I described why I was there, I had pretty much exhausted what I knew to say about it.

critterlady · Jun 18, 2012, 08:29 AM

I talk about things that I'm struggling with. Sometimes those are things going on currently and sometimes they're things from the past that I've been thinking about. Sometimes I lead with a question or thought about something we'd discussed in a previous session.

That starts a conversation about the subject, where T asks questions about or comments on what I've brought up.

Jun 18, 2012, 08:35 AM

I was the only person who said it's about 50/50 on who takes the lead in the sessions. The kinds of things I know to bring up are the things that are in my immediate view, my immediate concerns or stresses. All I have to do is bring it up and we go from there. Our sessions are a conversation between us, not the kind of session where I do all the talking and T injects something occasionally. That would never work for me. Once I bring up a topic, the conversation begins. T knows me very well and knows how to steer the conversation to a place that is most helpful. He's excellent at helping me dig deeper into a topic to get to the meat of it.

Sometimes he takes the lead because I'm clueless where to begin. Again, he is pretty skilled at ferreting out what I need to talk about, even when I'm not consciously aware of where to begin. He knows me well.

Jun 18, 2012, 08:40 AM

Quote:

Originally Posted by stopdog

Those of you who "take the lead" -how do you know the sorts of things to talk about that will help with why you see a therapist in the first place? If I knew what to say that would help, I could just tell it to my dogs or something and not need the therapist at all. Once I described why I was there, I had pretty much exhausted what I knew to say about it.

Thanks for this question. I wonder, too - I'm constantly asking my T whether this or that thing I'm saying is really relevant or important, because I genuinely don't know. I left previous T partly because she let me talk about whatever I wanted to and I rarely knew if what I was saying had any relevance to what I was feeling, and usually it ended up in general chitchat about safe topics.

I do not quite agree with you on one point, though: even when I do know what I want to talk about, it does seem to be more helpful to talk to a real live T than to myself or the pets or a random brick wall. But that's me.

stopdog · Jun 18, 2012, 08:59 AM

I put pets before brick wall. But that is possibly because talking to pets is somewhat more socially acceptable. And It is not like, for me, most people, including that therapist, respond in any way that is useful. I find it fun to verbally play spar. But other than that, or to convey information I don't find it makes much difference.

Perna · Jun 18, 2012, 09:01 AM

Quote:

Originally Posted by stopdog

Once I described why I was there, I had pretty much exhausted what I knew to say about it.

Therapy is a relationship. There is no "about"; it's present tense, hands-on. It took me nearly 5-6 years before I did not plan what to talk about each week and 7-8 years before I was able to respond to whatever came up, in real time.

It's our life, our "problems". Even if I knew your reasons for being in therapy I could not advise you on how you would learn or want to approach that problem in your life.

If a problem is concrete, we can list steps and go by the book but since most of us have problems like "anxiety" or "depression", no two of us experience them the same or come from the same background.

Basically, for your difficulty I would say "Take the lead about whatever you like". That causes you to figure out what you like (which no one else can do for you) and then bring it up and respond to another's comments about what you have to say and how you have to say it. They may, for example, tell you they feel they are being lectured. That can happen; we get on our favorite topic and happen to know a lot about it and we want to impart our knowledge. Or, as my therapist did, they may say, "Gee, your face really lights up about this topic, you really enjoy it".

What other people say to us is information about how they perceive us, how we look to another in the greater world. I think most therapists are trained to go after the "feeling" sense and I learned from that to also try to hone in on the feeling my therapist was expressing. For me, therapy was about learning to look where the therapist was pointing rather than at the end of her finger (as my cats do, look at my finger rather than where I'm pointing).

Jun 18, 2012, 09:03 AM

You just start where you are. But then again I'm I'm psychoanalyst where the therapist is skilled in recognising the unconsciOus and we take it from there.

stopdog · Jun 18, 2012, 09:05 AM

I do not go there just to chat with the woman and I do not have daily, weekly or even monthly crises. I want everything we talk about to have something to do with why I am going to a therapist. It is not really a problem for me in that the therapist asks questions and I respond. Just wondered what or how others knew what to do.

elliemay · Jun 18, 2012, 09:08 AM

I usually would lead with the event that was getting the most air time in my head - what my mind, for whatever reason kept coming back to.

It didn't even have to be the feelings about it, just whatever it was.

The feelings would come later I guess.

As with farmergirl, my therapist was always quite skilled at getting to the thing that was bugging me about it and what I needed to learn from it.

My life proved to be my best teacher I guess.

In a very real way my dog was sometimes much better than my therapist at sensing my mood. Very comforting and very engaging my little mutt of happy.

As a facilitator of self awareness and insight, however, not so much.

