[maybeblue]

I'm wondering how many sessions you go to with a new therapist before you give up and decide that it isn't working?

I'm having horrible reactions to my new therapist. It's not the first time. I have some trauma related to doctors, which I told her about but she doesn't seem to care. She seems to have kind of a hair trigger. She gets frustrated easily. I think I've seen her about 8 times.

The first few times it happened, I really tried to figure out my part in it and decide if I was imagining things or if I did something wrong. But this last time, I really don't think I did but she still got frustrated with me. I'm not projecting. She told me she was.

I'm quite sure I would have given up by now, but she has a specialty I want...DBT. However, I'm kind of iffy on how it is going. I realize it's more directive than most therapy and I generally want less directive, but I wanted to try it. It's a lengthy program, which is OK. I don't expect to be better yet. But I did expect to have a halfway ok relationship with her by now. And I don't. We fight. Somewhat politely, but we do fight.

I feel disappointed and sad.

[ArtleyWilkins]

One or two. Seriously. I know pretty quickly if a therapist or doctor is not going to work for me.

[Rive1976]

I think 8 sessions is plenty to know if it will work.

[SlumberKitty]

I went 4 sessions with T3 but I really knew after 1 session she wasn't the one for me.

[LonesomeTonight]

Originally Posted by Dnester

I think 8 sessions is plenty to know if it will work.

I agree. And if you're already fighting, that suggests she's not a good fit for you.

[Taylor27]

Usally i can tell if it wont work after 2 sessions. 8 sessions is really long enough it's okay to find another t. Some t's do not workout hugs

[Lonelyinmyheart]

I usually know after one session that they're not right. With the long term Ts I've had, I knew right from day one that I connected with them and wanted to work with them.

[koru_kiwi]

Originally Posted by maybeblue

She gets frustrated easily.

i would definitly struggle to build trust with the T if they were getting frustrated and defensive this early in the relationship.

Originally Posted by maybeblue

I feel disappointed and sad.

trust your gut on this one

[mugwort2]

I never experienced quitting a therapist because where I live its a really looooong waiting process to find a new one.

[guilloche]

Just wanted to add, I agree that 8 sessions is more than enough for you to decide that she's not going to work for you. I wouldn't be able to work with someone that was visibly frustrated with me either... it would wreck my ability to feel safe enough to share anything!

How does she get frustrated? Have you examples?

[Lemoncake]

I saw two T's before R:

1.The first one I saw = 3-4 sessions at the most. We didn't cover anything. I sat and cried in front of him but he didn't even mention it. I did learn all about his life though. That he had two sons, one of which lived in NZ and was a teacher. He went to cambridge, worked 28 hours a week also worked as a mental health nurse- yada yada. He worked on Harley street.

2.I knew during the first free intro . I said I would email back but didn't. She made me pick out colours from a deck which gave her info about my personality, but i felt very defensive with her.

You know when you know.Always trust your gut instinct.

[seeker33]

I think 8 sessions is definitely a long enough time to see if you're a good match. It's enough to see if the relationship can be formed or not.

[Rive.]

I believe we know it deep down in our gut. With previous Ts, I knew quite early on, within 3 to 5 sessions, whether it was working out or not.

My advice, don't stay longer than needed. IF you feel it is not working out, get out.

[Xynesthesia2]

Originally Posted by maybeblue

I'm wondering how many sessions you go to with a new therapist before you give up and decide that it isn't working?

What is the definition and criteria of "working"? I am kinda surprised how many people seem to say confidently that they could/can determine whether the therapy is working, from 1-2-...10 sessions. While the same people often make elaborate, seemingly endless posts about intensely ambivalent perceptions and not knowing at all.

I had 2 therapists, took ~10 months of ~weekly sessions with each, somewhat overlapping. So that's about 40 sessions each. I was confident at the end with both of them and, even more confident at the very end of my overall therapy adventure (after a bit less than 2 years) that it was not very useful/working for me. Of course I had learned many interesting things. If by "working" we mean we feel a good connection with the T - then yeah, 1-2-3 sessions.

