I've been through, already, collectively, years of therapy. The problem is: I almost never felt like I was getting anywhere. (I still feel I haven't really come all that far, so I guess that's fitting.) I say "almost" because, to be fair, there are a few things that one of my therapists in particular did help me see, things she helped me reframe; and I really value the new perspectives that helped me to have.
But--for the most part: I would go and talk for the better part of an hour, leave (often feeling drained), go back a week or two later, do the same thing all over again...and soon wonder if--you guessed it--I was getting anywhere. And, sometimes, wonder if I was paying someone to essentially just listen to me. And I'd think, "Well, I have friends for that."
So relatively recently, when I decided that therapy was something I still needed*, I decided to look into how to find a good therapist. (In the past I'd just taken recommendations from friends or whatever and never did much investigating. That's on me, but--I also didn't know how.)
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Here are some of the ideas from the book that I find the most helpful (all brand new to me).
First: If in therapy you're going to explore deep, painful stuff, the therapist needs to first ensure you have or help you build your emotional scaffolding.
When patients talk about painful events, they are at their most vulnerable. They don't yet know how to build their healed "new" selves because they weren't ready for the confrontation with their unhappy "old"selves. In fact, it is not uncommon to find that patients don't have the emotional scaffolding in place to deal with their pasts. Emotional scaffolding is our term for the coping strategies and skills that are taught to a patient by a therapist in order to help the patient manage and deal with the deep inner exploration that may be a part of psychotherapy. (page 6)Who knew?!? When I read this it made complete sense to me, but, as I noted above, it was a brand new thought. How many times in therapy had I expounded on deep, painful things--and we had done no scaffolding building, or even checking, first? It was many. I don't think I've necessarily been severely traumatized by the retelling, but as I alluded to above, it was extremely draining. I would often leave a session feeling just depleted and sad. (Interestingly, he says you should never leave a therapy session feeling worse than when you got there--see page 129.) I had no idea that perhaps I was being done a disservice by our jumping into the deep end without first seeing how well I could handle it.
Spending a lot of time delving into the past may not be necessary. This is touched on in many places throughout the book. And most of the places where he said something like this, I was thinking, "Hmm, I don't know," because one of my therapists said to me once, "Trauma stays with us until we deal with it," and that made a lot of sense to me. Still does. I think his repeated emphasis on not dwelling on the past may be a response to styles of therapy he's seen where all they did was talk about the past...and get stuck there, just dredging up pain and not really resolving the pain and moving on. In fact, on pages 169 and 170, he says:
[Y]ou may need to check into your past at least briefly. You may even need to spend some time talking about it....And if your past has so traumatized you that you can't remember or talk about it, it might take some time, perhaps several months or longer, to approach the subject and work through it. But neglecting the present and the future in order to immerse yourself in the past can cause you to lose perspective and avoid responsibility for who you are now and who you want to be tomorrow....Because there are linkages between the present and the past, of course you and your therapist will want to understand your past. While understanding the past is important, it is more important to avoid getting stuck in it. (emphasis his)If you're struggling with motivation to do the work of therapy, a competent therapist can and should help motivate you. (See pages 11 and 38-42.) I am a champion avoider of the painful. So much so that often when one of my therapists assigned me journalling, for example, to do, I wouldn't do it until I was in the waiting room waiting for the next appointment. Sad but true. I even asked this therapist once to get on my case more if I hadn't done my homework, because (good or bad) I knew that would motivate me. I was told I would get out of therapy what I put into it, so it was up to me. Now, it's not like I don't see where this comes from. I get that if I want my life to change, I'm gonna have to put the work in. It's just that that's one of the very areas I was struggling in, and I was told, basically, "you should just do it." Perhaps this even goes back to scaffolding: I probably didn't have the scaffolding I needed to journal about painful stuff...no wonder I didn't want to do it.
A competent therapist should respect--and be able to work with--your belief system or refer you to someone who can. (See pages 3 and 61.) I used to believe that I should only ever go to a therapist who was a Christian. Now, I think that there's probably a lot that any competent therapist can offer me, regardless of whether they're a Christian. Contrary to what some might think, I still have a filter. And--if a therapist works within the boundaries of my belief system or refers me to someone who can, no worries; if they disrespect or try to get me to go against my core beliefs, I'm outta there.
This one is huge: You can and should phone interview a therapist and check out their qualifications before beginning any sessions with them. (See chapter 3.) I remember that I did ask one of my therapists a few questions before meeting...but now I know how much I didn't know then about what kinds of questions to ask and what to look for in the answers. I specifically remember asking for references (that may've been the only substantive question I asked, come to think of it). I was told patient's names are kept confidential (which sounded like the most obvious thing once I heard it), but I was not then told I could ask for colleague references. I never even knew such a thing existed in the therapy world.
Zwolinski defines the major types of therapists (this one's back in chapter 1 on pages 12-17), talks about how to ask about their qualifications and how a therapist should respond, and tells how to verify those qualifications. He also suggests other things you should ask about, including their experience (especially in treating people with problems like the ones you're seeking help with), their rate of successful outcomes (the percentage of cases in which patients are generally doing well post-therapy), their clinical philosophy and theoretical orientation (the general approach they take to therapy), their ethics and values (and their ability to work with yours), and their fee structure. He even provides a phone interview checklist, one of several checklists in the book. So helpful.
Once you've decided to start seeing a particular therapist, in the first session, you should be continuing to evaluate the therapist, and the therapist should begin an evaluation, including a biopsychosocial history, of you. (See chapter 4.) Yeah, for me, none of this ever happened. As to the first part: again, I didn't know the questions to ask and perhaps even that I could ask more questions. As to the second part: how did my therapists know what all was going on with me or rule out other causes for my issues? They didn't.
For me this is perhaps the biggest one of all: There should be a written treatment plan and the therapist should not just share it with you but create it with you. (See chapter 5.) In a treatment plan, patient and therapist list the patient's issues, the therapeutic goals, and the strategies that will be used to meet those goals. It should be referred to throughout therapy to track progress. At the end of chapter 5, Zwolinski provides a checklist for all of the components that your therapy plan should include.
Remember I said I was never sure if I was getting anywhere? Well no wonder! If there was ever a treatment plan in my time with any of my therapists, I was unaware of it. I'm not sure we ever even really talked about goals. Certainly sounds obvious now. It's like the axiom: If you don't know where you're going, how will you know when you get there?
I could certainly go on; there's much more in this book that can benefit the therapy seeker. In fact, there's a lot of important stuff I'm not going into here; the above are just the ones that "hit me" the most.
I suppose the true test will come once I put the things I've learned from this book into practice. But now...I have confidence that I can achieve a better result. I feel armed with tools for navigating the therapy journey that I never had before. That is huge.
If you are considering therapy, I highly recommend you read this book.
Note: I purchased this book for my own use. This review was unsolicited and uncompensated. It represents my completely honest opinion.
*For anyone thinking "You don't need therapy; you shouldn't look anywhere besides the Bible," or other anti-psychology thoughts and may be harboring ideas of changing my mind: don't even bother...yeah, my mind's pretty made up. Thanks though.
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