[minúsculo]

I have had well over a decade of psychotherapy without being aware of any improvement. I am currently in therapy again, not because I want to be, but because it is the only way I can get a prescription for Ambien. In fact, my psychiatrist is also a psychoanalytically oriented psychotherapist. So I am pretty much stuck with this. But very frustrated. I really need to make psychotherapy work, but I don't know how to do this, despite many years as a patient.

Now, online when I look for advice about how to make therapy work, I often find something like this: "You must apply what you have learned in therapy to your life." This raises the question: how does one learn anything in psychotherapy? My career is education; I've spent years teaching. So I think I know something about learning, but it beats me how one can learn anything in psychotherapy. It's not a class. Can anyone help me with this?

[minúsculo]

I think I should reword my question. In an article appearing in Huffington Post, one finds the following: "It’s clear that therapy works for most people. Yes, there are outliers for whom it doesn’t work." The article then proceeds to ignore the outliers. That's fine, since the outliers are presumably a tiny sliver of the population, but the problem in my case is that I seem to be one of them. After many years in therapy, and well over 30 therapists, I obviously don't respond to therapy. But I feel that I need Ambien, and that means I must see a mental health professional. My current psychiatrist is also a psychotherapist and insists on doing therapy with me. Apparently, it's a precondition for getting the Ambien prescription, but I really don't think it is wise for an outlier to be in therapy.

At this point you might say "This is easy. Just find someone who is strictly a psychopharmacologist." In principle, that should be the answer. However, in the past some psychiatrists have diagnosed me as psychotic and prescribed neuroleptics for me. When I take a neuroleptic, I have an extremely bad reaction -- even if I force myself to stay on it for six months. And the neuroleptic relieves nothing, since I don't seem to have any psychotic symptoms in the first place. On the other hand, there is no guarantee that a psychiatrist will diagnose me as psychotic. My current psychiatrist does not believe that I am psychotic, and the one I had before that didn't think I was either. But there is no guarantee that the next psychiatrist will see things this way, so there remains this danger of being placed on a neuroleptic. One nice thing about my current psychiatrist is that he agrees with me that I really don't seem to be psychotic at all.

[unaluna]

What IS there to learn from other people?

I see you are from Brazil. So I can't really comment on how to get meds. Over here if you need meds, you get them.
The question about learning in therapy, that's a personal thing. I've certainly learnt a lot. But not in the way pyschobabble describes what one shoukd achieve and how it should be achieved.
Is true, therapy isn't for Everyone, for many reasons. That again I can't comment on.
It works just fine for me.

[Elio]

I guess my first thought was that if your mental health issues are balanced by the use of Ambien, what does your therapist hope to address in therapy? What are his goals and are they yours?

My second thought is since you found a psychiatrist that works for you, are you in a system that will let you stay with him for as long as he will see you?

In regards to learning in psychotherapy: for me, my journey, and the mode that my t/we are currently using, it is more about replacing memories of painful outcomes from experiences with memories of positive outcomes from experiences - all in a pre-verbal part of the brain. There is lots of talking around the experiences both historical and current. There is a lot of pushing through embarrassing requests, wants, thoughts to experience something that is healing, supportive, loving, and being attended to. Ok, typing that up really doesn't seem like it makes much sense. I guess, what I am trying to say is that the learning is not intellectual in nature for me so typical education methods don't work. I can intellectually know all kinds of things, such as I do this because of that. The knowing has to happen in part of memory that isn't so concrete - implicit and explicit learning.

I think once the knowing has happened we just change and it filters out into our daily life.

[atisketatasket]

I do not feel that any of my therapists have taught me anything (except that it is foolish to trust therapists). Perhaps they helped me unlock stuff I already knew. (I have also never regarded the Huffington Post as the last word on anything.)

Although I have adopted parts of No. 3's email style for emails with students. It seems to make them feel like I care for them. So, OK, I learned how to hoodwink people.

You can learn a lot from other people, una is right. But people go to therapy for all kinds of reasons. Learning may be one of them, but hardly the only one.

[Yellowbuggy]

Originally Posted by minúsculo

Now, online when I look for advice about how to make therapy work, I often find something like this: "You must apply what you have learned in therapy to your life." This raises the question: how does one learn anything in psychotherapy? My career is education; I've spent years teaching. So I think I know something about learning, but it beats me how one can learn anything in psychotherapy. It's not a class. Can anyone help me with this?

What an interesting question!