[maybeblue]

Originally Posted by The mouse

How does she get frustrated? Have you examples?

I asked her. She has told me that I was "projecting" onto her, so a couple of times when I thought she seemed mad I said "I can't tell what you are feeling toward me." And she said that she was frustrated. There have been many times when her voice gets sharp and she says something like "this isn't sustainable." For example in response to me being triggered/upset/overwhelmed at the end of a session and contacting her to repair the relationship after the session. In DBT it is allowed and you pay extra to get between session "coaching."

[maybeblue]

This last session was really bad because it seemed like there was a surprise attack. Things were going along well. Because I am such a difficult client she brought me up in her "team," which is other DBT therapists who are supposed to help your therapist stick to the model and to give them support about difficult clients such as people with borderline personality disorder. What I have been asking for from her from weeks is for her to use more validation and positive reinforcement and the "team" agreed with me. She had previously decided to leave 5 minutes at the end of the session for wrap up and processing anything that went wrong. Sometimes she did and sometimes she didn't. The "team" decided that she should leave 20 minutes instead.

So as I said, things were going well. At 20 minutes to the end she told me about what the team said. That was surprising and I think that maybe she could have mentioned it earlier. But although I don't particularly like surprises, I could have managed it. I actually didn't have any problems to discuss so I said that and reinforced her for being more validating this time. (DBT is big on the client reinforcing the therapist, just like the therapist reinforces the client.) So I asked if I could have something structured to work on between sessions, like a workbook or more skills. I'd asked before. And then she said something like "you just want all the skills right now," and that we weren't having two skills training groups, DBT isn't done like that. And I disagreed with the statement that I wanted all the skills right now. And then she spent the next 20 minutes "expressing" all of her frustrations about me including bringing up stuff from previous sessions and then saying that I was somehow to blame for her not doing chain analysis. Which again left me far more dysregulated than I was before the session.

So it took me 2.5 days to calm down after the session again. That appears to be my average. On Thursday I had to go to group. I like group. It doesn't stress me out. But I did have to see her again and funny thing, the group was talking about invalidation. I got stressed again and I cried a little, but shared appropriately and managed to make it through. (same therapist leads the group). So after the group half of the members texted me and one of them suggested that I do a DEAR MAN, which is a communication skill to try to get people to do what you want. I emailed it to her. The main thing that I wanted was if she decided to give me negative feedback to do it one thing at a time and be very specific instead of piling it all on. Also I asked her to not use the last 20 minutes of the session as time to do that at all. If the goal is for me not to go crazy after each session that is only logical. Jeeze.

She replied and said that I did a good job with the DEAR MAN and in group, so she is trying to do better with the reinforcement. But she didn't say anything about using the last 20 minutes to complain at me, or piling on a bunch of criticisms at once. So I emailed back and maybe got a little too mad, but not abusive. I pointed out that she didn't agree to not do those two things. And I asked to speak to her team leader. Also I said that if had to be able to control her own emotions in the session.

I realize that I am having a trauma reaction to her, and there is a specific trauma I think that I am reacting to. I've also told her that I was having one and specifically the things that she is doing to set it off...mainly listing out a whole bunch of things for me to do without giving me time to process or agree with them, and getting "frustrated" with me for my symptoms. (I panic, I shut down, I react defensively, I get depressed)...pretty much the reasons I'm going to DBT in the first place. I want to not do them, but it seems like if getting pissed at me was going to make them stop, I'd have been over it by now. I have not agreed to exposure therapy.

I found another therapist who seems like a better fit on the phone. But it's hard to say. I did know from the intake that I was going to have some problems with this one. But her initial emails seemed quite nice and understanding.

[GeekyOne]

Sometimes I know right away. Sometimes... it's weeks, or months.

We sometimes forget... you are in charge. You get to stop whenever you want, for whatever reason you want. You can stop with one person, or therapy altogether.


