# What do you think should therapists know?



## free2live (Apr 30, 2009)

*What do you think therapists should know/change?*

I've seen to close to 10 different therapists (due to having to move around as school/work required it), including social workers, psychometrists, psychologists, and a couple psychiatrists, and more often than not, I felt there was something left to be desired. From reading some of the posts here, it seems that many are also not totally happy with therapy. There are many complaints, including the mention of inadequate wait times. So I thought I'd create a thread for ppl here to voice out what you think are things that therapists should know, or should improve upon, to make therapy more effective.

First, I would like to say that not _every_ therapist had these problems.
*
Preparation before session*
One of the things that came up too often was how unprepared the therapist was for our sessions. They would often say to me that they didn't remember what we talked about before, that I would have to refresh their memory, or they would have to take time to reread their notes during the session. It's understandable that they often have many patients to deal with and a refresh would be in order from time to time, but not at the frequency I encountered. It indicated to me that they were not prepared for our session, and that I would have to take most of our session to rehash stories that already took such great effort to get out the first time around. It also indicated that they did not take time to look through my situation to think about possible solutions to my problems, which is the number one reason why I am seeking their "expertise" in the first place.

*Lack of experience with SA, Treatments (non-medicinal)
*It seemed to me that with many therapists I saw, there was no help in setting clearly defined goals/exercises; I often ended up going to subsequent sessions to just tell them what happened during that week, and for them to just listen and periodically ask me questions like "well, what did you think about that?" or other similar questions by flipping my own words. Of course, the idea of Cognitive Behavioral Therapy (CBT) was often brought up, either by the therapist, or if not, by myself. But with some, it was just a term, or a triangular diagram to draw and describe -- no real-world practical exercises were ever thought up. Sometimes I felt I had more knowledge of CBT than the therapist I was seeing! I suppose I was looking for more proactive solutions/plans in addition to just identifying what causes my anxiety (which I already knew, situation wise).

*Infrequent sessions
*Another problem that came up once in a while was having to set appointments that were spread apart two weeks or longer. In cases when SA is not that severe, it may be okay, but not for cases otherwise. It may also not be good for maintaining progress over SA; frequent checkups to see that goals are being met and to ensure the person with SA has someone to discuss major anxiety-causing incidents closer to when they have occurred would be more beneficial.

This isn't to discourage ppl from seeing therapists, but just some things I wanted to note from my experiences. What are some things _you_ would like therapists to note?


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## coeur_brise (Oct 7, 2004)

I agree with the list above. I'm not sure what else to add.. but I would say generally that in some cases, it would be helpful for the therapist to have some sort of plan of recovery for the person struggling with whatever issue they may have, that would be really helpful in the long run. And again, I think it's important to check up on the patient/client once in a while, in fact, it's probably the most helpful. You can't always hold the person with the issues accountable if their issues deter them from getting help in the first place esp. if their thinking is distorted and they don't even think they can get help. In some cases, the person doesn't exhibit signs of obvious signs needing help even though they have symptoms that interfere with their daily life. From personal experience, I discovered that therapists are really busy and tend to leave it up to the client to schedule appointments, which is why I put myself on the cancellation list just in case any appointments come up. It's more of a practical thing than something proactive and gung-ho on my part, and I never realized that until a therapist actually brought it up in session and suggested that I do it. Otherwise I would have never done it. My guess is that it's usually the new clients that get the longest time in between appointments, though I'm not exactly sure why that is.


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## free2live (Apr 30, 2009)

Good points, sanria22. I was very often on the wait list for canceled appointments too. And a positive of experiencing the above, is that it may make you realize that if you are to make progress, you yourself should be the one to lead/do it.

I'd like to hear more of what others have experienced


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## Pam (Feb 14, 2009)

*Assets I Think Therapists Should Have*

~An IQ above 105! (supposedly Britney Spears' IQ)

~Ears that know how to Listen!

~A working Memory!

~Have their personal problems (like their divorce from 3 yrs earlier) under control so they don't interfere in MY therapy!

~Consistent and stable personality during, and across, sessions.

~Knowledge of the difference between Schizophrenia & Social Phobia!

~Own, and preferably have skimmed through, the DSM-IV...

~Empathy!!

~Professional Boundaries.

~Follow-through

~Ability to think on their feet

~Knowledge of what to do in a CRISIS!

~Faith in their ability as a therapist and the therapy (so they don't feel the need to have every single patient be on antidepressants no matter what their actual problem is).

~*A REAL TREATMENT PLAN!*

But hey--what do I know? I've been told I have unrealistically high expectations! (she says sarcastically) Yeah, and they get unrealistically high pay!


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## Pam (Feb 14, 2009)

That was fun to write...and therapeutic.

As you can guess, I have had experiences with counselors I feel were just plain dumb, didn't listen, couldn't remember, had no empathy, and wasted my session time by having me explain the same crap over & over to them, I even drew pictures, made up analogies & used metaphors and they _*still*_ didn't get it. And who were overall--just plain Useless.

Also, I think some of them are "crazier" than me.

Which actually makes me feel better--that I'm not nearly as bad as I was thinking!