I've been in-and-out of therapy for 17 years. I found it largely useless for the first 10 years. It wasn't until I really broke down that I was able to benefit from it.

When I broke down several years ago, I was overwhelmed and unable to function in any meaningful way. I'm not sure what role this played in my ability to benefit from therapy for the first time. Perhaps it was my emotional state, my new therapist, or a combination of the two (I was hospitalized and given a new therapist on discharge).

My therapist doesn't really 'teach' me anything. He never gives me advice. What he does is ask me pointed questions that get me to think about what I'm saying, thinking or doing that enable me to teach myself. He also models the type of balanced, emotionally stable behaviour I strive to achieve for myself.

I was diagnosed with BPD several years ago, by the way. For those of you were were given this diagnosis as well, there is hope. Don't believe those who say there's no cure. There is remission - I am living proof! That's not to say that I don't still suffer, but my highs are not as high and my lows are not as low. Slowly but surely I am achieving stability.

[minúsculo]

Originally Posted by Elio

I guess my first thought was that if your mental health issues are balanced by the use of Ambien, what does your therapist hope to address in therapy? What are his goals and are they yours?

My second thought is since you found a psychiatrist that works for you, are you in a system that will let you stay with him for as long as he will see you?

In regards to learning in psychotherapy: for me, my journey, and the mode that my t/we are currently using, it is more about replacing memories of painful outcomes from experiences with memories of positive outcomes from experiences - all in a pre-verbal part of the brain. There is lots of talking around the experiences both historical and current. There is a lot of pushing through embarrassing requests, wants, thoughts to experience something that is healing, supportive, loving, and being attended to. Ok, typing that up really doesn't seem like it makes much sense. I guess, what I am trying to say is that the learning is not intellectual in nature for me so typical education methods don't work. I can intellectually know all kinds of things, such as I do this because of that. The knowing has to happen in part of memory that isn't so concrete - implicit and explicit learning.

I think once the knowing has happened we just change and it filters out into our daily life.

What I am getting is basically psychoanalytic, which is largely what I've had in the past. I once had a hypnotist who briefly tried to change bad memories in some way, but I don't think it was effective. It involved reliving some painful experiences which, for me at least, just makes things worse.

[minúsculo]

Originally Posted by atisketatasket

You can learn a lot from other people, una is right. But people go to therapy for all kinds of reasons. Learning may be one of them, but hardly the only one.

I mentioned learning, because when I search on the internet for advice about how to make therapy work, learning is often mentioned: one must apply what one learns in therapy to everyday life. That would be fine, if I were actually learning anything. Just recently, I have tried to think very hard after the session "Did I learn something?" But it is an aggravating question, because I find it unpleasant even to think of therapy. It pollutes my life, in a way. What I mean is: since I don't seem to progress in it, even reflecting on it brings on feelings of futility. So I naturally try to forget about it when I 'm not in it, just as a means of getting on with my life.

[minúsculo]

Originally Posted by Yellowbuggy

My therapist doesn't really 'teach' me anything. He never gives me advice. What he does is ask me pointed questions that get me to think about what I'm saying, thinking or doing that enable me to teach myself. He also models the type of balanced, emotionally stable behaviour I strive to achieve for myself.

On other forums, and also once in therapy, I was told that I don't progress in therapy because of hostility toward therapists. I admit I have trouble believing that. If there is any hostility toward the current therapist, it is buried very deep in my unconscious mind, because consciously I would even say I feel real affection for him, perhaps tinged with some eroticism. (We're both male.) He does talk some, but unfortunately he speaks in Portuguese in a soft voice, and I have to listen very very hard to get much from what he says.

[stopdog]

Originally Posted by atisketatasket

I do not feel that any of my therapists have taught me anything (except that it is foolish to trust therapists). Perhaps they helped me unlock stuff I already knew. (I have also never regarded the Huffington Post as the last word on anything.)

Although I have adopted parts of No. 3's email style for emails with students. It seems to make them feel like I care for them. So, OK, I learned how to hoodwink people.

You can learn a lot from other people, una is right. But people go to therapy for all kinds of reasons. Learning may be one of them, but hardly the only one.

I agree. I have also used idiotic phrases the therapist has tried at me on students and I was amazed at how often the student takes well and how happy and reassured empty psychobabble can make them (and usually I do care in some ways - not always the way it is taken -but in some ways). If I wasn't so happy it worked and made them happier - I would tell them **** I just threw that **** out there - don't believe it for god's sake. What is wrong with you?