Nightlight · Jun 18, 2012, 09:10 AM

Quote:

Originally Posted by stopdog

Once I described why I was there, I had pretty much exhausted what I knew to say about it.

That's how I felt for a long time. Once I'd told my background story, that was it. I didn't know what to say. I could answer questions, but really how many questions were left once I'd told my story. I'm lucky that my therapist stuck with me, because the appointments were really helping me a lot, despite my struggles with them. I just had no idea what to say, and if T didn't know, I definitely didn't know either. Now, she still leads at first. I think if something really bothers me during the week, I'll bring it up myself. Also sometimes I'll have a strong reaction to something T says, and then I'm able to bring that up and talk about that. There are plenty of things that remind me of the pain I feel so strongly (that I usually shut off when I'm with others) and when that happens I talk about it. I guess that's the only way I'm able to lead to where I need to go. T has to lead enough of the way, so that I discover what I need to talk about.

elliemay · Jun 18, 2012, 10:43 AM

Quote:

Originally Posted by stopdog

I do not go there just to chat with the woman and I do not have daily, weekly or even monthly crises. I want everything we talk about to have something to do with why I am going to a therapist. It is not really a problem for me in that the therapist asks questions and I respond. Just wondered what or how others knew what to do.

Just because it isn't a crisis, doesn't mean it's chatting either. You may not realize what lies beneath until you start at least skim the surface.

IMO therapy is not all drama, and it's not all trauma either. In fact, therapy can be quite boring at times.

I learned that therapy was going to be a marathon for me and not a sprint. A lot of that was my own doing of course, AND a lot of it was my therapist taking his time to before trying to "fix" me. He was a very thoughtful, intelligent, disciplined person.

ListenMoreTalkLess · Jun 18, 2012, 10:44 AM

Quote:

Originally Posted by stopdog

I do not go there just to chat with the woman and I do not have daily, weekly or even monthly crises. I want everything we talk about to have something to do with why I am going to a therapist. It is not really a problem for me in that the therapist asks questions and I respond. Just wondered what or how others knew what to do.

If your reason for entering therapy-- and IIRC, you've been at this current round for 1.5 years-- has something to do with your interactions with other people, then pretty much everything you say to the T, and every way you react to what she says to you, is relevant.

But if you are spending all your energy in T looking for her to lead and insisting on knowing whether and how a question or a topic is relevant to your specific reason, then I don't see how you can get very far with this approach. But then again, I'm sure you will respond back with you have your own way of doing things that is different than everyone else's and your T says that you are not doing it wrong. So I understand that nothing else will work for you other than what you are doing and that you have tried other approaches and they don't work. I'm not trying so much to comment on what you do-- which I know you are really defensive about-- it is merely my reaction to it that frames the other thing I'm going to say.

I take the lead almost all the time because I am unwilling to give up control to my T and allow her to decide what I should talk about. I'm typically not all that open to questions she asks, either. Sometimes I deftly (or not so deftly) avoid them and just start talking about something else. Once I asked her if she would help me figure something out by asking lots of assessment-oriented questions, and she was really good at it but she prefaced it by asking if I was really sure I wanted her to do it, because she didn't perceive that approach would be "welcomed."

But the way that I know what to take the lead about is that I'm really clear on what issue I want to work on. I have a very stable and easygoing life, although I have some occasional bouts of mild depression and conflicts over whether I want to continue working at the place that I do. I very rarely bring up issues of symptoms or career directly. Rather, my issue is centered around my interactions with my family (wife & kids) and having a desire for "cleaner" responses to them that have to do with the here-and-now and not old holdover response patterns from childhood. So I'm trying to identify the places in my life where my interactions are clouded with old stuff and then figure out ways to react and respond that don't include this old stuff.

So one thing that I regularly bring up is mindfulness. I report on occasions where I feel that I have been particularly mindful in stressful or emotional situations, or times when I haven't. We discuss those. I analyze how things have changed over time, and what's still difficult and what's gotten easier. My T responds with her own example from her life or notes patterns of change or points out what challenges might lie ahead. I usually come out of these discussions with an increased awareness of what I can do in the future or what kinds of things I want to be noticing in my interactions with others.

Another thing I regularly bring up is emotional reactions or behavioral reactions to small interactions in my family, usually with my spouse, a lot less often with my kids. For instance, I've been struggling with my wife's increasing workload bleeding into family time. I'm thrilled that she has made some major achievements/been promoted at work and she really loves her work and I want to support her. Yet, I don't get as much time with her as I'd like. So I've been talking about that with my T and trying to figure out ways to not see her workaholism as about me or our relationship and at the same time, find noncontrolling ways to ask her for what I need. There's always lots to talk about on my attempts to do this and my feelings around whether it worked or not.

