Need to make a decision.

Today my therapist told me it might be better if I try therapy someplace else. He wasn't angry or anything but he agreed with me when I said it's frustrating that we're just going round in circles all the time and not getting anywhere. It's been five months, I'm still stuck in my way of thinking and his CBT methods aren't really working for me at the moment. I told him it's probably all my fault but he just said something like "or perhaps I just can't present the method well enough. I mean you're very smart and you're smart enough to argue against all of my arguments. Perhaps CBT just isn't what you need".

He said he sort of didn't want to give up like this but he suggested that we both think about the whole situation until next time we see each other and then decide whether or not we should continue or if I should get referred to someone else. He said I could either try another CBT therapist (someone who might be able to explain things better) or I could get referred to someone who practices something else, like psychodynamic therapy.

So, this is it. I need to make a decision. I'm going to be honest here: even though I've been thinking about changing to another therapist for months now I'm really scared of this situation.

Fear 1: What if I start seeing another therapist and it doesn't work?
Fear 2: What if I'm making a huge mistake by giving up on CBT and/or this therapist?
Fear 3: I fear opening up to yet another person. Even though I've been thinking about changing to another therapist for months (like I said) I guess I've sort of built up some sort of trust/relationship with my current therapist and it doesn't feel great just throwing that away. It actually makes me feel rather sad. In some weird sort of way I guess leaving would make me feel abandoned. Does that make sense?
Fear 4: What if I won't find someone who understands me?
Fear 5: What if no one can help me?

Question 1: How do I know which kind of therapy to choose? CBT or psychodynamic therapy?
Question 2: Should I even consider trying something else?
Question 3: What are your good/bad experiences with the aforementioned kinds of therapy?
Question 4: Any other thoughts?

I realise these might be difficult questions but I'd really appreciate some help. This is tough.

Plenty of recent research suggests that the modality (CBT/psychodynamic) matters less than the therapeutic alliance does. Given that you might need both a more skills-focused therapy (to get strategies for getting through difficult patches in your courses, for instance), as well as something that focuses more on the underlying causes for your anxiety, the ideal would maybe be somebody who could combine a CBT and psychodynamic outlook, but I'm not sure how easy it is to find those. Although your current T might have good suggestions about that.

I have had bad and good experiences of psychodynamic Ts. Getting a T who was a good fit with me was such a huge difference that I could not quite believe it. I do think that you might be doing so much better with a T who was a better fit for you.

1. I ALWAYS hate changing ts. I am the original Klingon.
2. I would definitely prefer psychodynamic to CBT.
3. I still had to consciously decide to say yes to my t, cuz i was disagreeing with him on evetyghing, automatically. But i finally realized it was really just a habit i learned from my mother, who is always right and cannot be told anything and will literally change sides in an argument just to disagree with me (when i wanted to get married, she said no. When i said i didnt want to get married after all, she said i had to. Wtf??). So i asked my t to stop and get my attention before he said something, so that i couldnt automatically disagree. So he would say something like, "this is just off the top of my head but..." and i would find that so sweet and endearing that i would be disarmed and actually LISTEN to him. So now we dialogue much better, altho i still catch myself being negative at him. Good luck whatever you decide.

Maybe something to think about is what is exactly holding you back in your therapy?

• Do you not agree with your therapist's judgement or suggestions?
• Have you tried anything he's suggested?
• Is there a block on talking about something important?
• Are you feeling understood?
• Is it a collaborative relationship where you share, he shares, and you talk about solutions together?

• Are you clearly able to put your finger on what isn't working for you?
• Are you going around in circles because you're resisting change of some kind?

• What fundamentally do you disagree with during your "arguments"?

• Do you primary want to talk and gain insight or do you want advice?

I personally prefer psychodynamic over CBT as one is more time limited than the other.

Yes there are plenty of therapists and I'm sure you'll find one that's right for you.

I also prefer psychodynamic over CBT.

Something you might think about, though, is see if your T could refer you to a psychodynamic T that would work in conjunction with both of you. Then, you could try that T out and see if you like the approach better, while still seeing your current T.

I do both CBT and psychodynamic, but with different therapists. One is making immediate conscious changes to how I deal with things, and the other is finding out why I think and react as I do, and working towards slow sometimes conscious and sometimes subconscious changes.
I think it is important to do them with separate therapists, or to decide which you are working on with the one you are seeing.