I have not learned anything from a therapist. I use the therapist to sit there while I talk about my very ill person. She was pretty much useless for most other things.

[ruh roh]

I have been in therapy off and on for about two decades and it's only with the therapist I see now that I've learned anything--it all has to do with myself, though, so not really going to applicable to anyone else. I have, at times, a lot of trouble coping, staying employed and housed, so for me at a very basic level, I have been able to learn what kinds of things/people/situations trigger my ptsd symptoms that cause me to jeopardize my health and safety. That's just one example, but it's had a big impact in that I've not only stayed gainfully employed, but done really well financially, all while going through a traumatic family experience at the same time as being in therapy--so in that way I'm also learning how to function while being massively triggered and re-traumatized, and to minimize the damage. It is very slow going, but yeah...I have learned quite a lot about myself and have quite a long ways to go.

Therapy isn't going to meet everyone's needs, for sure, and there are also a lot of really bad therapists out there. I've tried lots of other approaches--nutritional, spiritual, physical (acupuncture, acutonics, yoga)--but I really do need another person who's helped people recover from trauma to help me understand what is going on with me and how to improve my way of living.

[minúsculo]

Originally Posted by ruh roh

Therapy isn't going to meet everyone's needs, for sure, and there are also a lot of really bad therapists out there. I've tried lots of other approaches--nutritional, spiritual, physical (acupuncture, acutonics, yoga)--but I really do need another person who's helped people recover from trauma to help me understand what is going on with me and how to improve my way of living.

I would consider dropping out of therapy and seeing someone who is strictly a psychopharmacologist, but I fear being labeled as psychotic again and prescribed a neuroleptic. That is really the last thing I need.

[feileacan]

I have learned quite a lot in therapy too, although, as pointed out by someone before, not in an intellectual way. Rather, I've gained new relational experiences that have emerged in places where there was nothing before. After gaining those experiences I am able to see that those things work outside of therapy between other people too - before those things were just completely invisible to me, like I would have been blind. Obviously I now can also use those things outside of therapy too.

I realise that those "things" are very abstract and it would be hard for me to describe what they are. I guess they are basically emotional experiences one should get in early age in the relationship with her parents and other close people. But yeah, that's been the learning for me in therapy.

I totally think it's more about 'unlearning' than learning, and like Elio said, it's implicit.

Unlearning a good bit of how you view yourself, others, and the world based on how you were brought up, then rediscovering who you are without those influences.

Also related to learning is understanding yourself. But I don't think this type of learning is captured in 'education gained', but more in terms of how it affects your life such as decisions you make, relationships, etc. Can you think in terms of how you've changed instead of what you've learned? If you've been in therapy that long, you might not even notice changes that are attributable to the therapy itself.

If it's just that psychiatrist requiring therapy in order to prescribe Ambien, if I didn't want to do therapy, I'd probably see if I could get it from a General Practitioner. It looks from your post it has to be a MH person?

[minúsculo]

Originally Posted by Skies

Can you think in terms of how you've changed instead of what you've learned? If you've been in therapy that long, you might not even notice changes that are attributable to the therapy itself.

That raises a very tricky question. Given that we are often expected to remain in therapy for years, even decades, and given that people inevitably change over the course of years, how is one supposed to know which changes are due to the therapy?

Apart from that, I can't say that I have changed in any really significant way. I remain very shy and introverted, as I have always been. I notice that I seem to be more relaxed when I have more financial security, and have felt better ever since my father died.

I learned a great deal in therapy but it was more about undoing old ways of thinking, self-perceptions, and entanglement in my own history. In the process, I learned healthier ways of coping, managing my reactions, etc. that I now apply in my life every day (very consciously so). I never found my therapist to have the style of a formal teacher; he was more like (as we say in the education field) a guide on the side. He worked with me as I worked through my history and my present, helping me see what worked and what needing tweaking (or outright changing). He had knowledge of skills that he helped me apply often until I found myself able to apply them on my own without needing his prompting or assistance, and at that point I was able to leave therapy.

It's no one's job except perhaps one's T to point out when one's patterns are abrasive to others IF one is working on improving interpersonal issues in their therapy. And then again, working on interpersonal stuff isn't everyone's goal and that's fine too. Just no bloody need for personal attacks, geez.

I learn through modelling in therapy. T models and coaches me on assertiveness, other social skills like apologizing gracefully without overapologising for things not my fault.

T also calls me out when I'm engaging in unhealthy patterns in relationships, which helps because it's easier for her to be objective.