You signed no contract guaranteeing unending participation in therapy until a given date or achievement.

If it feels like a good fit after 2 visits, but after 8 you change your mind... that's okay.

It also doesn't have to mean the T is bad. It's just not a good fit. Or they helped you as far along the path as they could, and you've grown or changed and now have different needs or wants that they can't help with.


It's okay to stop or try someone else if you want to. It does not make you a bad person or a bad client.

[susannahsays]

It's hard to say from an outside perspective if it would actually be helpful to continue with this therapist, but I doubt it. I think it can be sometimes positive to work things out if you've already been seeing somebody for a while, but it seems self flagellating to subject oneself to continuous misattunement from the beginning. The exception I guess would be if one really wants to pursue therapy but seems unable to get along with any therapist one tries. In that case, it might be the problem is self sabatoge or severe interpersonal problems rather than issues with the actual therapists - although not necessarily, of course. In any case, it really sounds like you aren't the only one having an abreaction here and it sounds like this therapist is unable and/or unwilling to manage her countertransference.

[maybeblue]

Originally Posted by susannahsays

It's hard to say from an outside perspective if it would actually be helpful to continue with this therapist, but I doubt it. I think it can be sometimes positive to work things out if you've already been seeing somebody for a while, but it seems self flagellating to subject oneself to continuous misattunement from the beginning. The exception I guess would be if one really wants to pursue therapy but seems unable to get along with any therapist one tries. In that case, it might be the problem is self sabatoge or severe interpersonal problems rather than issues with the actual therapists - although not necessarily, of course. In any case, it really sounds like you aren't the only one having an abreaction here and it sounds like this therapist is unable and/or unwilling to manage her countertransference.

Thank you. I have formed decent relationships with therapists before. But I have struggled with some of them too. I would have gone a long time ago probably if it wasn't DBT, and I have learned a lot. Because I don't have experience with DBT, I don't quite know what's "normal." In most types of therapies the therapist manages her own feelings. But DBT encourages a "real relationship between equals," and the therapist shares with the client how their behavior affects them.

I reacted a little strongly in our last email exchange when I told her that after sessions with her I was doing things like calling the suicide hotline which I hadn't done in years, not sleeping, having trouble concentrating, etc. and she told me that it bothered her that we were going right up to her next session because she really needed that 10 minutes to "ground" herself for the next client. Like there was some kind of comparison. And if she didn't want to go over the time she shouldn't start a fight with me right before the end of a session.

[LonesomeTonight]

Reading about your most recent session...I think changing therapists makes sense. This seems like an awful lot of conflict this early on. And you clearly seem willing to do the work--I'm puzzled as to why she isn't willing to give you a workbook. I'm not that familiar with DBT, but I thought a workbook was generally part of it? Is there another DBT therapist in your area you could try? Even if not one that strictly does DBT, but has been trained in those techniques?

[susannahsays]

Originally Posted by maybeblue

But DBT encourages a "real relationship between equals," and the therapist shares with the client how their behavior affects them.

Really? I've never heard that, but I've also never done a DBT program. In any case, I doubt it's actually supposed to be like a "real relationship." Who told you that? There are other types of therapy where the therapist discloses how the client affects them, but disclosures aren't made in the way you describe. The intention is always supposed to be that disclosures benefit the client in some way. They aren't supposed to be made with the purpose of benefitting the therapist.

[maybeblue]

Originally Posted by susannahsays

Really? I've never heard that, but I've also never done a DBT program. In any case, I doubt it's actually supposed to be like a "real relationship." Who told you that? There are other types of therapy where the therapist discloses how the client affects them, but disclosures aren't made in the way you describe. The intention is always supposed to be that disclosures benefit the client in some way. They aren't supposed to be made with the purpose of benefitting the therapist.

The "real relationship" thing is in the treatment manual written by Marsha Linehan. By "real" though she doesn't mean that you go out to dinner with your therapist. There are still all those boundaries. "Real" is meant in contrast to something like psychoanalysis where transference is sometimes encouraged, where the client acts toward the therapist as if she were someone significant in her childhood. Transference is discouraged in DBT by the therapist being a real person, not a blank slate.