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## free2live (Apr 30, 2009)

I agree that a therapist's job is not an easy one. After all, they are tasked with the job to help resolve something that patients have difficulty overcoming themselves, perhaps for a long time already. It is also understandable that they have problems of their own to deal with, very true. But if they felt it was impeding on their ability to counsel, then I would expect them to make it known to the client that there is something in the way and to not have unrealistic expectations. Or to even cancel/reassign appointments until they themselves can think clearly.

I would definitely not agree that the therapists I saw were "dumb". Nor did I say that all of them had the same problems/difficulties. The first social worker I saw, for instance, had great empathy, and patience, as did the last psychiatrist I saw. But a large portion of them did not have a good practical understanding of CBT, as compared to those who did. How is a person with SA supposed to overcome their anxiety without any practice at all (not mentioning meds of course)?

And if the therapist did not know the difference between Schizophrenia, Social Phobia and Social Anxiety Disorder, then I think there are larger problems up front in trying to be a good therapist. I would have to find another therapist immediately. I would not want to be wrongly diagnosed by someone who didn't know the difference, or who would intentionally make a wrong diagnosis because they couldn't take feedback/criticism in an objective manner. Not being sure of what the client was experiencing and having to ask the client more questions to clarify would be another matter. Moreover, if they find the range of mental disorders to learn about is too excessive, then would it not be prudent to specialize in a few certain areas, and make this known to incoming patients? I'm sure all patients are required to go through an assessment; I sure had to. And so at the outset they know they are likely dealing with SA by their own initial impressions.

Ideally, I would want someone who was genuine in and felt they had a great stake in my getting over my SA (not to keep me as a client for as long as they can, to be a steady source of income), helping to define a plan of attack, while providing an objective mind and positive encouragement. I am very very grateful for all those therapists who did give me that.

Oh, and in hindsight, I did not mean that some therapists only knew how to draw triangles 

Very good points, Pam. Does anyone agree?


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## LALoner (Dec 3, 2008)

This is what I don't get, either people rave about their shrink or hate them. Why is there nothing in between?


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## mountain5 (May 22, 2008)

I guess I would be in the "in between" camp, so obviously I don't have a lot of reasons to post about it. My therapist is nice, intelligent and knowledgeable about anxiety disorders, but it's been over a year and I haven't had any major breakthrough. I feel like what I really need is a whole squadron of therapists and having Tony Robbins follow me around all day to keep me on the straight and narrow.


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## Pam (Feb 14, 2009)

LALoner said:


> This is what I don't get, either people rave about their shrink or hate them. Why is there nothing in between?


Sometimes the strong opinions & feelings are connected to transference. (Good feelings or bad--doesn't matter.)

In my case, I am pretty opinionated in general, so I always have strong opinions, no matter what the topic is.


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## free2live (Apr 30, 2009)

mountain5 said:


> I guess I would be in the "in between" camp, so obviously I don't have a lot of reasons to post about it. My therapist is nice, intelligent and knowledgeable about anxiety disorders, but it's been over a year and I haven't had any major breakthrough. I feel like what I really need is a whole squadron of therapists and having Tony Robbins follow me around all day to keep me on the straight and narrow.


Wouldn't that be great, to have like a personal 24/7 motivator/counselor in your life when dealing with SA? A person who could experience situations as you encounter them, and give you immediate advice and other support.


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## rachelynn (Sep 12, 2008)

"I often ended up going to subsequent sessions to just tell them what happened during that week, and for them to just listen and periodically ask me questions like "well, what did you think about that?" or other similar questions by flipping my own words"

That's how my experience has always been! Except the first one or two sessions, where they ask you what's wrong and stuff.

Infrequent sessions have also been a problem. When I saw my first therapist, I saw her every week for about a month or two...which was good, then she cut it down to twice a month and then, after I lost insurance, she allowed me one free session a month, which wasn't that worth it. 

Another therapist, I saw her once every 3 weeks. And my current one...I've seen her once every 2 weeks (currently have to wait 5 weeks though, but I have seen her a few times in a row once a week) Her schedule is now being soo filled up.

I think maybe the one I am currently seeing has been the best so far though. Atleast most of the time, we don't have endless amounts of silence just because there's nothing to say...she always tries to say something. But the problem with me is I don't know what to say or what I'm "allowed" to talk about, and I can't really talk that good. 

I kind of wish someone out there somehow was smart or something, where they knew how to get into people's heads, by asking questions and actually being interested in their life and trying to understand.


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## AussiePea (Mar 27, 2007)

I have been to a couple though both were just counselors and not trained physiologists/psychiatrists but even with that in mind I did get something out of both. I think a lot of emphasis is placed on the therapist and how they do their job and not enough on how the patient actually approaches the situation themselves.

I think it's extremely important to be prepared yourself, and not just mentally prepared for the anxiety related to seeing a professional but also prepared to clearly explain your problems, where you think they began, your history since and any other important aspects of your life which could help them better understand your situation.

It's one thing I have been very lucky with since I feel zero anxiety when meeting people like this (in fact if anything I get excited because I know it's another opportunity to get better) and so I am able to go in completely prepared to clearly and concisely explain my situation so that their efforts can move directly to a) pinpointing the target area for treatment and b) undertaking the appropriate steps to begin the recovery process.

So obviously you want to find someone who is good at their job and also specialises in treating anxiety related issues but there is also a huge emphasis on YOU going in prepared because the more information you can get across to them the better chances they have of understanding your situation and subsequently solving it.


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