We discuss boundaries and so I learn how to set and maintain certain boundaries. I can read about boundaries and all, but it helps when I see T apply them. I can learn from the word choices used, the tone, how she structures the boundary setting.

Therapy for me is very much social skills training, I feel.

[satsuma]

I think I have learnt in therapy too, in a similar way to how Lolagrace describes.
I like the fact that schema therapy is quite structured in some ways. We made flashcards that say "Right now I am feeling X. I need to try to remember Y." etc. Which is actually a very structured way of learning to think differently. It often really annoyed me to be reminded to read the flashcard, because it made me feel stupid, but I had to admit that it really helped me when I did read the flashcard!
But even more than the structured elements like flashcards and evidence lists, the things I have learnt that have been most profound have been to do with my image of myself, and about relationships, and I have learnt them directly from my T and how I relate to T
and how T relates to me. An example is that I used to feel completely terrible if I ever had any kind of argument with someone, and in the past it has meant that I would simply end a friendship because I would never speak to the person again, because I would assume they hated me. But now I don't assume those things any more, and I can hear my T's voice saying "this relationship is more flexible than that, just because I was frustrated, doesn't mean that I think you are bad. It hasn't changed how I see you." I am able to hold on to that and generalise it to the other relationships in my life.
I think I've been very fortunate to have such a good T and that therapy has worked really well for me.

The changes that have come for me through therapy have come about without me consciously applying any learning. I never used to have much eye contact when I was speaking to people. With my T's I have have sustained eye contact with them when I've been speaking to them, and now I find that this happens out of therapy too. I LOVE my newfound ability to do this. I feel so much closer to people.

[iheartjacques]

Therapy, for me was to learn to handle life better. Life likes to constantly throw spanners and it's how I react that decides if I'm going to be depressed or not.

[atisketatasket]

Originally Posted by minúsculo

I mentioned learning, because when I search on the internet for advice about how to make therapy work, learning is often mentioned: one must apply what one learns in therapy to everyday life. That would be fine, if I were actually learning anything. Just recently, I have tried to think very hard after the session "Did I learn something?" But it is an aggravating question, because I find it unpleasant even to think of therapy. It pollutes my life, in a way. What I mean is: since I don't seem to progress in it, even reflecting on it brings on feelings of futility. So I naturally try to forget about it when I 'm not in it, just as a means of getting on with my life.

I think that is part of the way therapy presents itself publicly. And, yeah, I think it can induce feelings of failure in those who don't feel like they learn or improve.

Do you just have to go to therapy for the med? No other requirements? - i.e., could you just use therapy to vent about your boss, or your mother-in-law, stuff like that? That is useful too.

[minúsculo]

Originally Posted by Elio

I guess my first thought was that if your mental health issues are balanced by the use of Ambien, what does your therapist hope to address in therapy? What are his goals and are they yours?

My second thought is since you found a psychiatrist that works for you, are you in a system that will let you stay with him for as long as he will see you?

The only system is my paying him out of pocket. Sure, I can stay in it forever. What does the therapist hope to achieve? I have no idea. He is psychoanalytic and basically just sits there. What are my goals? To keep receiving a prescription for Ambien, that is the goal.

[minúsculo]

I suppose I have learned something in psychotherapy. Before I entered therapy in 1980, I thought that I had potential. I thought that I was only slightly mentally ill, and could make something of myself. Now, after, many years in psychotherapy, I realize that I am profoundly disabled, a shattered mind, a splintered personality, a non-entity. Now the question remains: how do I apply this wisdom to my life? Another question: why bother?

[Elio]

Originally Posted by minúsculo

I suppose I have learned something in psychotherapy. Before I entered therapy in 1980, I thought that I had potential. I thought that I was only slightly mentally ill, and could make something of myself. Now, after, many years in psychotherapy, I realize that I am profoundly disabled, a shattered mind, a splintered personality, a non-entity. Now the question remains: how do I apply this wisdom to my life? Another question: why bother?

Originally Posted by minúsculo

The only system is my paying him out of pocket. Sure, I can stay in it forever. What does the therapist hope to achieve? I have no idea. He is psychoanalytic and basically just sits there. What are my goals? To keep receiving a prescription for Ambien, that is the goal.

ADVICE WARNING:
Based on these two posts, I'd say go to him and be frank about it... I pay for the sessions out of my pocket, my sole goal is to keep receiving a prescription for a medication that seems to help me. What is the best way to achieve my goal without wasteful spending on excessive sessions?