DBT Assumptions | Dialectical Behavior Therapy Understood

And you are right, the therapist is supposed to self-disclose to benefit the client. Her self-disclosure of her negative emotions and things like how I am affecting her life is very stressful to me, mostly because the things that she seems to be reacting to feel out of my control and sometimes I'm not even sure what it is she is upset about. I *think* that is an incorrect use of self-disclosure, but I'm not 100% sure because I have no experience with actual DBT. I've just read about it and watched videos.

The examples I have read are the therapist saying something like "if you keep calling me every day, I am afraid I am going to get frustrated with you and I don't want that to happen because I like working with you." She said something like "I feel like you aren't letting me do DBT and at the same time becoming frustrated that you didn't know what to do between sessions, and that makes me feel stuck." And I have no idea how I was not "letting" her do DBT. I am completely mystified about that one. If I don't know what I am doing to annoy her I don't know how to change it. And "I have to be able to give you feedback," when I wince when she says something negative about me.

[maybeblue]

Originally Posted by LonesomeTonight

Reading about your most recent session...I think changing therapists makes sense. This seems like an awful lot of conflict this early on. And you clearly seem willing to do the work--I'm puzzled as to why she isn't willing to give you a workbook. I'm not that familiar with DBT, but I thought a workbook was generally part of it? Is there another DBT therapist in your area you could try? Even if not one that strictly does DBT, but has been trained in those techniques?

I have the workbook. There is nothing she could do to stop me from working ahead in it. But I wanted to be able to ask questions and frankly get reinforcement for doing something because it seems like she is mad at me a lot.

I started noticing that I was not getting upset in group even though the same therapist leads it. Focusing on something structured like that was keeping me calm, so I suggested doing more skills training in session so that I'd learn more skills and frankly so she wouldn't freak me out so much. First she said yes, but then she said no...I think because she talked to the team.

So I suggested working through the workbook between sessions. And then things went south. I don't know how exactly. I'm very confused and distressed about the whole thing.

There are no DBT therapists near me. I could probably find one who says that they know DBT, but I want the full program. I want someone actually trained in it, preferably from the Linehan institute. A lot of therapists say they do some type of treatment, but really what they mean is that they read a book about it or went to a workshop. I've mostly given up on CBT because I keep finding people who say they do it, but don't really and because it's frustrating to me to know that a thought is illogical but still believe it, which makes me then hate myself worse for "thinking wrong." DBT was developed because turns out there are a lot of people like that.

I did find one quite a long ways away (2 hours), but I'm still going to give her a try.

[susannahsays]

Originally Posted by maybeblue

The examples I have read are the therapist saying something like "if you keep calling me every day, I am afraid I am going to get frustrated with you and I don't want that to happen because I like working with you." She said something like "I feel like you aren't letting me do DBT and at the same time becoming frustrated that you didn't know what to do between sessions, and that makes me feel stuck." And I have no idea how I was not "letting" her do DBT. I am completely mystified about that one. If I don't know what I am doing to annoy her I don't know how to change it. And "I have to be able to give you feedback," when I wince when she says something negative about me.

I could be way off about this, but I do have a theory based on everything you've said. And please definitely don't take this as me saying she's right - she wouldn't work for me as a therapist (although honestly, I wouldn't seek out DBT, either). It sounds like maybe you aren't allowing her to be in charge and from what I understand, DBT is a directive type of therapy rather than client-led. For example, maybe your suggestion of structuring the individual sessions to be like the group ones is not really supposed to be how DBT programs work. And wincing when she provides feedback may appear to her as if you are unwilling to participate in that element of DBT.

If you really want to do a strict DBT program (with this woman or someone else), I don't think you will have the option of getting to decide how things are done based on what feels best or most helpful. If you want that, you might have to settle for learning the skills independent of a full fledged program or else going for a modality that isn't directive. Jmo.