There are other interactive issues that arise regularly too, in the context of work or interactions with people in my circle of friends or community. These usually start with some variety of "I noticed that [conversation with so-and-so] made me have [such-and-such] emotional and/or behavioral reaction. So I might comment on how I felt when someone made a critical comment about parenting, the sort of parenting that included things that I believe in and/or do. Or someone at work seemed to want to collaborate with me on a new project, but when I contacted them to follow up, they ignored me. Sometimes my focus is on my feelings, sometimes it is on my reaction (did I respond in a hurt fashion, did I let it roll off my back, did I not feel angry when I might have in the past)? For me, it's very helpful as I'm trying to change my interaction patterns to notice sometimes really tiny changes in how I talk, how I behave, the choices I make to do x, y, z or not, and how I feel about all of these things.

Jun 18, 2012, 10:44 AM

In the beginning, we worked on a lot of cognitive behavioral stuff: when I feel X, do Y. He was extremely practical and I felt noticeably better within matter of weeks.

Now, sometimes I walk in with concrete things I need to work on: coping strategies for Mother's Day, inability to work on a certain case because it's hitting too close to home, etc. Sometimes, I just need to talk about my feeeeelings about how my friends are acting, and he usually guides us from that to why I feel that way and healthier ways of thinking about things. Although sometimes he reminds me that some relationships do not survive therapy, or if they do, it's in a different form than before.

We have been slowly, [dear god, oh so slowly] getting to the place of discussing things that I thought I would never talk about and had pretty much convinced myself I didn't NEED to talk about. So, interspersed in with the other, practical discussion, my T has been slowly laying the ground work for convincing me that it is safe to discuss the really shameful stuff with him.

I don't really know how to describe the process. He has, with two exceptions, I think, allowed me to set the agenda for our meetings. Somehow, we are getting to what needs to be discussed and I know I am better.

Thornsandroses · Jun 18, 2012, 12:49 PM

I agree with so much of what the other posters have said.

I also feel that it is OK to discuss what ever is taking up space in your head at the moment. I usually have questions about something that was said in my last session, that I didn't think to ask about during that session, so I journal the question, then somehow that spurs some other thoughts and I journal about them also. It takes days for me to work on my journal pages. I then bring my new journal page/pages to the next session. I don't think I would know what to talk about in each session with out the journal page to read off of. After I read it/them out loud (or she reads them out loud, if the subject matter is particuliarly emotional for me.) We talk about each different thought, and then we go in one direction or another from there.

During our earlier sessions I needed to talk about my childhood hell, and that gave her some back round to go on. Now I talk more about my day to day issues, and she takes where I came from, to help me understand where I am, and why I am feeling the way I do, react the way I do, and say the things I say. Then she helps me understand how to deal with my current issues in a more productive manner.

I'm not saying this approach will work for everyone, but it works for me.

I love my T and the amazing amount of patience she has with me.
I am quite the handful.....God Bless Her!

skysblue · Jun 18, 2012, 02:04 PM

Quote:

Originally Posted by stopdog

And It is not like, for me, most people, including that therapist, respond in any way that is useful.

I find that my T is able to ask me gentle probing questions that allow me to think or feel more deeply about something. I do most of the talking. To be honest I usually forget anything T says but some of her questions have led me to some incredible insights.

So, it's the talking for me that allows stuff to come forth from a deeper place. Just listening to a therapist would not do me much good because that would enlist my analytical nature which hasn't served me well in the emotional realm.

So, although talking to the dog could be therapeutic because I believe talking in itself is therapeutic but it's the therapist who is able to ask the right questions that make therapy so useful.

SeaSalt · Jun 18, 2012, 02:07 PM

Quote:

Originally Posted by skysblue

I find that my T is able to ask me gentle probing questions that allow me to think or feel more deeply about something. I do most of the talking. To be honest I usually forget anything T says but some of her questions have led me to some incredible insights.

So, it's the talking for me that allows stuff to come forth from a deeper place. Just listening to a therapist would not do me much good because that would enlist my analytical nature which hasn't served me well in the emotional realm.

So, although talking to the dog could be therapeutic because I believe talking in itself is therapeutic but it's the therapist who is able to ask the right questions that make therapy so useful.

Yep, Im only three sessions in, but this is how I am. Wonder what it is with the forgetting thing? Lots of people on PC say things like that. I thought maybe it was just my first session but Im finding I do it all the time. She does ask me some questions but usually I am yammering nonstop.

skysblue · Jun 18, 2012, 02:09 PM

What to take the lead about? Well, I have a notebook that I jot down potential 'topics' to discuss for next session. It could be anything that comes up in my mind that has an emotional element to it. I also like to let her know some other parts of my life so she knows what kind of life I lead - like I went kayaking this week and I want her to know i had that adventure. It's not specifically relevant to any burning issue but I think it helps her to know me more.