Could you take a break and try something new for a few months? OR ask the one you see now if it is possible to come back in the future (all the ones I have tried have said I could always come back except the one who retired after we became friends - and she said it - it just wasn't physically possible because she moved to another state).

These are all reasonable fears and I don't mean to minimise them. But if we examine them dispassionately, we find that none of them is a conclusive argument in favour of staying with your current T.

Fear 1: What if I start seeing another therapist and it doesn't work?
Is it working now?
Fear 2: What if I'm making a huge mistake by giving up on CBT and/or this therapist?
If you decide you made a mistake, you can come back to CBT. I'm guessing your current T would take you back, too.
Fear 3: I fear opening up to yet another person.
My experience is that opening up gets easier with each new therapist. But it is a pain to have to start again.
Fear 4: What if I won't find someone who understands me?
The more people you try, the better the chance of finding someone who does.
Fear 5: What if no one can help me?
Then you don't lose anything by trying a new T.

I find it very difficult to make any process with straight CBT, but I have been able to gradually use some CBT techniques when they were incorporated into other modalities. I agree that the relationship with the therapist is one of the most important things, but so is the therapist’s flexibility in regards to their approach, I find. I’ve probably gone around in circles often enough and it’s been incredibly challenging for me if my therapist gets very frustrated with me and my lack of progress during those times. The most helpful thing has been having them stick it out with me. If they weren’t able to hang in there with me and believe that they could help me to make it out the other side, then I don’t think I would have continued to make any progress.

I really don’t think there’s too much harm in trying something new. In your situation, I think I’d contact a few other therapists and briefly outline the situation. If I got any hopeful sounding responses, then I’d think about making an appointment. It is hard to give up a trusting relationship, but it might help if you talk about your concerns with your therapist before you consider leaving. And you could see if the door can be left open for you to come back if something else doesn’t work.

I think that the relationship is very important, along with having a knowledgeable therapist. I went to a CBT/eclectic therapist for quite awhile, and it ended badly because I was unable to terminate the relationship when it was not helping me. Now, I know it was for the best because I now have a therapist who understands me and knows how to help me.

It sounds like you are at a place where both of you agree that something is not working, and that it has been that way for awhile. I would feel the same fears as you do. Can you get referrals from him for different types of therapists and then go out and interview while you are still seeing him? I thought that I wouldn't be able to find a therapist who was a good fit, but I did. Keep us posted. Take care.

A lot depends on what you are going for, which I am not clear on though some others seem to know you better and have a sense. I find psychodynamic therapy very helpful. I like a certain branch that is very new and contemporary, called relational. As people have said the relationship matters a lot more than the technique. In relational therapy they use the relationship sorta as a technique. Anyway, if you have tried CBT and feel frustrated, why not try something else and see if it fits you better and your situation. Yes, it is hard to start over and go to a new person, but in a way it is also exciting. It's amazing how much difference there is and how you can go over something that was flat before and suddenly comes to life and builds from there just by switching therapists.

Sorry you are scared Neutrino. I'll try and answer your questions..

If you end up regretting leaving T, you could always go back, right?

Yes, it makes sense. Even though you would be making the choice to leave, it might feel like he gave up on you, which could leave you feeling abandoned. Maybe you could just consult with another T for now rather than leave your T? That might alleviate some of your fears.

That's irrational-catastrophic-anxious thinking (I have this issue too)

Yes, from what your T said, quoted above, it sounds like you might rationalize and intellectualize, which are often used as emotional defenses. CBT can make that worse (and I think that is one reason it works for some-it strengthens these defenses). You most likely won't be able to do that with psychodynamic therapy. If you rationalize and intellectualize, the therapist wouldn't engage in any "argument". S/he'd listen and accept, so you'd naturally stop thinking since the T wouldn't reciprocate, and you'd be forced to feel rather than think. That could be a considerable change for you.

I know i'm probably in the minority here, but I think therapeutic modality does matter. CBT can cause you to live more in your head. I remember some of your patterns from when you helped me with my OCD anxiety questions a few months ago, and I'm thinking that maybe you could benefit from feeling more and thinking less. I could be wrong, but I wanted to give you my thoughts in case it helped.

Hope it works out for the best.

I'm not sure whether or not you want me to answer those questions here. I can if you want to. If so, let me know. I've been thinking about these things for months and I'm really worried that it really is my fault therapy isn't working. I just don't really know what I'm doing wrong.