By the time session arrives I have a list. And which thing(s) I choose to discuss are what are most compelling to me at the moment. Very seldom do I cover the whole list.

I like the list because there are some times in which I stall out and I can refer to it and remind myself of a thought or feeling or incident that occurred during the week.

Jun 19, 2012, 04:53 PM

For me it's partly already taken care of, because part of what we do is dream work. I record all of my dreams and type them up and bring copies to each session. So if I feel like I have "nothing to say" i just hand her a copy of my dreams and we go from there. On occasion I don't have any dreams to work on and I still don't have anythign to say so we just sit in companionable silence for a bit. That took some getting used to. But now when we do it it's just really comforting to sit quietly in that "t space". I have a notebook too that I record thoughts and feelings from previous sessions or whatever I bring that too. sometimes just telling her about a bad day at work or something else non-related like that, she'll find a seed in it and ask a question and off we go. Oh and I take lots of notes during sessions too, so a lot of times I'll be like "what did you mean by such-and-such last week? I forgot to ask."

There's probably as many ways to go about it as there are people who see t's!

ECHOES · Jun 19, 2012, 07:20 PM

Whatever pops into my mind. There are times I do know that I want to talk about something, but other times (even though beginning can be awkward) I just go with what comes up. I also struggle being able to say a lot about something, and I feel pretty lame when she asks me to say more and I feel like I've already said more than I thought I could. So I say... "I just did." Still I feel like there should be something more there.

.

learning1 · Jun 19, 2012, 08:07 PM

1. One's thoughts, feelings, actions in different situations can sometimes be generalized to understand ones thoughts/feelings/actions in the situation that you've gone to therapy about. So you do not need to know the direct relevance to think that the therapist might be able to find a connection. Sometimes I will bring something up because I think there is a connection, but sometimes when I've brought up issues for some other reason there will be a connection. So I don't have to worry too much that anything I bring up will be irrelevant. Of course, not everything I bring up will lead in lock step to a solution to my presenting issue, but therapy can't be a linear step by step process anyway.
2. The things one learns to take for granted growing up are relevant to the way one experiences any issue now. So any current interaction with foo is relevant to discuss to help t understand how you grew up (of course, the way you interacted will have changed over time, but a lot of it stays the same). Memories and feelings about family of origin are also relevant.
3. The way you interact with the therapist can sometimes be generalized to how you interact with others, so your feelings about interacting with the therapist are relevant to discuss. If you tell the t your feelings, it will help her understand why you act the way you act. then you can figure out how that relates to the reasons you went to therapy.
4 If there are immediate crises going on, obviously tell t about that if you want her help dealing with them. Even if you dont want much immediate help, telling her about immediate problematic issues helps her understand how you react to problematic issues, which she might be able to generalize to understand how to help with the reason you came to therapy.

Jun 19, 2012, 08:28 PM

stopdog, I thought I'd share my experience with therapy today, but it is kind of in this vein. I had a big case this afternoon that I was really anxious about anyway, and didn't want to talk about anything too difficult in therapy this morning. So, we sort of meandered around in conversation aimless and I was thinking that it was a giant waste of time and money other than I like looking at him and just enjoy his company. However, after a while we were discussing work and my anxiety about this case, and I mentioned (casually I thought) how I had been procrastinating at work. He started probing that more because procrastination is not generally my issue. We had a really thought provoking discussion about how I treat my errors, and my fears, and how I generally label myself a loser for every error, no matter how small. So, it was a weird case, where I took the lead away from my "big" issues, but he was astute enough to guide me to something productive and helpful, but not so difficult I couldn't handle it today.

As an aside, I made a giant error just in getting to my hearing, because it wasn't in the courthouse I expected, for some reason, they held state court in the federal courthouse. How often does that happen and wtf were they thinking???? I got the notice but didn't even look at the location, because when X court says I have a hearing, I assume it will be at X courthouse. Because that's where the court IS LOCATED for ****'s sake. AND, I had a panic attack at X courthouse in front of the court clerk and she was nice about it, AND when I finally showed up for court, the panel of judges were incredibly gracious about it. So, they treated my error with a grace and forgiveness that I did not expect and certainly do not generally accord myself.

Iamenough · Jun 19, 2012, 09:36 PM

I know that my homework will need to be talked over so I will take my journals out right away. She leads the discussion most from there now on. I used to make a list and realized that with my list I was controlling the session and so T asked me to stop having an agenda and to just come in. When I had an agenda I would steer the convo and ignore the harder things. I don't grow and heal when the tougher issues aren't looked at, so now I just bring homework in. If something ways heavy on my heart I do make sure it's in my journal to talk about.