I might ask him if it's possible to come back in the future if the next thing doesn't work out. Not sure that's how it works though.

Is psychodynamic therapy a kind of relational therapy? I've heard people say the relationship between the psychologist and the client is more important in psychodynamic therapy than in CBT.

But a psychodynamic therapist would engage in conversation, right? Or would I be doing all the talking all the time?

It's the other way around - relational psychotherapy is a form of psychodynamic psychotherapy. And yes, traditionally, the relationship is more important in psychodynamic therapy than in CBT.

I kind of like what I read about relational therapy, in terms of approach and focus - they work a lot with affects, which I think is an interesting area.

The therapist will talk, too. Especially in the beginning, when you are getting to know each other. My current psychodynamic T leaves very long silences and sometimes says very little, but previous Ts I've had have talked quite a lot. So it varies from one psychodynamic T to another.

Rather than worrying about the future and what might happen if I do/do not change therapy or therapists, what do you want right now? If you want this therapy to work, you decide that and work at making it work. If you want to try a different therapy or therapist then you decide that and see what that is like. Others here in this thread have talked about which therapy they prefer and having two therapists, one for each kind of therapy and other scenarios but you cannot get what you want and need by just reading about other people's experiences?

It sounds like you do not like CBT for some reason, that you are quick to defend against trying any of the methods presented. I remember when my T worked with my to learn something by rote and I hated it and fought, biting, kicking and screaming the whole way but it turned out to be very helpful to me over time. You may want to give CBT with this therapist a different try, grit your teeth and do some of the exercises faithfully, etc. and see if you can get out of your head some and into "doing" some things. It will probably be ugly because you probably do not have much experience in that realm and being/looking like a beginner can be very hard but it is the only way to learn new things. You have to fall off your bike a few times to learn to ride and you have to swallow a lot of nasty water to learn to swim.

That's what I decided to do a while back. I decided to try to be as open as possible and to try to communicate the best I could etc. It's not like I'm sitting there, in his office, thinking that I'm sure as hell not going to do anything. I'm really trying, ok?

I don't even really get exercises by the way. We just talk about thoughts. The same things over and over again. Even the exact same questions. Without getting anywhere.

Perhaps that should be enough to make up my mind. I don't know.

First, I'll address your fears:

1. That's a possibility. I'm afraid you'll find that there are many different therapists and therapies for a reason... there's no one size fits all, and not working with a particular therapist doesn't mean that there's something wrong, necessarily. I have consulted with a number of therapists, and have had to change therapists before. It's not easy, but it's also not a bad sign. Most of us hate changing therapists, but not liking it doesn't make it impossible, or not worth the effort. It is absolutely worth the effort.

2. Is there a reason to believe you could not go back? I left one therapist that wasn't working for me, saw another for a bit to try and sort things out, then managed to patch things over with the first one. It's been over a year since then. Even if your current therapist says he would prefer to make a clean break, this does not mean there is no other therapist that will work. It's a morbid thought, but your current T could be hit by a car tomorrow morning, and then you would *have* to find another T. Sadly, some of us have been in scenarios where we're forced to find new Ts. You would be able to do it, too. And if you leave CBT, but find you don't like psychodynamic (although if I were you, I'd give it a good year before deciding you don't like it), you can find a new CBT therapist. They will not disappear from the planet just because you leave this one T. I'm not saying that to be mean or condescending -- I'm trying to point out how your fear is causing you to think very, very narrowly.

3. This completely makes sense. For me, it is the hardest part of talking to a new therapist/pdoc. It's like the end of any relationship. It's sad, it's hard, and it doesn't seem like any other relationship will be the same. But a relationship doesn't have to be the same to be equally good. Still, opening up is tough and I sympathize -- but do you feel you are REALLY opening up with this current T?

4. Do you feel your current T understands you? If not, what do you have to lose by looking for someone who does? You may also find that no one is ever going to *fully* understand you, but a good T will help you populate your life with people who understand various bits and pieces. My H knows me better than just about anyone, but there are things about me he doesn't understand, and vice versa. My T also understands me extremely well, but it's the same. There are things he doesn't quite get. However, he has been better and better at helping me identify people in my life, or ways to find people in my life, that might be able to understand better than him.

5. Probably the same as above. It's unlikely any one person can fully help you. But, even if you were to believe that it's possible that no one in the world could help you... you might as well try to see whether that's actually true. I'm appealing to the scientist in you .

I will continue to appeal to the scientist in you by asking, how would the world look if the great biomedical scientists of the world didn't try something because it might not work? How would we ever make any advances? Now, it's very hard to look at one's own mental health as a science problem, but in a way, it is... the methods for addressing the problem are not as defined, and cannot be as rigorous, but still, it is an issue of your health. I think we tend to get wrapped up in blaming ourselves for our issues, or feeling like we are the one person in the world beyond help, while everyone else deserves assistance. Not true. Treat your health the way you would any subject in a clinical trial you were working on. You deserve that level of scrutiny and tenacity.

Second, because this is really long I'll just come back and answer your actual questions later. But I'd like to turn your fears around a little into other questions:

1. What if there are several therapists out there who might work well with you, and you never meet them because you talk yourself out of it?
2. What if giving up CBT and this therapist are exactly what you need, and you stay stuck in the same place because you hang onto something that isn't working for you?
3. This is a tough one, but I would say, what if all the emotionally difficulty of opening up to someone new was able to show you that although your relationship with current T is not a bad one, it wasn't the right one at this time in your life?
4 & 5. What if you miss out on the understanding and help that others are able to offer because you close yourself off to the possibility?

I'll get back to your questions a little later, but I wanted to assure you: you CAN do this. Don't let your fears corner you into black and white thinking. Your past experiences are not your destiny. Things will hurt and will go wrong sometimes, but there is support out there for you. I mean, you've gotten a fair amount of support from this forum, yes? And I'm sure sometimes this forum has hurt you. Both those things have happened to me. Isn't the support you found worth the risk?

SallyBrown, you are awesome.

Thank you for what you wrote and thank you for being so clear and rational. To be honest I don't even really know how to respond to your post. When I read it I thought "she's right, I can do it" and I thought that maybe I shouldn't let fear force me to stay put. Perhaps trying another therapist or another kind of therapy won't kill me. Perhaps I could find a therapist who understands me (maybe not fully but more than my current one does) and perhaps I could find someone who I really feel like I can trust. I bet therapy's better when you feel like you can trust your therapist properly.

I still haven't made up my mind and I'm still terrified of making the wrong decision but you've stated some really good things and I will certainly take them into account while trying to figure this whole thing out (of course I'll take everyone's opinions into account but your post really hit home somehow).

Looking forward to hear what you've got to say about the questions.

I think one thing I may have in common with you is that I can be a really big over-thinker. And these thoughts are all thoughts I have had about something or another at various points in my life. Fear can be blinding to even the most intense of over-thinkers.

Self-confidence definitely doesn't come naturally to me, but I've found it helps to fake it. If I can convince my very intellectual self that it makes sense to try, every time I make it through, it helps a little bit.

Still, almost every time a major life change happens, it's all I can do not to dissolve into a weepy puddle of "I can't". Knowing this has helped me, as I can tell the people closest to me that, although it's my responsibility to find my courage, sometimes I need help to keep my courage going, and I just need to keep hearing "Yes you f-ing can!" to keep my mind in the right place.

Even now, I'm due to have a baby in 5 months, and so my H and I have been talking about how he can help during labor and delivery. I told him the usual... hold my hand, bring me ice chips, advocate for me to the nurses and doctors present. And of course, my most important request: "Just keep reminding me that I can do it."

I'll get to your questions when I can!

Yes, of course; the T talks. You might talk more than the T if you are used to that with CBT. The difference is the T would not argue with you. S/he wouldn't make a judgment of your thinking; instead, it would be more to understand where you are coming from. I just think it will be much different because this type of therapy has a way that forces you to feel rather than think. I am just not good explaining it. Maybe someone else here can.

But remember-since you fear making the wrong decision...if you don't try a psychodynamic T, you will always be wondering "what if". It's worth a try just for that reason, I believe. I know what you mean by decision remorse. It doesn't help that you have an expansive mind and that there are so many choices today in comparison to years ago. That makes it so much more difficult to make a decision. Good luck.

I have found that the only real regrets I've had in my life are things I didn't do because I let fear make a decision for me.

Any decision you make in this case is reversible. You really can't make a wrong decision.

Madame T argued with me all the time!
(She would say that I argued with her. There was no reasoning with that woman. )

Do not fear regrets. Who has no regrets never made a decision.

The psychodynamic ones I have seen argue, make judgments and don't seem to focus on where the client is coming from. I think they are not all one way.